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Told to increase my hb1ac?

Wilko 2

Member
Messages
20
Location
South London
Type of diabetes
LADA
Treatment type
Other
My health authority has changed the providers, so the really supportive consultant I had, has been replaced by a new team. A virtual meeting with the new nurse has left be bewildered and frustrated. Ive been diagnosed LADA for 3 years now, and manage my blood sugar with a mixture of low carb, exercise and metformin on a daily basis. I went from a Hb1ac of 106 to 42 in 3 months, and it has kept stable at that rate ever since.

The new nurse on seeing my Libreview stats of a daily average of 5.9 mol/l over 90 days - Time in target range (4-7) 91% over 90 days. and 1% < 3.9 told me to increase my Hb1ac to 48. On questioning, she said this would prevent hypos.

I explained my last consultant said he was happy that I can go as low as 3.5 before meals quite safely and was happy with these figures.

Ive now been referred to see a new consultant. Advice please?
 
The medics swing between moving HBA1C up and down depending on the weather. Even my nice knowledgeable DN has told me to both avoid hypos and also to bring my HBA1C down a bit. The reality is you just have to choose a compromise and unless you have Libre or pump etc you're not going to get it right some of the time.
 
> daily average of 5.9 mol/l

Are you sure?
An average of 5.9 mmol/L would give a HbA1c of 35 mmol/mol or 5.3% which I think is quite low.

(There is such a thing as having a HbA1c that is too low, but I am not sure exactly what the recommended lower level is)

I would suspect you mean a HbA1c of 5.9% which is around 41 mmol/mol or an average of 6.81mmol/L ?

If the latter, then it would be around my estimated HbA1c. My consultant commented that my figures might be 'too good', but didn't actually suggest I change anything. I think the worry is that if you are spending a low time close to the low threshold, then you may become hypo unaware, or that it doesn't give you much leeway for when you have a bad day.

> On questioning, she said this would prevent hypos.

Some people still consider anything below 3.9 a hypo, whereas others understand that some people can go as low as 3 without causing any problems. If your HbA1c has been at this level for a long period and it hasn't caused you any problems and you don't have problems with hypos and your previous consultant was happy with the situation, then I would have thought a consultant who knows you would trump a nurse seeing you for the first time.

I don't think there is anything wrong with the nurse's advice and if you are having lots of hypos, it would be good advice, but it may not be necessary in your case.
 

Thank you for your reply, yes Im sure, but I haven't had a blood test since Feb, but that's what the Libreview figures are over the last 90 days. (I have asked to have another HbA1c) I don't have hypos that I am aware of, but it does drop to around 3.5 before meals and I know that I am hungry!
 

Hi there, have you downloaded your data from the libre system that shows your glucose readings for every 15 minutes? You might find lower readings that you were unaware of and you will be able to see any particularly low trends. x
 

First of all, well done on getting your hba1c down to 42 from 106, that's awesome!
That seems odd to me too as 5.9 isn't too low at all, and 42 sounds like a really ideal hba1c. Although 3.5 does seem quite low, so maybe that's why your new nurse is worried? Do you feel lows when you have them? Are you on both long acting and short acting insulin?
 
I guess you could increase blood glucose by eating more carbs. But if it is a reactive hypoglycemia issue, lows before meals could get worse. I would want to know why blood glucose is dropping to 3.5 before meals. You are not injecting insulin or taking medication to increase insulin production, so it must be something else.
 
1% < 3.9 is an amazing result. I achieved that when I was still getting a glucagon response. It stopped after 2 months.
 
But you are not having hypos right? You happen to tolerate a lower level of bg because your blood sugars are well controlled. The assumption being made is to have such an hba1c you must be dipping too low and therefore risk losing hypo awareness however it sounds as if you have this and know what to do! Take advantage of getting access to the consultant and ask all your questions. I would be delighted to have a 42 so well done on getting near normal blood sugars that minimise your risk of complications.
 
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