Type 1: Hba1c too low

3 answers from me

1 -- that is totally awesome( A1C) !!!!!!!!!!!!!!!

2- your consultant does have a point in that you are still diabetic and dependant on insulin -- so if your hypo symptoms are reduced / eliminated due to running in the 4-5's most all of the time you could be in a spot of bother with the lows.

3 - the libre is fab -- but has not been totally 100% for me -- ok -- very good most of the time but I still needed to test
individual choice there.

drahawkins_1973 said:

I had my annual Hba1c result today and it was 29 mmol/mol. My consultant was worried it was too low. I do appreciate it is low but I eat a low carb diet and so generally don't have big spikes. Therefore I quite often will stay between 4-5 for a lot of the day. My consultant thinks it's bad because I will get used to being 'reasonably' low all day and lose hypo sensitivity.
I'm not sure what response I'm expecting as I don't really know what my question is but do others feel comfortable being in that range. I do use a libre so I have a pretty clear idea of what is happening. Maybe I'm too controlling???

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I had the same response from my consultant a few weeks back - I don't think they are used to seeing anyone with a flat line and a low HbA1c. He hadn't even looked at my graphs and just assumed I was hypoing and had no awareness

Yeh I'm on MDI and my endo doesn't like me to have my sugar below 5. I was getting a lot of figures in the 4's in the mornings at one point and he wasn't impressed. But I can see his point as I get hypo symptoms in the 4's and then drop real fast. But sounds to me like you've done real well with sugar control.

I was in the boat last month at 28 but my nurse is okay with it. She said it's below recommendation but if I settle well with my range 4- under 6 then is okay.

I wouldn't worry too much about it. Many of the specialists are having to catch up with the idea that the old ways of thinking may not be correct any longer. In the past a low Hba1C was always considered to be risky in terms of Hypos. But then there was no way of knowing.

Since then, we've got CGMs and Libres and we know a lot more about the day to day of our conditions than anyone thought possible when they were trained. By using combination therapies (Reduced Carbs, Bolus calculation, continuous monitoring) we are able to not only achieve normal results, but achieve them safely. This blows the minds of many as they simply aren't used to seeing people with that level of insight and monitoring that allows this stuff to be achieved.

And just to add to this, as we see closed loop systems coming more to the fore, we'll start to see that these numbers happen even more consistently.

There's no such thing as a hba1c that it too low, unless you are achieving that through lots of hypos. If you are running at 4-5 that's not hypo. There's a world of difference between being under 4 and over 4, especially if you are flat lining in the 4s. So long as you are confident you can feel that difference and your libre shows you not dropping hypo it sounds as though your consultant has gone textbook without actually considering the reality of the situation for you.

catapillar said:

sounds as though your consultant has gone textbook without actually considering the reality of the situation for you.

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A brilliant sentence! Think this applies to so many post on this forum!

My doctor thought I was to low at 6.1. He suggested shooting for 7.1. He also noted that I was to old to worry about keeping my A1c below 7. I'm 38. And I am looking for a new doctor .

I am 77 yrs and my last 4 a1cs were; 5.9;5.8;5.8 and 5.7 .my doctor said I should go to 7.5's normal a1c's are 4-5 and they don't have diabetic problems..
robert

randinihill said:

My doctor thought I was to low at 6.1. He suggested shooting for 7.1. He also noted that I was to old to worry about keeping my A1c below 7. I'm 38. And I am looking for a new doctor .

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The one you've got isn't much use.

rharry said:

I am 77 yrs and my last 4 a1cs were; 5.9;5.8;5.8 and 5.7 .my doctor said I should go to 7.5's normal a1c's are 4-5 and they don't have diabetic problems..
robert

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It's like they don't listen to the words that come out of their mouths.

My doctor also told me my HbA1c of 6% (42 m/m) was too low.

robert72 said:

I had the same response from my consultant a few weeks back - I don't think they are used to seeing anyone with a flat line and a low HbA1c. He hadn't even looked at my graphs and just assumed I was hypoing and had no awareness

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I know where yer coming from..

I could given them sheet music & they wouldn't notice....
My parting shot reply is "so you would prefer it if I was in a wheelchair pulled by a guide dog?"

nickm said:

My doctor also told me my HbA1c of 6% (42 m/m) was too low.

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Oh I would love to have written that sentence! Well done!

That would be normal for a population urged to eat all those healthy carbs.

Resurgam said:

That would be normal for a population urged to eat all those healthy carbs.

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I'm not really sure what relevance your comment has to this discussion about hba1c levels in people with type 1 diabetes? The target hba1c for adults with type 1 is 48. I.e the aim is to keep it under 48. Targets can be adjusted for individual circumstances. A few people on this thread have been told that hba1c under 48 is too low. There is no guidance providing for a minimum hba1c. However, a low hba1c does, perectly reasonably, raise a concern that the low average might be reached because the patient is having lots of hypos. A couple of people that have commented they have been told their hba1c is too low people are using continuous glucose monitors so they know and have proof that they aren't having a lot of hypos yet the doctors appear to have discounted this evidence and gone on with the warning that their hba1c is too low because of the risk of hypos. It's like the doctors don't understand the benefit of a continuous glucose monitoring system.

Do you think type 1 diabetics are urged to eat carbs? Cos I've never been urged anything to be honest. What is the that you are referring to as "that would be normal"?

I just don't see this as a conversation about carbs, it's more about treating clinicians being so traditionally cautious about avoiding hypos that they can't see the reality of living with type 1 diabetes with modern technology even when it is put in front of them.

A couple of years ago at my annual review my consultant at the diabetic clinic said she thought my HbA1c of 6 in old money was too low and said what sort of figures do I aim for, I said I usually aim for 4 before a meal as that is what the NICE guidelines state, she stated I must be mad as that is almost hypo! It didn't give me much confidence in her knowledge of diabetes and still aim for this control like I have done for the last 41 yrs so far with no problems.