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HbA1c question

P

pinewood

Well-Known Member
Messages
792
Location
London
Type of diabetes
Type 1
Treatment type
Insulin
So everyone with T1 knows that key to reducing the risk of health complications is to keep your HbA1c down to a well controlled level.

My question is this: on that basis, does it matter HOW you get to that HbA1c?

For example, (theoretically) let's say:
  • Person 1 has a blood glucose of 5 mmol/L constantly for 3 months. Their HbA1c would be around 4.7%.
  • Person 2 has a blood glucose of 2 mmol/L for 50% of the time and 8 mmol/L for 50% of the time over the 3 month period. Their HbA1c would also come out at 4.7%.

Is it clinically proven that both people have the same risk of complications as their HbA1c is the same?

My question is basically asking about the impact of fluctuations. Are high numbers counteracted by low numbers not a problem if your HbA1c comes out good? Do any studies prove that it's the average that's important rather than the day-to-day/hour-to-hour swings in numbers?
 
pinewood said:
So everyone with T1 knows that key to reducing the risk of health complications is to keep your HbA1c down to a well controlled level.

My question is this: on that basis, does it matter HOW you get to that HbA1c?

For example, (theoretically) let's say:
  • Person 1 has a blood glucose of 5 mmol/L constantly for 3 months. Their HbA1c would be around 4.7%.
  • Person 2 has a blood glucose of 2 mmol/L for 50% of the time and 8 mmol/L for 50% of the time over the 3 month period. Their HbA1c would also come out at 4.7%.

Is it clinically proven that both people have the same risk of complications as their HbA1c is the same?

My question is basically asking about the impact of fluctuations. Are high numbers counteracted by low numbers not a problem if your HbA1c comes out good? Do any studies prove that it's the average that's important rather than the day-to-day/hour-to-hour swings in numbers?
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Precisely. I don't recall what or where I read, but my IMPRESSION is that person number 2 would be much worse off than person no 1.. Spikes and swings are bad.
 
LucySW said:
Precisely. I don't recall what or where I read, but my IMPRESSION is that person number 2 would be much worse off than person no 1.. Spikes and swings are bad.
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Yes. Obviously it's best to keep it low and not have the swings in the first place but I guess this also begs the question as to whether having a slightly higher HbA1c but fewer fluctuations is better than keeping it lower at the cost of such swings. Diabetes is certainly confusing.
 
pinewood said:
Yes. Obviously it's best to keep it low and not have the swings in the first place but I guess this also begs the question as to whether having a slightly higher HbA1c but fewer fluctuations is better than keeping it lower at the cost of such swings. Diabetes is certainly confusing.
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I have no idea about that. Perhaps @phoenix, who is very well informed, might know.
 
pinewood said:
So everyone with T1 knows that key to reducing the risk of health complications is to keep your HbA1c down to a well controlled level.

My question is this: on that basis, does it matter HOW you get to that HbA1c?

For example, (theoretically) let's say:
  • Person 1 has a blood glucose of 5 mmol/L constantly for 3 months. Their HbA1c would be around 4.7%.
  • Person 2 has a blood glucose of 2 mmol/L for 50% of the time and 8 mmol/L for 50% of the time over the 3 month period. Their HbA1c would also come out at 4.7%.

Is it clinically proven that both people have the same risk of complications as their HbA1c is the same?

My question is basically asking about the impact of fluctuations. Are high numbers counteracted by low numbers not a problem if your HbA1c comes out good? Do any studies prove that it's the average that's important rather than the day-to-day/hour-to-hour swings in numbers?
Click to expand...
High fluctuations are not good, anything more than 3=4 of a rise is damaging.
 
I believe from my own experiences that it is the fluctuations that make the differences... Intry to keep my average SD to less than 2.8 over 90 days. I can't do anything about pump failures when they occur when my levels shoot to excesses but I can at all other times...
 
18 months ago my HBA1C was 5.8. Not bad for a type 1 diabetic, right? Wrong. Very, very wrong. My control was appalling. My 13s and 14s and 20s were offset by my 1.8s. My wife was being forced through the wringer, calling the paramedics or having to force sugar into me.

The HBA1C is one tool to monitor diabetes, but it is not the only important thing to consider. It took me a very long time to realise this. Author and long time diabetic Jenny Ruhl aims for what she calls 'The 5% club.' This means having an HBA1C under 6. However, there are other rules to adhere to in order to truly be in 'the club.' These include not seeing bloodsugars above 7.8, and not having frequent hypos.

Unfortunately, even those described as 'prediabetic' can see early signs of diabetic complicatjons such as neuropathy and retinopathy. This suggests that regularly going above 7.8 is enough to start on the rocky road that so many of us end up travelling. It is my belief that the only way to truly stay healthy as a diabetic is to avoid high blood sugars whenever humanly possible. I do this by eating a low carbohydrate diet. It sounds extreme, but my control has been much better since I started doing this just over a year ago. Before dismissing it, go to youtube and Google Dr Troy Stapleton. He is a doctor in Australia, and also a type 1 diabetic. He manages his condition with a low carbohydrate diet. He also puts forth the argument for doing this in a very straightforward way. Jenny Ruhl's book 'diabetes 101' is also well worth a read. And if you want the absolute authority on diabetes, get hold of Dr Richard Bernstein's complete diabetes solution. Dr bernstein is in his 80s, and has been eating low carbohydrate foods to manage his diabetes for over 40 years. He is in excellent health and is probably the most important doctor I have ever come across (via his book). However, his book is extremely in depth, and very, very hardcore. It's clear that he was an engineer before he was a doctor, as he writes in a very detached and scientific way.

The main thing is to test your blood sugars regularly, and eat to your meter. A good HBA1C is a start, and by keeping informed and making an effort, you can remain a healthy and active person. Best of luck, and keep posting on your progress.
 
This is what frustrates me about my DSN. My HbA1c results aren't a true representation of my glucose levels. I give them records of me fluctuating between 3 mmol/L and 24 mmol/L... This is with 12 plus short acting injections per day mainly for correction purposes and they still tell me I am doing well
 
ask your dsn for the loan of a cgm for a few days- sounds ike just what you need or ask for a pump because it is so erratic.
 
Or have a couple of months of the Libre? Not cheap, but no startup cost. You need that data.
 
Rillum said:
Here's a study, where all the participants with type 2 have the same Hba1c, but different variability in glucose levels. The people with less fluctuations are better off: http://www.ncbi.nlm.nih.gov/pubmed/25530811
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Thanks for finding that. I'm T2 for 15 years & followed the DUK high starchy carb diet for over 7 years, suffering a range of complications including peripheral neuropathy. My diabetees was considered well controlled at HbA1c of about 6.6.
A change to low carb brought a rapid improvement in my condition, but only a small reduction of HbA1c.
Checking for after meal spikes showed that with a carb b'fast my BG spiked to mid-teens after one hour, reducing to 8-9 after 2 hours, &dropping below 5 after 3 hours.
A low carb b'fast rises to 8-9 after one hour & drops to 6-7 after 2 hours. It rarely drops below 5.
I am convinced that it is the spikes (from carbohydrate) that cause the damage.
HbA1c does not measure fluctuations.
Left hand in ice & right hand in boiling water gives a pleasantly warm average ....
 
Person 2 is dead or in a persistent coma, if her blood glucose averages 2.0 mmol/L for 50% of the time.
 
Using HBa1c as a measure of good management only makes sense if it is used in conjunction with some kind of measure of variability. For example, Standard Deviation (SD) measures from blood glucose meters or (much better) from CGMs. However HCPs seldom ask for this information on variability, even when it is available. They just approximate this by asking if you have had a lot of hypos or not.
 
Totally. I wish more people realised this.

When you can get continuous data, then you're really away, with mean and standard deviation. Also time in target.
 
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