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Type 1: A good HbA1C without hypos?

Discussion in 'Type 1 Diabetes' started by Soplewis12, Jan 8, 2017.

  1. Soplewis12

    Soplewis12 Type 1 · Well-Known Member

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    I honestly don't know how you can manage to maintain such low hba1c results. I am diabetic 27 years & the worst hba1c I have had is 9.2 & the best 7.0, to maintain in the 5`s or 6`s I would be on the verge of hypo constantly. I weigh my carbs, always inject & follow my regime to the best I can. How do you manage to get & maintain such good results?
     
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  2. david.ed.bullock

    david.ed.bullock Type 1 · Active Member

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    I agree with this, I am usually between 8.4-9.6 for hba1c and about to go onto the insulin pump on Wednesday, I also agree to keep a hba1c to that low level must be on verge of hypos :/ I hope pump is suitable for me to help bring hba1c down to a better level! Would be great to chat with you about this, pm me if you want :) x
     
  3. azure

    azure Type 1 · Expert

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    Keep the spikes down. That helps a lot, along with lots of testing.
     
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  4. catapillar

    catapillar Type 1 · Well-Known Member

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    @david.ed.bullock @Soplewis12 a hba1c of 5.3 translates to average blood sugar levels of 5.9, so quite safely away from hypos really.

    The target for type 1 is a hba1c of 6.5, individual targets are adjusted if there is some concern over hypo awareness etc.

    The key building block of diabetic management would be checking your basal dosage works for you and keeps you flat when not eating or bolusing (checking your not going high overnight) and then you can get your insulin:carb ratio correct for you and considering pre bolusing to help with cutting out post prandial spikes, all involves lots of testing.
     
  5. david.ed.bullock

    david.ed.bullock Type 1 · Active Member

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    I had a CGMS fitted and the issue with mine was dawn phenomenon, I was going low around 4am but by 6am it went high, and by time I wake up, it was still high. They decided pump therapy would be best as they can control insulin overnight to prevent this from happening!
    Hopefully this will work!
     
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  6. Soplewis12

    Soplewis12 Type 1 · Well-Known Member

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    Best of luck with the pump. I opted out after discussions, think the young doctor thought I was off my head, but I didnt mind the injections & didn't fancy the permanent canuela (not sure of spelling!) I was told when diagnosed that they thought that even though type 1 I was still producing insulin myself & to expect a honeymoon period that after initial use my requirements for insulin would increase, this never happened. I have also been told that I am sensitive to insulin. Unsure if this overall adds to maintaining optimum control. Thank you catapilla for your advice, I have recently reduced my basal & am very hopeful this will help.
     
  7. Soplewis12

    Soplewis12 Type 1 · Well-Known Member

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    Thanks, I do try, sometimes it works like a dream & then other times it's up & down with genuinely no apparent reason!
     
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  8. leking

    leking Type 1 · Well-Known Member

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    "On the verge of hypo"

    Actually, isn't that what we dream of as perfect management?!

    I used to get a bg reading of 4.x and panic, take some glucose and up it would go. Getting the freestyle libre has shown me that actually, a bg reading of 4.x is fantastic, if the trend says it's going to stay like this.

    It's more difficult with a standard bg monitor, maybe why I used to prick my fingers so often each day. My average glucose level over the last 7 days (according to the libre which reads every 15 mins) is 5.5 mmol. Which you could say that's on the verge of a hypo!
     
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  9. TorqPenderloin

    TorqPenderloin Type 1 · Well-Known Member

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    High Carbs=High Insulin Doses=High miscalculations=High corrections=High A1C

    In short, if you maintain the mindset "I can eat whatever I want I just need insulin," you are setting yourself up for failure.

    As someone with an a1c in the 30s, I actually have more hypos when my average blood sugar increases. The main reason is because of the equation I typed above. When I eat more carbs, that means I have to give myself more insulin for those carbs. That makes it easier to miscalculate which can then lead to very high or low numbers. Sometimes you can overcorrect for those very high/low numbers and find yourself in the totally opposite place you were before.

    Simply put: I try to avoid the blood sugar rollercoaster as much as possible. On most days, I limit my carbs to somewhere 10-20% of my total caloric intake and I try not to eat too many in one sitting. That doesn't make me immune to highs and lows, but it certainly reduces the chances of them happening.
     
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  10. Diamattic

    Diamattic Type 1 · Well-Known Member

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    I have only ever had HbA1c's in the 5s (knock on wood) - I do my best to eat low carb, test 7-10 times a day, and correct at anything above 7, or under 4.5, inject 15-30 minutes before every meal, check 2 hours after, adjust.

    The only hypos I ever have are when I eat high carb food (usually when I eat out, or its junk food), and go high and have to correct to bring it down. There is just to much risk associated with high carb foods - its not worth it IMO. Never fries, always salad. Never burgers with whole bun, low carb bread, small portions, rarely pizza but its always a battle lol

    I try to limit my meals to 20-50g carbs, and only eat 2 meals a day. When I snack its with cheese and vegan lunch 'meats' and veggies which have no carbs. Occasionally i will have chips/crisps and that will almost always ruin my night and send me high so I am working those out lol

    To be honest I haven't had to change much to hold this 'diet' and what I have changed I don't miss at all. Its totally worth the minor trouble in my eyes.
     
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  11. CathP

    CathP Type 1 · Well-Known Member

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    You definitely don't need to hypo all the time for a decent hba1c. My daughter's a1c is 5.6% which equates to an average blood sugar of 6.1...far from hypo. Nightscout says for 90 day average she's below 4mmol only 2-3% of the time, and below 3.5 mmol never. Less carbs, less insulin, less glycemic variability.
     
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  12. Jurga66

    Jurga66 Type 1 · Member

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    Hello,everyone,just trying to undersatnd HBA1c results,my son was diagnosed 4 months ago,we had a hospital app today,his HbA1C is 35,doctor said it's a bit to low,i just dont understand why a bit low is not good?
     
  13. noblehead

    noblehead Type 1 · Guru
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    Their concern is that low HbA1c's are at the expense of frequent hypo's, plus HCP's are also concerned that running bg levels too low will result in loss of hypo awareness symptoms.
     
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  14. catapillar

    catapillar Type 1 · Well-Known Member

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    The default medical position is be concerned about hypos. Did your medical team ask you any questions to find out whether hypos are actually a problem for your son? Does your son have a lot of hypos? Does he have good awareness of his hypo symptoms? Have you/do you test overnight to check he's not hypoing overnight? If you can have a look at those questions and say hypos aren't a problem, there's no such thing as a hba1c that's too low, it's just doctors aren't used to encountering diabetics who are managing well with a lower hba1c and no problem with hypos.
     
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  15. Jurga66

    Jurga66 Type 1 · Member

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    Thank u for your replies..no he's not having a lot of hypos,thanks to libra we r can check as often as we want,but he's quite low all the time,they told me we r doing too good,our night insulin was decreased a bit ,i am checking twice during the night..i may not need to check that often with less lantus,it's been only 4 mnths since his diagnosis,still learning to cope with it
     
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  16. mentat

    mentat Type 1 · Well-Known Member

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    Also remember that the correlation between HbA1c and actual blood sugar varies from person to person. Two people with exactly the same blood sugars can have different HbA1cs.


    Unfortunately some people's sugars are easier to control than others. So don't feel bad.

    A few points to consider:
    • Carb counting only approximates how a meal will affect you. You can further tweak your dosages based on your experiences with particular meals or other aspects like fat content etc.
    • Different management strategies work for different people. If your sugars are very unpredictable, you may benefit from a "sugar surfing" strategy instead of the usual regime.
    • You can learn a lot with a CGM.
     
  17. steve_p6

    steve_p6 Type 1 · Well-Known Member

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    Interesting article here on HBA1C.
    https://diatribe.org/BeyondA1c

    Whilst it is a useful indicator it actually has a wide error bar , quote "an 8% A1c value could reflect an average blood glucose from 140 mg/dl all the way up to 220 mg/dl due to individual differences in how red blood cells and blood sugars bind." From personal experience this helps answer why lab A1C is always 0.5% above prediction from CGM avg. BG.

    But with respect to the OP I have to say @TorqPenderloin nails it in his first four lines.
     
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  18. ann34+

    ann34+ Type 1 · Well-Known Member

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    Why not contact the diabetes centre and ask if you can have a followup or a phone call so you can ask the doctor or your nurse to explain in more detail, they will have all the records, Not sure what you mean regarding him being quite low all the time - if you mean just over 4.0, the doctor may be concerned your son might just dip into a low when active, or when asleep, etc. and this, as mentioned above, can lead to hypo unawareness, and it can make someone at risk of a sudden bad hypo. Also,, if conditions/need for insulin very suddenly change short term, this could be unsafe - - there are many things that could lead to a very sudden change regarding needing less insulin, especially in children , who are still growing and developing, and who are not going to have the same levels of activity every day. The doctor may also have given the advice because, as far as i understand, it is not good for a child or young person's developing brain, in particular, to have hypos.
     
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  19. Kristin251

    Kristin251 LADA · Expert

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    Mine has b en 5.1 the last 3 times. I get tested every 6 months. The ONLY way I can do that is very low carb. Not everyone wants to do that. When I eat carbs I hypo then hyper or the opposite. I rarely hypo because I'm taking very small doses of insulin so the errors will be small. I pretty much eat the same macros at the same meals everyday. Not the same food but 80% fat, 15% protein and 5% carbs. I mix up my proteins and my above ground veggies, always add avocado in some form. This works for me but would probably bore most people.
     
  20. Dillinger

    Dillinger Type 1 · Well-Known Member

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    Avoid carbohydrates and the highs and the lows will go (you need to adjust your insulin appropriately).
     
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