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Normal(ish) HbA1c - what next?

LittleGreyCat

Well-Known Member
Retired Moderator
Messages
4,432
Location
Suffolk, UK
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
My last HbA1c after three months of sticking strictly to LCHF (or at least LC - I think I am still a bit high on the protein) my last HbA1c was 5.8 (39.9).

This is on the high side of normal, but is below pre-diabetic so I assume that I am officially in remission.

I do, however, have high cholesterol (due at least partly, I think, to the high fat part of my diet which is mainly dairy; it majors in butter and cream).

I know that there is much debate on how dangerous high cholesterol is, and I am researching this at the moment, but the major issue for me at the moment is which health care team should I now be bothering?

The Diabetes team have helped me succeed in normalising my BG control.

Are they now the best team to address the high cholesterol, or should I be looking at a cardiovascular specialist team?

Equally, should I be bothering https://heartuk.org.uk/ who call themselves the cholesterol charity?

This is a very serious question: I know that at best I am in remission from T2 because of my change in eating style. However this seems now not to be my most pressing health issue and perhaps I should refocus on the cholesterol (although I am mainly convinced that it is not an issue).

I have another background concern; assuming that I maintain my normal HbA1c I assume that I will be considered "sorted" by my GP. I would obviously still like at least an annual check on HbA1c and I am also considering that keeping taking Metformin may be good for my long term health because of the reported non-diabetic beneficial side effects. So I would still like background monitoring and some medication. I may have to self fund test strips. Annual retinopathy eye check as well, of course.

So, for those in remission (or the fortunate ones who have normal BG control without diet or medication) what effect did this have on your medical care?
 
I am officially in remission I have it in black and white. But my GP has no intention of removing me from the diabetic register.
And I am happy with this as I still have complications to contend with.

I am going to continue with my LCHF life style as I believe remission is a fragile state and can be undone if I go back to a high carbohydrate diet. there is no going back.
 
I think to be recognised as officially in remission you need a few consecutive non-diabetic HbA1cs and no medication. Once declared to be in remission you are still at risk, so annual reviews, foot checks and eye screening continue.

My DN has been nagging me to come off the register for a while now but I declined because it meant moving from 6 monthly blood tests to annual and I want to stay on 6 monthly ones. She assured me I would still have the foot and eye checks.

How bad is your cholesterol?
 

"Remission" isn't in my surgery's vocabulary. I have been in the non-D zone for 3 years on minimal metformin. I am not ready to give it up yet because, as you say, it has other benefits. I still receive annual tests for hba1c, cholesterol, eye screening and feet counting.

If you are at all concerned that dairy may be adversely affecting you cholesterol, you could try stopping it and see what happens. It is not essential for good health unless you are a calf. My hba1c dropped from 40 to 35 when I gave it up.

Well done on your good results
 
As you are only 3 months into doing LCHF your cholesterol levels are probably still affected by high insulin levels.
Dt Atkins points out that insulin can raise the amount of bad cholesterol significantly, and that early tests can result in misleading results as things have not stabilised.
 
I would focus on maintaining and improving glucose levels for a couple of years...it had taken probably just over a decade to raised it significantly. So it would likely take a couple of years of normalized glucose levels to achieve some significant healing...
 
LittleGreyCat said:
I do, however, have high cholesterol (due at least partly, I think, to the high fat part of my diet which is mainly dairy; it majors in butter and cream).
Click to expand...

How high is high, the British Heart Foundation found that the number of people having cardio vascular events had cholesterol above 5.4 . . . . . . and below 5.4. Suggesting that 5.4 was a sort of optimum. However, that doesn't agree with what the doctors are telling us, they seem to be aiming for below 4. I was 4 last christmas and 5.7 a few weeks back. As you say the high fat especially dairy was probably the culprit. I'll find out soon as I have another test while having an HbA1c to check Januvia is doing it's job. It isn't yet, after a few weeks, I'll give it another week or two. I'm seriously considering Newcastle Diet because I only have to remove protein from my present diet.
 
Serum cholesterol.........................7.95 mmol/L
Serum triglycerides.......................1.44 mmol/L
Serum HDL.....................................1.78 mmol/L
Cholesterol/HDL ratio....................4.47
Serum LDL.......................................5.51 mmol/L

The issue seems to be the high LDL level; I assume I would need a detailed lipid analysis to check if it was the “good” LDL or the “bad” LDL.
 

Yes, it does seem the LDL is causing the problem, and yes, you would need a detailed LDL test to determine how much of it is good and how much bad. I doubt a GP would arrange one of these due to cost etc. but there may be other ways and means.

LDL can be lowered with (not in any particular order)
dark chocolate
avocado
red wine
almonds, walnuts, or pistachios
salmon and other oily fish
olive oil
soy milk
berries
 
My main issue is that I am now allegedly running on fat, and so I would expect to see more fat circulating in my blood stream.

From my limited understanding LDL carries fat to the tissues for storage and energy, and HDL scavenges the residues of LDL use and carries them back to the liver for excretion in bile or for reuse (presumably again as LDL).

If you have too much(?) LDL in your blood stream then either the cells are not taking enough out of the bloodstream or the liver is putting too much in (does this sound a little familiar?).

The obvious method of reducing cholesterol in the blood stream is to eat less fat and encourage more take up in the tissues by exercising more. Still sounding familiar?

So; first phase is cutting out nearly all carbohydrates and substituting fats.
Result; normal BG levels but high cholesterol.
Second phase; cutting out nearly all fats and substituting.............

Too much protein is not good for you so I need some form of calorific fresh air, apparently.
 
I have only been on metformin, but still keep on with metformin even though my HbA1c is around 36 -37 area

I think exercise is the next level... as it both lower cholesterol and do lower insuline resistance too especially if getting a bit bigger muscles...so resistance training...

changing fat to the more fish-fat kind can also lower cholesterol and protect the heart.. so if you don´t eat fish every day you should take at least fish oil capsuels of a good quality at the best a double dose daily. and then maybe go a little lower in other animal fats..
olive and olive oil is also good for cholesterol

if they wan´t to take away your metformin against you will the claim that your blood glucose goes up in the diabetic levels then...(it might do anyway) it is different from one person to the other how much difference it does... in my case it lowers my blood glucose like 1-1.5 mmol at a daily basis, which is why I keep on taking them untill my levels gets even lower... not likely at the moment though
 
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