HbA1c

[SueJB]

Hi everyone,
I'd like some advice and thoughts on HbA1c. To be honest, I'm not sure what this really is and how important it is and what to do about it.
I was diagnosed T1 in Aug this year when it was 118mmol (13%). Two months later it was 67 (8.2%).
I measure my blood glucose and inject (basal/bolus).
From what I've read on other people's posts, they seem to be injecting a lot and I'm hardly doing anything.

So the questions are:
have I been correctly diagnosed?
can someone with type 1 go without medication and deal with diabetes just through diet?
if I've been given a target of 50-55mmols for HbA1c, what do I do to achieve this?

 

[paulus1]

no type1 cant do without meds. you maybe in the honeymoon period so your body is still producing some insulin but not enough. it will eventually die off 67 is still well into the diabetic range. please dont stop your meds. its very unsafe. see your consultant and get the 2 test that will determine if you are type 1.

 

[urbanracer]

Hi everyone,
I'd like some advice and thoughts on HbA1c. To be honest, I'm not sure what this really is and how important it is and what to do about it.
I was diagnosed T1 in Aug this year when it was 118mmol (13%). Two months later it was 67 (8.2%).
I measure my blood glucose and inject (basal/bolus).
From what I've read on other people's posts, they seem to be injecting a lot and I'm hardly doing anything.

So the questions are:
have I been correctly diagnosed?
can someone with type 1 go without medication and deal with diabetes just through diet?
if I've been given a target of 50-55mmols for HbA1c, what do I do to achieve this?

1/ Diagnosis - what symptoms did you present with, and what tests were you given?

2/ It is highly unlikely that a T1 can survive without medication.

3/ Your A1c number is basically an average of your blood glucose level over the previous 2 to 3 months. We lower it by using insulin and possibly some changes to diet, although in theory at least, you can eat what you want as a T1.

 

[therower]

Hi @SueJB . Welcome to the forum.
Firstly looking at the vast improvement in your HbA1C it is safe to assume that you need medication to control your diabetes which it would be safe to say is T1.
In the early stages of diabetes, you will be in a honeymoon period, your pancreas hasn't completely stopped producing insulin. It can have a mind of it's own though, being very irregular in how much and when it decides to supply insulin. The fact you are taking insulin now even be it a small amount also aids the pancreas, it gives it a helping hand as it were. Unfortunately this situation will not last forever at which time your insulin medication will change and you may find an increase in the amount of insulin you inject.
Never gauge your insulin dosage/ requirements alongside others. We are all different with different requirements.
Lifestyle and diet play a major role in insulin requirements which is important to remember.
You've been given a target. Getting close to this target is something to strive for and will take time. Remember it's only a target though, again we are all different, you have to find a comfortable, satisfying lifestyle that helps you get as good a HbA1C as possible. You're doing great at the moment, that's for sure and if you continue in your current vein you'll be just fine.

Diabetes isn't just about numbers, it's about living your life.

Keep posting.

 

[catapillar]

From what I've read on other people's posts, they seem to be injecting a lot and I'm hardly doing anything.

What exactly are you doing? You are measuring you blood glucose and taking your insulin? Have you done any basal testing to check your basal dosage is correct for you? Are you carb counting and are you confident your insulin to carb ratio is correct for you?

have I been correctly diagnosed?

I've got no idea. Do you want to tell us a bit more about how you were diagnosed? What were you blood sugar and ketone levels on diagnosis, what caused the trip to the doctors to get diagnosed, what symptoms were you presenting with, did you have dramatic weight loss pre diagnosis, what age were you when diagnosed and what was your BMI? What do you blood sugar levels look like now you are on insulin and what sort of total daily dose of insulin are you taking? Have you had cpeptide testing to see what your endogenous insulin production is looking like (bearing in mind a newly diagnosed type 1 can still be producing insulin - see below) or antibody testing to see if you have the antibodies associated with autoimmune type 1 diabetes (beating in mind only a positive GAD test is definitive that you are certainly type 1, a negative GAD test doesn't necessarily mean you aren't type 1, about 25% of type 1s are GAD negative)?

can someone with type 1 go without medication and deal with diabetes just through diet?

No. They'll die, dead. Everyone needs insulin to stay alive. Type 1 diabetics don't make insulin themeselve, so if they want to stay alive they must continue injecting insulin regardless of whatever diet they might be on.

Newly diagnosed type 1 diabetics do have some residual insulin production, this is known as the honeymoon period. Type 1 is an autoimmune disease where the immune system gets bored/confused and kills off the insulin producing beta cells in the pancreas. The kill off of the beta cells doesn't happen all at once, it's not like flicking a switch, the kill off can take time, especially in later diagnosed type 1s where the immune system is not so efficient. Some type 1s can have a particularly long, strong honeymoon period where they are able to come off insulin for a little while. But once the autoimmune attack has started, we don't know how to stop it. So the honeymoon period will come to an end and insulin will be needed to stay alive eventually.

if I've been given a target of 50-55mmols for HbA1c, what do I do to achieve this?

You control your blood sugar levels by using your insulin. Again, I would suggest basal testing and carb counting. I would also suggest getting a hold of the book "think like a pancreas" which is a great guide to the basics you need to know to manage type 1.

 

[Scott-C]

I'd like some advice and thoughts on HbA1c. To be honest, I'm not sure what this really is and how important it is and what to do about it.

The "posh" name for hba1c is "glycosylated haemoglobin". When you eat carbohydrates, they get broken down into glucose and then go into your bloodstream and then into body cells to be used as energy. Insulin acts as a chemical key to alllow the glucose to get into the cells - too little insulin and the glucose just stacks up in the bloodstream. Some of the glucose, even in non-diabetics, gets chemically "stuck" or glycosylated onto red blood cells, the haemoglobin. The more glucose there is, the more that gets stuck. Red blood cells last for about 2 to 3 months. So, the hba1c test looks to see how much glucose is stuck to blood cells to give an idea of how much glucose on average there's been kicking around in your bloodstream in the last few months.

The higher it is, the higher the chances of longer term complications, because excess glucose puts pressure on smaller blood vessels.

The way to reduce hba1c is to pay careful attention to how you use your insulin, balancing it against how much carbohydrate you eat. Generally, we try to keep blood sugar levels between 4 to 7, but spikes above that after meals are ok provided they don't last too long. You're newly dx'd so don't expect to be in range all the time - it's a learning game at the moment.

 

[DavidGrahamJones]

have I been correctly diagnosed?

Probably, you might try and get a c-peptide test to see how your pancreas is doing. Problem being our cash strapped NHS might not like it. I funded my own c-pep test at around £90. For me it merely confirmed that my pancreas wasn't broke after years of taking gliclazide which gets the pancreas to produce more insulin.

can someone with type 1 go without medication and deal with diabetes just through diet?

No.

I've been given a target of 50-55mmols for HbA1c, what do I do to achieve this?

I think Scott describes it well, it's a balancing act. It's also going to be a big learning curve, but at least here there are people who have got the t-shirt and seen the video. They can share experiences, but cannot advise.

 

[ringi]

My advice would be to assume you are Type1 until proven otherwise. Measure your BG after every meal, and adjust your insulin based on your BG levels. Slowly reduce the carbs you are eating, so as to reduce the risk of Hypos.

"basal testing" will tell you how much basal you need.

A few people have reported stopping the autoimmune process in Type1 by going very low carb and avoiding all grains, but it is reasonable to assume that if you have tested positive for Type1, you will not be able to stop the process. But lots of people with Type1 find that "very low carb" makes it easier for them to control their insulin dose.

If you have not tested positive for Type1 antibodies, the doctors will be guessing the type of diabetes you have, as about half the people with Type1 don't test positive. If it turns out you have Type2 installed of Type1, you would have done the right thing by slowly reducing your carbs adjusting your insulin dose for what your body needs.

Remember you MUST keep testing BG even when it has been OK for some time, as your body can without warning stop producing insulin of its own.

 

[SueJB]

no type1 cant do without meds. you maybe in the honeymoon period so your body is still producing some insulin but not enough. it will eventually die off 67 is still well into the diabetic range. please dont stop your meds. its very unsafe. see your consultant and get the 2 test that will determine if you are type 1.

Thanks, I thought as much but still living in hope

 

[SueJB]

Hi @SueJB . Welcome to the forum.
Firstly looking at the vast improvement in your HbA1C it is safe to assume that you need medication to control your diabetes which it would be safe to say is T1.
In the early stages of diabetes, you will be in a honeymoon period, your pancreas hasn't completely stopped producing insulin. It can have a mind of it's own though, being very irregular in how much and when it decides to supply insulin. The fact you are taking insulin now even be it a small amount also aids the pancreas, it gives it a helping hand as it were. Unfortunately this situation will not last forever at which time your insulin medication will change and you may find an increase in the amount of insulin you inject.
Never gauge your insulin dosage/ requirements alongside others. We are all different with different requirements.
Lifestyle and diet play a major role in insulin requirements which is important to remember.
You've been given a target. Getting close to this target is something to strive for and will take time. Remember it's only a target though, again we are all different, you have to find a comfortable, satisfying lifestyle that helps you get as good a HbA1C as possible. You're doing great at the moment, that's for sure and if you continue in your current vein you'll be just fine.

Diabetes isn't just about numbers, it's about living your life.

Keep posting.

I appreciate your comments but the only thing I'm sorting hanging on to at the moment is how I compare to others. I don't know what is "normal"

 

[SueJB]

What exactly are you doing? You are measuring you blood glucose and taking your insulin? Have you done any basal testing to check your basal dosage is correct for you? Are you carb counting and are you confident your insulin to carb ratio is correct for you?



I've got no idea. Do you want to tell us a bit more about how you were diagnosed? What were you blood sugar and ketone levels on diagnosis, what caused the trip to the doctors to get diagnosed, what symptoms were you presenting with, did you have dramatic weight loss pre diagnosis, what age were you when diagnosed and what was your BMI? What do you blood sugar levels look like now you are on insulin and what sort of total daily dose of insulin are you taking? Have you had cpeptide testing to see what your endogenous insulin production is looking like (bearing in mind a newly diagnosed type 1 can still be producing insulin - see below) or antibody testing to see if you have the antibodies associated with autoimmune type 1 diabetes (beating in mind only a positive GAD test is definitive that you are certainly type 1, a negative GAD test doesn't necessarily mean you aren't type 1, about 25% of type 1s are GAD negative)?



No. They'll die, dead. Everyone needs insulin to stay alive. Type 1 diabetics don't make insulin themeselve, so if they want to stay alive they must continue injecting insulin regardless of whatever diet they might be on.

Newly diagnosed type 1 diabetics do have some residual insulin production, this is known as the honeymoon period. Type 1 is an autoimmune disease where the immune system gets bored/confused and kills off the insulin producing beta cells in the pancreas. The kill off of the beta cells doesn't happen all at once, it's not like flicking a switch, the kill off can take time, especially in later diagnosed type 1s where the immune system is not so efficient. Some type 1s can have a particularly long, strong honeymoon period where they are able to come off insulin for a little while. But once the autoimmune attack has started, we don't know how to stop it. So the honeymoon period will come to an end and insulin will be needed to stay alive eventually.



You control your blood sugar levels by using your insulin. Again, I would suggest basal testing and carb counting. I would also suggest getting a hold of the book "think like a pancreas" which is a great guide to the basics you need to know to manage type 1.

Yikes! Thanks for all of this. Lots of questions and lots of stuff I just don't understand. I'm 64 and was diagnosed 3months ago, weight loss over 2years of 17k but the thirst was making me worried and that prompted me to visit the doc. Ketone then when the doc tested it was 4.8 and was sent straight to hospital. I actually felt fine and was told I wasn't in/didn't have ketoacidosis or something sounding like that. Since diagnosis I've put on 5k. I test my BG and it's between 5-7mmols except when I'm bad and eat ginger nuts or drink cider. I have no idea what a cpeptide is nor what a GAD test is.All I do know for certain is they say I've got type1. I don't know how to do a basal testing to see if the dose is correct, the diabetic specialist nurse just said "inject 5 units twice a day". I understand now about the honeymoon so that's probably where I am. I really appreciate your comments.

 

[SueJB]

The "posh" name for hba1c is "glycosylated haemoglobin". When you eat carbohydrates, they get broken down into glucose and then go into your bloodstream and then into body cells to be used as energy. Insulin acts as a chemical key to alllow the glucose to get into the cells - too little insulin and the glucose just stacks up in the bloodstream. Some of the glucose, even in non-diabetics, gets chemically "stuck" or glycosylated onto red blood cells, the haemoglobin. The more glucose there is, the more that gets stuck. Red blood cells last for about 2 to 3 months. So, the hba1c test looks to see how much glucose is stuck to blood cells to give an idea of how much glucose on average there's been kicking around in your bloodstream in the last few months.

The higher it is, the higher the chances of longer term complications, because excess glucose puts pressure on smaller blood vessels.

The way to reduce hba1c is to pay careful attention to how you use your insulin, balancing it against how much carbohydrate you eat. Generally, we try to keep blood sugar levels between 4 to 7, but spikes above that after meals are ok provided they don't last too long. You're newly dx'd so don't expect to be in range all the time - it's a learning game at the moment.

Thanks, makes me wonder if my hba1c has been high for all the time I was losing weight and didn't know about it.

 

[SueJB]

My advice would be to assume you are Type1 until proven otherwise. Measure your BG after every meal, and adjust your insulin based on your BG levels. Slowly reduce the carbs you are eating, so as to reduce the risk of Hypos.

"basal testing" will tell you how much basal you need.

A few people have reported stopping the autoimmune process in Type1 by going very low carb and avoiding all grains, but it is reasonable to assume that if you have tested positive for Type1, you will not be able to stop the process. But lots of people with Type1 find that "very low carb" makes it easier for them to control their insulin dose.

If you have not tested positive for Type1 antibodies, the doctors will be guessing the type of diabetes you have, as about half the people with Type1 don't test positive. If it turns out you have Type2 installed of Type1, you would have done the right thing by slowly reducing your carbs adjusting your insulin dose for what your body needs.

Remember you MUST keep testing BG even when it has been OK for some time, as your body can without warning stop producing insulin of its own.

I'm definitely type 1 I've been told but am just hoping it's not correct. I eat very few carbs anyway but there is carbs in almost everything so I just don't know how much to inject before a meal. It just seems like guess work and it's so frustrating I could weep or scream or both

 

[ringi]

Remember that if a meal is low carb, you need to inject for the protein at half the rate (per gram) you do for carbs. The BG peak is also later if you have few carbs, so you may need to split your insulin dose.

 

[catapillar]

Yikes! Thanks for all of this. Lots of questions and lots of stuff I just don't understand. I'm 64 and was diagnosed 3months ago, weight loss over 2years of 17k but the thirst was making me worried and that prompted me to visit the doc. Ketone then when the doc tested it was 4.8 and was sent straight to hospital. I actually felt fine and was told I wasn't in/didn't have ketoacidosis or something sounding like that. Since diagnosis I've put on 5k. I test my BG and it's between 5-7mmols except when I'm bad and eat ginger nuts or drink cider. I have no idea what a cpeptide is nor what a GAD test is.All I do know for certain is they say I've got type1. I don't know how to do a basal testing to see if the dose is correct, the diabetic specialist nurse just said "inject 5 units twice a day". I understand now about the honeymoon so that's probably where I am. I really appreciate your comments.

It's very very unusual for a type 2 diabetic to have ketones on diagnosis because ketones are caused by more than just high blood sugar, they are caused by a lack of insulin. Type 2s have too much insulin. Type 1s have not enough insulin. So your diagnosis with very high ketones present strongly suggests type 1 is the correct diagnosis. Not being in diabetic ketoacidosis means the ketones hadn't yet got to a stage where they were turning your blood acidic. But 4.8 is still a high ketone level and makes type 1 the most likely diagnosis.

A C peptide test is a test to see what your endogenous insulin production is looking like. Cpeptide is a protein waste product made when your pancreas is making insulin. It can be done via a blood test or a urine test. But, it is not unusual for a newly diagnosed type 1 to still have decent insulin production happening.

A GAD test is a test to see if you have the antibodies associated with autoimmune type 1. A GAD test is done via a blood test.

Both cpeptide and GAD tests would need to be ordered by a medic.

A basal test is something you can do yourself. Here is guide on how to basal test - https://mysugr.com/basal-rate-testing/

 

[SueJB]

Remember that if a meal is low carb, you need to inject for the protein at half the rate (per gram) you do for carbs. The BG peak is also later if you have few carbs, so you may need to split your insulin dose.

Thanks Ringi,
No one told me about protein

 

[SueJB]

It's very very unusual for a type 2 diabetic to have ketones on diagnosis because ketones are caused by more than just high blood sugar, they are caused by a lack of insulin. Type 2s have too much insulin. Type 1s have not enough insulin. So your diagnosis with very high ketones present strongly suggests type 1 is the correct diagnosis. Not being in diabetic ketoacidosis means the ketones hadn't yet got to a stage where they were turning your blood acidic. But 4.8 is still a high ketone level and makes type 1 the most likely diagnosis.

A C peptide test is a test to see what your endogenous insulin production is looking like. Cpeptide is a protein waste product made when your pancreas is making insulin. It can be done via a blood test or a urine test. But, it is not unusual for a newly diagnosed type 1 to still have decent insulin production happening.

A GAD test is a test to see if you have the antibodies associated with autoimmune type 1. A GAD test is done via a blood test.

Both cpeptide and GAD tests would need to be ordered by a medic.

A basal test is something you can do yourself. Here is guide on how to basal test - https://mysugr.com/basal-rate-testing/

Thanks, you clearly know a lot and appreciate you sharing it.

 

[ringi]

All the people with Type1 who have impressed me most with the level of control they have say they have read the "Dr. Bernstein's Diabetes Solution" book.........

I don't agree with some of his views on Type2, but even on Type2 he is way ahead of the NHS, and most people find reading his book for the first time to be hardwork, but I expect you will find it is well worth investing a few weekends in reading it.