hba1c drop by 12 points ?

[sw600]

For the past 6 years since I first got a prediabetic hba1c test my levels have ranged between 40-44, depending on how good I've been with the low carb. It was 44 last time (6 months ago) so I have been trying harder to avoid carbs. Today I got a value of 32! Much as I'd like to believe it WAS 32, I can only assume something is up. Anyone else had this? Options are:

* inaccurate measurement (seems unlikely to be (25% off)
* I got someone else's results by accident

Or some kind of underlying medical condition

* acute anaemia due to end-stage kidney failure
* splenomegaly (I think I've got a record by them)

I did a 235km ride on Saturday so I don't think I'm anaemic. I'm going with the "someone else's results" option, I guess I'll need to get them to re-test.

 

[Pipp]

For the past 6 years since I first got a prediabetic hba1c test my levels have ranged between 40-44, depending on how good I've been with the low carb. It was 44 last time (6 months ago) so I have been trying harder to avoid carbs. Today I got a value of 32! Much as I'd like to believe it WAS 32, I can only assume something is up. Anyone else had this? Options are:

* inaccurate measurement (seems unlikely to be (25% off)
* I got someone else's results by accident

Or some kind of underlying medical condition

* acute anaemia due to end-stage kidney failure
* splenomegaly (I think I've got a record by them)

I did a 235km ride on Saturday so I don't think I'm anaemic. I'm going with the "someone else's results" option, I guess I'll need to get them to re-test.

Hold on a minute, there.
@sw600, for the past 6 months you have been working harder at avoiding carbs, and you have a new HbA1c of 32. What makes you assume that is an error, or that you have unerlying health conditions?
Have you had any unusual symptoms? Do you have any other health conditions diagnosed? Is there something you are not telling us? Are you using a meter or CGM device to keep daily record of your BG levels?

Sorry to reply to you with more questions than answers. If I had such a result as you have I would be celebrating rather than fretting. However, as you are fretting you could try to get another test. If your GP won’t provide one there are home tests available to purchase.

 

[Pipp]

In addition, I forgot to mention the 235km ride. If that is a bicycle ride, I am impressed. Cycling distances like that would also be likely with the low carb diet, to give improved HbA1c.

 

[sw600]

Yes it was on the bike. I'm a keen cyclist anyhow so I do that kind of thing occasionally. I've been out quite a lot in the last few weeks actually. But I have been doing that type of exercise for at least 5 years, and attempting lower carb eating also. I have always resented the fact that this didn't ever get me down below 40, even though there are some people I've seen on this forum who have dropped from say 90 or 100 down to 35. I just figured that I have a lot of homeostasis in the hba1c measurement. That's why this 32 seems an outlier, making me a little pessimistic!

 

[Pipp]

Ok, so the tests may not be accurate, but what you have described as your diet and actions over the last few months seems to me to be a readonable explanation for the result. Your choice? Celebrate success, or seek a retest?
Good luck, whatever you decide, do come back and let us know.

 

[Melgar]

Well I would say enjoy those low figures @sw600 ! It sounds like trying harder to avoid those carbs paid off. Congrats

 

[EllieM]

I'd be inclined to celebrate but you could always ask for a retest and/or a fructosamine test if you are really paranoid.
Congratulations.

 

[Outlier]

Consider: if it was a rogue reading, what are you going to do about it, given that you have already finetuned your diet and exercise? If it wasn't a rogue reading, then all is well and you can continue to do what you are already doing. So IMO not actually worth making any waves over, because there are none to be made, and not worth rattling the medical chains either.

That's my take, but you may well think differently and it is your decision whether or not to pursue. Congratulations from me at your improvements, though!

 

[ajbod]

I would say it's a genuine result, and you are amply demonstrating the much greater affect of diet over exercise in controlling blood sugars. WELL DONE, keep it up.

 

[KennyA]

The drop in itself is excellent (well done) and isn't all that unusual. I went from 50 to 36 in January - April 2020, and many others have similar stories of even larger falls. The HbA1c is looking at the red blood cells for the last three months, and there will have been a complete turnover in that time.

Each A1c test (including your one of 44) has an allowable and acceptable error, but it's around 5% of reading (not 5 percentage points) - so the "true value" of your 32 should be somewhere in a range from around 30.4 to 33.6.

 

[Melgar]

I would say it's a genuine result, and you are amply demonstrating the much greater affect of diet over exercise in controlling blood sugars. WELL DONE, keep it up.

Everyone is different of course, but exercise works for me. Both diet and exercise are very important for over all health and well being. Ed for clarity.

 

[mouseee]

I went from 101 to 39 in 3 months. I'm not giving any health condition the glory for that result.... that was hard won by low carb!
It did go up again when carb levels slipped so it would be nice to blame an underlying condition for that, but sadly, just lack of will power....
Celebrate and ask to have another check in 3 months if you want to.

 

[RayCox]

I say well done

 

[Paul_]

It's easy for us to slip into a mindset where, when receiving good news, we assume something must be "wrong" or that it can't be accurate.

As Kenny said, the error margin on hba1c tests is relatively low. In turn, you've worked hard at controlling carb intake, so to flip your perspective on its head - why wouldn't you expect to see improvement?

Feel proud of yourself @sw600. You're allowed to enjoy the hard earned fruits of your labour and use it to motivate yourself to keep going with the improvements you've made. It's a fantastic achievement, well done!

 

[Robbity]

@sw600 my T2 diagnosis was via HbA1cs between 60 and 62, and 3 months later my next result was down to 47, and my later results have continued at similar lower levels. As a fat and inactive old lady I was just happy and relieved to see this drop and that eating a lower carb diet actually helps control my diabetes.

I've seen other members post with often extremely successful and impressive reductions in levels - e.g. see @mouseee 's post, - and I think you should be well pleased with the result of your good work rather than being concerned over it.

 

[sw600]

Thanks all, did another test (same testing company, but they are a reputable lab so I don't expect there is a systemic issue) and got exactly the same. I'm now suspicious that the numbers are identical

I will just accept it I think and keep up the 3-6 monthly testing and hope that the better numbers don't make me complacent with the low-carb lifestyle. Now I need to fix my cholesterol

 

[KennyA]

Thanks all, did another test (same testing company, but they are a reputable lab so I don't expect there is a systemic issue) and got exactly the same. I'm now suspicious that the numbers are identical

I will just accept it I think and keep up the 3-6 monthly testing and hope that the better numbers don't make me complacent with the low-carb lifestyle. Now I need to fix my cholesterol

Two HbA1c tests a week or so apart are essentially the same test. I'd expect to see similar/identical results, particular;ly if you use the same lab. It's why I usually advise that you don't do repeat HbA1c tests within days of each other: you're testing the same blood and you should expect to get the same result.

 

[sw600]

Just got myself another test after 6 months and it comes out at 36. I have been very bad at exercise recently (too much DIY and work) but still good at the other aspects of low-carb. One of the key changes, it seems, is to never eat carbs for breakfast. Well perhaps a croissant once per month or something, but in general always 10% fat greek yoghurt plus a handful of almonds, walnuts, nixed seeds and cacao nibs. It was something I noticed when I had a few months of the CGM that the dawn effect was particularly strong with me. In fact this is BETTER than skipping breakfast completely, and may explain why 5:2 didn't seem to help me with levels.

As an aside, the lower bound for prediabetes has apparently now changed from 42 to 39? I'm assuming this is the 'new reference range' mentioned for the 11th september.

 

[Melgar]

Just got myself another test after 6 months and it comes out at 36. I have been very bad at exercise recently (too much DIY and work) but still good at the other aspects of low-carb. One of the key changes, it seems, is to never eat carbs for breakfast. Well perhaps a croissant once per month or something, but in general always 10% fat greek yoghurt plus a handful of almonds, walnuts, nixed seeds and cacao nibs. It was something I noticed when I had a few months of the CGM that the dawn effect was particularly strong with me. In fact this is BETTER than skipping breakfast completely, and may explain why 5:2 didn't seem to help me with levels.

As an aside, the lower bound for prediabetes has apparently now changed from 42 to 39? I'm assuming this is the 'new reference range' mentioned for the 11th september.

View attachment 70859

Hi there @sw600 reading your last reply I see you have written that the UK has a new Prediabetes reference range 39 to 47. I can’t find anything about that. Am I reading you right? If I am can you provide a link, thanks.

 

[sw600]

Hi there @sw600 reading your last reply I see you have written that the UK has a new Prediabetes reference range 39 to 47. I can’t find anything about that. Am I reading you right? If I am can you provide a link, thanks.

That's what my lab report says, which was Sussex Pathology ltd (which does the testing for onedaytests.com). I can't find much else though.

Here is another testing company, they claim it's based on US ADA recommendations:

What is HbA1c and what’s the HbA1c normal range?

Understand what HbA1c is and why there’s more to the HbA1c normal range than meets the eye.

www.selph.co.uk

I note that ADA were saying 39 back in 2016:

Update on pre-diabetes: Focus on diagnostic criteria and cardiovascular risk - PMC

Pre-diabetes, which is typically defined as blood glucose concentrations higher than normal but lower than the diabetes threshold, is a high-risk state for diabetes and cardiovascular disease development. As such, it represents three groups of ...

pmc.ncbi.nlm.nih.gov

But I don't know what changed on 11 Sept in the UK. Are we aligning with the US, or is it just two testing companies with an opinion?