Hb1ac always 90+

[Stay healthy]

Hi, wife has Diabetes since 2017. She had pancreatitis in childhood and we were told her diabetes is a result of that as opposed to unhealthy diet etc. she was out in insulin a year ago and is currently on 26units a day. she has a BMI of 26 and is active otherwise but every time we go for hb1ac it comes out to be on the higher side even after insulin. I am really confused and worried as to what such high hb1ac over years mean? Her fasting reading come out ok and is rarely over 7 plus her other checks like feet etc comes out fine. Eye site was fine too last time we checked so really not sure what’s happening with hb1ac?? Any ideas / guidance please

 

[EllieM]

Eye site was fine too last time we checked so really not sure what’s happening with hb1ac?? Any ideas / guidance please

What are her blood sugars like during the day? There are some (rare) blood conditions that can make an hba1c an inaccurate measure of blood sugar levels.

You could try out a cgm (eg libre) for a couple of weeks to see what her levels are like. I believe Abbott are doing free trials for UK diabetics (assuming that is where you are).

https://sample.freestyle.abbott/gb-en/freestylelibre.html

(Hopefully that link works for you, as I'm in New Zealand I may have picked up the wrong one.)

 

[In Response]

What insulin regime does your wife follow? You mention 26 units which suggest she is on a fixed dose.
She may be experiencing highs when eating and could benefit from a basal bolus regime with carb counting to reduces potential highs.

 

[Antje77]

Her fasting reading come out ok and is rarely over 7

Does she only test her fasting sugars or does she test after meals as well?

 

[Stay healthy]

Does she only test her fasting sugars or does she test after meals as well?

So far mostly fasting and hence we were hopeful of a lower hb1ac this time

 

[Stay healthy]

What insulin regime does your wife follow? You mention 26 units which suggest she is on a fixed dose.
She may be experiencing highs when eating and could benefit from a basal bolus regime with carb counting to reduces potential highs.

She takes fixed unit of slow release insulin in the morning. What’s basal bolus ?

 

[EllieM]

She takes fixed unit of slow release insulin in the morning. What’s basal bolus ?

T1 diabetics, who end up producing no insulin at all, typically take two types of insulin for a basal/bolus regime. The basal (long acting) covers their insulin needs when they are not eating (eg overnight) and then they take fast acting insulin (bolus) to counteract the carbs in any food they eat and sometimes to act as a correction dose if their bg is too high. This allows for flexibility in meal amounts and times, as you only need to inject bolus when you eat, and you can change the amount to cover the food you eat.

My guess is that your wife is still producing some of her own insulin so the doctors are hoping that her insulin needs can be covered by just a basal dose, and her own insulin will cover her food. If that hba1c is accurate it suggests an average bg of around 14 so it's likely that she could either do with adding some fast acting insulin to her system or to drastically reduce the carbs in her diet. Whatever she does, I'd recommend testing before and after meals so that she knows what her blood sugar is actually doing.

Her medical team should be helping her to get on a regime that lowers her bg, because running permanent levels of 14 or so will probably cause long term damage (eyes, kidneys, nerves etc). OK, if she's 90 that might not be an issue, but if she wants to have several more decades of healthy life (I've been T1 for 52 years and would like some more decades myself, if possible) then I would strongly suggest that she takes control of her levels and pushes her team for help.

Good luck to the both of you.

 

[Daibell]

Hi. I suspect the insulin regime may need changing. She probably needs to be changed to the Basal/Bolus regime which most T1 and LADAs are on. This is two different insulins. A long acting one such as Lantus or Levemir etc (Basal) and a fast acting one for meals such as NovoRapid (Bolus). The Bolus is adjusted at each meal to suit the carbs (carb-counting). It does mean 4 to 5 injections per day plus any correction dose but I'm sure would give much better control.

 

[Antje77]

So far mostly fasting and hence we were hopeful of a lower hb1ac this time

She needs to test over the day as well, if she wants to know what is going on. Something seems to be going wrong here, but without testing you don't know what it is.