Raised Hba1c on low carb diet

[EllieM]

The problem is that the alternative tests have their own issues.

I thought fructosamine tests were an option? (Usually given to pregnant women because they reflect the last 2-3 weeks of control).

 

[KennyA]

I thought fructosamine tests were an option? (Usually given to pregnant women because they reflect the last 2-3 weeks of control).

It is, but it's another one that measures something else (glycated serum protein) and is therefore a proxy for blood glucose. Bilous & Donnelly say that it correlates well with HbA1c "except where control has changed recently" and has advantages over HbA1c in a couple of situations, including pregnancy. Apparently (B&D again) standardisation is difficult as uraemia, lipaemia, hyperbilirubinaemia and vitamin C use can affect the test, as can high or low levels of blood proteins.

There's also such things as the estimated Average Glucose (eAG) and A1c Derived Average Glucose (ADAG) which have, again, advantages and disadvantages.

 

[Antje77]

Bilous & Donnelly say that it correlates well with HbA1c "except where control has changed recently"

In which case the fructosamine test would be more useful than hba1c, because hba1c tells you something about the last 2-3 months, and the fructosamine one tells you something about a shorter time period.
This is exactly the reason why it can be useful in pregnancy, when things tend to change fast.

 

[Ian_White]

According to Bilous and Donnelly, there are a few people for whom HbA1c doesn't work. There can (chapter 3) be spurious results for example where there is iron deficiency, haemoglobinopathies, renal failure, or amongst different ethnic groups.

The problem is that the alternative tests have their own issues. B&D quote the US NHANES study where 1.6% of the population had HbA1c >6.5% (>48mmol/mol) but 5% of those would have been undiagnosed by a fasting plasma glucose or an oral glucose tolerance test. FPG is said to be problematic because the subject needs to fast (and presumably there is low compliance).

Conclusion they draw is that the HbA1c isn't entirely perfect but is the best there is.


@Ian_White
You mention

As a side note, in the 3 months prior to my bloods being taken, I'd stayed off alcohol completely.

Alcohol tends to suppress blood glucose levels because in the system it interferes with the liver topping up ("trickle-charging") your blood glucose. It is possible that your liver became a bit more active doing this top-up in the three months before your last test, in the absence of alcohol.

Hi Kenny,
Yes, I hadn't considered this, but a re-vamped 'trickle-charge' of glucose from the liver with the absence of alcohol sounds like a viable reason for a higher HbA1c.

 

[smile2010]

SOMEONE PLEASE HELP ME

Recently had my over 40 Blood Test check with my NHSGP and despite working heavy times for a week and eating very clean carbs usually no more than 200 g on a workout day and lower on a non-workout day. My HB one was showing 41.

Also cholesterol increased from 4 (Nov 22) to 5.3 (Dec 2023).

Potassium 6.2 (another blood test arranged in 48 hours)

I'm devastated at this as I generally eat very clean and have never felt fitter, stronger, or leaner in my life.

I am guilty of over supplementating:

1000 mg Vit C
1500 mg magnesium glycinate
25 mg zinc
4000iu Vit D

Pre workout
2/3g tyrosine
2/3g l Carnitine
Using alpha GPC
5g creatine 4/5 a week

I have since stopped this immediately.

Morning glucose levels showing 7.5 and 6.7 for last two days.

Can someone help me to understand what is happening?

Thanks in advance.

 

[smile2010]

I've had similar issues. I'm on a very low carb diet (weighing out everything, under 20g a day), and have been very strict over the past 6 months, plus a 36 hour fast once a week. Just had by hba1c done and instead of it lowering as I thought it would, it's risen to 44. As a side note, in the 3 months prior to my bloods being taken, I'd stayed off alcohol completely.

I was diagnosed diabetic in 2016, and have had HbA1c readings as low as 34 since.

It's a head-scratcher.

I did find this info which I'm not allowed to post a link to as I'm a newbie, but it is on a website called Marks Daily Apple. It discusses a high HbA1c with low blood sugar. It basically says that:

• for every 1% rise in blood sugar, red blood cell lifespan fell by 6.9 days.
• hba1c is measured using red blood cells
• in those with better blood sugar control, red blood cells lived longer, and therefore had more time to accumulate sugar and give a bad HbA1c reading

I'd be interested in anyone's thoughts on this - have you heard of this before?

Interesting theory, but what would normal waking morning blood glucose show any change etc?

 

[KennyA]

SOMEONE PLEASE HELP ME

Recently had my over 40 Blood Test check with my NHSGP and despite working heavy times for a week and eating very clean carbs usually no more than 200 g on a workout day and lower on a non-workout day. My HB one was showing 41.

Also cholesterol increased from 4 (Nov 22) to 5.3 (Dec 2023).

Potassium 6.2 (another blood test arranged in 48 hours)

I'm devastated at this as I generally eat very clean and have never felt fitter, stronger, or leaner in my life.

I am guilty of over supplementating:

1000 mg Vit C
1500 mg magnesium glycinate
25 mg zinc
4000iu Vit D

Pre workout
2/3g tyrosine
2/3g l Carnitine
Using alpha GPC
5g creatine 4/5 a week

I have since stopped this immediately.

Morning glucose levels showing 7.5 and 6.7 for last two days.

Can someone help me to understand what is happening?

Thanks in advance.

An HbA1c of 41 is at the top end of the normal range (see graph). There's a 5% allowable error in an HbA1c lab test so in theory a result of 41 could have been generated by an actual value anywhere in the 39-43 range. What was your previous result? Similar, lower, higher?

Personally I have no experience with supplements (apart from vit D) so have no knowledge of how what you've been taking might affect BG levels.

 

[ajbod]

200g of carbs, is about 10 days worth for @KennyA and myself.

 

[smile2010]

An HbA1c of 41 is at the top end of the normal range (see graph). There's a 5% allowable error in an HbA1c lab test so in theory a result of 41 could have been generated by an actual value anywhere in the 39-43 range. What was your previous result? Similar, lower, higher?

Personally I have no experience with supplements (apart from vit D) so have no knowledge of how what you've been taking might affect BG levels.

I haven't really been tested for HB1AC before but fasting glucose was 4.9 a year ago (I get that's a snapshot and not comparable). Can anyone recommend who I should see as GP didn't really provide any answers or solution.

 

[KennyA]

I haven't really been tested for HB1AC before but fasting glucose was 4.9 a year ago (I get that's a snapshot and not comparable). Can anyone recommend who I should see as GP didn't really provide any answers or solution.

Unless I'm missing something there's no evidence so far from what you've said of any problem with your blood glucose. If you had had (say) four or five years' worth of previous tests all coming in around 36, then you might want to ask why the rise this time. You would be asking different questions if your previous results had been 45 or 55. As you don't have that sort of data, there's no way properly to interpret the single data point that you've got. There can be error in the HbA1c (5% is acceptable) and some things (like iron levels) can affect it. But yours is normal.

It's possible to reduce your blood glucose level very quickly by reducing carbohydrate in the diet. I do that because I have diabetes, which results in high blood glucose, which gives me a range of symptoms that I really don't want. You're not diabetic or even out of normal BG range so I can understand why your GP isn't concerned about it. 200g carb/day would be a lot for me (I'm on ~20g/day) but it is still some way under what the recommended daily intake is. I just googled it and the Mayo clinic is saying 225-325g carb per day.

Was your cholesterol test done fasted? Personally I pay it no attention (given that the body makes at least 70% of what cholesterol we've got) but I know for me a non-fasted test will result in a total cholesterol calculation up to two points higher than a fasted test.

Can't comment personally on your potassium level but you will already know that it's not supposed to be above 5.2 mmol/l. I think you'd need to talk to your GP about this and the supplements you're taking as these might either be adding potassium or preventing you getting rid of the excess.

 

[smile2010]

Unless I'm missing something there's no evidence so far from what you've said of any problem with your blood glucose. If you had had (say) four or five years' worth of previous tests all coming in around 36, then you might want to ask why the rise this time. You would be asking different questions if your previous results had been 45 or 55. As you don't have that sort of data, there's no way properly to interpret the single data point that you've got. There can be error in the HbA1c (5% is acceptable) and some things (like iron levels) can affect it. But yours is normal.

It's possible to reduce your blood glucose level very quickly by reducing carbohydrate in the diet. I do that because I have diabetes, which results in high blood glucose, which gives me a range of symptoms that I really don't want. You're not diabetic or even out of normal BG range so I can understand why your GP isn't concerned about it. 200g carb/day would be a lot for me (I'm on ~20g/day) but it is still some way under what the recommended daily intake is. I just googled it and the Mayo clinic is saying 225-325g carb per day.

Was your cholesterol test done fasted? Personally I pay it no attention (given that the body makes at least 70% of what cholesterol we've got) but I know for me a non-fasted test will result in a total cholesterol calculation up to two points higher than a fasted test.

Can't comment personally on your potassium level but you will already know that it's not supposed to be above 5.2 mmol/l. I think you'd need to talk to your GP about this and the supplements you're taking as these might either be adding potassium or preventing you getting rid of the excess.

Firstly, thank you so much for taking the time and commenting in such detail. I really appreciate this.

I totally understand your comments and I think I am just overreacting as I didn't think my markers would be this way. I am planning on getting a retest done early next week and the GP has recommended a fasting lipids and also potassium test.

I shall definitely keep you posted on the results. What I wanted to be sure of is that "training fasted" and also intermittent fasting does not have any irreversible affects or damage to my body and insulin sensitivity. Essentially, I am very confused at the moment.

 

[smile2010]

Firstly, thank you so much for taking the time and commenting in such detail. I really appreciate this.

I totally understand your comments and I think I am just overreacting as I didn't think my markers would be this way. I am planning on getting a retest done early next week and the GP has recommended a fasting lipids and also potassium test.

I shall definitely keep you posted on the results. What I wanted to be sure of is that "training fasted" and also intermittent fasting does not have any irreversible affects or damage to my body and insulin sensitivity. Essentially, I am very confused at the moment.

 

[N4WS]

ive been prediabetic for 6 years - i have noticed the stricter i am with keto/carnivore the higher my HbA1c is. Once on carbs got it down to 40 now following a period of being really strict and mainly once a day eating its 46mmol/mol (2 points away from being diagnosed diabetic). Trigs and HDL fantastic. I have worn several CGMs and they all predict my HbA1c to be around 31/32. I suggest if you are worried about the lab HbA1c you wear a CGM and see what it predicts. from my experience the more strict I am the longer my read cells live. BTW i am also a LMH

 

[stondec]

Type 2 Diabetes never goes away in my opinion, meaning you still have to eat low carb enough to control it for the rest of your life. This is why we say that remission of Type 2 diabetes is a marathon, not a sprint.
If it took doing under 50gms of carbs per day to get your BG as low as you wanted back 1yr ago or so, it will always be like that and may need to go lower carb still, even though for a while it may seem that it is cured.
It's the insulin resistance and the health of the Beta cells in which make insulin in the pancreas. They tend to get slightly worse rather than better. If they do get better, then usually it is just temporary. Cardio exercises don't compensate for this, which is why I say you can't outrun a poor diet.

What I'm painting here is a realistic picture. If you want the optimistic picture then there are a very few, mainly in the other UK diabetes forum who claim they are 'cured' and can eat like they used to before diagnosis. I have seen no proof, so I think they are either mistaken or trying to fool other people.

Hi @CW84 and welcome to the forum.

Did you think exercise made a difference? Muscle building exercise makes a small diference, but cardio exercise makes less. The harder you exercise, the more glucose you body needs (unless you are using Ketones for energy) and even your liver will make some and kindly add it into your blood stream if you do hard exercise.

We can't outrun a poor diet. The key is in keeping the carbs we eat down low enough.

I know that some people do claim to be cured of T2D, but most of us in remission with 'normal HbA1C levels realise that if we go back to eating like we used to do, we will soon be fully T2D again!

A1C is dependent on 2 factors →1) RBC lifespan and 2) How high your blood sugar is. People on noninflammatory diet tend to have RBCs that live longer which tends to increase A1C in such people.

If you're concerned about Type 2 Diabetes, you should chech your fasting insulin and also calculate your HOMA-IR. If you have low fasting insulin, and low HOMA-IR that should dispel any concern about Type II diabetes. You can also try getting a CGM .