Great HbA1c, Very Disappointed!

[AdamJames]

I won't go on about the many flaws of HbA1c results as I gather other people on this forum are already doing a very good job of that!

After spending a year reading around the subject of diabetes, I'd already got the impression that HbA1cs are not a great indicator, but yesterday it just got personal.

I saw my GP yesterday to get my latest blood test results. He was very happy indeed with me. The weight loss, the complete abstention from alcohol (I can't begin to describe how hard that was), and everything in the blood results looked great. Cholesterol was never particularly bad but now it's great. There was a question mark about my liver but now that looks great also.

Most of all he was blown away by my HbA1c being reduced from 92 to 40, when I told him I'd stopped taking the Metformin 3 months ago.

Now don't get me wrong: going from red to green on the HbA1c chart *has* to be a good thing, and I was happy with that, and most of all I was happy that the doctor was happy, and agreed to cancel the repeat prescription for Metformin.

But here's the thing: on that same day I'd also given myself a carb tolerance test (just a coincidence, not because I was going to be getting my HbA1c results). I got *exactly* the same 2hr postprandial rise as I had 3 months ago. The measurements are fairly accurate - I take 3 at each end.

So I am *precisely* as diabetic as I was 3 months ago. The only thing I've noticed that may have changed, is that my body is getting better at dealing with a spike if I exercise during it. I'm not even sure about that - as I'm sure many people here will recognise, you can spend weeks thinking you know what's going to happen with your body, then the rules change!

I'm one of those people, as I expect many are on this forum, who is, deep down, hoping they may be able to go into remission via lifestyle changes.

Based on the rules set out in the recent DiRECT study, it looks like I'll be classed as "in remission" if I keep things up. But I'm not. I'm clearly not. I am diabetic. I have a metabolic disorder. My body is poisoned by carbohydrates, and that doesn't seem to be changing.

There are far, far worse positions to be in regarding health. For me at the moment, all this means is that I may never be able to safely eat the foods that I like. I'll need to go low carb and adjust my tastebuds. Big deal. But, you know, it would be really nice not to have a metabolic disorder, and it seems that some people can indeed put theirs into remission.

I hope it will happen one day, and I'm going to keep trying. If it ever does, the news will come from my glucose meter, not my doctor.

 

[Snapsy]

@AdamJames as you say that's a great result. I don't know much about reversing type 2, and I appreciate that you're disappointed, but please take heart in the fact that you are doing what is needed to give you the best chance of steady control and minimising the risk of complications. And those are really really good things.

Hugs - and well done.

 

[bulkbiker]

So you were hoping for a "cure" and after a year?
What were your OGTT results? Did you just do a 2 hour reading or did you do every 15 minutes?
With an HbA1c of 40 from 92 you are most certainly not in the same place with your diabetes. So I'll give you a pat on the back even if you don't seem to want to do so yourself because I've been there and know it can be bloody hard work. But seriously you are healthier, lighter, have better numbers all round and have stopped drinking.. sounds like a win win win from my perspective.

 

[AdamJames]

Just to be clear based on responses, I'm not feeling desolate at all about this. And I agree my health has to be in a far better place than a few months ago. This is really about the definition of remission.

 

[AdamJames]

So you were hoping for a "cure" and after a year?

As we know, some people's insulin response can largely return to normal after just 8 weeks. I've lost more fat than many people for whom that is true. And I gather that even during the weight loss, insulin response slowly improves. Mine doesn't appear to be changing at all.

I don't *expect* that to happen, by any means. I was careful to say that deep down I'm hoping it might. So yes, I am hoping it might.

What were your OGTT results? Did you just do a 2 hour reading or did you do every 15 minutes?

I haven't done an OGTT, that's on my list for when I can pass my much "easier" 34g carb test without a horrible rise. If and when I do one, I am planning to take a reading every 20 minutes.

Thanks for the positive words, and I totally agree, my health is in a much better place, not just in terms of numbers and blood results, but the fact I can stay awake for a whole day and exercise and am really enjoying life again. And that is the most important thing - like I say, if I need to change my diet permanently, big deal!

 

[bulkbiker]

I haven't done an OGTT, that's on my list for when I can pass my much "easier" 34g carb test without a horrible rise. If and when I do one, I am planning to take a reading every 20 minutes.

One thing you may notice is that the fewer carbs you eat the more you may react when you do take them in.. your body (quite happily) gets used to not having to process carbs so gets bit of a shock when you have some. That could explain your results.
Anyway well done you!

 

[Brunneria]

Well done! What a difference in those results.
And you know the best bit is that you are interested in knowing WHY and continuing to work at it.

So while I totally appreciate what you are saying about how some people are able to introduce carbs again, there is a huge variety of carb-like low carb food indulgences that you can enjoy.

My experience is always changing. Just this Autumn I have been experimenting with the different squashes as potato alternatives. Very impressed with the results, and the ease of using them.
You seem to be someone who is always thinking, investigating, questing. I really relate to that.

With me, the goal was first to get control of my blood glucose, then start investigating what/why/how the variations happen.
Understanding insulin resistance, etc.
Then I tried different ways of eating (always LC, but there are a lot of variations under that heading).
Then fasting.
Then gluten free (which has a massive impact, for me, in that gluten reduces my carb tolerance, and gluten free means that I get much more carb leeway)

I suspect that the more we know about our own personal version of T2, the better we can create an enjoyable life with T2, and you are well on that path.

 

[AdamJames]

One thing you may notice is that the fewer carbs you eat the more you may react when you do take them in.. your body (quite happily) gets used to not having to process carbs so gets bit of a shock when you have some. That could explain your results.
Anyway well done you!

I have to say that that is one reason why I was particularly disappointed - I'd just been on a "carb bender" on previous days, then moderate carbs the day before (140g), and that's why I was curious enough to give myself the carb tolerance test - I was wondering what effect it may have had!

It's just possible that the carb bender could have adversely affected the results also, I don't know? DURING the carb bender my body seemed to be handling spiked remarkably well, provided I was also exercising. My bg was constantly high throughout the days, however.

I haven't done a huge number of these 34g carb tests, but generally there appears to be 2 states, and I haven't worked out the factors to help me get the better results, all I know is it's fluctuated consistently since I started doing them, and overall the average rise isn't changing.

 

[Bluetit1802]

I'm not at all sure your 34g carb test is a valid indicator. In your research have you come across the phrase "last meal effect"?
There is a very good reason why people are supposed to eat at least 150g carbs a day before an OGTT. On a low carb diet our pancreas is not producing much insulin and putting it simply, it goes to sleep. A sudden hit with 75g glucose catches it unawares and it takes a while to catch up. It is the same with a sudden hit of 34g carbs at one sitting. The insulin response will be slower.

Edit. Cross posted with your last post above.

Can you explain your "carb bender"

Also, what were these 34g carbs and what else did you have?

 

[AdamJames]

So while I totally appreciate what you are saying about how some people are able to introduce carbs again, there is a huge variety of carb-like low carb food indulgences that you can enjoy.

Absolutely, and I intend to explore low-carbing as an adventure. Thanks for the other tips.

I'm actually quite a positive person, and I'm beginning to realise I shouldn't have put "very disappointed" in the title!

I AM very disappointed, but in the same way that I'm disappointed at Christmas when nobody gets me cotton socks. Which are getting quite hard to find these days

 

[AdamJames]

Can you explain your "carb bender"

For about 10 days, I'd been experimenting with eating "normally" and exercising. I started at about 2,000 calories and an amount of carbs I forget, I've got it logged on paper somewhere. For the last 3 days of that, the calories had increased to 4,000 and the carbs to 300g (fairly accurate), and the exercise had increased a lot also, e.g. walking up 400m high hills with a heavy rucksack as fast as I could. I didn't gain weight, as much as it's possible to be sure in that timeframe.

On the day before the carb test, I reduced calories to 1800 and carbs to 140g (I was aiming for 150), and still did the exercise.

 

[Brunneria]

I'm disappointed at Christmas when nobody gets me cotton socks. Which are getting quite hard to find these days

Have you tried the bamboo ones? I think they are even better than cotton.

 

[AdamJames]

Have you tried the bamboo ones? I think they are even better than cotton.

Top tip. Ask me again in January!

 

[AdamJames]

Also, what were these 34g carbs and what else did you have?

Sorry, I missed that bit!

Months ago I decided to make my standard test a "personal" one, i.e. something which in an ideal world I'd like to have for breakfast.

It's two slices of toasted wholemeal bread (always the same), weighed after it's finished evaporating water after toasting and cut down, if need be, to 64 grams (because that's how much the two slices in the first test weighed!).

Add to that 20g of butter (yes, it's supposed to be a carb tolerance test, but also it's tailored to real life, i.e. what I'd like to be able to eat!).

Add to that a mug of tea with exactly 70g of semi-skimmed milk in it.

I take 3 readings, consume, enjoy, sit still for 2 hours, then take another 3 readings.

I often use NetFlix to help pass the time. Some shows are far more exciting than others, and I do wonder if that has an effect

 

[Bluetit1802]

What was your rise from before to the 2 hour mark that disappointed you so much?

 

[AdamJames]

What was your rise from before to the 2 hour mark that disappointed you so much?

2.9 mmol/l

I used to think that the higher the starting point, the greater the rise, as the first few tests showed that, but that doesn't seem to be the case. I think I need to do a heck of a lot more before patterns, if there are any, become clear.

I think this one was 6.1 to 9 from memory, I can't find the piece of paper I used and I haven't entered into my spreadsheet yet, but I'm sure about the 2.9 bit.

 

[AdamJames]

What was your rise from before to the 2 hour mark that disappointed you so much?

I don't know if I'm being too hard on myself, but I believe some people say 7.8 is a "good" 2hr value for diabetics to try to keep under. Also, the "worst" value for non-diabetics in a study seemed to be about 6.2, and that was for people who were allowed to eat whatever they want.

 

[CherryAA]

Sorry, I missed that bit!

Months ago I decided to make my standard test a "personal" one, i.e. something which in an ideal world I'd like to have for breakfast.

It's two slices of toasted wholemeal bread (always the same), weighed after it's finished evaporating water after toasting and cut down, if need be, to 64 grams (because that's how much the two slices in the first test weighed!).

Add to that 20g of butter (yes, it's supposed to be a carb tolerance test, but also it's tailored to real life, i.e. what I'd like to be able to eat!).

Add to that a mug of tea with exactly 70g of semi-skimmed milk in it.

I take 3 readings, consume, enjoy, sit still for 2 hours, then take another 3 readings.

I often use NetFlix to help pass the time. Some shows are far more exciting than others, and I do wonder if that has an effect

One thing I have noticed is that having become fat adapted which I definitely am, if I do eat carbs, whilst I still get a spike - ( eg 12 after a chinese fried rice dish - ie at the very highest point using a libre not the 2 hr mark) the big difference for me is that that meal does not trigger a sudden rush of desire for carbohydrates. Instead I find that my fat processes seem to carry on going so I don't get any particular hunger pangs and thus find it easy to then not eat for a while and so let my blood glucose come back to very normal levels( 4's and 5's) .

The result of the above is that whilst I know its not great to have the spike, I also know it will be very short-lived and its easy to then get very low numbers again. I suspect this type of reaction to carbohydrate foods is much more similar to how non diabetic people react - which may be why for them carbs don't trigger massive overeating binges.

For me this has meant that I have become comfortable to eat an LCHF diet as my norm, but now and again if its something special simply not worry too much knowing I can kick back to the same diet again the following meal . Looking at how my weight has behaved over the last few months, I am now comfortable that I can " maintain" my weight indefinitely using this process whilst still having an Hba1C in the 42 and under range.

The other thing I have noticed is that having indulged in a high carb meal there are all sorts of side effects I don't like much - in particular smelly poo, (TMI) and this is actually helping me to not actually desire the high carbs very often at all - it being much nicer all round without the after effects of the carbs !

 

[Biggles2]

but the fact I can stay awake for a whole day and exercise and am really enjoying life again

Wonderful job all around @AdamJames! Remember, diabetes is a marathon, not a sprint!

 

[ickihun]

I won't go on about the many flaws of HbA1c results as I gather other people on this forum are already doing a very good job of that!

After spending a year reading around the subject of diabetes, I'd already got the impression that HbA1cs are not a great indicator, but yesterday it just got personal.

I saw my GP yesterday to get my latest blood test results. He was very happy indeed with me. The weight loss, the complete abstention from alcohol (I can't begin to describe how hard that was), and everything in the blood results looked great. Cholesterol was never particularly bad but now it's great. There was a question mark about my liver but now that looks great also.

Most of all he was blown away by my HbA1c being reduced from 92 to 40, when I told him I'd stopped taking the Metformin 3 months ago.

Now don't get me wrong: going from red to green on the HbA1c chart *has* to be a good thing, and I was happy with that, and most of all I was happy that the doctor was happy, and agreed to cancel the repeat prescription for Metformin.

But here's the thing: on that same day I'd also given myself a carb tolerance test (just a coincidence, not because I was going to be getting my HbA1c results). I got *exactly* the same 2hr postprandial rise as I had 3 months ago. The measurements are fairly accurate - I take 3 at each end.

So I am *precisely* as diabetic as I was 3 months ago. The only thing I've noticed that may have changed, is that my body is getting better at dealing with a spike if I exercise during it. I'm not even sure about that - as I'm sure many people here will recognise, you can spend weeks thinking you know what's going to happen with your body, then the rules change!

I'm one of those people, as I expect many are on this forum, who is, deep down, hoping they may be able to go into remission via lifestyle changes.

Based on the rules set out in the recent DiRECT study, it looks like I'll be classed as "in remission" if I keep things up. But I'm not. I'm clearly not. I am diabetic. I have a metabolic disorder. My body is poisoned by carbohydrates, and that doesn't seem to be changing.

There are far, far worse positions to be in regarding health. For me at the moment, all this means is that I may never be able to safely eat the foods that I like. I'll need to go low carb and adjust my tastebuds. Big deal. But, you know, it would be really nice not to have a metabolic disorder, and it seems that some people can indeed put theirs into remission.

I hope it will happen one day, and I'm going to keep trying. If it ever does, the news will come from my glucose meter, not my doctor.

So your insulin resistance has improved as well. Hba1c doesn't cover that nor your fasting test.
So very very well done.