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Hba1c 33 6 months since diagnosis

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kms1985

Well-Known Member
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49
I've had a call from DN today saying by hba1c is 33 which is too low, I need to see them on Thursday to find out what they are going to do. I think I'm taking too much insulin and might have nighttime hypos. If I am could this be why the result was low.

Thanks


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Yes its way too low for someone on insulin and will result in hypos. You need to alter yr insulin doses so that yr bg is about 6mmol before a meal and then about 8mmol 3hrs later falling back to 6mmol by 4-5hrs.

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Hmm. Isn't at least possible that it's just good control? I know that the NHS considers that too low and likely to be associated with hypos, so definitely worth checking and investigating. But if it turns out there are no hypos, then this is a great achievement. 5% HBa1c in "old money". Nearly as good HBa1c as a non diabetic.

I realise probably it will turn out to be associated with hypos in this case. I am, as they say, "just saying".

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it may possibly be that you are in the honeymoon period too
 
How can a HB1AC of 33 be classified as too low. My last HB1AC was 5.0 % or 31 and this was achieved without any hypos only tight (Non-Diabetic level) control.My Doctor didn't complain


Non-diabetics don't get diabetic complications so that is my target.
 
That is an excellent result, I have no idea why this would be classified as 'too low'. My last HB1AC was 5.0 % ~ 31 and I was given a 'well done', I didn't have any hypos just tight control. Your value is in the non-diabetic range, non-diabetics don't get diabetic complications.

As for nonsensical values like 6 mmol before eating and 8 mmol after , these are around 50 % higher than non-diabetic values ............
 
Cblake843 said:
That is an excellent result, I have no idea why this would be classified as 'too low'.
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The reason is that one way to have a non diabetic HBa1c is to have frequent hypos. In the NHS that is a common reason for seeing low HBa1c in insulin treated patients. It's why the NHS considers a non diabetic HBa1c level to be a warning sign for Type 1.

In this case however as it's only six months after diagnosis, it may well be that there are no hypos and it's perhaps the honeymoon effect. Or just very good control.


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Cblake843 said:
As for nonsensical values like 6 mmol before eating and 8 mmol after , these are around 50 % higher than non-diabetic values ............
Click to expand...

These values are not nonsensical. They provide some slack vs non diabetic levels because otherwise there is an increased risk of hypos and the likelihood that patients will be discouraged either by failing to meet the targets, or by meeting them with frequent hypos. Obviously if you can do better, without hypos, that's excellent. But these are reasonable and achievable targets for diabetics on insulin.

The NHS / DUK goals for diabetics say that each patient should be given personal BG targets and that these should be reviewed periodically (annually I think).


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The NHS / DUK goals for diabetics say that each patient should be given personal BG targets and that these should be reviewed periodically (annually I think).
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................. I'm glad I live abroad and have ***k all to do with the NHS if these are the levels they advocate.
 
Just gonna chime in and say if you're not having frequent hypos and your levels actually come from good control then thats an ideal hba1c.

Cblake843 said:
................. I'm glad I live abroad and have ***k all to do with the NHS if these are the levels they advocate.
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I'm from Aus, if I told my endo i was aiming for a hba1c of above 6 she would strangle me.
 

How do you think your control is? Do you feel in control of your diabetes generally? 33 is an excellent HbA1c for a Type 1.

The reason that your DN is freaking out is that 93% of Type 1 diabetics fail to get an HbA1c below 47.5 mmol/mol.

That makes you an oddity. If you are happy that you have things in control that you understand the condition and are not having unexplained hypos then keep doing what you are doing; you are a very successful oddity. You may well still have some pancreatic function which will help with your levels and long may that last but often the 'honeymoon' period that people have mentioned will not last more than a few months.

The hands down absolute worst piece of advice I ever got was when I got my HbA1c to under 40 mmol/mol was that that was 'too low' and I should get that raised. I got it there by having good control not by having uncontrolled hypos but the HCPs could not/would not believe that. Which follows really as the advice we are given on control is so abysmal that something must be seriously wrong for it to lead to non-diabetic blood sugars...

Best

Dillinger
 
totsy said:
it may possibly be that you are in the honeymoon period too
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Yes kms1985 is still in the honeymoon period, only recently being diagnosed as I said yesterday:

http://www.diabetes.co.uk/forum/threads/hba1c-33-type-1.55909/


As a long-term type 1 I wouldn't want an Hba1c of 5 as that would ultimately lead to more hypo's and possibly hypo unawareness, as a driver that would be totally out of the question and it would impede on quality of life, just my opinion...........
 
Nobody mentions diet and eating habits.

If you have a normal Western diet and eating habits (breakfast, lunch and evening meal), then a near-normal HbA1c could not - in my opinion - be safely achieved.

My past few HbA1c readings have been 27mmol/l, which is normal for a non-diabetic. I manage to achieve this, with no increased risk of hypos, on account of what I eat, the way that I eat (mostly grazing), and because I test my blood sugar quite a lot (mostly using the cheap, visually read strips) - on average, once per waking hour.

In particular, I could not safely achieve a normal HbA1c without steadily eating around 220g of rye bread each day. (I don't eat any after 4.00pm, or my blood sugar would rise in the evening and overnight.) For not only does this keep my blood sugar relatively stable, the symptoms of any hypo tend to be much less rapid and severe in onset: I can tolerate low blood-sugar levels - and relaxedly take action - which previously would have brought me to the floor.

I still have to be careful, of course, but not anything like as careful as I used to have to be. It used to be so very difficult, with so much guesswork. Now it's easy.
 
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noblehead said:
As a long-term type 1 I wouldn't want an Hba1c of 5 as that would ultimately lead to more hypo's and possibly hypo unawareness, as a driver that would be totally out of the question and it would impede on quality of life, just my opinion...........
Click to expand...

I don't think an HBa1c of 5% (30 ish) would "lead to" hypos. It is an indication of possible hypos, probable hypos even, when looking at Type 1s as a population. But looking at you as an individual, if you are achieving 5%, and you are not having hypos or skating close to them, then the near normal HBa1c is not going to cause you to have hypos.

Another way of looking at it is this. If you have an HBa1c of 5% and erratic blood glucose, you are definitely having hypos. If you have an HBa1c of 5% and stable blood glucose, you are not having hypos. Because HBa1c measures an average, but doesn't measure whether blood sugar is stable or erratic, the HCPs have to treat low HBa1c as a reason to investigate in case blood sugar is erratic, in which case low HBa1c will be an indicator of hypos. But low HBa1c does not necessarily mean hypos.


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Yes I do see your point Spiker and I'm well aware of the points you make, however from my time being a member of this forum I've seen a great deal of posts where members have lowered their Hba1c too low which has resulted in hypo unawareness, hypo unawareness is not something I would wish for as an insulin dependant type 1 and that is why I've never wanted an Hba1c of below 6.
 
It's a fair point about hypo unawareness. If you run normal blood sugars all the time is that going to impair hypo awareness. Quite possibly. :-(

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Amongst other things, it depends on what you tend to eat, and on the way you eat.

If I mostly ate white bread and potatoes and stuff - or even wholemeal wheat bread and potatoes - there'd be no chance of me safely achieving a non-diabetic normal HbA1c reading.
 
I guess what this hinges on is, what's the cause of losing hypo unawareness? I don't know. I thought - and this is only what I was taught - is that it was repeated hypos that cause hypo unawareness. Like the boy who cried wolf, if you trigger the hypo warning symptoms too frequently, they start not to trigger (or trigger at a lower level?). That loosely matches my experience.

And definitely if you run high BG then the trigger point of hypo awareness is reset to a higher level, sometimes falsely high.

I was told more recently that hypo warning symptoms are triggered more by the drop rate of BG than by the absolute BG level. This also matches my experience.

I appreciate it's a critical issue with driving and not worth taking risks with and nor worth pushing the limits either. That makes perfect sense.

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I know when I was first diagnosed and didn't know any better i.e I was following the recommended B/S target ranges , I would get mild hypo symptoms when I was in the low 5 mmol range , which is nowhere near a hypo. I now get mild symptoms at 3.8 mmol which to me is where hypo awareness should start not when it's in the normal range


Diet and exercise regime are both big factors in control.
 
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