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GP says HbA1c 0f 46 is too low

Oldvatr

Oldvatr

Expert
Messages
8,453
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.
 
Never heard of the 56 A1c > 70 years before.
I wasn't aware of your kidney issues
I always remember reading Jenny Ruhl & how the prescribed A1c of 7% would lead to complications.
 
Oldvatr said:
He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for.
Click to expand...

Look, I can see the logic (sort of). It definitely applies to my dad who will be 92 next month, and has a lot of falls without adding hypos to the mix. (But 92 is a little different to 70)

But I don't see the point of applying it to people who haven't been getting hypos and don't have issues with falls. And I can't see why it would affect prescriptions of drugs that don't normally cause hypos, such as metformin.

And as a T1 on insulin , pre-cgm an hba1c of much less than 7% gave me too many hypos and caused loss of hypo awareness, so I never tried that hard to go much lower, but T1 and T2 are very different conditions.

Could you change to a different doctor?
 
I wonder who is teaching the teachers this. I suspect it is the old ageist attitude that most elderly people are too frail or get too obsessive etc. Same reasonng behind the No Home Tessting for us T2D. Even more confusing since the US article goes on about poor kidney function leading to hypo's which is another nugget of unknown source.

OK we were both wrong NICE has amended the guidelines, as copied here
https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management
I am on Gliclazide, so my target according to NICE should be 53 (not 56 as stated by my GP) Its still buzzcocks since the lowest reading I saw in the last year was 4.6, which is nowhere near hypo.

I note that the guidelines now state that SGLT-2 should NOT be used with a low carb or keto diet. They say the diet must change before taking an SGLT-2.
 
Oldvatr said:
Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.
Click to expand...

That is perfect - within normal range. Dr Bernstein who is type 1 has said that lower the better.
 
I dream of being too low, nice work!
 
Codswallop!

Logic dictates that being in normal levels, should be applied at all ages.
As this is where our health is maintained and actually improved as we age!
 
My gP was worried my HbA1c was too low, and said he was concerned about hypos because I’m on glicazide. (Im 60). I convinced him that because I fund a libre I would easily be aware of any impending hypo, and he allowed my medication to continue.
 
Oldvatr said:
I wonder who is teaching the teachers this. I suspect it is the old ageist attitude that most elderly people are too frail or get too obsessive etc. Same reasonng behind the No Home Tessting for us T2D. Even more confusing since the US article goes on about poor kidney function leading to hypo's which is another nugget of unknown source.

OK we were both wrong NICE has amended the guidelines, as copied here
https://www.nice.org.uk/guidance/ng28/chapter/Recommendations#blood-glucose-management
I am on Gliclazide, so my target according to NICE should be 53 (not 56 as stated by my GP) Its still buzzcocks since the lowest reading I saw in the last year was 4.6, which is nowhere near hypo.

I note that the guidelines now state that SGLT-2 should NOT be used with a low carb or keto diet. They say the diet must change before taking an SGLT-2.
Click to expand...

same documents says if they achieve a lower than target hba1c without suffering hypos encourage them to maintain it. 1.6.10
 
Oldvatr said:
Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.
Click to expand...


Suspect this has come from the USA....big Pharma need more of us to be buying , or be prescribed, their drugs.........
 
Oldvatr said:
Just had my annual review, and my HbA1c was 46 which is one click up from last year, GP told me it is too low, and that he wants the next one to be 56 or higher. This equates to a daily average of 9 mmol.l, I pushed back, and he cut my Dapagliflozin med that had been prescribed for my heart. This is on top of withdrawing my Metformin completely last year. I asked for more gliclazide since I had secretly been trialling some to get my HbA1c back to 42. But NO. He wants 56 because his recent refresher course says this is what patients over the age of 70 should be advised to go for. Buzzcocks. I could not find any UK directive supporting this change, but did find a US advisory
https://www.arkansasonline.com/news/2019/apr/29/lower-blood-sugar-is-not-always-the-bes/

Looks like I will need to go keto or carnivore now. That will make my eGFR worse, of course because of the extra creatine. I am also cutting out the furusomide since that med is definitely raising my blood sugar level, and giving me constipation.
Click to expand...

That’s a prefect number
 
It's all crazy my diabetic nurse because I was achieving normal range blood glucose levels changed my classification to in remission the next thing that happened was I got a letter from the diabetic eye screening service to say I no longer qualify for the annual dibetic eye test all this based on levels I was getting prior to covid since I had covid my levels have increased but according to NICE she should have told me my HbA1c was too low and to eat more carbs.
 
JohnEGreen said:
It's all crazy my diabetic nurse because I was achieving normal range blood glucose levels changed my classification to in remission the next thing that happened was I got a letter from the diabetic eye screening service to say I no longer qualify for the annual dibetic eye test all this based on levels I was getting prior to covid since I had covid my levels have increased but according to NICE she should have told me my HbA1c was too low and to eat more carbs.
Click to expand...
That should not happen - I am classed as in remission and I have all the usual checks - I think the nurse must have entered the wrong classification which is why you are no longer eligible for the checks.
Maybe contact your GP to sort out what has gone wrong.
 
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