Told to raise HbA1c

You are right @LucySW yes.

I think saying that "over the period of time, low BG causes a reduction in the aggregate gkycation' is the same as what you are saying about 'curbs the expansion'.

Actually, low BG (lower than the equivalent current HBA1C) does kind of cause an immediate reduction in HBa1c if you think about it, since HBa1c is continually changing as old blood cells die. So every time old highly glycated cells die, in a current environment of sufficiently lower active glycation, there is a potential for aggregate glycation and HBA1C both to instantly decrease.

So it's a stockpile that can or can't be depleted?

Erghhh.

LucySW said:

So it's a stockpile that can or can't be depleted?

Erghhh.

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It's a (kind of) weighted moving average. So everything you do or don't do at every moment influences the weighted moving average.

Peter Attia on a podcast says, A running three-month average of your aggregate glucose level.

It's on the first of these two podcasts at 16 mins.

http://fourhourworkweek.com/2014/12/18/peter-attia/

LucySW said:

Peter Attia on a podcast says, A running three-month average of your aggregate glucose level.

It's on the first of these two podcasts at 16 mins.

http://fourhourworkweek.com/2014/12/18/peter-attia/

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Well, he's wrong. Or let's say, he's being imprecise.

Spiker said:

Yes there is a reason, though it's not a great one.

They are assuming that your low HBa1c represents a risk that you are having too many hypos. And that you are at the point where the risk of the (presumed) hypos is more harmful than the benefit from the lower HBa1c.

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This is where most type 2 folk are left in the dark not being prescribed meters. Too much assumptions by medics. It is stupid telling people to RAISE their HBA1c's on an assumption.

nigelho said:

This is where most type 2 folk are left in the dark not being prescribed meters. Too much assumptions by medics. It is stupid telling people to RAISE their HBA1c's on an assumption.

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If you want low HbA1c's without hypos, read Dr Bernstein's Diabetes Solution. I have been following Dr B's advice for about 18 months now. My last HbA1C was 5.1% and I never have hypos. I no longer need fast acting insulin which, along with a high carb diet, was causing wild fluctuations in my readings.

Interesting thread. Initially I had the same reaction from my consultant and nurse too - I was diagnosed type 1 three years ago. I got my numbers down to near normal levels and hypos are rare, mild and rather predictable (after exercise). I admit I am obsessed with tight control and am very strict with myself. I have an insulin pen in 0.5 units and, yes, I eat a pretty restrictive and monotonous diet. I do odd things like always go for a walk or climb stairs after I eat and I also wear a CGM intermittently when I feel I can afford the sensor.

However, in more recent check ups they have gone out of their way to encourage and help me with my tight control. I suspect from their change in attitude that they have been on a course about 'patient-centred' care and can now see they how my psyche works and that telling someone like me with perfectionist tendencies to relax just isn't going to work. I think they can also see that I am equally obsessed by avoiding hypos and have helped me to do this and still not spike after eating with some tips, for example to graze and go lowish carb and not have normal meals so insulin requirements are lower and swings between high and low less distinct. I know some people feel that I am not having a normal life and that I am very odd in my reaction to diabetes, but actually, having now accepted that I am type 1 and it is pretty rubbish, I've actually found my decision to live in this way rather a relief. Rather than being continually challenged to achieve reasonable control and eat like everyone else I can just get on and enjoy the rest of my life (as it was, but minus normal meals on most days (I do relax a little at weekends to eat with friends and family).

PS I do appreciate that my way of doing things will not be for everyone and is probably indicative that I need some counselling at my next check up!

I'm a chemistry teacher, and the relationship between glycation and glucose concentration is due to the effect of the concentration on reaction velocity. That is, in a reaction between two reactants (here glucose and hemoglobin) the reaction velocity is higher, if the concentration of either reactant is higher, because a higher concentration means more collisions between the reactants. See here: http://www.bbc.co.uk/schools/gcsebi..._pre_2011/rocks_metals/7_faster_slower3.shtml

So if there's more glucose, there's more glycated hemoglobin produced.

Also, the glycation reaction has several steps and the last is shown as irreversible in this paper (http://www.jbc.org/content/256/10/5204.full.pdf), so the reaction is not reversible, and low glucose will not remove glycation. Death and removal of old heavily glycated red blood cells will lower HBa1c, if the current glucose levels are lower.

Elizwoo, you remind me of when I was first diagnosed 22 years ago! I was put on 2 injections of mixed insulin a day and had to follow a strict daily routine. Getting up and going to bed at the same time each day, having the same amount of the same type of food ( very low fat, high fibre carb, no sugar ) and the same amount of excercise at the same sort of time each day. It sort of worked as my HbA1C was 5.8 with few hypos, but I struggled to put on weight as I couldn't eat enough calories with such a high fibre and low fat diet. Eventually I had to switch to MDI so I could have more flexibility, less fibre and put on weight. My weight has been OK ever since, but my HbA1C gradually crept up to 8.3. My attempts to bring it down caused too many hypos, so I was advised to have a pump. My HbA1C is now 6.4 but I still have more hypos than I am happy with and would like more stability. I am convinced that flexibility is actually as much of an enemy as too much carb. I am thinking of going back to my original strict routine for a while to see what happens.