HbA1c up - have been trying quite hard - what next?

[RFSMarch]

Yet again (please see multiple responses up thread) I am concerned that taking any medication which carries a hypo risk will require me to notify the DVLA, and renew my licence more frequently, and test before driving and every two hours after.
This could impact my licence, insurance, and the range of vehicles that I am licenced to drive.
This is the testing regime that I am trying to avoid.

Hopefully it should be glaringly obvious that if I am going to the trouble and expense of self funding a Libre I will be scanning it and looking at the results.
Otherwise, why do it?
I don't see anywhere in my original post where I said or implied that I don't want to test in the normal course of the day.

I note that you did not quote the part of my OP+1 which talked about not wanting to test in specific circumstances.
So:
"I think almost anything else will carry a hypo risk and complicate my life enormously.
Mainly with the ability to drive.
I know I can do the testing before and every 2 hours but I would prefer not to go down that route."

I have highlighted the relevant sentence.
I have looked again at the OP and I do not see anything there which says that I don't want to test.

You are not on insulin and you are not on a medication that could cause a hypo according to the DVLA so this is not an issue.
I have mentioned Jardiance as have others.

You asked for experiences of if people had their hba1c go up - I brought mine down, it went up, it is coming down again. Why? Because I burned out and then I got control back - it is THAT simple.

I used the fact that I am not travelling as much to get things back under control.

You are not insulin dependent. So you need to either go back to basics and understand why your levels are rising or go see your doctor if you truly believe you should be lower.
Metformin is not one of the meds specified by the DVLA for notification, so I really do not understand what the issue is when a couple of people now have mentioned Jardiance as an additional med to bring down your levels. .

TL. DR?

I AM ON TWO MEDS (NEITHER OF WHICH ARE SULPHONYLUREAS) AND I STILL AM NOT REQUIRED TO TEST BEFORE DRIVING OR REPORT THAT TO THE DVLA - I believe that answers your original question.

 

[LittleGreyCat]

@RFSMarch so far I have had mention of Jardiance which is helpful and appreciated.
This fits the bill of a medication that can be added to Metformin to reduce BG levels but not carry a risk of hypoglycemia. This is what I was asking for.
You are also reporting from personal experience which is also what I was asking for.

This was ALL that I was asking for.

I have a follow up due with my GP (as the test results have only just arrived) to discuss my results.
I am doing my "due diligence" before that discussion so I can be as well informed as possible.

Am I getting the feeling that others consider an HbA1c of 7.3%/56 mmol/mol to be no big issue?

 

[RFSMarch]

@RFSMarch so far I have had mention of Jardiance which is helpful and appreciated.
This fits the bill of a medication that can be added to Metformin to reduce BG levels but not carry a risk of hypoglycemia. This is what I was asking for.
You are also reporting from personal experience which is also what I was asking for.

This was ALL that I was asking for.

I have a follow up due with my GP (as the test results have only just arrived) to discuss my results.
I am doing my "due diligence" before that discussion so I can be as well informed as possible.

Am I getting the feeling that others consider an HbA1c of 7.3%/56 mmol/mol to be no big issue?

Ahhh I see... so sorry I didn't stick to the letter of what was asked. LOL.

 

[DCUKMod]

Yet again (please see multiple responses up thread) I am concerned that taking any medication which carries a hypo risk will require me to notify the DVLA, and renew my licence more frequently, and test before driving and every two hours after.
This could impact my licence, insurance, and the range of vehicles that I am licenced to drive.
This is the testing regime that I am trying to avoid.

Hopefully it should be glaringly obvious that if I am going to the trouble and expense of self funding a Libre I will be scanning it and looking at the results.
Otherwise, why do it?
I don't see anywhere in my original post where I said or implied that I don't want to test in the normal course of the day.

I note that you did not quote the part of my OP+1 which talked about not wanting to test in specific circumstances.
So:
"I think almost anything else will carry a hypo risk and complicate my life enormously.
Mainly with the ability to drive.
I know I can do the testing before and every 2 hours but I would prefer not to go down that route."

I have highlighted the relevant sentence.
I have looked again at the OP and I do not see anything there which says that I don't want to test.

Edited for additional emphasis.

LittleGreyCat - I am reliably informed (by an Endo Consultant, albeit who was talking about the REVITA DMR Trial at the time) that there are over 400 combinations of medications that can be given to those living with T2, prior to going onto insulin. Of course, so of those will be in the lump of meds you are looking to avoid, but I feel confident there will be others that do not.

Please note it is 400+ combinations of drugs, not 400+ individual drugs.

Sometimes GPs have open minds and take on a challenge when prescribing, and others seem to have a core panel of medications they prefer to prescribe; quite possibly because they are familiar with them. Nobody really likes to go outside their comfort zone.

You could always ask your GP what he/she considers your next steps to be, but not accept any prescription (if even offered) there and then, allowing yourself to research the options before agreeing a way forward - whether one of those suggestions or not.

 

[ziggy_w]

From memory, the HbA1c test has an accuracy of about 1%, so a change of 0.5%, either way, may be an instrumental error. Discouraging I know, but maybe a kick in the butt is necessary on occasions to keep shipshape and trim. If it was me I would just tighten things up a bit, and wait to see what the next one is. Even at the current level, your risk of complications is still very low and recoverable.

@Oldvatr -- Personally, I've seen my HbA1c be off by maybe as much as 0.5% on a DCCT format (i.e. in percent). The average blood sugar reading of of 93 mg/dl or 5.2 mmol (corresponding to an HbA1c of 4.9% or 29 mmol), but an HbA1c of 5.4% or 36 mmol (which corresponds to an average reading of 108 mg/dl or 6.0 mmol) -- which does correspond to the 0.5% in either dirrection you mentioned. From what I have read on the topic, this type of discrepancy is also not uncommon. So, an HbA1c is also not very accurate in my pov.

@LittleGreyCat -- Hugs for the higher than desired HbA1c, very frustrating to say the least. Also agree with some of the others, it easy to see how lock-downs may have contributed to this.

As to medication, I would also think (as @nutribolt has already mentioned) of an SGLT2 inhibitor as a possible route as it lowers the threshold when glucose starts getting spilled into your urine (so there should be no risk of going hypo). Not sure though whether this would do much in your case as your HbA1c is still relatively low as the threshold at which SLGT inhibitors do any good might be higher than your still relatively low blood sugar levels.

Another option is looking into into are GLP-1 agonists (as they only increase the insulin response to meals, but do not produce a more general increase in insulin levels like sulfonylureas). Also DDP4 inhibitors are also said to carry a lower risk of hypoglycemia compared to sulfonylureas.

Hope you find something that works for you. Keeping my fingers crossed.

Edited to correct tag and for readability.

 

[Oldvatr]

@RFSMarch

Am I getting the feeling that others consider an HbA1c of 7.3%/56 mmol/mol to be no big issue?

Yes, I think that is what I said.

As a DVLA user myself, and taking Gliclazide which is the one oral med specifically mentioned by DVLA, and having had a history of medical emergencies regarding CVD, as well as having laser eye surgery in both eyes, I had to do the usual licence surrender at age 70. and re apply with a DIAB1 form etc. I was not required to register with DVLA previously since I was not an insulin user or an HGV or PSV driver, so it took a while for DVLA to untangle my history. Meanwhile, I was given a temporary permit to continue driving. In time and an eye test later, I received my 3-year licence as all over 70's are required to do.

Are you Class II driving? Are you Hypo aware? Have you had any hypo's that required assistance (i.e medical intervention)

 

[LittleGreyCat]

Yes, I think that is what I said.

As a DVLA user myself, and taking Gliclazide which is the one oral med specifically mentioned by DVLA, and having had a history of medical emergencies regarding CVD, as well as having laser eye surgery in both eyes, I had to do the usual licence surrender at age 70. and re apply with a DIAB1 form etc. I was not required to register with DVLA previously since I was not an insulin user or an HGV or PSV driver, so it took a while for DVLA to untangle my history. Meanwhile, I was given a temporary permit to continue driving. In time and an eye test later, I received my 3-year licence as all over 70's are required to do.

Are you Class II driving? Are you Hypo aware? Have you had any hypo's that required assistance (i.e medical intervention)

Thanks for that, very useful.

I thought (I may be wrong) that you had to notify DVLA if you took any medication which carried the risk of a hypo.

Having never had a hypo (as far as I am aware) I have no idea if I am hypo aware.
This is one of the troubling things about moving onto anything that can cause a hypo.
Will I notice during the day? Will I notice over night?
Basically, won't know until you've had one.

I am on an 11 month automatic extension of my licence at the moment, due to lack of resources to process renewals at DVLA.
I have all the forms ready to go.
D4 asks all sorts of questions, including about oral hypoglycemic agents.
I've posted in the past about how illogical the form is, especially where you asked if there is any hypo awareness when you are not on hypo inducing drugs.
[No box for "How the *** would I know???]

Anyway, no hypos on metformin so far.

I want to retain the right to drive vehicles over 3.5 tonnes, because possible motor home some time in the future and I get called on to drive a 7.5 tonne tail lift every year or so for family removals.
In general, I intend to retain every class that I currently have because....well, my older brother didn't bother then found himself shifting loads of stuff in a Luton van. Also cursing his lack of foresight.

 

[Oldvatr]

Thanks for that, very useful.

I thought (I may be wrong) that you had to notify DVLA if you took any medication which carried the risk of a hypo.

Having never had a hypo (as far as I am aware) I have no idea if I am hypo aware.
This is one of the troubling things about moving onto anything that can cause a hypo.
Will I notice during the day? Will I notice over night?
Basically, won't know until you've had one.

I am on an 11 month automatic extension of my licence at the moment, due to lack of resources to process renewals at DVLA.
I have all the forms ready to go.
D4 asks all sorts of questions, including about oral hypoglycemic agents.
I've posted in the past about how illogical the form is, especially where you asked if there is any hypo awareness when you are not on hypo inducing drugs.
[No box for "How the *** would I know???]

Anyway, no hypos on metformin so far.

I want to retain the right to drive vehicles over 3.5 tonnes, because possible motor home some time in the future and I get called on to drive a 7.5 tonne tail lift every year or so for family removals.
In general, I intend to retain every class that I currently have because....well, my older brother didn't bother then found himself shifting loads of stuff in a Luton van. Also cursing his lack of foresight.

I got my first hypo while I was on the max dose of Gliclazide (320 mg)/ I had just that morning completed the DCUK online training course they offer and had just come out of the chemist having just bought a pack of glucose tabs in case of emergency, just like my mum used to do. It was quite mild, and I was not driving and did not need assistance. I had just started low carbing, and it was obvious from my reading progression that I needed to reduce my glic dose, which did over the course of the next month or so. I quite often got low sugars and learned how to recognize the early stages. I rarely get them now as I have reduced down to a maintenance dose (40mg). I never had an event that meant I lost control, although I would not drive at those levels, my diet will drop me into keto fat burning as protection. The beauty of low dose Glic is that I take it at night, and even if I get low, the drug wears off quite quickly so I am not in danger. I think insulin users suffer longer and deeper hypos if they dose wrongly.

 

[Rose22]

Try not to let the med and driving be too much of a worry. I have taken Repaglinide and Glicalazide in the past, both under the needing to test as can cause hypos. I informed my car insurance and they said it’s fine, it’s not based on medical. Didn’t change anything!
Once I was diagnosed type 1 and am now on multiple daily injection of insulin, I informed them and you get a medical licence, so it’s renewed every 3 years instead.
GP stressed on Gliclazide, that 4 is the floor, don’t drive at or below that. I always have hypo treatments in the car, pockets, bags etc on me.
Sometimes over time the meds can’t do what they where at the start, a gp said to me once try as much as you can, but please don’t be upset if it doesn’t work as sometimes there’s nothing you can do, and in my case it was true! I was type 1 all along.
I’ve tried a three month approach before, in 3. Months if still high levels then will look at a new plan and trying this med, with review in 3 months, hba1c and side effects etc. If something doesn’t work or suit you, it’s ok to stop taking it and with your team come up with the next plan in action.
If it’s any consolation I know how you feel re hba1c up...sometimes it’s so upsetting when you see a highest result than expected or would like. I’ve just had the worse in 4 years! Was in contact with specialist nurse and changed regime and helping lots already. Diabetes changes lots.

 

[Resurgam]

Sorry I misunderstood - you wrote several times that you don't want to test, which I took at face value.

 

[pm133]

I specifically don't want to take a drug which REQUIRES me to test before driving and every two hours during a journey, because of the implications for driving licence renewal and insurance. This is the route that I do not wish to go down.
As stated in another response I am self funding Freestyle Libre so I have a very good idea of how my BG is trending throughout the day.

Fair enough. A few of us were under the impression you didn't want to test.
I'll leave it at that.
Good luck with things.

 

[LittleGreyCat]

I have edited my (OP+1) post to try and make it very, very clear that I am only talking about driving when I say I don't want to have to test.

Those who read through the whole thread will; note that I have mentioned using a Freestyle Libre more than once.

 

[LittleGreyCat]

Or could you eat fewer carbs?
When you say "LCHF" what do you mean exactly?

Maybe keep a detailed food diary for a week weighing everything before cooking and see what your intake really is?
Carb creep is a thing and may explain some of your issues?

You did ask....

I might have to revisit, but as far as I am aware I eat between 20 and 50 grams of carbohydrate a day, often less.

Last few times I tested I was in nutritional ketosis but that was a while back.

I've just got some new strips so must test again soon.

 

[LittleGreyCat]

LCHF diet coupled with 4:3 intermittent fasting

Just got round to checking this.
I have previously tried 5:2 but that didn't really help.
I currently eat OMAD.
A 500 kcal limit every other day is worth considering although the usual LCHF relies on the protein and fat to control appetite instead of calorie counting.

 

[nutribolt]

Just got round to checking this.
I have previously tried 5:2 but that didn't really help.
I currently eat OMAD.
A 500 kcal limit every other day is worth considering although the usual LCHF relies on the protein and fat to control appetite instead of calorie counting.

I am eating belly full on non fasting days... not overeating but eating enough... not counting calories .. only counting carbs and focussing on eating good fat... I am a vegetarian but with an exception to egg so while my choices are limited. They aren't as difficult as say what might be for a vegan..

Though i am not extremely overweight to begin with, I am still loosing some weight and i can do with reaching the lower limits of ideal weight range for my height. Thanks for the tip though.