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Normal HbA1c Levels - What should we be aiming for?

Cblake843 said:
His reasoning is to avoid any diabetic complications , additionally he achieved these HBA1C target levels and by doing so reversed a number of diabetic complications he was suffering from. I've read the book several times , it's my diabetic 'bible'.
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Yes I would imagine that is his reasoning, but why such tight bg control to the point where it is unachievable to many when the average non-diabetic range is 4.7 - 5.7 (as Dillinger made reference to in his opening post). It just doesn't make sense to me I'm afraid.

As iHs has pointed out, there are many type 1's who have higher bg control than Dr Bernstein suggests and don't have complications after 40, 50, 60 of living with diabetes, some are members of this very forum.
 
noblehead said:
As iHs has pointed out, there are many type 1's who have higher bg control than Dr Bernstein suggests and don't have complications after 40, 50, 60 of living with diabetes, some are members of this very forum.
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There are also many smokers who have smoked for 60 years and not got lung cancer To me it's the risk factor , running your blood sugars higher than normal (i.e outside the. non-diabetic range) constitutes a certain amount of risk to your health.
 
Cblake843 said:
There are also many smokers who have smoked for 60 years and not got lung cancer To me it's the risk factor , running your blood sugars higher than normal (i.e outside the. non-diabetic range) constitutes a certain amount of risk to your health.
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That's what I'm saying, outside the non-diabetic range which is 4.7 - 5.7 (according to the Mendosa article).

I do think it's an individual choice as to what targets one aims for, I couldn't possibly aim for an Hba1c in the 4's as I rely on my driving licence to make a living, plus I like the fact that I can get in my car and use it at my leisure, to run bg levels so tight (as Bernstein Suggests) would inevitably mean the loss of hypo awareness symptoms which many of us wouldn't want.
 
Also as my histogram shows many more non diabetics in that US sample had levels in the 5-5.9 range, than in the under 5 range so he is aiming for a level lower than most non diabetics.
 
I received my clinic report today - hba1c = 4.4%....I'm really pleased however, my doctors keep telling me to run my levels higher lol
 
Depends what you call complications, @noblehead. I've only just been diagnosed and I may have lots of low-level complications from recent years. Just because they come in below the official red lines doesn't mean I want them to continue.
 
Now signed off consultant, so left to duel with practice(ing) nurse!
 
Thanks for posting that Mendosa blogpost, Dillinger. It's totally to the point. There's a big discussion of this - of low HbA1cs versus hypo risk -going on here at the moment, if you're interested.
 
I think the DCCT trail in the 90s (10s of thousands of patients) found that the risk of complicatins reaches unity with the non-diabetic population at an HbA1c of around 6.5%.

From personal experience, my retinopathy disappeared when my HbA1c went from the 7s to <6.5%, so I believe that to be true. I think that retinopathy scans are a good measure of your overall complication status as they are the only tissue that can be microanalysed regularly.

I agree with Noblehead, any T1 that can get close to 6.5% is doing very well.
 
@SamJB - have you returned from the wilderness? Or possibly I've not seen your posts recently.

Either way good to hear from you!

Best

Dillinger
 


The study into the Joslin 50 Year Medallists made interesting reading, of those who had reached this milestone (with no or few complications) they found that other factors may be playing a part in why some type 1's get complications and others don't, of those who took part in the study the average Hba1c was 7.2%, but crucially they also found that these individuals had good cholesterol levels throughout their time with diabetes and had probably inherited good genes from their parents.

My retinopathy has been in remission for 9 years now, I do think it's a combination of keeping more steady bg levels (not swinging from high to low all the time) and keeping bp and cholesterol levels in check, I started on a low-dose of Ramipril soon after my retinopathy progressed and I do think this has helped somewhat.
 
Dillinger said:
@SamJB - have you returned from the wilderness? Or possibly I've not seen your posts recently.

Either way good to hear from you!

Best

Dillinger
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Hi Dillinger,
Yes I've been posting much less frequently than normal. I've been overwhelmingly busy in work recently. Everything, including my diabetes, has had much less effort spent on it! Hopefully I'll be a little less busy in the new year!
 
smidge said:
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Personally, I'd go for the lowest HbA1c that I can safely achieve.

Smidge
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Same here. I was surprised when I went to a different hospital in summer for a non-diabetic related issue and the consultant there said my Hba1C of 6 was the best one she had seen in years. I aim for 6 and high 5s usually..
 
I am still very new at this game compared to many of you Masters level players, but so far since my diagnoses last May i have been able to keep my HbA1c levels at 5.7% 3 months after diagnoses and again 5.4% when tested about 2 weeks ago.

I may be in my Honeymoon phase still, but I also do my best to inject 15-20 minutes before eating to avoid spikes, stay as active as possible, and eat only 30-60g of carbs per meal. TBH this is just the way i have always been living, even before diagnoses, the only change i have made is no more alcohol, and no more binge eating pizza and crisps while watching movies.. but that is probably for the better.

I don't use a pump, or have a CGM, i just inject before meals, and test before and after (a lot of the time), and tend not to panic if i see readings in the 4mmol/l range.. i welcome 4s most of the time, in fact i get more worried when i see an 8 or above then a 4 lol

So I assume its possible, and safe to achieve, and as others have said "at what cost?" - well for me its been no cost, or at least nothing that i have noticed. But again, thats just me, i have never placed any large value or importance on eating... It keeps me alive, thats enough, it doesn't have to always taste amazing lol
 
I think you are still benefitting from honeymooning diamattic. Once the end of that period is reached, your control of post meal spikes is likely to require more management. I hope I'm wrong and that you have everything nicely set up, but that would be my suspicion.
 
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