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HbA1C

S

stoney

Well-Known Member
Messages
321
Location
South Wales
Type of diabetes
Parent
Treatment type
Pump
Hi Everyone

Went to our Diabetic Clinic for James' first HbA1C since carb counting and came out at 7.4%. We were a bit disappointed cos the readings were always in the 7's when on 2 injections per day, but the Consultant said he expected it to be more as say 9 cos what with his age, puberty, hormones he should be eating a lot more and covering with insulin as he is not really taking on much insulin for his age and weight. I did mention that he is always saying he is starving so we are upping his carb intake, and may even have to inject more often (James was not happy with having to maybe inject more) but we are going back in 2-3 weeks time with a detailed diary to show the DSN.

I was pleased though that James had put on weight and gained height since we started the regime in February but Consultant said he should be eating more now to grow even more :roll:

Oh and the Consultant has asked would I like to go along with him to a lecture so that young doctors can actually ask me about 'Living with Diabetes' (as a parent of course), which I said I would.

Will let you know the outcome of our next meeting with the DSN
 
When I think of what happened when my son (non diabetic) was 14 - 15 I can tell you that he grew about 10 inches, his voice suddenly dropped and there stood a young man instead of a boy. He was always hungry also and could eat a huge amount at afternoon tea, still eat dinner and would be searching the cupboards before bed. If he were the T1 child he would most definitely been having at least one extra injection in the afternoon. Hope you can keep the food and insulin going to keep him less hungry and still with good levels. There is nothing wrong with an hba1c in the 7's. Had you not been carb counting maybe it would have been in the 8's or 9's due to the hormones of puberty.

Look forward to hearing about the lecture with the doctors. Would be interested to hear what they think 'living with diabetes' is really like.
 
Hi,

Don't be disheartened that his hba1c is still in the 7's, it may still be 7 but it may be a BETTER 7.

for example averages:

3.5 + 10.5 + 3.5 + 10.5 + 7 + 7 / 6 = 7 ... (example meaning shows an average of 7 but has highs and lows)

now...

7 + 7 + 5.5 + 8.5 + 5.5 + 8.5 / 6 = 7 ... (example meaning shows an average of 7 but the highs and lows are much closer to seven)

being on basal bolus may in fact be giving you better control even though your hba1c doesnt seem to be any different, hba1c is ONLY an average reading, it disguises highs and lows that produce a good hba1c but when broken down and looked at day by day may not look as good as it seems.

I think your doing great after such a big change!

:)
 
i'm a (relatively May 2010) newly diagnosed diabetic. i had ignored the symptoms for a while but got fed up with drinking litres and litres of water a day and the associated 1/4 hourly trips to the toilet.

initially i was told it was type 1 as my keytones (?) were off the scale. i was put straight onto insulin - noverapid and insulatard. my 1st hba1c was 7.1 - the consultant wrote 'satisfactory' on the letter. my next hba1c was 5.7 - tremendous i thought, that will please her! au contraire, the consultant said it was the sort of level you would expect of a non-diabetic and too low! i thought the point of the insulin, diet control and extra exercise was to make me more like a non-diabetic.

then she told me that she now thinks it is T2 but had been undiagnosed for a long time. i was given the option of switching from injections (which i hate) to tablets but on the basis she said i would almost inevitably end up back on the injections i decided to stick with them.

whilst i appreciate there's a difference between 5.7 and 7.1, my understanding of 'satisfactory' is "kind of OK, could do better" but when i did better (so i thought) i was told it was effectively too good.

any views on what i should be aiming for?

confused of bristol!

by the way, i've really enjoyed reading some of the threads on this site. reading about other peoples' experiences has really helped with some aspects.

wigzaah
 
hi, when i looked at this again i rather formed the view that i may have posted a comment in a 'personal' exchange/discussion. no offence intended if that is the case, i'm very new to the site and still finding my way round it so to speak

apologies

wigzaah
 
wigzaah said:
i'm a (relatively May 2010) newly diagnosed diabetic. i had ignored the symptoms for a while but got fed up with drinking litres and litres of water a day and the associated 1/4 hourly trips to the toilet.

initially i was told it was type 1 as my keytones (?) were off the scale. i was put straight onto insulin - noverapid and insulatard. my 1st hba1c was 7.1 - the consultant wrote 'satisfactory' on the letter. my next hba1c was 5.7 - tremendous i thought, that will please her! au contraire, the consultant said it was the sort of level you would expect of a non-diabetic and too low! i thought the point of the insulin, diet control and extra exercise was to make me more like a non-diabetic.

then she told me that she now thinks it is T2 but had been undiagnosed for a long time. i was given the option of switching from injections (which i hate) to tablets but on the basis she said i would almost inevitably end up back on the injections i decided to stick with them.

whilst i appreciate there's a difference between 5.7 and 7.1, my understanding of 'satisfactory' is "kind of OK, could do better" but when i did better (so i thought) i was told it was effectively too good.

any views on what i should be aiming for?

confused of bristol!

by the way, i've really enjoyed reading some of the threads on this site. reading about other peoples' experiences has really helped with some aspects.

wigzaah
Click to expand...

Hi,

Only just saw this, and i've seen your other comment so don't worry about it at all! can be quite confusing knowing where to post at first as there is many places!

Sounds like you need a definate diagnosis of what type of diabetes you have, ask your doctor to back up her thoughts of you actually being type 2, i can't remember what the test is called but your doctor should know.

I'm pretty sure the targets for HBA1c for type 1 is 6.5-7.5% this is to reduce your chances of developing complications, and being below 6.5% can sometimes indicate you are having too many hypo's which of course is not good, however this is not always the case, many Type 1's have HBA1c's in the 5's and 6's without hypos and just general great control!

The targets for T2's are set lower, as not all T2's are treated with oral medication or insulin, it's easier to acheive a lower HBA1c as there is a lesser risk of hypo's when not on medication.

It's only a guideline though, and it's become very apparent to me it should be set on an individual basis what your personal targets are.

My HBA1c is currently 7.2% that was after two months of using an insulin pump instead of injections, so i'm waiting for another 3 months to have another when it's settled down more and a full view so i don't think thats quite accurate yet. However my consultant is delighted with my hba1c being 7.2% as my perivous ones have been horrendous!

I think you should first establish what type you are, and it is clear that your HBA1c is good by most peoples standards so i don't see why you should stop what your doing. 5.7% for type 1 is brilliant. 5.7% for type 2 is also brilliant to me, other people may agree or disagree.

I think it's still a very much debated subject of what level is best depending on type, where as it should be what your targets are, not everyone elses!

And again, you certainly didn't cause offence at all. Hope this helps a little for you :)
 
James seems to be doing fine, don't be disappointed with those HbA1c's, as said you need to look at his daily control to get a good idea of how it's going.. If you can slowly build up on the carbs side of things then you be better able to gauge what effects with insulin..

Some carbs cab be pretty sneaky such as one that contain high fat content, which slows the adsorbtion down and giving was it termed as a pizza effect, where by you hit a hypo at the 1-2 hour mark and the bloods then increase at 3,4,5 hour marks.. Sometimes on high fat content meals it's better to inject part of the bolus before eating and the rest just after or about 30-60mins after to avoid the pizza effect.. But keep doing the BG's and you will hopefully find what suits James the best..

Sadly to do MDI effectiviely it can mean increasing the injections with having to do corrections or splitting injections to achieve the control, if James doesn't like injections perhaps a insulin pump maybe a option for him, they can be niffty little gadgets and when you got your head around best way to use them, give you so much more flexibility than injections.. There are actually well suited to teenagers because it can make the keeping up with hormones and teenage lifstyle changes a lot easier and effective..

Wigzaah

Are you being treated by your GP or the diabetic clinic! if GP then asked to be referred to the diabetic clinic Bristol diabetic clinic is pretty good.. As if you just been dignoised you could still be in the honeymoon period, your pancrea's is still able to produce stablising insulin which helps to maintain better control and a lower need for insulin!

But the tests that can help to determine whether you are T1, T1.5 or T2 etc are called C-petide and there is another one called GAD test...
 
Stoney,

It's early days and all things considered James is doing really well! :)

Both MDI and carb counting takes a little time to adjust too and I am sure this time next year it will become much easier for you all. Hope the lecture goes well and do come back and let us know how you got on.

Nigel
 
ebony and jopar

thanks for the kind comments and advice. i'm under the consultant at southmead hospital, the dsn there (Prue) is just amazing, i would never have managed without her help and advice at the outset. i can't praise her enough. the consultant is very helpful and clearly very knowledgeable but i feel like i'm left wondering which type i have, or indeed in the long term whether it matters. given at my last appointment i was told i could possibly switch to tablets but would end up back on injections one day i just don;t know if it matters particularly whether it's T1 or 2 and i've convinced myself it doesn't matter as long as i keep my readings within the range i was given.

can i ask what an insulin pump is and how does it work? i see someone had on their signature that they've just changed to a pump from injections, is it easier / less painful? my tummy and backside look like pin cushions and i find it embarrassing at the swimming pool and in the showers at the golf club when people are looking at the bruises!

stoney - i don't you or anything about your circumstances with your son James but from what i've read here sounds like you're doing a sterling job at what is a very difficult time of life for a young person anyway, but added to puberty your lad has to adjust to diabetes as well. i can only comment on my own experiences, it does become easier over time and you do get to grips with the ratio of insulin to carbs although from your postings sounds like you've got a pretty good handle on it already.

when i was diagnosed my wife was away and i remember vividly being on my own trying to do my first injection, it took about half an hour / 45 minutes and a lot of vodka (i'm terrified of needles and although they're only small the act of putting one into myself was almost too much!)

anyway, the point i was trying to make is that it does get easier. good luck with james and i commend you for agreeing to go to the lecture to pass on your own experiences to those who have to understand the condition but only have books and good people like yourself who are willing to give up their time to learn from. i look forward to reading about the experience in due course.

Wigzaah
 
''can i ask what an insulin pump is and how does it work? i see someone had on their signature that they've just changed to a pump from injections, is it easier / less painful? my tummy and backside look like pin cushions and i find it embarrassing at the swimming pool and in the showers at the golf club when people are looking at the bruises!''

Sure :)

An insulin pump is another way of delivering insulin, is still uses the basal/bolus regime, but only uses fast acting insulin (i use only novorapid) this is because it's programme to give very small amount of insulin over a few minutes. (mine delivers insulin every 3 minutes) because it's delivered pretty much constantly you wear what is called a cannula, its a needle into the fatty tissue just like an injection, which is held down by a sort ot sticky patch, this is connected to a tube which is connected to your pump.

There are different sorts of cannula's, i use a steel 6mm cannula, which is very often painless to insert, and can hardly feel it when i wear it everyday, the steel cannula's are worn for the maximum of 48 hours, the teflon cannulas you can get can be worn for up to 72 hours, but there are people who change them more often.

You are connected 24/7 really and only disconnect for showering, swimming and things like that.

It's not easier, especially in the beggining, you have to test your BG ALOT! i'm currently testing no less that around 8 times a day.

The pump enables you to be more precise in your basal insulin as you can programme how much insulin you get per hour. so for example is you suffer from the Dawn phenomenom then you can counter act this by increasing a few hours in the morning, instead of having to have a fast acting injection at 3am like many people do to overcome this.

It also gives boluses to 0.1 of a unit, so unlike the pens you use for injections you can be very accurate in what doses you give.

There are many pro's to an insulin pump, and like everything there are con's too.

It's an individual thing as to it all if you would like to try a pump. Some people are very happy and well controlled on injections.

There are many different reasons why people choose a pump, such as poor control on MDI, Loss of hypo awareness etc.

I chose to go on a pump because my control wasn't very good on MDI, and boy did i try!

Since being on the pump my control is now pretty **** good by my standards, i've only have it for just over 3 months though so i'm still learning alot!

Hope this helps explain it a little, theres alot to explain about insulin pumps, you can always google if you want to learn more as thats what i did when i first heard of them and read about them on many different websites. There are also pump forums, devoted to pumpers so thats always a good read to just to see people experiences and thoughts :)
 
thanks ebony, it's useful to read about personal experiences rather than just theory. my outlook on may things is "if it ain't broke don't fix it", i've got good control of my levels so i think i'll stick with pin cushion!

thanks again for your reply

Wig
 
wigzaah said:
thanks ebony, it's useful to read about personal experiences rather than just theory. my outlook on may things is "if it ain't broke don't fix it", i've got good control of my levels so i think i'll stick with pin cushion!

thanks again for your reply

Wig
Click to expand...

I prefer to read about experience rather than theory too, glad MDI is working well for you. Always good to know your options :)
 
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