HbA1c Level Reduced

Hello Malc
Firstly extremely well done on your achievements - further proof that by taking control we can manage DB.
I think it's a personal thing re pills vs no pills. Have a read around on here and look at other folks experiences. I tried the pills but stopped them. That was my choice. No doctor can force you to do anything you don't want to.
Cd

Congratulations Well done!

The doctor is doing what most doctors do, write out prescriptions. My HBA1c was 83 or similar and he wanted to put me on metformin. I said no and that I would see if I could get it down with diet and exercise. I told him I wuld aim for 48, he laughed and said it would be a miracle if I was 54 or 54. 8 weeks later, I was 48.

Since then, I consider that I have got my blood sugars under much better control. I am most of the day in the 4s and 5s and feel bad about getting readings in the 6s. If I get a 7, I get depressed They won't give me another HBA1c but if I did have one, it ought to be a lot better than 48.

Lose more weight, eat fewer carbs or at least stick to complex carbs or low GI carbs and do more exercise and down you'll go. You've seen it for yourself. You've seen that it works. 50 is too high anyway. Aim to be below 40. In the words of the good professor from Newcastle:

"The extent of weight loss required to reverse type 2 diabetes is much greater than conventionally advised. A clear distinction must be made between weight loss that improves glucose control but leaves blood glucose levels abnormal and weight loss of sufficient degree to normalize pancreatic function."

Your GP is simply aiming at getting you to around 50. It's good, but not good enough. You can do better with a determined effort. Just keep at it, you're on the right track. It doesn't matter if it takes you another year. It's not a time trial.

It is upto u what u decide to go ahead and do but Metformin is a very very good drug with many benefits outside of diabetes, try doing a little bit of research or googling about it and see what u think....? The slow release version is better as the one main side effect can be gastro trouble but in many an opinion the pros outweigh the cons with Metformin...


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

Sorry if I'm mis-reading this, but based on the WHO guidelines as shown on this page --> http://www.diabetes.co.uk/what-is-hba1c.html an HbA1c of 56 is in the T2 range. If I understand it correctly you'd have to be below 42 to be in the non-diabetic range.

That said, with control of your diet and exercise it should be possible to reduce your levels to the target your doctor has set and even below that. On diagnosis, my HbA1c was 62. Four months later after removing sugar, sweets, cakes, biscuits and crisps from my diet and with 40 minutes moderate walking daily, my HbA1c was down to 38.

My hba1c was 45 on my last appointment and my consultant said it was non-diabetic range and discharged me from consultant care! lol I guess they don't even agree on that!


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

MalcToy said:

Hi All

Last ApriI I was diagnosed Type 2 following a visit to my Heal Centre for a 'Well Man' clinic. The subsequent Glucose test along with an HbA1c showed my level at 63.0 mmol.mol. On a retinal scan traces of diabetes were found but only level R1.

Since then through diet and limiting/reducing my sugar intake I have lost about 6/7kg in weight and my average blood sugar level has been reduced from 6.23 last April to 5.57 at the end of August. This was established using Free Style Lite Testing Strips which I used once each day before meals varying each day between pre-breakfast, pre-lunch and pre-dinner.

This week I had a second HbA1c test which confirmed my level at 56 mmol.mol which, according to the information I have sobtained online, in non-diabetic.

That said, my GP who specialises in diabetes recommends that I start taking one metformin tablet each day to further reduce my HbA1c level ideally to 50.

Unless it is necessary, I don't really wish to start taking continual medication and would prefer control being by diet and excercise.

My question is, should I follow my GP's advice ?

I would really appreciate peoples thoughts.

Many thanks from a Newbie Diabetic !

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Firstly, congratulations on reducing both your weight and HBA1c. :clap: However, there's room for improvement on your HBA1c.

For more information on what your HBA1c result means, go to http://www.diabetes.co.uk/what-is-hba1c.html

HbA1c can be expressed as a percentage (DCCT unit) or as a value in mmol/mol (IFCC unit). Since 2009, mmol/mol has been the default unit to use in the UK.

On diagnosis, your HBA1c was 63 mmol/mol - 7.9% (DCCT) which is an average BGL (Blood Glucose Level) of 10.0 mmol/l

Your latest HBA1c of 56 mmol/mol equates to 7.3% (DCCT) actually shows that you have reduced your average BGL to 9.0 mmol/l

Note that the HbA1c value, which is measured in mmol/mol, should not be confused with a blood glucose level (BGL) which is measured in mmol/l.

Use this converter tool to calculate your average BGL from your HBA1c result.

http://www.diabetes.co.uk/hba1c-units-converter.html

You said that you had reduced your average BGL to 5.57 at the end of August. You came to this figure by testing once each day before meals varying each day between pre-breakfast, pre-lunch and pre-dinner. Unfortunately, as you can see from the figures above, testing only pre-meal does not give a true picture of your average BGL, and as important, is how much your BGL rises AFTER eating.

To get a more accurate picture you need to test pre-meal and 2 hrs after you finish eating that meal to see the effect of the food you have eaten on your BGL. Your BGL will start to rise the minute you start eating. If you want to see how high your BGL might spike after eating, try testing at 1hr after you finish eating. At +2 hrs you want to aim for a similar value to your pre-meal value. If it's not of a similar level, then you likely consumed too much carbohydrate in that meal.

Make a note of what was in that meal, and the effect on your BGL, and if all's well and you're back to pre-meal levels at +2hrs, then you know that you can keep that meal or food in your diet as it's good for you. If your BGL rises higher than you would like at +1hr or +2hrs, or is still high at +3hrs, then you know to adjust portion size, or in extremis, exclude that meal or ingredient from your diet. Fats, & proteins have neglible effect on BGLs, what you really need to take notice of is the carbohydrates you eat.

As well as cutting sugar, you may want to look at reducing the carbohydrates in your diet, especially the refined carbohydrates which can push up your BGL quickly - things like, white bread, potatoes (especially mashed), cakes, pastries obviously, pasta, white rice etc., Some people advocate cutting these things entirely from their diet, but if you find this difficult, reducing carbohydrate portion sizes may also produce results. I would recommend weighing everything at first, so that you can learn appropriate portion sizes - you might be surprised by how much you eat and what might be an appropriate portion size.

At the same time, I would recommend increasing the amount of vegetables you eat, especially those grown above the ground - i.e. green leafy stuff like broccoli, cabbage, spinach, cauliflower etc., Eat root veg. in moderation (carrots, turnip etc.,)

Another tactic is to eat low-GI carbohydrates which have higher levels of fibre and which don't provoke such an instant rise in BGLs as their refined counterparts. You might consider, wholewheat pasta or noodles, brown basmati rice, barley, wholewheat bread etc., Be careful of the sugar in fruits, berries are best, as they are high in fibre, and lower in sugar than other fruits.

Most diabetics find that they can improve control by testing before and after each meal, until they get a good idea of what works for them. Everybody's tolerances are different, so there is no one-size-fits-all formula. You have to find out the foods which will work for you, to lower and maintain your BGLs and to reduce your risk of complications. Be adventurous, and find what suits you best. Learn to love what you CAN eat, making it as tasty, healthy and interesting as possible. This has to be a way of eating that you can sustain, and enjoy for life, or you may be tempted to "fall off the wagon". You can still have treats, but they should be just that, not the norm. IMO, they are best factored into what you plan to eat for the day, not EXTRA. You want a treat? - compensate by having less pasta or rice...

Your GP will likely tell you not to test, as their agenda is to reduce costs and they don't want to have to prescribe expensive test strips. But ask any diabetic and they will tell you that testing is vital. so TEST, TEST, TEST is the best advice I can give. Once you know what foods work for you , you will be able to reduce or eliminate testing as you see fit.

If you are overweight, reducing your weight will reduce your insulin resistance, which in turn will reduce your BGLs.

Exercise will also help with insulin resistance, even 30 minutes fast walking 5 times a week; take the stairs instead of the lift or escalator; join a gym, go swimming. Exercising regularly can improve your cholesterol profile, reducing the total, and increasing the HDL (so-called good cholesterol) and reduce triglycerides. Can't recommend it highly enough!

It's really up to you whether you take metformin or not. I don't personally take it, but many folks do, and it works for them. I believe some of the benefits, might be reduction of CVD risk, and it assists with weight loss. It does have its downsides too - something delicately called "gastric upset". Metformin doesn't help hugely with BGL levels. It supposedly helps with insulin resistance, but losing weight can be just as effective, if not more so, IMO. Only you can decide if it's worth it to you.

I would recommend that you browse other areas of this site, not just the forum, for information on all aspects of diabetes, diet and medication to help you decide the best way forward for you. It's an excellent resource, that I've found invaluable.

Whatever you decide, I wish you the very best of luck!

Personally I disagree with the 'fat content is negligible to BSL' as it certainly isn't for LADAs like me who are insulin deficient.

If I have a pasta bolognese I am usually about 6.5mmol 2hrs later (cooked in oil etc etc) but if I eat tuna pasta (hardly no fat) I'm around 12.3mmol based on the same size portion of pasta for both meals. The fat content between the two is quite different and having a lot of fat in the meal slows down the absorption of the carbs which allows insulin deficient people like me more time to break it down and can make all the difference in avoiding big spikes.

This may not apply to type 2s and people with insulin resistance, I'm not sure as it doesn't apply to me, but for LADA the fat content has a massive effect on BSL, or at least it does with me.


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

elaine77 said:

Personally I disagree with the 'fat content is negligible to BSL' as it certainly isn't for LADAs like me who are insulin deficient.

If I have a pasta bolognese I am usually about 6.5mmol 2hrs later (cooked in oil etc etc) but if I eat tuna pasta (hardly no fat) I'm around 12.3mmol based on the same size portion of pasta for both meals. The fat content between the two is quite different and having a lot of fat in the meal slows down the absorption of the carbs which allows insulin deficient people like me more time to break it down and can make all the difference in avoiding big spikes.

This may not apply to type 2s and people with insulin resistance, I'm not sure as it doesn't apply to me, but for LADA the fat content has a massive effect on BSL, or at least it does with me.


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

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Hi Elaine,

Thanks for that. You’re absolutely right about fats slowing down absorption of carbs and smoothing out spikes - and it’s the same for me as a T2, as I imagine it is for all diabetics. (someone might correct me on that!) It’s a very important point, and one I should have mentioned.

What I said was, in context, Fats & proteins don’t tend to RAISE BGs, and the OP might want to count the carbs, and take note of portion sizes as a way of controlling BG's. I should also have said that fats, although they may not raise BGs significantly, can counteract the spiking effects of carbohydrates consumed at the same meal. How much is down to experimenting with quantities and testing. Personally, I don’t tend to eat a lot of fat, so I find it less significant for me, and forgot to mention it.

btw .. I'm no expert... but, as far as I’m aware….T2’s can be both insulin deficient and insulin resistant to different degrees. We're all different, and as I understand it ... we can have different problems which result in one or more bodily mechanisms breaking down, to a greater or lesser extent - which contributes to our becoming diabetic. But, we end up in the same place - in a Diabetic state.

IMO this may go some way to explain why we react in different ways to different foods, and why we have to test to find out our individual tolerances. We may not like the results....but at least we know..... Love oats - had to give it up :cry:

I believe that I reduced my insulin resistance significantly by losing weight, but I still have a defective 1st phase insulin response which means that I spike shortly after eating and it’s not until the second phase insulin kicks in some time later .. that my BG’s start to come down. I also have had hypothyroidism for many years, which may have contributed to my diabetes, and is a whole other set of problems :crazy:

As you know, there's something of the "dark arts" in both treating and managing this disease. However, individuals, on this forum and beyond, are showing that it can be done, if sufficient motivation can be found - and what better motivation can there be than the chance to restore yourself to better health?

Finally, given that increasing numbers of people are succumbing to Diabetes, I'm sure you would agree that more research is urgently needed into the myriad of mechanisms which cause it, and how to fix them.

Take care.

I agree i think type 2s can become insulin deficient if they have lost beta cells through exhaustion... Can't think of any other way a type 2 would become insulin deficient but the problem is the lack of knowledge in the UK medical profession. Other countries, particularly Scandinavian and American are a million miles ahead of the UK when it comes to diabetes and the amount of misdiagnoses that occur just on this forum alone is very telling! The NHS most definitely need a shake up when it comes to both diabetes care and knowledge...


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

I agree wholeheartedly with all you said. I think that the HCPs in this country are too quick to pigeonhole diabetics across the spectrum, to a handful of "types"... I'll bet they will find more "types" .... given time. Time and funding constraints deters anything more than cursory initial investigation. "Here's your label....... next!"

They likely think it makes it easier for them if we have a particular label. "Type 2? - take this and this" "Type 1.5 .. take that"
It's understandable - not enough is known about the causes of the disease, and with the limited knowledge at the present time, HCP's can only try to treat the outcome (diabetic state). But, there are too few effective safe drugs for treating any "type" at this time, and while they work fine for some, they don't work for all.

Treating the symptoms of the disease, rather than the individuals can be problematic. Many diabetics, like me, may have other conditions. It might work better if they took a holistic approach to individuals, rather than treating the individual diseases.

This happened to me... "Take this drug for that symptom" ... "oh! what do you mean there's contraindications for the other conditions you have?" ... "where did you get that from?" ... "Oh!... the leaflet that came with the prescribed drugs" ... oops! Scary! :shock:

So IMO, the more we can do to help ourselves and others the better.

Yorksman said:

The doctor is doing what most doctors do, write out prescriptions. My HBA1c was 83 or similar and he wanted to put me on metformin. I said no and that I would see if I could get it down with diet and exercise. I told him I wuld aim for 48, he laughed and said it would be a miracle if I was 54 or 54. 8 weeks later, I was 48.

Since then, I consider that I have got my blood sugars under much better control. I am most of the day in the 4s and 5s and feel bad about getting readings in the 6s. If I get a 7, I get depressed They won't give me another HBA1c but if I did have one, it ought to be a lot better than 48.

Lose more weight, eat fewer carbs or at least stick to complex carbs or low GI carbs and do more exercise and down you'll go. You've seen it for yourself. You've seen that it works. 50 is too high anyway. Aim to be below 40. In the words of the good professor from Newcastle:

"The extent of weight loss required to reverse type 2 diabetes is much greater than conventionally advised. A clear distinction must be made between weight loss that improves glucose control but leaves blood glucose levels abnormal and weight loss of sufficient degree to normalize pancreatic function."

Your GP is simply aiming at getting you to around 50. It's good, but not good enough. You can do better with a determined effort. Just keep at it, you're on the right track. It doesn't matter if it takes you another year. It's not a time trial.

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Hi, I am trying lo carb and have started running 3 times a week plus cycling too and more walking but I haven't had anything like the results you've had. I think i have to really eat much less and reduce carbs even more. I can see some ways I can improve but I don't think I can get such fast or dramatic result. How did you do it? Seeing the nurse tomorrow so let's,see what they say! I didn't start the tablets but do want to come lower than the 54 average I seem to be on. I'd definitely like to get to below 48, even if it's only just below.

Hello Bec, welcome to the forum.
You have replied to a rather elderly thread, so the people might no longer be on the forum, but I can assure you that it is possible, with luck, to get normal glucose and Hba1c even if fully type two diabetic.
It is a simple concept - type two diabetes is having a problem with carbohydrate, so only eat the amounts you can cope with from the foods you can cope with.
Type ones are usually advised to under treat with insulin, to try to avoid hypos, but hopefully with better understanding, improved delivery systems and sensing that can be pushed more towards normal levels.

Resurgam said:

Hello Bec, welcome to the forum.
You have replied to a rather elderly thread, so the people might no longer be on the forum, but I can assure you that it is possible, with luck, to get normal glucose and Hba1c even if fully type two diabetic.
It is a simple concept - type two diabetes is having a problem with carbohydrate, so only eat the amounts you can cope with from the foods you can cope with.
Type ones are usually advised to under treat with insulin, to try to avoid hypos, but hopefully with better understanding, improved delivery systems and sensing that can be pushed more towards normal levels.

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Thanks so much for your message Resurgam. You're an inspiration. I'm feeling the need for some encouragement. I'm generally doing really well; look much better; feel so much better; have lost a stone and am running in a way I never thought I could and I am even really enjoying my new diet (most days). But I have eating issues and have yet to find a way to stop myself from overeating whenever I'm stressed or bored. I guess I might need some additional help with that.

I am amazed by the way many of you have just dropped your levels so quickly. I want to do that too but don't seem to be able to do it and I think it's because of the quantity of what I eat. So how do you manage to count the carbs to get them down so low? Do you measure everything you eat? That just seems to be such a faff. I am using MyFitness Pal but I guess it is pretty rough. I am often under 100gms but rarely under 40gms.

I'm averaging around 128 {7.1} and really want to get down to the 5s. The more I test, the more I understand what I can tolerate but I think I need to get much more rigorous with it. But how do you fit that into life?! I'm giving myself time to focus on this, as it is so important but all the other stuff is being to clammer for my attention and I am missing being care free about going out. But I am determined. I saw my nurse two weeks ago and she said to try for another 3 months without Metformin as she could see the improvement in the past 3 months. But will Metformin speed it up. The nurse wasn't able to tell me if Metformin would bring my levels down lower than a diet and exercise could. I am really hoping I can get to at least 48 by then.

I seem to be really consistent in what I eat - if the receptionist at the surgery is to be believed my Hba1c is once again 42.
Basically I have the foods I do not need to count -fish meat etc. With them I have various low carb foods - bags of salad - they have the weight and the carb content on the packet, and I know the carb content of the mushrooms, courgettes, peppers etc. and I have several sets of kitchen scales around, so I can check the weight of what I take out of the fridge, what I cut up and what I put on my plate. They make it really easy to have about 10 gm of carbs in a morning and then around 25gm of carb as a main course, or a bit less and then have berries and cream.

Resurgam said:

I seem to be really consistent in what I eat - if the receptionist at the surgery is to be believed my Hba1c is once again 42.
Basically I have the foods I do not need to count -fish meat etc. With them I have various low carb foods - bags of salad - they have the weight and the carb content on the packet, and I know the carb content of the mushrooms, courgettes, peppers etc. and I have several sets of kitchen scales around, so I can check the weight of what I take out of the fridge, what I cut up and what I put on my plate. They make it really easy to have about 10 gm of carbs in a morning and then around 25gm of carb as a main course, or a bit less and then have berries and cream.

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Hi @Bec in Brighton

getting the numbers down especially the morning Fasting ones is a longish journey.
they are usually the last to begin lowering.

Mine were in the 9's for a month or so when i started and each month on they'd drop then plateau for a few weeks until they dropped again and repeated the plateau..so over oct -jan 2018/19 i went almost month by month form 9-8-7-6..then started hitting the 5's and even one occasion a 4....

now i normally run at the mid 5's or the low 6's each morning.

As @Resurgam , mentions, you need to perhaps measure a lot at the start, it's not the end of the world if you have 10 OR 11g
you just need to know visually what THAT particular amount looks like, so you don't overeat it...if that makes sense.

i do weigh foods, but nowhere near as much as i did, because i've got pretty good at knowing that any weight is :
a SMALL handful OR 'this much' of a bowl, etc
so life gets easier.

and eating out, i tend to try and relax about it, it's no fun for either of us if i'm obsessing about the food per se.
BUT i do try to make sensible choices.
cooked meat, light soups, starters NOT wrapped in a floury wrapping or batter, and a nice wine or ONE beer.

Anything covered in sauce COULD be carb bomb, so best avoided. imho.

Do test once able to, you might be pleasantly surprised at your reading..happy days OR not so happy, BUT you'll have learned what affects you, so can avoid next time.

I've tried to take this as a grand experiment into what i CAN eat..sometimes i get it wrong, but i don't stress about that, i acknowledge it and take it as a lesson on what i should avoid..

it all adds to the puzzle we all have to piece together of just what IT is
WE can eat, and not be too affected by the Carbs Conundrum that is Type 2.

Enjoy the journey.