HBA1c up from 42 to 44 - what about a CGM?

swissmiss said:

My thinking is that I might stay on track better with a monitor, which I can’t fool.

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If you're in the UK I think they still do a free trial for the Freestyle Libre, so why not give it a two week try?

swissmiss said:

I’ve done all the quick wins (try to low carb, don’t drink, smoke, low fat for cholesterol

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How do you do low carb and low fat? It's very hard to eat sufficient calories if you reduce two of the three food groups.
Many of us have found our cholesterol numbers have improved on less carbs and more fats to make up for the reduced carbs.

A hba1c of 44/42 is basically the same, so it looks like what you did kept you stable, and only just over the prediabetic threshold, so not bad at all!

swissmiss said:

Following my recent HBA1c test, I received the following text message from my registered GP:

“Your blood sugar level has increased from 42 to 44 since you last spoke to Dr [Niceguy] in Dec 2020, which suggests that you were not successful in the lifestyle measures you were planning to take.”

This was annoying as my GP surgery has had nothing to do with me during the pandemic and has no idea what health situations I’ve managed or improvements I’ve made. Dr Niceguy has doubtless moved on.

it’s my responsibility; I get that. I’ve done all the quick wins (try to low carb, don’t drink, smoke, low fat for cholesterol) and wonder if anyone who has prediabetes has gone for a Continous glucose monitor. Trying to track my blood sugar with a finger prick (which I’ve done sporadically for years) makes me focus more on food and eating. My thinking is that I might stay on track better with a monitor, which I can’t fool.

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Well it’s nice I guess that they are monitoring your pre-diabetes as it’s not always been monitored below 48, but my experience could be very out of date

however, 42 and 44 are so close that you appear, to me, to have kept stable. Was there a figure you and the doctors were aiming for?

CGM is an option but not cheap, you said you have tried to low carb and low fat too which isn’t usually, so what does that look like diet wise? Is cholesterol an issue? From what I have read, and not an expert by far, it’s not that straightforward and there are more aspects to it than jus the general figures doctors quote

Your GP is just plain pedantic - 42 to 44 is well within the range of statistical variability. Also, rounding could be from 42.49999 to 43.50000!

There is very little difference between 42 and 44. The HbA1c test does have an acceptable error rate (not sure what it is), and the actual results are rounded to the nearest whole number before being published. I personally have had a 4 point difference in 2 simultaneous tests done at different labs from the same blood draw (arranged by my GP at the time)

“Your blood sugar level has increased from 42 to 44 since you last spoke to Dr [Niceguy] in Dec 2020, which suggests that you were not successful in the lifestyle measures you were planning to take.”

Wow, that was encouraging. I'd be inclined to question the negative wording, and the implication that you didn't take the measures you planned. Over the year, you may have been hugely successful, but with ups and downs. Has GP made any useful suggestions this year?

I would click on this link and review the food lists for low carb, then adjust as neccessary:
low carb food list - Google Search
I have a protocol of diet and exercise that I tweak to keep sustainable. It is easy but hard at the same time, e.g. I need to do my 15-20 workout, but don't feel it today (sleep issues last night). I prefer facts over eminence, so the fight you have over cholesterol might be abaited with this video:
Now to the workout for me.

pumas said:

“Your blood sugar level has increased from 42 to 44 since you last spoke to Dr [Niceguy] in Dec 2020, which suggests that you were not successful in the lifestyle measures you were planning to take.”

Wow, that was encouraging. I'd be inclined to question the negative wording, and the implication that you didn't take the measures you planned. Over the year, you may have been hugely successful, but with ups and downs. Has GP made any useful suggestions this year?

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Exactly what I would do - but would have to calm down first before I let rip. Talk about give you encouragement what is wrong with these gps and diabetic nurses

@swissmiss - I think you GP was spouting a load of old codswallop and obviously isn't aware either that small changes are quite normal and may also be attributed to issues other than diet and might well be beyond our control - e.g. stress, pain, illness, some medications, etc.

Think about the huge range of possible HbA1c figures, which should show you that your tiny rise from 42 to 44 is insignificant and that you are keeping your glucose levels under control. IMO the time to start being concerned is if you ever begin to see a regular increase rather than your one minor fluctuation.

My GP is happy to ignore my minor fluctuations - he believes that my T2 is well controlled.

I would recommend the 2 week trial of a Freestyle CGM. I recently tried this and it helped me to realise that my healthy breakfast was very bad news, and how I reacted to various other regular foods. It really helps you to make educated adjustments to your diet to reduce glucose spikes. I am seriously considering investing in CGMs for 2-3 months to gain further insight re diet, sleep, etc and how these affect my blood glucose. I would also recommend reading Jessie Inchauspe’s book Glucose Revolution, which is very informative.

swissmiss said:

Following my recent HBA1c test, I received the following text message from my registered GP:

“Your blood sugar level has increased from 42 to 44 since you last spoke to Dr [Niceguy] in Dec 2020, which suggests that you were not successful in the lifestyle measures you were planning to take.”

This was annoying as my GP surgery has had nothing to do with me during the pandemic and has no idea what health situations I’ve managed or improvements I’ve made. Dr Niceguy has doubtless moved on.

it’s my responsibility; I get that. I’ve done all the quick wins (try to low carb, don’t drink, smoke, low fat for cholesterol) and wonder if anyone who has prediabetes has gone for a Continous glucose monitor. Trying to track my blood sugar with a finger prick (which I’ve done sporadically for years) makes me focus more on food and eating. My thinking is that I might stay on track better with a monitor, which I can’t fool.

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Hi,

First, I can not believe that it is possible for a GP to send this type of message. No comment. HbA1c is the average of your blood glucose for the last 3 months and your HbA1c is at the lowest treshold of prediabetes range, which means starting with life style changes at this stage increases your chances of going back to normal glycemic control. Also I do not know all the details but if you are overweight one thing that can help you is to calculate your resting metabolic rate (you can do it online and you will find for sure more details) and then you multiply that number with an activity factor to estimate how many kcal your body is cosuming during the day. Then you start by decreasing 500 kcal, and you create a energy deficit that can help you lose weight. Regarding other changes you can make for improving your glycemic control, there is strong evidence that exercise is having a positive impact on improving your glycemic control. Maybe you are already doing that, but I strongly believe that including exercise in your daily activity (it can be low intensity exercise like walking, running) will help you as well.