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HbA1c too low?!?

G

Gannet

Well-Known Member
Messages
129
Location
London
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Showbiz
Yesterday my doctor said she thought my HbA1c was too low at 39. She had already reduced me ( 6 weeks ago) from 3x500g to 2 tablets of metformin daily because it was too low at 43!!! I am eating lchf, and feel good. I do like the way she is taking an interest in me so I don't want to rock the boat. She has agreed to leave things as they are for the moment (holidays coming up) I do want to get rid of the metformin eventually, but not in too short a time.
She checked all the things I should have - inoculations, eye screening etc, then came to dietitian. 'Oh no,' she said 'You don't need that, do you.' (bless her).
 
39 is fine. You are in the non-diabetic range (below 42). You probably don't need Metformin at all with such a low HbA1C.

My diabetes nurse suggested I stop taking metformin (I was on 1x500 daily) and see how my HbA1C changes in three months time. My HbA1C was 44 and I am hoping to get below 42 next time without the help of Metformin. I would be very happy with a reading of 39.
 
Too low? My HbA1c has been 36-37 for 3 years on Lo-carb eating and 1000mg of Metformin a day. Why is reaching non-diabetic levels considered too low? My GP thinks I am doing just fine!
 
Too low? Blimey. It's a brilliant HbA1c. Ignore her. She probably isn't used to seeing her diabetic patients with such a lovely low HbA1c. What does she think the harm is in being at 39?
 
Bluetit1802 said:
Too low? Blimey. It's a brilliant HbA1c. Ignore her. She probably isn't used to seeing her diabetic patients with such a lovely low HbA1c. What does she think the harm is in being at 39?
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I think perhaps she is following guidelines for people on multiple diabetic medications. I did read something recently about patients going too low and it making them ill (apart from hypos). I am rarely below 5.0. She is very ready to discuss and listen to another point of view. I will be happy to get rid of the metformin after my next blood test, but am a little worried about backsliding on holiday away from my usual routine.
 
Gannet said:
I think perhaps she is following guidelines for people on multiple diabetic medications. I did read something recently about patients going too low and it making them ill (apart from hypos). I am rarely below 5.0. She is very ready to discuss and listen to another point of view. I will be happy to get rid of the metformin after my next blood test, but am a little worried about backsliding on holiday away from my usual routine.
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You must have read comments on the forum threads about Metformin. It really does very little to lower blood sugars. If you came off them I doubt you would notice any difference. Don't worry too much about your holidays, you should find plenty of low carb choices wherever you are, and as you are on holiday an odd treat is perfectly acceptable. (So I tell myself!) ;)
 
justbe said:
When doctors see a low HbA1c, they assume you're getting lots of low BGs. They have no understanding of LCHF, and how it lets you have good control whilst REDUCING lows. Yes, ignore her, as others have said. If necessary, play along and tell her that you'll try to get it a bit higher, but "fail" to do so. Act like it's a mystery :)
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That's what I thought. In fact the last nurse appointment suggested that 43 was OK - going in the right direction, but try not to go any higher. The doc is lovely- a real keeper, but I think will keep on with what I'm doing. I am just rather mystified!
 
Hba1c is not a fixed factor that applies to all persons diabetes. It all depends on the way our bodies replace glyciated cells in the cell renewal process. One person may have an hba1c a few points different to a.n.other on the same average blood glucose. As I see it, Hba1c is a one size fits all kind of measurement and not absolute. regards D.
 
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Gannet said:
Yesterday my doctor said she thought my HbA1c was too low at 39. She had already reduced me ( 6 weeks ago) from 3x500g to 2 tablets of metformin daily because it was too low at 43!!! I am eating lchf, and feel good. I do like the way she is taking an interest in me so I don't want to rock the boat. She has agreed to leave things as they are for the moment (holidays coming up) I do want to get rid of the metformin eventually, but not in too short a time.
She checked all the things I should have - inoculations, eye screening etc, then came to dietitian. 'Oh no,' she said 'You don't need that, do you.' (bless her).
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Hi @Gannet ..
Sounds like a good scenario for ...
# Listen
# Nod
# Smile and say thank you
# Ignore

And well done on your numbers .. :happy:
 
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Thats a really weird thing for your doctor to say! My DN was absolutely delighted when she told me mine was 29 and no mention of it being too low - she just said she wondered if I could keep up with the low carbing permanently. She did suggest reducing or stopping my Metformin but I chose to remain on it for the time being as I've read on this forum that it has other health benefits. If my HbA1C is still this low next time I will experiment with reducing the Met to one tablet
 
Well done on your HbA1c and enjoy your holiday.

I think you are right that your doctor may be looking at reports which may not be relevant to you.

There is an article in medivizor in 2014 which summarises a study undertaken by Diabetes Research and Clinical Practice report called Hemoglobin A1c, comorbid conditions and all-cause mortality in older patients with diabetes: A retrospective 9-year cohort study dated 29th July 2014. The summary is noted below

The target HbA1c level (a measure of average blood glucose over 3 months) for a diabetic patient is approximately 6.5%. However, some studies have found that diabetic patients with intense glycemic control, meaning HbA1c levels lower than 6.0%, have higher mortality rates than patients with HbA1c levels between 7.0% and 7.9%. This may be partly due to the treatments they receive, particularly in patients with other conditions such as hypertension (high blood pressure) or other cardiovascular disease. For patients with co-existing medical conditions a higher target HbA1c level may be more appropriate.

There also seem to be other more recent studies again looking at older cohorts and people with more than one condition which come to similar conclusions and a concern about over medication with older frailer people.

However as you are lucky to have a doctor who is ready to discuss your options with you , you will be able to ask her what her concerns may be.
 
39 is great well done. Remember surgeries get paid for delivering Metformin and get nothing if you are off it (this policy should be reversed).

The downside of Metformin is 1. It is a drug, it has got to be better where possible to let your body regulate where possible. 2. For some like me it reduces kidney function. On the upside it is said to protect the heart.
 
@Gannet
Well done! That is a great result! you should be very pleased.

All an HbA1c does, is give an average figure. A steady well controlled blood glucose is much less harmful than repeatedly swinging high and then low. Maybe your doc was thinking that you are constantly having hypos, which are hard on the body. A lot of health care professionals seem to make that assumption when they see a nice low HbA1c.

There is a vast difference between lowering HbA1c with low carbing and lifestyle changes, and aggressively lowering HbA1c with strong medication.

Have a look at this link, which mentions the ACCORD study, which was intended to map the effect of lowering HbA1c and achieving tight control
http://www.phlaunt.com/diabetes/35169265.php
The study was ended early, because of increased risk to patient health, and blamed it on the low HbA1cs.
But the method they used to achieve the lowered blood glucose was by using a whole range of drugs, one of which (Avandia) was later linked to increased risk of cardiac problems and death.
The result was that a lot of people assumed that the lower HbA1c's caused the cardiac problems, when in fact it was the drug.

So I would be very wary of being told to raise your HbA1c to diabetic levels, when you have successfully lowered your HbA1c to non-diabetic levels, using a sensible, sustainable method, and not using strong drugs (Metformin does not have a big effect in lowering blood glucose).
 
Brunneria said:
@Gannet
Well done! That is a great result! you should be very pleased.

All an HbA1c does, is give an average figure. A steady well controlled blood glucose is much less harmful than repeatedly swinging high and then low. Maybe your doc was thinking that you are constantly having hypos, which are hard on the body. A lot of health care professionals seem to make that assumption when they see a nice low HbA1c.

There is a vast difference between lowering HbA1c with low carbing and lifestyle changes, and aggressively lowering HbA1c with strong medication.

Have a look at this link, which mentions the ACCORD study, which was intended to map the effect of lowering HbA1c and achieving tight control
http://www.phlaunt.com/diabetes/35169265.php
The study was ended early, because of increased risk to patient health, and blamed it on the low HbA1cs.
But the method they used to achieve the lowered blood glucose was by using a whole range of drugs, one of which (Avandia) was later linked to increased risk of cardiac problems and death.
The result was that a lot of people assumed that the lower HbA1c's caused the cardiac problems, when in fact it was the drug.

So I would be very wary of being told to raise your HbA1c to diabetic levels, when you have successfully lowered your HbA1c to non-diabetic levels, using a sensible, sustainable method, and not using strong drugs (Metformin does not have a big effect in lowering blood glucose).
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Thanks @Brunneria. I think that was probably the article I saw. (I read so much I couldn't remember where I had seen it). She did say 6 weeks ago that I was probably having hypos, and I said I knew I wasn't, and wasn't the guidance for people on multiple treatments? I don't think she's come across a patient like me before. I'm not going to try to increase my levels, but I do welcome the discussion from her rather than 'here's your result, come back in 6 months.'
 
Gannet said:
Yesterday my doctor said she thought my HbA1c was too low at 39. She had already reduced me ( 6 weeks ago) from 3x500g to 2 tablets of metformin daily because it was too low at 43!!! I am eating lchf, and feel good. I do like the way she is taking an interest in me so I don't want to rock the boat. She has agreed to leave things as they are for the moment (holidays coming up) I do want to get rid of the metformin eventually, but not in too short a time.
She checked all the things I should have - inoculations, eye screening etc, then came to dietitian. 'Oh no,' she said 'You don't need that, do you.' (bless her).
Click to expand...

I think sometimes GPs aren't used to seeing healthy T2s with low HbA1cs. My GP is very happy with mine at 31, but does admit she doesn't see many like it.

Provided you are feeling well on it, and all your other health markers look good, she'll get used to the idea. :)
 
At one point, my Hba1c was down to 30, which even I thought was a bit on the low side. The DN was practically having a fit but my doctor was more sanguine; he first reduced my dosage of metformin from 2 to 1 tablet(s) per day and then suggested that I came off them completely, which I did. My levels have drifted up a bit without medication and now hover around the mid to upper thirties, which I and everybody else seems to be comfortable with ("keep doing whatever it is that you're doing" was what my DN said at my last review, thus carefully linking encouragement of my current regime with an avoidance of endorsing a low carb diet :))

Like most of the respondents here, I'd regard 39 as an excellent number and something to be proud of, not worried about. Note, however, what a couple of people have said about suitable levels for people with multiple conditions......
 
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