My first HbA1c after diagnosis

[Kylie_Baker]

Hi all,

I've received my first HbA1c result after diagnosis to be 6.1 I thought this was great. However, my consultant has told me that this is too low and that i should be looking to increase this to around 6.5 as the risk of sudden death is more possible with readings of around 6.0.

I was reading low BS in the mornings averaging 4.5/5.0 and i have therefore decreased my Lantus by 1 unit, which seems to be sorting this out. Perhaps this is what he was directing the comment to?

Does anyone had any experience or knowledge about the above? It seems strange especially when I see everyone's recorded HbA1c on this forum to be decreasing to around 5.0.

Thanks so much

Kylie

 

[Pneu]

Kylie... This is a difficult question to answer...

In some ways your consultant is right... the closer you run your blood glucose to 'normal' levels the greater the risk of hypo's...

On the other hand if you can run stable low blood glucose then in my opinion there is nothing wrong with this.. I have run an HbA1c in the low 5's / high 4's for a long time.. I know my body and my diabetes... my consultant is not unhappy with this as I have hypo awareness and test regularly.. I haven't had a serious hypo in years..

Non-insulin controlled diabetics have a much lower risk of hypo (these tend to be the individuals with sub 6% HbA1c's) and therefore can afford to run much tighter control safely than those type II on insulin and us type I's.. I would suggest that as you are newly diagnosed you do run you blood glucose at a slightly higher level.. this will give you more head room to make a mistake... once you get the hang of it and an understanding of your diabetes you can then make the decision to run tighter control should you wish..

 

[Elc1112]

Kylie,

6.1 is an excellent reading, so well done. As you're newly diagnosed your consultant may want you to increase this level slightly to avoid hypos, at least until you've got a fill handle on how to adjust your doses etc. My hba1c is usually between 5 and 6.5. When it reaches the top of this range I'm normally told to reduce it to ward off any potential complications. It's true that the lower your hba1c te lower your average blood sugars. This could mean you're having more hypos, which is why some type 1s are told to increase their hba1c. To be told by your consultant that 6.1 is too low and you're at risk of sudden death is ridiculous though. Once youve been diabetic for a few years they'll be telling you that anything above 6.5 is bad. I think you need to chat with him again to understand why he wants you to raise this figure and what the safe ranges for a diabetic are. I imagine he just wants to help you avoid hypos but his advice on sudden death is, quite frankly, appalling. Well it is in my opinion at least!

 

[SAH154]

Hi Kylie my first HBA1C post diagnosis was 6.7% which I put down to the honeymoon period as my sugars/insulin control rocketed and things went badly as my HBA1Cs were 11-12 for many years after much hard work and complications and above all after a row with a stupid consultant I was moved to a different PCT and my present consultant is fantastic and prior to my operation my HBA1Cs were in the 8s so not perfect but this did arrest a lot of the complications I have.

6.1% as said is a fantastic result and is almost within the non-diabetic range of between 4- 6%

Study's have shown 7% is the best result and below that the risk of death/hypos outweighs the benefits of tighter glucose control

A lot depends of nocturnal hypos if you have them now and then you need to be aware this is a very at risk time for a lot of T1s and you also need to be aware some T1s have little problems and great control I used to work with a guy who hardly ever tested his bloods, used mixtard insulin (which is generally rubbish) never had hypos and had HBA1c between 6-7% but these people are rare

 

[Pneu]

Study's have shown 7% is the best result and below that the risk of death/hypos outweighs the benefits of tighter glucose control

I am afraid this is not the case.. There was one 'study' that looked at a collection of data that suggested this result.. this data was then later re-reviewed and this was shown not to be the case. There is also plenty of other more recent research that supports the later findings, I am not at home at the moment where I have the links but I am sure someone will be able to provide the links.

The simple truth is if you have hypo awareness and stable control then you are best to run your glucose as tight as possible.. this is why a lot of countries the recommended maximum HbA1c is 6.5%. The last time I had a doctor quote this at me I asked the following question: "assuming the same number of hypo's, would you choice an HbA1c of 7% or 5.5%" the consultant said 5.5% everytime.. now for some people this is an unrealistic target but lets be clear if you have hypo-awareness and stable glucose you are best to aim as low as safely possible.

 

[SAH154]

Study's have shown 7% is the best result and below that the risk of death/hypos outweighs the benefits of tighter glucose control

I am afraid this is not the case.. There was one 'study' that looked at a collection of data that suggested this result.. this data was then later re-reviewed and this was shown not to be the case. There is also plenty of other more recent research that supports the later findings, I am not at home at the moment where I have the links but I am sure someone will be able to provide the links.

The simple truth is if you have hypo awareness and stable control then you are best to run your glucose as tight as possible.. this is why a lot of countries the recommended maximum HbA1c is 6.5%. The last time I had a doctor quote this at me I asked the following question: "assuming the same number of hypo's, would you choice an HbA1c of 7% or 5.5%" the consultant said 5.5% everytime.. now for some people this is an unrealistic target but lets be clear if you have hypo-awareness and stable glucose you are best to aim as low as safely possible.

I think half the problem for T1s is you get conflicting info from all the various people you see - a lot of it is down to never seeing the same person at hosp twice!
When I was diagnosed in 1992 the rubbish I was told about diabetes now many years later appears frankly shocking

I see what you mean about the HBA1C results google gives me this which suggests 6.5% is perfect and not a maximum

FWIW my own consultant suggests in the 6-7% range

http://medweb.bham.ac.uk/easdec/prevent ... _hba1c.htm

A normal non-diabetic HbA1C is 3.5-5.5%. In diabetes about 6.5% is good.

This is perhaps a more sensible approach
http://www.diabetes.co.uk/what-is-hba1c.html

For non-diabetics, the usual reading is 4-5.9%.
For people with diabetes, an HbA1c level of 6.5% is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics.
People at greater risk of hypoglycaemia may be given a target HbA1c of 7.5%

For a lot of T1s of even getting to an HBA1C of 7%-8% is not easy best I managed was 8% exactly which is why it depends on hypos etc I had enough random ones as it was if I tightened up control I'd have them most days and usually several

 

[Pneu]

I quite agree if you are have more brittle control then running higher blood glucose is going to give you more wriggle room.. For the most part I think hypo's are always explainable.. after all blood glucose is a closed system with certain inputs and outputs... understanding everything that goes on is clearly not easy but usually you can make an educated guess..

Although not in all cases in a lot of cases where I have talked to people via PM on here re-control the issue has always been incorrect background insulin... many don't fully understand how to control it... if you don't have control over your background you will never have full control of your blood glucose.

My control is tight I test often and for the most part have very few hypo's I know however if I tested say 4 times a day instead of 12 then I would hypo a lot more and could never dream of running such tight control. I am not saying that good control is easy.. and some will find it easier than others but I think a lot of it is down to regime.. if you test a lot and dose adjust and split background insulin then you will achieve better control, couple this with a controlled carb diet and exercise and you will see real results.. is 5% a target everyone can reach probably not.. but I don't think sub 7% is out of the question for 99% of diabetics..

 

[SAH154]

I quite agree if you are have more brittle control then running higher blood glucose is going to give you more wriggle room.. For the most part I think hypo's are always explainable.. after all blood glucose is a closed system with certain inputs and outputs... understanding everything that goes on is clearly not easy but usually you can make an educated guess..

Although not in all cases in a lot of cases where I have talked to people via PM on here re-control the issue has always been incorrect background insulin... many don't fully understand how to control it... if you don't have control over your background you will never have full control of your blood glucose.

My control is tight I test often and for the most part have very few hypo's I know however if I tested say 4 times a day instead of 12 then I would hypo a lot more and could never dream of running such tight control. I am not saying that good control is easy.. and some will find it easier than others but I think a lot of it is down to regime.. if you test a lot and dose adjust and split background insulin then you will achieve better control, couple this with a controlled carb diet and exercise and you will see real results.. is 5% a target everyone can reach probably not.. but I don't think sub 7% is out of the question for 99% of diabetics..

Yes I achieved the 8% by 6-8 tests a day some T1S I know are hampered by their GPs being stingy with the strips mine were fine and gave me 4 boxes at a time - yes the background insulin can be a nightmare to set.

also insulin absorption can vary with some individuals for no apparent reason - my consultant used to always check my sites but couldn't find any problems but still it carried on

Your HBA1C seems pretty perfect and if you rarely have hypos then 8) 8) 8)

Wish I'd found this place earlier

 

[LaughingHyena]

I had a 5.5% around 6 months after diagnosis, which my consultant was worried was a bit on the low side. Her explainiation at the time (form what I remember, this was a year ago) was that she wanted to make sure that the changes I'd made to get that result were sustainable for the long term. She said she sees a lot of people who make big changes when they are first diagnosed but find them too restrictive to stick too and give up completely. Hypos were another risk we discussed though I was not finding them a problem at that point.

Personally I like to wake up around 5, partly as I feel it gives me a bit of room to drop if I have a lie in (well if the kids will let me :lol: ) and partly because I'm often driving or cycling shortly after (though I do have breakfast first)

 

[noblehead]

Congratualations on your excellent Hba1c Kylie :clap:

 

[thetallerpaul]

Kylie,

Second the congratulations. Mine was 11.9% on first diagnosis. I've got a long way to go on mine to be as good as you!

Paul

 

[xyzzy]

Kylie

If your consultants arguments were based more on what is a healthy HBA1C as opposed to the hypo risk argument then there was a 2009 UK study that suggested it may be better to run at 7.5%?

http://www.sciencedirect.com/science/article/pii/S0140673609619693

I can't find the counter research but the fact the result was later over turned is mention in this 2011 Swedish research doc as they examined the UK data and rejected it when making that countries HBA1c target policy last year. I think the problem others had with the UK data was something to do with the general unhealthiness in CVD terms of the set of diabetics they chose to measure.

http://www.healthcare-bulletin.com/...ascular_Disease__in_Diabetes_Care_-_2011_.pdf

 

[thetallerpaul]

xyzzy,

Ah the old sample selection issues that plague all diabetes research. If I'd know ahead I would be in this place and how poor the research is in a chronic illness that effects millions of people I'd have gone to medical school so I could help. I wouldn't need to figure out a cure to make a big difference just a better understanding of the risks and strategies for management would be great. If anyone is a medical researcher on here can you get on this ASAP? Thanks!

Peace to all!

Paul.