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Rising HBA1C

C

coco44

Well-Known Member
Hi everyone feeling quite low and confused after my latest HBA1C result 2 weeks ago. My last 3 tests were 49, 48 and now for some unknown reason my latest has risen to 52! Strange thing is I have had some really bad hypos during the 3 month period that came back as 52. For the last week my DSN wanted me to log all my readings which I did. They are so erratic. swinging from 13 to 2.9. Going to bed on 7.0 then next morning's reading is 10. I take 17 units of Lantus and this has always worked fine. My diet is the same, but I am finding I'm getting more and more anxious. My DSN seems more concerned about the hypos than the highs whereas my doctor is not happy about the highs, neither am I. Either way my good control for the past 5years since being diagnosed Type 1 at 55 years old is slipping away. Can anyone help please.
 
Here's an article which suggests that one cause of wide glucose variability in Type 1 patients is gastroparesis. Gastroparesis, a result of diabetic neuropathy, is one of the complications of the disease. "People with [gastroparesis] may have problems synchronizing insulin dosing with the glucose absorption from the food they eat, resulting in blood glucose fluctuations."

There are many physiological things that could be going wrong, and they could be caused either by the disease or by aging.

The A1c test is not always accurate. There are factors which throw it off, and old age is one of them. There are published lists of interferences to the A1c. Unfortunately, the medical literature has nothing to offer as to the respective sizes of the effect of these interferences. But as to the difference of 52 and 48: I would be glad to attribute 1 or 2 points of it to aging.

Digestion is a complicated process with many biochemical steps. This is not just true in general, but with respect to diabetes. Have you heard of the "loss of the incretin effect"? When food slides into the small intestine, this is supposed to stimulate some cells in the intestinal wall to send chemical messengers to the pancreas. This is one of the mechanisms for signalling the pancreas to release digestive enzymes. Anyway, the loss of this effect is one of the complications of diabetes and it is the basis of two new categories of diabetes medications since 2005.
 
Thanks for your reply sud5nala. I have heard of gastroparesis , but not the loss of the incretin effect. I will have a little read up on that one. It did cross my mind that aging may be starting to play a part in making management and glucose controlling just that little bit more difficult. Thanks again
 
If you've only been diabetic 5 years, you've always previously had good control and in target hba1c and you have no other diabetic complications (neuropathy, retinopathy) gastrparisis wouldn't be my first thought.

It could just be that you're 5 years in so, no more honeymoon & things are just a bit more challenging. It could be other hormones going on.

One thing that did strike me from your post was the comment that 17 units of lantus had always worked fine. It's just, that seems like quite a static, fixed approach to diabetic management, which is fine when it's working. But unfortunately diabetes is a condition where sometimes things change, occasionally for no apparent reason, and what worked yesterday just doesn't want to work today. So sometimes there is a need for the management to be flexible too. Requirements for background insulin can change - if you are going up overnight you might need to increase your dose of lantus, or think about splitting it so you have less in the day to avoid the daytime drops, or think about moving to a different basal insulin as lantus is not actually that flexible (changes take 2-3 days to take effect) and could be said to have some instability issues.

Maybe have a read up on basal testing - https://mysugr.com/basal-rate-testing/ - and have a chat to your nurse about next steps, especially if you have had concerning hypos.

& don't be so hard on yourself, nothing's slipping away
 
Awww thanks catapillar I guess I am hard on myself because I see myself as a failure now this is happening which I know is a daft way of thinking as I'm doing my best. I did wonder about splitting the dose and see what happens then. Thankfully I don't have any complications, but I do worry if these highs continue I will be looking at developing complications sooner rather than later or developing DKA which was how I was diagnosed in the first place and a week's stay in Intensive Care.
 
In my reply, regarding the loss of incretin effect: actually, those drugs are prescribed for Type 2's, not Type 1's. Is that because Type 1's produce little to no insulin, so that there's nothing to stimulate? I meant to highlight that the digestive process has many modules and and an intricate set of feedback paths between the modules. The Webpage mentioning gastroparesis was specifically about Type 1.

Here is a page with a list of digestive symptoms that could reflect autonomic neuropathy. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/autonomic-neuropathy.html

During middle age, I seemed to age as much in the last 5 years as in the first 15. Aging is only going to accelerate. For example, aging is one possible cause of reduced secretion of digestive enzymes. Even without diabetes, an old person's digestion may grow sluggish due to the dwindling of the enzymes (most of which are produced by the pancreas).

If you aren't already pursuing diet changes (like low carb, high fat (LCHF)) and physical activity, they can help retard the complications by improving blood pressure and glucose levels.
 
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