HbA1c level of 32

[TUC]

I have type 2 diabetes. As I understand it, although a HbA1c level of 32 would be normal for a person without diabetes, a level of 48 would be more usual for someone with diabetes. On my most recent HbA1c test I have come out with a level of 32. Given this is normal for someone without diabetes, but lower than normal for someone with diabetes, I am unclear whether it should be regarded as on the low side and potentially of concern, or should be regarded as safe and normal. Can anyone please advise?

 

[Deleted Account]

I think it depends on how you are treating your diabetes and how you achieve this level.
As HbA1C is an average, it could be achieved by maintaining a steady BG of around 5.0 all the time which is typical for someone without diabetes, or it could be achieved by someone with diabetes constantly swinging from 2.0 to 8.0.

 

[Freema]

my last HbA1c was 34 .. it is just fine to be in that area, and no it is not too low... it is close to ideal , only if one is hypoing all the time , and especially if one is on insulin or insulin affecting medication then one needs to be much more aware avoiding anything that can lead to a much-lowered blood glucose of under 3.7mmol, then some even need to be never lower than 5 mmol or even a bit higher .. but as I read your signature that is not the case for you

 

[britishpub]

What do you mean by "a level of 48 would be more usual for someone with diabetes" ?

I'm not sure I understand why this would be.

 

[sally and james]

An HbA1c of 32 is perfectly normal for people who have been given a T2DM diagnosis. They usually achieve it without using any diabetic medication and by severely reducing their sugar intake (ie a low carb diet). In other words, they return to normal. Others may achieve these levels with generous doses of medication, including insulin. This has been shown to be less safe (was it the Accord Study??) in terms of general health and because of potential hypos. @TUC how are you achieving your seemingly excellent results?
Sally

 

[TUC]

I was moved from Gliclazide and Metformin onto Alogliptin last year, mainly because of the hypos I'd been experiencing. However, since then I've also been doing Slimming World and have lost over 2 stone, so it's hard to be sure whether it's the change in medication or the weight loss that is primarily contributing to the reduced HbA1c level.

I went to see my GP recently due to feeling energyless and, for the first time since I changed my medication, experiencing a hypo. My HbA1c result in my annual review a couple of months before had been 32, which my GP practice said was normal when I rang for the results. However, given the above symptoms, I went to see my GP a couple of weeks ago. He said that a level of 48 would be normal for diabetes and arranged a further HbA1c test, saying he would review the medication if it was 32 again. It was 32, but when I rang the practice for the result, they are insisting that 32 is normal, so I'm confused.

 

[sally and james]

@TUC An HbA1c of 41 or less is regarded as normal. 42 to 47 is called "pre-diabetic" and 48 and above gives a diagnosis of diabetes. These are all for an undiagnosed person presenting at their doctor's surgery. This will be why the nurse/receptionist or whoever will tell you that 32 is Normal.
As I have said above, many T2 diabetics alter their lifestyles and consistently have HbA1c results in the 30's or even the 20's. This may even be possible for you.
You, however, are getting a low HbA1c due to the amount of drugs you are taking and, therefore it is highly likely that there will be times when your blood sugar is actually too low. The drugs will be preventing your body from doing its natural balancing and raising of sugar levels when you need it. I am not medically qualified and, even if I was, I would not provide individual medical advice over the internet, but it does look as if a visit to your doctor to discuss reducing your drugs might be in order. An HbA1c of 32 is far lower than GPs are encouraged to achieve (using drugs) with diagnosed diabetic patients.
Very few will discuss diet as a means of dealing with T2. If you want to explore that avenue in due course, have a read around this site and ask all the questions you need - there are thousands of answers here!
Sally

 

[TUC]

Just to update on the outcome of this. On the back of my result being a score of 32, ny GP arranged a second HbA1c test and said he would adjust my medication downwards if it came out at a similar level.

When I rang my GP practice for the result, I was told it was 'normal' and I had to ask for the specific score. It was 32 but they advised again that their system said this was normal. When I said that ny GP had already said he would adjust my medication if it was 32, I was asked to ring again when another colleague was in. Again they said it was showing as normal but, when I advised of my previous discussion wiyh my GP and that 32 for someone with diabetes could include variation lower and higher, they arranged for my GP to ring me. After discussing it with him he has adjusted my medication from 2x Alogliptin per day to 1 x Metformin per day, and for me to be retested in December to check the effects.

I'm fine with this outcome, but it does demonstrate how someone could be badly advised if they just accepted that their GP practice said their result was 'normal'.

 

[Bluetit1802]

Presumably it was a receptionist telling you that 32 is normal. It is normal, so she was correct. The computer would have "normal" written alongside the score. The receptionist would have no idea that it is the medication causing this and that you needed to speak to a doctor. Once you pushed the matter, they arranged for you to speak to your doctor - and hey presto, you got good advice.

Now you have a few months to see if you can stay in the normal range without the strong medication. Metformin only helps a tiny bit, so now only diet can keep you normal. Have you any plans with regards to diet? Have you got your own blood glucose meter? (you will need one)

 

[bulkbiker]

Just to update on the outcome of this. On the back of my result being a score of 32, ny GP arranged a second HbA1c test and said he would adjust my medication downwards if it came out at a similar level.

When I rang my GP practice for the result, I was told it was 'normal' and I had to ask for the specific score. It was 32 but they advised again that their system said this was normal. When I said that ny GP had already said he would adjust my medication if it was 32, I was asked to ring again when another colleague was in. Again they said it was showing as normal but, when I advised of my previous discussion wiyh my GP and that 32 for someone with diabetes could include variation lower and higher, they arranged for my GP to ring me. After discussing it with him he has adjusted my medication from 2x Alogliptin per day to 1 x Metformin per day, and for me to be retested in December to check the effects.

I'm fine with this outcome, but it does demonstrate how someone could be badly advised if they just accepted that their GP practice said their result was 'normal'.

As so many of us have found GP's and especially receptionists aren't very clued up on Type 2.
Do you regularly measure your blood sugars?
If not I would heartily recommend you start then you can see for yourself the impact of what you eat has on your blood sugar levels.

 

[dbr10]

I have type 2 diabetes. As I understand it, although a HbA1c level of 32 would be normal for a person without diabetes, a level of 48 would be more usual for someone with diabetes. On my most recent HbA1c test I have come out with a level of 32. Given this is normal for someone without diabetes, but lower than normal for someone with diabetes, I am unclear whether it should be regarded as on the low side and potentially of concern, or should be regarded as safe and normal. Can anyone please advise?

It's in the normal non-diabetic range.
Should have added so long as you don't have hypos

 

[Fitzysgirl]

hope this helps abit xxx

 

[pavlosn]

Whose color coding is this? Seems ridiculous

Sent from my SM-G935F using Diabetes.co.uk Forum mobile app

 

[Bluetit1802]

Whose color coding is this? Seems ridiculous

Sent from my SM-G935F using Diabetes.co.uk Forum mobile app

Agreed!

 

[Brunneria]

hope this helps abit xxx

Unfortunately, the chart above doesn't show the HbA1c units that TUC was given. Here in the UK, our HbA1c units are mmol/mol and the chart below shows how the UK mmol/l and the American % units compare.

 

[ringi]

Sometimes you have to go and sit in a room with a GP to get them to engage their brain when looking at test results. Most test results are looked at by whatever GP is checking reuslts on the day, and they have many to look at, so will not look at someone's nodes if the result is "normal". The days of having your own GP that know you are long gone.....

 

[TUC]

Presumably it was a receptionist telling you that 32 is normal. It is normal, so she was correct. The computer would have "normal" written alongside the score. The receptionist would have no idea that it is the medication causing this and that you needed to speak to a doctor. Once you pushed the matter, they arranged for you to speak to your doctor - and hey presto, you got good advice.

Yes it was a receptionist I originally spoke to, and I don't blame her for simply reading the interpretation that the system gave to the score. What does concern me is, if a score of 32 may or may not be normal for someone with diabetes, why the system flags it purely as 'normal' rather than adding prompts for further enquiry. Someone a bit less assertive would potentially have walked away after the first call without knowing they had a possible issue.

 

[TUC]

Sometimes you have to go and sit in a room with a GP to get them to engage their brain when looking at test results. Most test results are looked at by whatever GP is checking reuslts on the day, and they have many to look at, so will not look at someone's nodes if the result is "normal". The days of having your own GP that know you are long gone.....

But in this case I'm not sure whether a GP had actually reviewed the result before my first call. The advice at the end of my first call was to ring back to speak to the 'results team' but this turned out to someone else from the practice staff rather than a GP, and even they initially referred to the 'normal' statement for the score, so I was left wondering whether it was simply a computerised system giving a standard interpretation to a 32 score.