• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

'Satisfactory' Hba1c

T

TreboroughLiz

Member
Messages
11
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Does anyone understand why the NHS defines an HBa1c of between 48 and 58mmol/mol as 'satisfactory' for people diagnosed with Type 2 when this is so far over a healthy level and will be damaging your body? I asked my last GP and he did not have an immediate answer. After a long pause he said that he thought people were not expected to be able to achieve a healthy level. I find this very strange as you would think the aim of medicaiton would be to lower blood sugar into a healthy range? have recently managed to get my level to 44mmol/mol and my new GPs response was to say she needed to stop one om my medications. I pointe out that it was still not in a healthy range and I had only achieved it while on medication and would not want it to go back up again. I would love to reduce my medications but not at the expense of having higher blood sugar levels again.
 
sort of they are worried about potential lows which can lead to larger damage than highs in a shorter timeframe.
Current result: 46 mmol/mol (6.4%) on 01/05/2025 is my latest hba1c and the dsn rabbited on about too 'too tight control' and nagged about potential lows. i was happy with that figure especially given prior result: Previous result: 162 mmol/mol (17.0%) on 21/01/2025. i'm expecting next hba1c to be up a little as currently zero meds hospistal on monday drew bloods and some vials seem to of went awol :F

the other thing is that diet / exercise can have impact on sugar levels, so they may feel that your possibly able to reduce further via focusing on that without requiring drugs which cost the nhs money.

i look at treatment choices offered same as insurance pretty much, weighted risk vs potential costs. Which meds are you on ?
 
thank you for your reply - I can see that about their worries about lows but worry they apply the risks for those on insulin to those who are not. I have been on metformin for 25 years and on dapaglaflozin for 15 years. I have had periods of time on Gliclizide as well but then did have a problem with hypos. I worry that the acceptance of higher than healthy blood sugar is what keeps people in a diabetic 'state' which keeps us fighting weight gain. I'd love to taper off meds as I get into a healthy range. I am not sure if it will be possible after so long on the wrong advice and all the insulin resistance this will have created. It is a good suggestion that they might be worried about hypos and perhaps I need to approach them reminding them I am paying for a CGM and an alarm will go off if my blood sugar starts dropping low.
 
TreboroughLiz said:
Does anyone understand why the NHS defines an HBa1c of between 48 and 58mmol/mol as 'satisfactory' for people diagnosed with Type 2 when this is so far over a healthy level and will be damaging your body? I asked my last GP and he did not have an immediate answer. After a long pause he said that he thought people were not expected to be able to achieve a healthy level. I find this very strange as you would think the aim of medicaiton would be to lower blood sugar into a healthy range? have recently managed to get my level to 44mmol/mol and my new GPs response was to say she needed to stop one om my medications. I pointe out that it was still not in a healthy range and I had only achieved it while on medication and would not want it to go back up again. I would love to reduce my medications but not at the expense of having higher blood sugar levels again.
Click to expand...
I think there's a few things going on. One is that the NICE guidelines don't really cover anything except drugs treatment, and you could be forgiven for thinking there was no alternative. The other is that there seems to be zero expectation that things will ever get any better. Only slowing the inevitable BG rise with more and different drugs.

The relevant section of the guidelines for 'what a patient's HbA1c should be' is this one-

1.6.7​

For adults whose type 2 diabetes is managed either by lifestyle and diet, or lifestyle and diet combined with a single drug not associated with hypoglycaemia, support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a drug associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015]

1.6.10​

If adults with type 2 diabetes reach an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example deteriorating renal function or sudden weight loss. [2015]


The guidelines seem to express a fear of any potential for a hypo episode, and taken with the general acceptance that drug treatment is the only treatment. For me, had I paid any attention to these recommendations, this would have meant staying at BG levels that were causing a range of nasty symptoms. There is no thought anywhere of the impact of the recommended levels on the patient. Obviously, hypos are to be avoided, but it's strange that this seems to be the main consideration. I don't know why I should be expected to be having hypos at BG levels that are well above normal.
 
I have ended up with enduring years of symptoms that I just sort of accepted as unavoidable because whenever my Hba1c was below 58 mmol/mol my GP would congratulate me and tell me I was doing really well. I do wish I had taken my health into my own hands years ago rather than always feeling I had to follow the official advice. Now getting back down to almost healthy I feel so much better and I am not experiencing the inflammation linked issues that have been part of my life since my thirties.
 
TreboroughLiz said:
I have ended up with enduring years of symptoms that I just sort of accepted as unavoidable because whenever my Hba1c was below 58 mmol/mol my GP would congratulate me and tell me I was doing really well. I do wish I had taken my health into my own hands years ago rather than always feeling I had to follow the official advice. Now getting back down to almost healthy I feel so much better and I am not experiencing the inflammation linked issues that have been part of my life since my thirties.
Click to expand...
From around 2010-11 I had a range of symptoms - weight gain and fluid retention were the first. I hadn't changed anything, and Dr Google suggested that what I was getting could be diabetic symptoms. GP said it wasn't, as my blood sugar wasn't high enough. What I wasn't told was that my blood sugar was no longer in normal range. It was there on my records, but I had no reason to look.

Eventually diagnosed in 2019, when BG finally crossed the imaginary line at 48. I could have avoided nearly ten years of pain, discomfort and weight gain. In my book, the point of intervention should be when BG goes out of normal range.
 
Back
Top