My OH manages to keep his HBA1C around 5.9 but each time he has a fasting test it is high. He is not eating/drinking after 10pm at night - any suggestions?
HBA1C Normal but fasting bloods always elevated
- Thread starter slummymummy
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DiabeticGeek
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The HbA1c test gives you an indication of the average BG over roughly the previous three months. Since this is an average it covers all of the time - including night - so if you are getting results that differ from the values you monitor that means you are missing some highs or lows. An HbA1c of 5.9% means that the average BG is in the 7-8.3 mmol/l range (it is hard to calculate exactly). This is rather high (I know that medics often consider anything under 7% as acceptable, but non-diabetics will usually have an HbA1c of less than 5% and the closer you can get to that then the lesser the chances are of complications).
You didn't say what your OH's fasting BG actually is. If it is in the 7-8.3 mmol/l range then that is exactly what you would expect with this HbA1c. If it is much higher than that, then maybe you are seeing the so-called "dawn effect". Some people's BG rises during their sleep, if their liver goes into "starvation mode" and starts releasing stored energy as glucose. Often this can prevented quite successfully by eating a high protein snack shortly before going to bed.
You didn't say what your OH's fasting BG actually is. If it is in the 7-8.3 mmol/l range then that is exactly what you would expect with this HbA1c. If it is much higher than that, then maybe you are seeing the so-called "dawn effect". Some people's BG rises during their sleep, if their liver goes into "starvation mode" and starts releasing stored energy as glucose. Often this can prevented quite successfully by eating a high protein snack shortly before going to bed.
- 34
Thanks for your reply diabeticgeek! OH had appointment with the gp today - had a letter the other day requesting him to make an appointment with regard to his results which said BG was high but everything else was normal. During appointment today, his HBA1C was 6.0, fasting BG was 7.1 (previous HBA1C was 5.9, fasting BG was 7.1). He saw a different GP today who told him that he needs tablets to control the diabetes with this fasting result - he refused saying that with his HBA1c result shows he has good control and therefore he was not going to be taking tablets unless his results showed otherwise. We started to eat low gi since end of last August(he was diagnosed 1 year ago last June), prior to that we were just watching carbs etc. He was originally referred to a diabetes centre as the practice diabetic nurse was away on a detachment (he is in the armed forces). The centre was fantastic and at his appointment (6 weeks following diagnosis) his HBA1c was 6.3 - (on diagnosis 8.3), they said he did not need medication as they fully expected his next result to be within normal ranges, which it was (5.9) and has continued to be. His fasting results however, are the ones we have problems with. Last night we took your advice and he had 1oz of cheese before bed (his bloods at bedtime were 4.8) on waking this morning they were 5.8. Feel really frustrated as his medical centre are obsessed with wanting him to take meds! Any further ideas? Are we being unreasonable saying no to meds? If we can get his fasting levels down then that will bring his overall HBA1C down as well. We thought we were doing really well but they obviously don't think so. If he has to go on meds, he will be out of his job! What size protein snack should he be having before bed? Gave him 1oz cheese last night but still his bloods increased from 4.8 to 5.8!!! Aaaarrgggghhhh!
DiabeticGeek
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- 309
In my view too many people (and I include both medics and patients here) tend to view drugs treatment of Type 2 diabetes as a first resort rather than a last. Now, for some people there is no option - especially if the pancreas is too badly damaged before the diabetes is diagnosed. However, many people can control it very effectively by diet and exercise alone - especially if it is diagnosed early enough. An HbA1c of around about 6% isn't bad, but there is evidence to suggest that, in the long term, you really should be aiming for something closer to 5% (which is roughly that of a non-diabetic) to minimize or eliminate the risks associated with diabetes.slummymummy said:Feel really frustrated as his medical centre are obsessed with wanting him to take meds! Any further ideas? Are we being unreasonable saying no to meds? If we can get his fasting levels down then that will bring his overall HBA1C down as well.
There are several things that your OH can do to try to bring down the HbA1c without resorting to medication. First of he could try increasing his exercise. The recommendation is generally at least 45 minutes of moderately strenuous exercise per day, but if he is already doing this then it would make sense to do more. Secondly, if the GI diet is working for him then that is great, but if he wants to lower his BG further then it is worth trying to cut back on carbohydrates. You might like to try reading Dr. Bernstein's Diabetes Solution, that is the low carbers bible and is a very readable book full of helpful advice. If he does all of this and the HbA1c still doesn't come down (or if it starts creeping back up again) then I am afraid it is going to be time for medication.
- 34
Many thanks for your response. We will purchase the book and read with anticipation!!!!! He has been 'persuaded' into taking 10mg of Lisinopril per day for BP - which is actually within normal ranges; however as he is 'diabetic he should be taking it' - the med centre where he is stationed are very 'pro' medication and he thinks I am just being very 'anti' when I am telling him that they are not used to dealing with chronic conditions with a predominantley 'young and fit' patient list and therefore they see a protocol and just think that everyone should just be put into that slot, end of story!!!! (I am a NHS trained allied health professional and their line of thinking drives me insane). Unfortunately, he has no choice but to remain under the 'care' of the armed forces medical centre rather than that of a civvi dr.
We have now started to cut back on the carbs as well as low gi and he has for the last two nights had a protein snack before bed to try and counteract the increase in overnight BG. Exercise will also be increased further as per your suggestions.
I am at my wits end with the armed forces medical practitioners who seem to be just desperate to make you take medication for no good reason, other than they have seen a protocol (which doesn't lump everyone into the same category as we are all different!!!)
Sorry for the rant, OH thinks that I am overreacting and gets very tetchy with me and the way I respond to the cavalier way in which the med centre is almost trigger happy with their prescribing without actually considering the necessity.
We have now started to cut back on the carbs as well as low gi and he has for the last two nights had a protein snack before bed to try and counteract the increase in overnight BG. Exercise will also be increased further as per your suggestions.
I am at my wits end with the armed forces medical practitioners who seem to be just desperate to make you take medication for no good reason, other than they have seen a protocol (which doesn't lump everyone into the same category as we are all different!!!)
Sorry for the rant, OH thinks that I am overreacting and gets very tetchy with me and the way I respond to the cavalier way in which the med centre is almost trigger happy with their prescribing without actually considering the necessity.
Buachaille
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When I was first diagnosed I was surprised that no medication was mentioned and I was told I would be referred to a Consultant. I asked why and was told that the Practice has strong view that treatment of diabetes is something which should involve specialist input at the outset. The only problem I had was the queue for the Consultant's time.
The Consultant I saw 3 months after being diagnosed was more than pleased that an initial Hba1c had dropped from 14.4 to around 7 by strict a self imposed strict diet regime and increased exercise which took my daily visits to the gym from 3 days a week to 7 plus 6-8 miles a day walking dogs. She said that a few years ago she would have only recommended that I continue with the revised diet regime and exercise. However, she mentioned also that there was now sufficient evidence available to show that early intervention with oral medication had longer term benefits in reducing the risks of stroke, heart disease and other problems associated with diabetes; hence I was prescribed 2*500 Metformin and, because I am over 60, the seemingly mandatory Ace inhibitor, Statin and soluble aspirin.
I have no difficulty with the Meformin side-effects and only occasionally have a problem if I eat certain types of fruits as the combination appear to cause some nasty noxious gases and rather loose bowels. I would prefer to avoid the other medications but I feel it would not be sensible to ignore the Consultant's advice.
Given that the Consultatnt does not want to see me again - unless something goes dramatically wrong with my quarterly Hba1c -I am happy to continue with the low carb + Metformin regime for the diabetes. My GP thought she might take me off Metformin when I reached the current Hba1c until I pointed out the views expressed by the Consultant.
Perhaps I am fortunate that the Practice do not prescribe anything until each newly diagnosed diabetic has been seen by the Consultant.
The Consultant I saw 3 months after being diagnosed was more than pleased that an initial Hba1c had dropped from 14.4 to around 7 by strict a self imposed strict diet regime and increased exercise which took my daily visits to the gym from 3 days a week to 7 plus 6-8 miles a day walking dogs. She said that a few years ago she would have only recommended that I continue with the revised diet regime and exercise. However, she mentioned also that there was now sufficient evidence available to show that early intervention with oral medication had longer term benefits in reducing the risks of stroke, heart disease and other problems associated with diabetes; hence I was prescribed 2*500 Metformin and, because I am over 60, the seemingly mandatory Ace inhibitor, Statin and soluble aspirin.
I have no difficulty with the Meformin side-effects and only occasionally have a problem if I eat certain types of fruits as the combination appear to cause some nasty noxious gases and rather loose bowels. I would prefer to avoid the other medications but I feel it would not be sensible to ignore the Consultant's advice.
Given that the Consultatnt does not want to see me again - unless something goes dramatically wrong with my quarterly Hba1c -I am happy to continue with the low carb + Metformin regime for the diabetes. My GP thought she might take me off Metformin when I reached the current Hba1c until I pointed out the views expressed by the Consultant.
Perhaps I am fortunate that the Practice do not prescribe anything until each newly diagnosed diabetic has been seen by the Consultant.
- 34
Thank you for your reply. On reading your post I note that although you made a massive improvement with your BG levels in the 3 months prior to seeing the consultant, they were still at 7.0; we were told that anything under 6.2 can be described as 'normal' and with your increase in physical activity and indeed your age group, it would be unlikely that you could sustain these levels of physical exercise indefinately and I therefore see the rationalle behind your consultant's decision to opt for medication.
My OH has what is regarded as a 'normal' HBA1c and it is only his fasting levels that we seem to have real difficulty with (other than the gp service attached to his work). He is only 40 and is a very physically fit individual (apart from the diabetes diagnosis), infact we were both completely stunned when he was given the diagnosis!
We wish to avoid meds for as long as possible (without it being detrimental to his health) and indeed the diabetes centre he was referred to were 100% behind us with his results etc and wrote to the med centre fairly explicitly telling them that no medication was required. We are fully acceptant that one day (when the physical exercise etc is not possible) that he will require meds, but in the meantime, I wish they were supportive rather than seemingly desperate to prescribe just because you have a condition regardless of whether it is controlled or not.
My OH has what is regarded as a 'normal' HBA1c and it is only his fasting levels that we seem to have real difficulty with (other than the gp service attached to his work). He is only 40 and is a very physically fit individual (apart from the diabetes diagnosis), infact we were both completely stunned when he was given the diagnosis!
We wish to avoid meds for as long as possible (without it being detrimental to his health) and indeed the diabetes centre he was referred to were 100% behind us with his results etc and wrote to the med centre fairly explicitly telling them that no medication was required. We are fully acceptant that one day (when the physical exercise etc is not possible) that he will require meds, but in the meantime, I wish they were supportive rather than seemingly desperate to prescribe just because you have a condition regardless of whether it is controlled or not.
DiabeticGeek
Well-Known Member
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Some medics regard this as quite good control (although that is debatable), but an HbA1c of 6.2% is not "normal" in the non-diabetic sense. Most non-diabetics have an HbA1c of around about 5%, and someone with an HbA1c of 6.2% is likely to have an average blood glucose level in the 7.6 - 9 mmol/l range. That is quite high, and there is evidence to suggest that to minimize risks of long-term complications you really should aim to be getting it as close as possible to that non-diabetic 5%. Many medics seem to view this as "unrealistic", but if you look around these forums you will see that plenty of diabetics do get it down to that sort of level - some with the aid of drugs, some without.slummymummy said:we were told that anything under 6.2 can be described as 'normal'
An excellent aspiration, and it may well be possible. It is certainly worth trying, although if it doesn't come down (or stay down) then you shouldn't be too resistant to the possibility of drugs. They aren't just for people who are incapable of exercising - it all depends upon the state of your pancreas. Also, do be aware that many doctors view of a "safe" level is quite high, and you are probably better off on drugs with an HbA1c of 5.2% than you would be with a diet controlled HbA1c of 6.2%.slummymummy said:We wish to avoid meds for as long as possible (without it being detrimental to his health) and indeed the diabetes centre he was referred to were 100% behind us with his results etc and wrote to the med centre fairly explicitly telling them that no medication was required.
Buachaille
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If age has anything to do with it I still do 1 hour a day in the gym followed by 30 mins steam/sauna. The 7 dogs still get their 6 - 8 miles and I cover 2 miles in around 25 mins. Fourteen months since diagnosis and 63 years old.
The Consultant was quite clear that early oral medication had evidence led benefits - I don't think age and ability to keep to a diet/exercise regime had anything to do with it.
The Consultant was quite clear that early oral medication had evidence led benefits - I don't think age and ability to keep to a diet/exercise regime had anything to do with it.
- 34
Thank you for the replies. I was not in anyway meaning to belittle the exercise you follow each day; merely replying with the information we had been given at the diabetes centre - in that, it would be likely that my OH would eventually need medication later on in life as it would be unlikely that he would be able to continue with the exercise levels he currently does and as such this would result in BG levels increasing.
As I have said in earlier posts, he is in the armed forces and the future of his job will be questionable unless we control the diabetes successfully without medication; hence the need and indeed desire to control without medication if possible.
We are in the unfortunate position of the armed forces being exempt from the disavbility discrimination act as far as diabetes is concerned. We have a young family and my OH is the main breadwinner.
As I have said in earlier posts, he is in the armed forces and the future of his job will be questionable unless we control the diabetes successfully without medication; hence the need and indeed desire to control without medication if possible.
We are in the unfortunate position of the armed forces being exempt from the disavbility discrimination act as far as diabetes is concerned. We have a young family and my OH is the main breadwinner.
Being a diabetic using medication as part of the control does not appear to prevent serving members continuing in post - unless there are other complications. See Parliamentary Question below.
"Hansard
27 Nov 2006 : Column 357W
Diabetes
Mr. Harper: To ask the Secretary of State for Defence what duties personnel diagnosed with (a) type 1 and (b) type 2 diabetes may undertake in each of the forces and their reserves. [101364]
Derek Twigg: Candidates having either type 1 or type 2 diabetes are considered unfit for entry into the armed forces. For those already serving in the armed forces, the first priority if diagnosed with either type of diabetes is always the full assessment, treatment and stabilization of their condition. All personnel suffering either type of diabetes mellitus should be referred to a Medical Board when a decision on their medical category(1) will be made. Each case is considered on its merits.
Thereafter a decision is made on the continued employability of the person. Factors taken into account are:
The illness—its severity, its stability, the required treatment
The individual—their wishes, their motivation and commitment
Their service history—experience, trade, specialization
Their utility in a Service environment (once other factors have been considered)
Guidance on the appropriate medical category for personnel with diabetes mellitus is contained in the Joint Service Publication JSP 346. This states that:
“Clear differentiation should be made between those personnel suffering from insulin dependent (Type I) or non-insulin dependent (Type II) diabetes mellitus, and the respective risk levels with military service. For this reason all cases should be graded P31 or P71 when first diagnosed while their disorder is assessed. Following assessment, they are graded as follows:
a. Non-insulin dependent diabetes mellitus (NIDDM). Those suffering from NIDDM (i.e. asymptomatic glycosuria), controlled by diet or biguanide hypoglycaemic medication, with no other signs or risk factors present (e.g. a personal/family history of heart disease, stroke, other endocrine dysfunction, smoker, obesity, hyperlipidaemia, eye or renal disease etc.), and whose functional capacity is otherwise unaffected, may be graded P2(1)."
"Hansard
27 Nov 2006 : Column 357W
Diabetes
Mr. Harper: To ask the Secretary of State for Defence what duties personnel diagnosed with (a) type 1 and (b) type 2 diabetes may undertake in each of the forces and their reserves. [101364]
Derek Twigg: Candidates having either type 1 or type 2 diabetes are considered unfit for entry into the armed forces. For those already serving in the armed forces, the first priority if diagnosed with either type of diabetes is always the full assessment, treatment and stabilization of their condition. All personnel suffering either type of diabetes mellitus should be referred to a Medical Board when a decision on their medical category(1) will be made. Each case is considered on its merits.
Thereafter a decision is made on the continued employability of the person. Factors taken into account are:
The illness—its severity, its stability, the required treatment
The individual—their wishes, their motivation and commitment
Their service history—experience, trade, specialization
Their utility in a Service environment (once other factors have been considered)
Guidance on the appropriate medical category for personnel with diabetes mellitus is contained in the Joint Service Publication JSP 346. This states that:
“Clear differentiation should be made between those personnel suffering from insulin dependent (Type I) or non-insulin dependent (Type II) diabetes mellitus, and the respective risk levels with military service. For this reason all cases should be graded P31 or P71 when first diagnosed while their disorder is assessed. Following assessment, they are graded as follows:
a. Non-insulin dependent diabetes mellitus (NIDDM). Those suffering from NIDDM (i.e. asymptomatic glycosuria), controlled by diet or biguanide hypoglycaemic medication, with no other signs or risk factors present (e.g. a personal/family history of heart disease, stroke, other endocrine dysfunction, smoker, obesity, hyperlipidaemia, eye or renal disease etc.), and whose functional capacity is otherwise unaffected, may be graded P2(1)."
hanadr
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Dear buachaille
How long does it take you to do 7 - 8 miles with the dogs? Do you have really good places to take them? Mine are lucky to get more than a couple of miles. I live in an urban area, but do go on health walks. I go with a friend and we manage 2 of my dogs between us. They have to be on-leash when they accompany the health walk group. I do let them run if it's safe and clear, i e no cattle or traffic and a path wide enough so they don't run under people's feet
How long does it take you to do 7 - 8 miles with the dogs? Do you have really good places to take them? Mine are lucky to get more than a couple of miles. I live in an urban area, but do go on health walks. I go with a friend and we manage 2 of my dogs between us. They have to be on-leash when they accompany the health walk group. I do let them run if it's safe and clear, i e no cattle or traffic and a path wide enough so they don't run under people's feet
- 34
Thank you for your reply Jenny - but in reality it is not as simple as the post you posted 11/08/08; as we have found. I too came across this paper around 11 months ago.
I don't understand your last post (12/8/08 @ 11.55pm)
I don't understand your last post (12/8/08 @ 11.55pm)
Jenny said:vvvvv
Buachaille
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Dogs get walked - but not as a pack.
Currently 7, two older ladies 15 and 13 left us for boot-hill beyond the pond in the last 12 months.
Three youngest (2,2 and 5 months) get a quick 2 mile stride into town, we live in the countryside, and a similarly 2 mile stride back home - never more than an hour but a 50 minute target time. All, including me, are normally hot and sweaty. This is a road walk. Two middle aged dogs, 5 and 7) get the same treatment. On occasion they get walked 2.5 miles to the gym and the better half comes to collect them. I do the gym/sauna/steamroom bit then the pair are delivered and we do the sprint home.
Two oldest ladies get driven to the beach, about a mile from the house. Tide in or out there is a mile or so of sand. They get to run free while I generally stroll. Once knackered, back to car and home. The second eldest does like to swim and has on occasion been seen heading towards Norway.
We also have a country park about 6 miles away and an alternative is to take some dogs for a trog through the woods. Never more than 3 and never all off the lead at one time - the pack instinct takes over and if rabbits, hares, deer rise from cover you have no dogs for a long time. Also what might appear as hunting to some can bring the long arm of the law into the eqation.
I never walk dogs in company. Its so much easier to control the pace and the beasts. I also make the first walk early in the day, before 07:00 hrs, and we rarely meet other dogs. If you have 2 strong dogs, tie the leashes together at the hand loops and let them take the greater part of the strain against each other.
For the next 3 weeks we have a Pomeranian and a Maltese. They only get the treat of the beach with the old ladies. Occasionally we have a water loving Cocker, 2 King Edwards, a few Westies and the beast of all beasts - a Labradoodle. They too get the beach only job, unless I fancy a pint when the Cocker can make a beeline for the Pub - 2 miles. The Labradoodle never gets of the lead and there are occasions when lead boots for that beast would be useful.
Thank goodness the cats do not need to be exercise. Nor do the 60 or so racing pigeons. We intend to get some chickens soon.
Madness, but it helps.
Currently 7, two older ladies 15 and 13 left us for boot-hill beyond the pond in the last 12 months.
Three youngest (2,2 and 5 months) get a quick 2 mile stride into town, we live in the countryside, and a similarly 2 mile stride back home - never more than an hour but a 50 minute target time. All, including me, are normally hot and sweaty. This is a road walk. Two middle aged dogs, 5 and 7) get the same treatment. On occasion they get walked 2.5 miles to the gym and the better half comes to collect them. I do the gym/sauna/steamroom bit then the pair are delivered and we do the sprint home.
Two oldest ladies get driven to the beach, about a mile from the house. Tide in or out there is a mile or so of sand. They get to run free while I generally stroll. Once knackered, back to car and home. The second eldest does like to swim and has on occasion been seen heading towards Norway.
We also have a country park about 6 miles away and an alternative is to take some dogs for a trog through the woods. Never more than 3 and never all off the lead at one time - the pack instinct takes over and if rabbits, hares, deer rise from cover you have no dogs for a long time. Also what might appear as hunting to some can bring the long arm of the law into the eqation.
I never walk dogs in company. Its so much easier to control the pace and the beasts. I also make the first walk early in the day, before 07:00 hrs, and we rarely meet other dogs. If you have 2 strong dogs, tie the leashes together at the hand loops and let them take the greater part of the strain against each other.
For the next 3 weeks we have a Pomeranian and a Maltese. They only get the treat of the beach with the old ladies. Occasionally we have a water loving Cocker, 2 King Edwards, a few Westies and the beast of all beasts - a Labradoodle. They too get the beach only job, unless I fancy a pint when the Cocker can make a beeline for the Pub - 2 miles. The Labradoodle never gets of the lead and there are occasions when lead boots for that beast would be useful.
Thank goodness the cats do not need to be exercise. Nor do the 60 or so racing pigeons. We intend to get some chickens soon.
Madness, but it helps.
If the Armed Forces are saying something different from what the Minster said in his answer to a PQ I would be more than tempted to write to Mr Ingram at the MOD, or better still his constituency office and ask him to clarify the position.
vvvvv?
God knows where that came from.
vvvvv?
God knows where that came from.
