Permission to follow a low carb diet (and fasting)

kitedoc said:

You have to remember that hypos can increase the risk of motor vehicle accidents. Would any doctor be prepared to sign a continuance of driver's license with such low HBA1Cs? They have a responsibility to the community at large to not certify drivers who may be at risk.
Doctors will not be using just knowledge out of a textbook but I agree not all are up-to-date !!

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Hi kitedoc,
Yes of course a hypo is dangerous whether when driving or in any other situation and I hope I didn't insinuate otherwise. I know a Dr would never sign a continuance of a license when he looks at an hba1c in isolation because that hb1 is indicating to him that it has been achieved through a combination of highs & lows. My point was that an individual with an hb1 in the 30s would know whether they go below 4 by the use of a libre BUT a Dr will never take a personal record as proof of anything, thus they go by the 'text'. I fully understand why.

KK123 said:

Hi kitedoc,
Yes of course a hypo is dangerous whether when driving or in any other situation and I hope I didn't insinuate otherwise. I know a Dr would never sign a continuance of a license when he looks at an hba1c in isolation because that hb1 is indicating to him that it has been achieved through a combination of highs & lows. My point was that an individual with an hb1 in the 30s would know whether they go below 4 by the use of a libre BUT a Dr will never take a personal record as proof of anything, thus they go by the 'text'. I fully understand why.

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Hi @KK123, No insinuation assumed. Not everyone will have a Libre attached, or necessarily have it on alarm. And they cannot be continually checking a libre whilst driving. I am uncertain about UK but in Adelaide South Australia, the stipulation made by the certifying doctor is that no driving by a person on insulin or other BSL-lowering agents is to be undertaken with BSL (currently fimger-prick reading) of less than 5 mmol/l.
The other thing the doctor has to be prepared to do when he/she signs off on the certificate is to justify to a court that a HBAic of less than 40 for the patient involved in a motor vehicle accident is consistent with the ability of that patient to drive safely.

I'm type one and my first Hba1c was 17%. Then 3 months later it was 4.5%. The endo wanted to prescribe meds to raise it because she was alarmed but I said no to that. I have decreased my insulin and am eating more carbs instead. I find the hba1c very confusing. I don't understand how it can be an average of your BG over the last 3 months. I know there's a tricky calculation behind it but wouldn't the carbs consumed in the prior 24 hours have more to do with it than what you ate 2 months ago?

JAT1 said:

I find the hba1c very confusing. I don't understand how it can be an average of your BG over the last 3 months. I know there's a tricky calculation behind it but wouldn't the carbs consumed in the prior 24 hours have more to do with it than what you ate 2 months ago?

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It's about glucose binding to haemoglobin in red blood cells. https://en.wikipedia.org/wiki/Glycated_hemoglobin

The binding is irreversible, but it's also slow enough to only affect a small amount at once, so seeing how much is bound is a fair guess at average levels over the lifetime of red blood, ie 3 months.

I use libre/blucon with xdrip+ smartwatch. I eat LCHF and have reduced my hba1c to 57 or 7.4, I am aiming for hba1c between 39 and 57 or 5.7 and 7.4. I am very impressed with the results I am seeing. I use a spreadsheet to record my daily hba1c estimates, which automatically estimates both weekly and monthly scores.
The estimates are close to clinical results so I will continue this form of tracking.
39 to 57 show on the spreadsheet as blue or green cells. Red is too low and yellow too high.

My consultant is prepared to support low carb and is allowing me to change Lantus for Levemir to allow more variation and lower doses.
I find that hypo unawareness does creep in with lower glucose levels, so I aim for compromise not perfection.

I'm much the same. My HbA1c's have historically been mid- to low-60s. Best ever with strict carb-counting was 57 mmol/mol. After 6 months on keto, I got it down to 51 mmol/mol, which is the best it's been in 28 years. The only downside now is my astronomical LDL! But I love the freedom I get from keto now. No more carb counting, very flat CGM traces (I also use Libre/Blucon/xDrip), far fewer hypos - they used to be daily - and far fewer highs, too - they used to be 18+ frequently. Now I get worried if I'm over 9...