HbA1c unchanged but GP happy

I'm not sure if I need any advice on this - just to keep going on as before - but I thought I'd get more sense in this forum than from my GP.

HbA1c July 2021: 40

November 23: 47 "acceptable - continue to monitor"

March 2025: 45 "Referral to NDPP (National Diabetes Prevention Programme) within 4 weeks"

I then applied to the in-person meetings, which I am in the middle of - final meeting is 4.2.1026
I also ate fairly low carb and followed Jason Fung's recommendation of 24-hour and even 36-hour fasts. Weight has gone down from 130kg to 123kg. I hope it will continue to go down without resorting to weight-loss jabs

September 2025: 45 "Acceptable/stable for this patient. Continue to monitor. This test should be used for monitoring of long-term glycemic control in patients with a known/established diagnosis of diabetes"

I had expected the score to improve. I will of course mention it at the next pre-diabetes group meeting (done by InHealth) but it seems the presenters are not experts and have just done 6 weeks' training. They recommend the Eatwell Guide of course.

I will continue to eat low carb. I have got a glucose monitor and fasting rates in the morning are always high.

The March 25 reading followed 3 months including lots of carbs at Christmas.

Many thanks for any opinions.

lovinglife said:

Great result @Zeppx

Click to expand...

Thank you. But the HbA1c result is not so great!

Thanks, Resurgam, that does sound lke a good idea. I am not spherical, more barrage-balloon-like. Am 78. I will see about the low carb thing. I do not systematically count carbs. I do have nutricheck, which I occasionally use to see how much protein and fibre I am getting. I am interested in, but don't use, the Freshwell Low Carb project/app which someone mentioned on here.

My breakfast is usually 200g 5% Greek yogurt with fruit and a lot of fibre stuff, and some chicken breast too. I suspect I could omit the oat bran and cut down the fruit. I don't regularly have bread, potatoes, rice or pasta and I possess chickpea etc. pasta and have just made and eaten some red lentil "rolls". The combination of this plus occasional longer bouts of TRE is reducing my weight, which is my main aim, as overweight is putting too much strain on my legs and back. I do some weight training but it seems to take ages for it to have any effect. The last day I actually used nutricheck was August 19th and I had 44g carbs and 31.5g sugar, most of it fruit sugar, I don't add sugar to anything.This is about 50% of my daily allowance, but I can't work out what that is and why. I only use the app for fibre and protein (I wonder if I am not getting enough when I do a 24-hour fast) but I will see if I can set the carbs. I do tend to eat too much cheese and probably olive oil, which is relevant to my weight but obviously not to blood sugar. I have never gone low-fat.

I haven't actually got diabetes and have no experience of Metformin or Atorvastin.

Thanks, that does sound lke a good idea. I am not spherical, more barrage-balloon-like. Am 78. I will see about the low carb thing. I do not systematically count carbs. I do have nutricheck, which I occasionally use to see how much protein and fibre I am getting. I am interested in, but don't use, the Freshwell Low Carb project/app which someone mentioned on here.

My breakfast is usually 200g 5% Greek yogurt with fruit and a lot of fibre stuff. I suspect I could omit the oat bran and cut down the fruit. I don't regularly have bread, potatoes, rice or pasta and I possess chickpea etc. pasta and have just made and eaten some red lentil "rolls". The combination of this plus occasional longer bouts of TRE is reducing my weight, which is my main aim, as overweight is putting too much strain on my legs and back. I do some weight training but it seems to take ages for it to have any effect. The last day I actually used nutricheck was August 19th and I had 44g carbs and 31.5g sugar, most of it fruit sugar, I don't add sugar to anything.This is about 50% of my daily allowance, but I can't work out what that is and why. I only use the app for fibre and protein (I wonder if I am not getting enough when I do a 24-hour fast) but I will see if I can set the carbs. I do tend to eat too much cheese and probably olive oil, which is relevant to my weight but obviously not to blood sugar. I have never gone low-fat.

I haven't actually got diabetes and have no experience of Metformin or Atorvastin.

Pipp said:

Hi @Zeppx

I notice you are 78 years old. With HbA1c in pre-diabetes levels, no medication for diabetes.

you are otherwise healthy, apart from, perhaps, being overweight? You have lost weight recently, but want to lose more?

Your time restricted eating regime could, perhaps be aided by reducing the fruit for the sugar content, and keeping a record of the carb content of the food you are eating.

What struck me most about your posts in the thread is your apparent disappointment at your HBA1c of 45. That number seems fine, as you haven’t reached diabetes level. You might also find the following article of interest. I know I did.

Diabetes Management in the Elderly - PMC

IN BRIEF Older adults with diabetes present unique challenges and require considerations that are not traditionally associated with diabetes management. In this review, we focus on issues that are unique to the older population and provide practical ...

pmc.ncbi.nlm.nih.gov

As a retired person of a certain age myself, I feel ok with my Hba1c in prediabetes levels after 20+ years of having T2, after reading this. I still strive to improve management of T2 and weight by diet and exercise, but emotional wellbeing is just as important. Striving for perfection and feeling of failing if I can’t improve the figures is counterproductive.

Click to expand...

Thanks, Pipp. I can understand why you refer to my "apparent disappointment". But that is not how I feel, I am simply confused as to why I can do so well in six months with no change in the HbA1c. I thought this was the most sensible place to ask. I have a friend who is also concerned on my and her own behalf. I am not going to get any sense out of the prediabetes programme, I don't think.

The article you linked to makes me feel 20 years older already. It is for people with diabetes who are living in supported accommodation. It is certainly a grim warning, but maybe I should read it when I'm 88. I live independently and don't have diabetes.

(to Pipp)
I don't understand this forum and I sent off my reply too soon, but I can't see it now. I just wanted to add that "striving for perfection" is surely not a good idea. But I don't see how I can write or reply in this forum without being interpreted as a perfectionist. What we are writing about here may well come over as striving for perfection, but for myself I am just interested in advice.

Thank you, Antje.

Yes, of course the carb figure in nutracheck is not specific to me, but it is sufficient for me to see how much I ate - though it is fibre and protein I usually look for. The carb figure seems to be something like 25% of what they have decided I should be eating every day. I don't think it's possible to create more suitable targets - maybe there are apps that do that, I don't really mind as long as it shows me the figures.

At the moment I scarcely test at all. I have tested before and after meals in the past (around 2010). I was also a member of Zoe and had a continuous monitor for two weeks but I didn't understand it well - about three years ago. They did tell me I am poor at processing glucose and fat. I assume the fasting number can be high anyway (dawn phenomenon?) but I see it is reported by members in this forum so I presume there is a point to it. My friend in Germany tests her glucose much more than me and she always wants me to report the fasting level, which is usually 7 or 8. I have not much tested before and after meals recently because I assumed that eating fairly low starchy carbs would be sufficient. I will try it starting with breakfast.

Many people including myself have found that carbs in the morning have a much larger impact than carbs in the evening. So having this 'daily allowance' for breakfast and no carbs for the rest of the day would mean a considerable difference in average blood glucose than doing it the other way around.

Click to expand...

I don't use a daily allowance at all, as I don't use nutricheck to follow a calorie-deficit diet. I just see (when I use it at all) that I am usually under their figure. I don't understand the meaning of average blood glucose. If I had most carbs for breakfast and got a higher figure, would that not average out the same way three moderate figures would? The idea of a daily allowance of 50g or 100g was mentioned by Resurgam, I don't know if that is what you are referring to.

becca59 said:

Hi @Zeppex as a type one my management of this condition is different. However I am going to try and address some of the issues you are raising. Yes the medical profession are less worried about the higher level HbA1c in the older amongst us. However, it is perfectly acceptable on a personal level to strive for better. We are human and the medical profession are not always correct.
So, how to get there. The only way for pre diabetics and Type twos is to monitor and reduce their carb intake. Basically by finding the carbs that are your personal problem.
To do that you need to test just before you eat and two hours after the first bite. The rise, from wherever your initial reading was, should not be higher than two mmol. If it is, your insulin reaction shows it is working for that particular food. After a few weeks of testing you will have more of an idea which foods you can handle.
Morning readings always tend to start higher as our bodies waking us up release glucose from the liver. It can be a bind but to accommodate eat breakfast of very low or no carbs. As a type one I eat full fat Greek yoghurt and a few berries and require triple insulin to what I would need later in the day. But I am someone for whom breakfast is a must. Which reminds me, full fat not reduced. Fat helps slow down those pesky carbs.
Finally your comment at the end regarding those higher carbs producing a higher figure and averaging out with lower readings later in the day. Unfortunately not, it will be those individual molecules that stick to your blood and help raise the HbA1c. Yes low readings will help overall. But to lower that reading totally they need to be lower every meal. That was always my understanding anyway. A higher one off over the three months wouldn’t have a great impact on the level. But a higher level every morning would.

Click to expand...

Thanks very much, becca59. That helps me to understand the question of averaging out or not over the day, which I had not understood from the previous exchange. I will try it out starting with the breakfast. I don't usually have breakfast before 10, if at all, so I will test when I get up but also just before I eat and 2 hours after, and see how it goes.

becca59 said:

Hi @Zeppex as a type one my management of this condition is different. However I am going to try and address some of the issues you are raising. Yes the medical profession are less worried about the higher level HbA1c in the older amongst us. However, it is perfectly acceptable on a personal level to strive for better. We are human and the medical profession are not always correct.
So, how to get there. The only way for pre diabetics and Type twos is to monitor and reduce their carb intake. Basically by finding the carbs that are your personal problem.
To do that you need to test just before you eat and two hours after the first bite. The rise, from wherever your initial reading was, should not be higher than two mmol. If it is, your insulin reaction shows it is working for that particular food. After a few weeks of testing you will have more of an idea which foods you can handle.
Morning readings always tend to start higher as our bodies waking us up release glucose from the liver. It can be a bind but to accommodate eat breakfast of very low or no carbs. As a type one I eat full fat Greek yoghurt and a few berries and require triple insulin to what I would need later in the day. But I am someone for whom breakfast is a must. Which reminds me, full fat not reduced. Fat helps slow down those pesky carbs.
Finally your comment at the end regarding those higher carbs producing a higher figure and averaging out with lower readings later in the day. Unfortunately not, it will be those individual molecules that stick to your blood and help raise the HbA1c. Yes low readings will help overall. But to lower that reading totally they need to be lower every meal. That was always my understanding anyway. A higher one off over the three months wouldn’t have a great impact on the level. But a higher level every morning would.

Click to expand...

I certainly have enough information to proceed, but just one further question. I read here that full fat Greek yogurt, which I used to eat, is best, but currently I eat the 5% stuff because I like the taste. So I tried some glucose monitoring today: fasting at 8.00 was 7.0, then at 9.50, just before breakfast, it had risen to 7.3 - is this normal? And two hours after breakfast it was 5.4. So there is no rise but a fall. You wrote that my rise should be no higher than 2 mmol. I hope this is OK.
I intend to try the 0% and 10% Greek yogurt too on other days.

Antje77 said:

Perfectly normal, and it proves that your chosen yoghurt works very well for you.

The initial rise was likely your liver adding some glucose to your bloodstream to help get you going for the day, the drop shows that you can deal with the yoghurt just fine.

A reason to eat the 10% yoghurt can be that it has more calories per amount eaten, so it's more filling and we're less likely to snack or eat more at our next meal. Another reason may be flavour, I absolutely love the fattier yoghurt.
But if you prefer the 5%, and eating to your meter shows this is totally fine, diabetes wise, there is no reason at all to eat something else.

Click to expand...

Many thanks. It is the Yeo 5% yogurt I like, not the Fage or whatever.