HBA1c Results question

[madfish69]

Hi!,

I've had type 2 for almost 10 years now and my results have pretty much always in the normal range. This time the results have come back as "normal no action"...but my level is higher at 52.

For the first several years I was given 4 metformin tablets a day so 2000mg/day.

Then because my results were falling below the old "6" range, the doc reduced my metformin to only 1000mg/day...so 2 tablets.

My question is...isn't 52 too high? Apparently the target is 42 or something....shouldn't I be reverted back to the old original dosage I used to be on?

Please let me know.

Thank you!!

 

[Bluetit1802]

The doctor should be contacting you, not marking your result up as no action required. I would make an appointment to discuss this.

As your previous results were around the 42 mark (the old 6 range) you have obviously gone up a lot and this needs sorting out.
Under 42 is non-diabetic
42 to 47 is pre-diabetic
48 and over is diabetic.

The guidelines set out by NICE recommend the target to be 48, although obviously it is better to be under 42.

Do you test your own bloods with a meter at home? If not, I suggest you start doing this and go back to basics with a suitable low carb diet. It is perfectly possible to control this disease with diet. If you try this you may find you don't need the high dose of Metformin.

 

[GrantGam]

Hello @madfish69,

Where do you live? I'm in Scotland and the upper end of the target range here (for T1's) is still 53mmol/mol. I believe in England is has been reduced to 48mmol/l. I don't know about Wales or NI though. Also, I'm unsure whether the target ranges differ between T1's and T2's.

You should aim for as low an HbA1c as humanly possible if you are diet/exercise or not on any glucose lowering drugs. If you do take drugs which can cause hypos, then a little more caution is advised as too low an HbA1c can often be an indicator of regular hypos.

You and your consultant/GP should agree on a value that is good for you. If you have seen a marked increase in HbA1c then I'd be wanting to find out why, as should your Doctor.

http://www.diabetes.co.uk/what-is-hba1c.html

 

[Brunneria]

There is a treatment protocol that NHS doctors are supposed to follow, based on the NICE guidelines.
It suggests that one drug is appropriate for type 2 diabetics until they hit an HbA1c of 53, at which point a second drug is appropriate.

Here is an infographic that gives an idea of how it works.
http://www.bmj.com/content/bmj/suppl/2016/04/06/bmj.i1575.DC1/diabetes-t2a-v19-web.pdf

My suggestion is that you check back with your doc and ask if upping the metformin dose would be a good idea.
He/she may not realise that you are still on the lower dose.

 

[Art Of Flowers]

The difference between 2x500 and 4x500 metformin is very small. Raising to 2000 daily dose may only reduce HbA1C from 52 down to maybe 50. If you want to reduce to 42 or below you should think about a lower carb diet. Get a blood glucose meter if you haven't got one and test which foods spike your blood sugar.

 

[Bluetit1802]

As Metformin is not a drug associated with hypos, the recommended target is 48 for people with T2.

This is what NICE has to say:

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

1.6.7 For adults with type 2 diabetes managed either by lifestyle and diet, or by lifestyle and diet combined with a single drug not associated with hypoglycaemia, support the person to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support the person to aim for an HbA1c level of 53 mmol/mol (7.0%). [new 2015]

1.6.8 In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher:

• reinforce advice about diet, lifestyle and adherence to drug treatment and
  
  
• support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and
  
  
• intensify drug treatment. [new 2015]
  

 

[Resurgam]

From my own experience, stopping eating dense carb foods dropped my readings to the normal range in 6 months, but I went from Hba1c of 91 to 47 in 80 days.
I'd have lived on frogspawn if it had meant not being in the diabetic range, but I just stopped eating anything with sugar, no wheat flour or potatoes and cut back on anything which spiked my blood glucose.
Metformin had very little to do with lowering BG as far as I was concerned.

 

[Mbaker]

From my own experience, stopping eating dense carb foods dropped my readings to the normal range in 6 months, but I went from Hba1c of 91 to 47 in 80 days.
I'd have lived on frogspawn if it had meant not being in the diabetic range, but I just stopped eating anything with sugar, no wheat flour or potatoes and cut back on anything which spiked my blood glucose.
Metformin had very little to do with lowering BG as far as I was concerned.

I to also would have done anything to spend my time with my wife and kids - best motivation for me ever.

 

[ringi]

I view 52 as too high but not as bad as a lot of the Type2 drugs......

52 is a wakeup call to take action on diet by reducing carbs etc and a little more exercise.