HbA1c too low?

[LizzMeg]

Hi I’m new here! I’m type 1 diabetic, diagnosed several months ago and I have just got back my second HbA1C result and it’s 5.5% and I was told that it’s too low… curious to know if other T1D have been told the same?

Also just to add that I eat a plant-based diet which is high in carbs (average of 200g carbs a day) and I am only moderately active. I’ve seen so many T1D’s talk about keto/low carb as the only way to get a good HbA1c…

 

[Tony337]

Hi
The medical profession believe to achieve 5.5 you have had many lows to combat the highs to give that particular average.
They fail to take in to account the individuals control and are worried you might pass out etc.

I for one am in my 50th year of type 1 diabetes and havn't been hospitalised........

My last Hba1c was 6.0 and i was told it was too low!

Good luck

Tony

 

[Westley]

Hi and welcome!

As Tony says, the reason they sometimes complain about 'too low' HbA1C is that they think it must be coming at the expense of lots of hypos. (I think this view is based on outdated thinking, from a time before modern tech for managing T1 made such levels possible while still keeping good time in range).

I've encountered this attitude from the nurse at the GP sometimes, but my hospital team are more supportive of aiming for non diabetic levels.

If you're not having lots of hypos, then it's a great result, and if you can show them this on your readings then they should be congratulating you.

 

[LizzMeg]

Hi
The medical profession believe to achieve 5.5 you have had many lows to combat the highs to give that particular average.
They fail to take in to account the individuals control and are worried you might pass out etc.

I for one am in my 50th year of type 1 diabetes and havn't been hospitalised........

My last Hba1c was 6.0 and i was told it was too low!

Good luck

Tony

Interesting, that makes sense! Thank you

 

[LizzMeg]

Hi and welcome!

As Tony says, the reason they sometimes complain about 'too low' HbA1C is that they think it must be coming at the expense of lots of hypos. (I think this view is based on outdated thinking, from a time before modern tech for managing T1 made such levels possible while still keeping good time in range).

I've encountered this attitude from the nurse at the GP sometimes, but my hospital team are more supportive of aiming for non diabetic levels.

If you're not having lots of hypos, then it's a great result, and if you can show them this on your readings then they should be congratulating you.

Thanks for your reply! That makes a lot of sense. My time in range is pretty good but I could probrably aim to have a few less hypos.

 

[Deleted member 527103]

I’ve seen so many T1D’s talk about keto/low carb as the only way to get a good HbA1c…

That is because DMM who host this forum promote a low carb diet but I am proof that a low carb diet is not the only way.
I eat a moderate number of carbs and have a similar HbA1C to you.
Through using a CGM I can see that my TIR is within the NiCE targets but still expect the “you are at risk of too many hypos” lecture at my next appointment.

 

[Nicola M]

My last HbA1c was 5.6% so pretty close to yours and was told by my doctor he has absolutely no issues with it as he can see from my CGM data I'm rarely having any lows. As long as you're not having too many lows I would just ignore them saying it's too low.

Also, in terms of diet, I eat 150g-200g of carbs every day and my last HbA1c was as above 5.6% so personally don't think low carb is the only way to achieve a good HbA1c.

 

[Djinn 2]

My last HbA1c was 5.6% so pretty close to yours and was told by my doctor he has absolutely no issues with it as he can see from my CGM data I'm rarely having any lows. As long as you're not having too many lows I would just ignore them saying it's too low.

Also, in terms of diet, I eat 150g-200g of carbs every day and my last HbA1c was as above 5.6% so personally don't think low carb is the only way to achieve a good HbA1c.

And then there is the B12 levels that many forget in the shadows of Iron deficiency. There is not a lot of B12 in carbs.

 

[Nicola M]

And then there is the B12 levels that many forget in the shadows of Iron deficiency. There is not a lot of B12 in carbs.

Funny you should say that I’m recently diagnosed severely deficient in B12 although they suspect pernicious anaemia rather than diet related.

 

[RoughcutAU]

At my last Endo appointment I got the usual spiel about avoiding hypos and that my HbA1c is alittle low at 6.1 (lol)even though they can see the CGM and TIR data. They are usually ok about it and I just smile and nod and carry on doing me.

I’m also in the 150-200grams of Carbs a day crowd.

 

[EllieM]

Before the days of cgms I used to lose hypo awareness due to too many hypos whenever my hba1c got too close to 6.5 or 48. It was definitely better for me to run a little higher and keep the hypo awareness. But cgms can now be used to stave off hypos when running lower so I think that clinics' concerns may be becoming outdated. Of course, if your time in range showed a lot of lows then I think you should expect to get complaints from your clinic...

 

[Deleted member 527103]

And then there is the B12 levels that many forget in the shadows of Iron deficiency. There is not a lot of B12 in carbs.

Is that relevant? When we say we eat a "moderate" amount of carbs that does not mean we only eat carbs.
I also eat plenty of fish and dairy and eggs. (For non-diabetic reasons I eat no meat.)
Pernicius amaemia is more likely to be the reason for low B12 levels for someone with Type 1 as, sadly, auto-immune diseases tend to stick together.
And regardless of how much B12 you eat, it won't help if your body can't absorb it ... in case you were to suggest that pernicious anaemia was cause by eating carbs.