Prioritising HbA1c?

[paulmh]

Quick question -

I don’t bother testing my BG any more and haven’t done for months. My HbA1c is down to 37 (from 123 at diagnosis 14 months ago). I’m pretty settled in my routines of diet and exercise. I’m off medication and have been for about six months now. I feel like I’m all about the quarterly reviews of HbA1c and I’m not too bothered about BGs from day to day or even hour to hour. When I was first diagnosed I tested at least twice a day, but I never got into the habit of “two hours after meals”.

This has served me well up till now, but I’m wondering if I’m missing out on some benefits and insights from regular testing, or if my regime of monitoring HbA1c alone is adequate?

 

[bulkbiker]

Depends if you like pleasant (or unpleasant ) surprises..
I like being in control so see my daily recording and testing as being very important to my continuing health.
If you don't then your way will be different.
However your surgery will probably try to push you to 6 monthly then annual reviews and tests over time so you have to ask yourself if things do go wrong would you be happy to find you have had high blood sugars for a year without knowing?

 

[britishpub]

I have cut down on my regular day to day testing (not that I was ever overly obsessive about it) but I would never just rely on using HbA1c testing as my only guide.

I tend to test 4 or 5 times on individual days, maybe only one or two days a week, but enough to get reassurance that I am still able to maintain control.

 

[paulmh]

Depends if you like pleasant (or unpleasant ) surprises..
I like being in control so see my daily recording and testing as being very important to my continuing health.
If you don't then your way will be different.
However your surgery will probably try to push you to 6 monthly then annual reviews and tests over time so you have to ask yourself if things do go wrong would you be happy to find you have had high blood sugars for a year without knowing?

So I shouldn’t assume that because all other factors are relatively constant, that my T2 progression will be constant?

 

[bulkbiker]

So I shouldn’t assume that because all other factors are relatively constant, that my T2 progression will be constant?

What "progression" your HbA1c down from 123 to 37 doesn't look much like progression to me?
I just prefer to monitor myself rather than rely on others to do it for me.
You could well be fine simply continuing what you have done but as I say it is up to individual personalities as to how to manage the condition in future. I like to monitor to know for sure I'm not going to get a nasty surprise from my annual HbA1c. I certainly wouldn't want to go into that "blind". But if you're happy then that's fine.. we're all individuals and make our own decisions.

 

[paulmh]

Ok, thanks. I’ll give it a go every now and then, like you say to avoid nasty surprises.

I just did it tonight, a couple of hours after my evening meal (which was almost exclusively protein!) and it was 5.2

 

[caroline_92]

I got my HbA1c down to 37, seven years ago now, through changing to a low carb diet and testing to see what different meals and foods did to my blood sugar. After 3 months I had figured out what to eat to stop post meal spikes.

Now I only test sporadically, perhaps once every 1 or 2 weeks, 2 hours after eating or if I feel like my blood sugars may be high. Eg I feel tired or thirsty so want to check if this is blood sugar related or I am actually tired or thirsty.

My blood tests are now only once a year (& I have to ask for these!) so whilst I know I am generally fine, I do keep an eye as a year is a long time. And agree that nasty shocks are not pleasant...

 

[paulmh]

After 3 months I had figured out what to eat to stop post meal spikes.

.

OK I’m now beginning to think this is the stuff I could do with understanding a lot better. When I do bg tests during the day they can be all sorts - for instance this morning, after some light exercise and before I’d eaten anything it was 9.6. When I’d tested when I woke up it was 6.4. Now my routines haven’t changed and those routines led to a good HbA1c, but clearly I’m having spikes. Why are spikes a bad thing if my average is good? Why am I even having them? Is this something to do with the “severity” of my condition?

Maybe there are threads on the forum someone could steer me to to better understand spikes?

 

[Bluetit1802]

OK I’m now beginning to think this is the stuff I could do with understanding a lot better. When I do bg tests during the day they can be all sorts - for instance this morning, after some light exercise and before I’d eaten anything it was 9.6. When I’d tested when I woke up it was 6.4. Now my routines haven’t changed and those routines led to a good HbA1c, but clearly I’m having spikes. Why are spikes a bad thing if my average is good? Why am I even having them? Is this something to do with the “severity” of my condition?

Maybe there are threads on the forum someone could steer me to to better understand spikes?

The HbA1c is merely an average (of sorts). The best way to avoid future complications is to keep your levels as flat as possible. To keep your standard deviation to a minimum with no roller coasters.

It is a known fact that you can have 2 people with identical HbA1c results. One of them roller coasters from quite high to quite low, (and mostly we are quite low over night when we are asleep - so that is a lot of times when we are low.) The other person stays steady with small gentle rises. They can average out the same.

Additionally, the HbA1c has a lot of issues. People with non-standard red blood cells or with red blood cells that live longer or less than the standard 120 days on which the HbA1c relies can have inaccurate HbA1c results. Sadly, we have no way of knowing how long our red blood cells live. We are all expected to be standard - but we aren't.

I prefer to self test. It really would not bother me if I never had another HbA1c, except it keeps my nurse happy.

 

[johnme]

People with non-standard red blood cells or with red blood cells that live longer or less than the standard 120 days on which the HbA1c relies can have inaccurate HbA1c results.

This makes me feel as if I can't trust anything. Cholesterol results aren't cholesterol results but measurements of lipids transporting cholesterol, the statins prescribed to correct the not-cholesterol levels can wreck your memory, official diet advice is the inverse of what's required by T2s, I only ever have high blood pressure in the doctor's surgery and have to have a groundhog day argument about the high blood pressure I don't have every time I go there, now I discover HBA1C may or may not be correct.

 

[kitedoc]

Hi @paulmh, As others have pointed out HBA1C just happens to be the best long-term test but it has limits.
If things are stable for you, (and your doctor/DN agree), why not do some BSL testing in a rotation fashion, say first thing on waking on Monday, 2 hours after breakfast on Tuesday and so on, including some before meals testing at times.
That way over the week you have a spread of results to reassure you.
Of course we are all advised to test more often if we are ill and yes, testing some time after exercise, after a vaccination or after a stressful day might help keep those matters under observation.
Best wishes with your excellent progress.

 

[JohnEGreen]

There are doctors around the world who consider Glucose spikes a hazard in themselves.

 

[T2#Me]

This makes me feel as if I can't trust anything. Cholesterol results aren't cholesterol results but measurements of lipids transporting cholesterol, the statins prescribed to correct the not-cholesterol levels can wreck your memory, official diet advice is the inverse of what's required by T2s, I only ever have high blood pressure in the doctor's surgery and have to have a groundhog day argument about the high blood pressure I don't have every time I go there, now I discover HBA1C may or may not be correct.

Nicely put. You can't. The more you learn, the more you disbelieve. LOL.
However, speaking just for myself, we can only go by the resources available, I suppose, and experience, and good advice. More here than in my surgery, I find.
I had a similar experience with the blood pressure, so now I use a home machine and take my blood pressure every morning, same time same place, and keep a record to take to the surgery. My surgery has a blood pressure machine in reception which (a) hurts my arm (2) gives different readings depending how deep your arm is inserted (3) gives mad readings sometimes ... they even give a warning that is the pressure is too high, get it done again by a nurse.And my home machine sometimes plays silly ******* as well ...
I'm treating the whole thing as a warning and a learning experience, and I have never felt better than when I restarted lchf and walking, so all good so far.
Best wishes.

Edited by mod for asterisks

 

[Mr_Pot]

There are doctors around the world who consider Glucose spikes a hazard in themselves.

I have only seen this doctor, are there others so convinced?

 

[Mr_Pot]

I only ever have high blood pressure in the doctor's surgery and have to have a groundhog day argument about the high blood pressure I don't have every time I go there,

Next time get them to lend you a 24hr recording blood pressure monitor and they will change their minds.

 

[Indy51]

I have only seen this doctor, are there others so convinced?

I've lost the study reference, but ISTR seeing a study about how many hours it takes the glycocalyx to recover from the effects of a high carb meal. Maybe @bulkbiker will remember more details. I think it may have been tweeted by Ivor Cummins.

 

[Pinkorchid]

I think you will find testing is a personal preference and it has a very wide range how people do it here. Some people do it a lot all the time and others once they have had diabetes for a while and have sorted their diet and are happy with their results do it a lot less or not at all so it is what we personally want to do to do not how others do it
The HbA1c is important to me but everyone is entitled to their own opinion about that. My own GP practise is now doing the blood test and review for all diabetic patients every six months and I do not think they would be spending money doing that if it was not important

 

[HICHAM_T2]

Hi
Daily tests are important for those who have recently been diagnosed
But those who got a good score at hba1c rate I do not think they will get complications in three months

 

[Indy51]

@Mr_Pot - not having much luck finding the study I was thinking of, but have found this one linking post-prandial hyperglycemia and LDL oxidation in diabetes:

https://www.ncbi.nlm.nih.gov/pubmed/10599980

 

[bulkbiker]

I've lost the study reference, but ISTR seeing a study about how many hours it takes the glycocalyx to recover from the effects of a high carb meal. Maybe @bulkbiker will remember more details. I think it may have been tweeted by Ivor Cummins.

Hi sorry can't recall anything although there's always Dr Bernstein
http://www.diabetes-book.com/short-term-spikes-blood-sugar/