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Hba1c or blood glucose?

A

allen-uk

Member
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I know it's not an either/or, but I'm confused reading some posts on the forum where a person's Hba1c is almost discounted in favour of blood glucose readings.

My diabetic nurse (actually a Nurse Practitioner, and a very sensible woman) always tells me that my Hba1c results which hover around the mid-50s are in the 'good' control range, and although she might like better, she's happy with that. My occasional high blood glucose readings (sometimes creeping up into the low teens) she can't explain, at least not in terms of the 'good' 3-monthly reading.

So is my diabetes in good control (Hba1c), or am I in imminent danger of collapse (blood glucose readings)?

Advice welcomed.

A
 
Mid 50's is quite good since you are considered diabetic at 48 and you are not much more than that. Your figures remind me of me when I fall off the wagon a tad. My eating habits are good and on their own would result in quite low blood glucose readings. My drinking habits are not good and result in quite high spikes which might take a couple of days to settle down again. For me, alcohol seems to raise the base line of my sugar graph and good behaviour is needed to slowly restore normality.

I am not suggesting that you drink since fructose can produce a similar effect so do you binge on sugar, fruit, fizzy drinks or alcohol at all?
 
Personally I am unhappy with any BG reading above 7.5 and unhappy with any HbA1c above 47, but we all have differing views on what is good control, and you don't say what type you are, or what meds you are on.

An HbA1c of 55 is equivalent to an average BG of 8.9mmol/l
 
I like to keep my Hb result in the 30's but I think everybody should have their own personal goal and if you are quite happy then 50 is fine, you're not in any danger at that level. I hardly ever test by BS during the day anymore unless I want to test the effects of a new food item. The results of my Hb test are more my priority.
 
For myself I consider my glucose levels more important as I can tell if I'm getting high and low readings or the fairly stable ones which I want and (obviously!) prefer. If I have high levels I need to take action to reduce these. My HbA1c tells me only what my average glucose levels have been over the previous six months, and as similar averages may be obtained from either stable or unstable levels (high/low spikes), they don't necessarily tell me very much. If my HbA1c is higher than is good for me I've also lost up to six months worth of time in which I could have been doing something to improve matters - but using the data from my meter and the Bayer software I use tells me in "real time" how I'm doing.

I've also used our Diabetes.co.uk HbA1c/average glucose converter tool and the predictions I get using my meter's 3 month averages have been very close to my actual HbA1c the last 3 times, but my meter has given me much more useful information.

Robbity
 
I was going high and low with R.H. I got my Hba1c down to 45 but I was still peaking high on carbs and afterwards low and even lower on exercise.

I cut down carbs on lchf and my Hba1c was still 45 but it has now dropped to 44 after being on it four months. But lchf has cut out the highs and lows and Hba1c did not record this.
regards
Derek
 
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Hi and welcome!
The HbA1c test gives an approximate average of your bg readings for the last 2-3 months. It is approx because other factors affect the result. ( health conditions, some genetic factors and the the result is weighted towards recent weeks).

A home meter bg test varies every few minutes, depending on food, state of digesting food, exercise, time of day... It rises with food and should drop down again afterwards.

Your nurse should have been able to explain that to you!

She should also have explained that with an HbA1c in the mid 50s your bg is running higher than is good for you, and is likely, over time, to lead to the development of diabetic complications.

Sorry.

NHS guidelines say that ideal bg should be under 8.5 for type 2 diabetics after they have eaten. Type 1s should be under 9 mmol/l after meals.
Your average reading is up there.

Have a look at the link to bloodsugar101 in my signature. It takes you to a site (aimed mainly at T2 diabetics) explaining most of the things you need to know about bg control. :)

For people in your circumstances, there are options (diet, exercise, medication) to lower blood glucose to reduce the risk of complications and improve the quality of life. Most people feel better if their blood glucose is at near-normal levels.
 
allen-uk said:
So is my diabetes in good control (Hba1c), or am I in imminent danger of collapse (blood glucose readings)?
Click to expand...

Neither, but having your BG's running in double figures for any length of time is not good for you longer term, so identifying exactly what is causing those spikes is vitally important.

When you can eliminate what causes those, you are further along the path to gaining control.
 
Thanks for your replies, and thanks for the many helpful comments.

But intellectually (and scientifically) I am still puzzled.

Comments such as
"we all have differing views on what is good control"
and
"I think everybody should have their own personal goal and if you are quite happy then 50 is fine"
and
"Your nurse ... should also have explained that with an HbA1c in the mid 50s your bg is running higher than is good for you"
are difficult to take in.

A couple of years ago, for example, a correspondent on your forum posted an Hba1c chart from a Health Trust (Basildon & Thurrock, as it happens):

http://www.diabetes.co.uk/forum/threads/hba1c-conversion-table.51014/

and I have seen other similar charts from other similarly auspicious institutions.

According to the chart, there is 'Excellent' control, and there is 'Good' control, then there is 'Less than ideal', followed by 'Poor' and 'Very Poor'.

I have spent decades (too many possibly) believing that while excellence was better than merely 'good', 'good' was certainly not a synonym for 'bad', or for 'ok-but-don't-get-too-complacent-pal', etc.

My point, simply put: are these charts WRONG in describing an Hba1c reading of 50 to 55 as 'good'?

You see, what I fear is that there seems to be a pursuit of numbers going on here. It's as if while health professionals were saying 'Your weight at 12 stone is good', some patients are responding 'Maybe so, but I'm going to aim for TEN stone. Good isn't good enough for me. I want excellence!'

Isn't all this about compromise? About life being for living? And no, I'm not advocating an 'Eat, drink and be merry, for tomorrow we die' philosophy. Just one of enjoyment, but sensibly so. (And no again, I don't drink - gave it up 13 years ago!)

I wish all here good health, and as long a life as they want.

A.
PS T2, insulin, occasional gliclazide)
 
I believe you will find that most people here will prefer to see BG levels that are as flat or gently curved than an "excellent" HbA1c. Whether this level is in the 4's and 5's, 5's and 6's, 6's and 7's or 7's and 8's is personal choice, but the variance should be as narrow as possible and the NICE top level recommendations say under 8.5 at least 90 minutes after food for type 2's. http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

It is the avoidance of future diabetic complications that is important, and it is constant high spikes that can cause them. An HbA1c is a sort of average, so if you have a lot of lows and a lot of highs, the average will be somewhere in the middle and may appear to show good control, but the spikes are still there and still potentially causing damage. Also, a spike is irreversible and not "made better" by a subsequent low. The HbA1c will not catch these damaging spikes.
 
allen-uk said:
I have spent decades (too many possibly) believing that while excellence was better than merely 'good', 'good' was certainly not a synonym for 'bad', or for 'ok-but-don't-get-too-complacent-pal', etc.

My point, simply put: are these charts WRONG in describing an Hba1c reading of 50 to 55 as 'good'?

.
Click to expand...

I believe that there has been a recent meta study that demonstrated that an HbA1c of 50 is still carrying a significant risk of long term damage that can lead to 'diabetic complications'. It can be identified as being GOOD because it is better than the new lower target (56) for T2D as set by the latest NICE guidelines. I myself am currently running at 53 so I gave myself a pat on the back, and rang my DCN with the news, and posted on the appropriate subthread here on the Forum. But I want to get it lower, and I would put my current acheivement into the 'ok-but-don't-get-too-complacent-pal' category simply because I recognise that I am still at risk.

But, and this is a big but, my HbA1c does not give the full story. I have to use plasma testing to check my swings. If they are large, then I am still pumping unwanted glucose into my fat cells, so for me plasma testing is more important than HbA1c since I can use my own calculated averages to estimate my HbA1c.

I use my HbA1c to check the accuracy of my meter, which is currently reading 1 mmol/L low. The Doctor uses HbA1c as a generalised indicator because it does not rely on the patient self monitoring, and so applies across the board. It does NOT show if you as a individual are in control of your bgl which could be swinging wildly but averaging low.
 
HbA1C is like the overflow on the bath, or more like an overflow tank that catches the ovespill. imagine sitting in the bath and making waves that sends water through the overflow. small waves only send a little water through, and the HbA1c tank will fill slowly. Large waves will pump proportionately more into the tank. Overfilling the bath by high carbing will very quickly fill the tank.

We cannot empty this tank, but it leaks gradually over a 3 month period. Our baths keep topping it up, so the more waves we make, or the bigger the waves, the higher the level in the tank (our HBA1c reading) If we can reduce our wave making activities then our HbA1c levels drop. Our home meter measures how big the waves are, so gives us an idea of how we are filling the overflow tank. This gives us a tool we can use to prevent big waves. Its as simple as that.
 
Bluetit1802 said:
I believe you will find that most people here will prefer to see BG levels that are as flat or gently curved than an "excellent" HbA1c. Whether this level is in the 4's and 5's, 5's and 6's, 6's and 7's or 7's and 8's is personal choice, but the variance should be as narrow as possible and the NICE top level recommendations say under 8.5 at least 90 minutes after food for type 2's. http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

It is the avoidance of future diabetic complications that is important, and it is constant high spikes that can cause them. An HbA1c is a sort of average, so if you have a lot of lows and a lot of highs, the average will be somewhere in the middle and may appear to show good control, but the spikes are still there and still potentially causing damage. Also, a spike is irreversible and not "made better" by a subsequent low. The HbA1c will not catch these damaging spikes.
Click to expand...
I'm only asking out of curiosity but is there any evidence that short spikes in blood sugar levels lead to more complications than stable levels in otherwise identical hba1c scores. It seems logical but I've never heard it from any GP, and never having a reading over 9 mmol seems almost impossible on the diet recommended by NHS.

I followed the nhs rollercoaster diet for the last 12 years with excellent hba1c scores but lots of highs and lows. I'm 2 weeks into lchf diet (moderately low carbs) and can't believe how much better my life is
 
Griffter15 said:
I'm only asking out of curiosity but is there any evidence that short spikes in blood sugar levels lead to more complications than stable levels in otherwise identical hba1c scores.
Click to expand...

In scientific analysis we use a term 'area under the curve'. if you imagine a graph of a spike drawn on squared paper, then the AUC is basically counting the number of squares covered by the spike. Thus a tall but thin spike could have the same number as a shallow bump.

In general sharp spikes tend to have less effect than a prolonged bump. in boxing a short jab might hurt, but doesnt have the same effect as the knockout blow which has follow through.

In my way of thinking, I am more concerned about the 4 hr Post prandial result than the 2hr PP that drops quickly. by the 4 hr PP.
 
As i said above, have a look at the bloodsugar101 website link in my sig.
It provides you with information to answer all your questions.

My own view, from reading the books listed in my sig, the 101 website, and reading the various articles and links posted on this forum over the last 3 years, is that the guidelines on diet and blood glucose control suggested by the NHS are bunkum.

The NHS believes that T2 is a progressive disease, with an escalation of medication, over time, and progressive damage, leading to neuropathy, blindness, kidney failure and decline.

The reality is that all of these degenerations are the result of living with high blood glucose.
Avoid the high blood glucose, avoid the degenerative diabetic complications.

T2s in the UK who eat the NHS recommended diet of starchy carbs and rely on vague 'your blood test is fine, have some tablets' tend to follow the tried and tested path to injecting insulin and diabetic complications. This makes it a self fulfilling prophesy for NHS staff, and their poor uninformed patients.

On the other hand, if you read widely, look at reduced carb diets, monitor blood glucose and avoid foods that do not raise blood glucose high, then those diabetic complications don't emerge.

Read the forum. You will find many success stories of T2s who have reduced their carbs, who eat to their meter, who have reduced their medications and who are feeling better than they have for years. Sometimes their neuropathy improves too. But the key thing to notice is that this is happening when their blood glucose is significantly lower than the levels you have been told by your nurse is 'good'.
 
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