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Type 2. HBA1C is now 37

L

Laura-lm80cls

Newbie
Hi
I've been told to immediately stop taking my Metformin. I'm still OK, for now to take my Mounjaro. I'm booked a call with the diabetic nurse at my GP Surgery for next week to fully go through my results.

My questions here are:
Can HBA1C be too low in T2D Remission?
Do folks experience hypo symptoms above 4mmol?

My current thoughts are to gradually increase my carbs to increase my next HBA1C test so as to reduce the risk them taking me off Mounjaro - I'm still morbidly obese, but it's helping.

Thoughts please - I think I'm in for a long week
 
So - I cannot tell you that one course of action is the right thing to do..

But - being told to stop Metformin is an excellent step - the goal is not about "holding" your blood glucose at a set level, it's about getting back to a state that your body can control things normally by itself.

Hypo events are largely concerns for people taking insulin, or meds which mimic insulin.
4 mmol/L is considered the lower end of normal, and absent any meds which directly affect insulin, and with a functioning pancreas, your body will simply produce more as at needs.

If you understand that the basic rule of energy management in people is that if insulin is high, and there is enough energy, your body is storing energy (as fat, whether it was eaten as fat or not) - and if insulin is low, you are burning fat for energy.

Some people are more sensitive to the old adage that "sugars and starches are fattening" - so you should see stopping Metformin as a really good sign that what you are doing is the right thing.

As long as you are feeling ok, having a low blood glucose level means that your insulin level must be low, which means that over time, you will continue to burn fat. I can't tell you that this will lead to weight loss (everyone is unique), but adding carbs to raise your blood glucose level may do the opposite.
 
I dont think it can be too low, just low enough that they want to stop the medication as there is no real benefit to taking it.. the challenge then is to keep things controlled by diet so that you dont start needing the medication again

its a good situation to be in
 
I don’t think an HbA1c of 37 is too low. I have had Hba1cs in the 30s since a couple of months after diagnosis (see my signature for my numbers). I was initially put on Metformin. However for the last 18 months I have been on GLP1 meds, similar type of meds to Mounjaro. They have enabled me along with a low carb diet to control my diabetes plus lose weight. Personally I wouldn’t want to increase carbs and elevate my HbA1c just to manipulate my HCPs. If you still have weight to lose I think that’s a good enough reason on it’s own to stay on Mounjaro. I would hope your diabetic nurse would think the same.
 
Hi

I don't think an HbA1c can be too low in the wqy you're thinking - and 37 is bang normal anyway.

Hypos are extremely rare in T2s without glucose lowering medication. It seems from recent CGM data that lots of people (diabetic and non-diabetic) go "low" quite often, and the liver naturally self-corrects. Without the CGM data it probably wouldn't be recognised as anything to do with blood glucose at all.

I've had just the one hypo that needed some intervention in 14-15 years T2 diagnosed and undiagnosed - which I brought on myself through not eating plus alcohol, and it's something to avoid. My infrequent short term dips into 3s and 4s correct naturally, and don't compare.

People do get what are called "false hypos" at higher BG levels. These seem to happen when a person drops from a (very) high BG to a not-so-high BG. The liver detects the fall in BG, and doesn't care that the BG level is still comparatively high - it just rings the alarm bells and dumps a bit more glucose. I remember having these - I'd feel better after a cup of milky coffee with a couple of sugars in it, but all that really did was to make the problem worse.

Having succeeded in reducing your BG you've reduced the risk factors for a lot of complications related to having high blood glucose - things like neuropathy, nephropathy, and retinopathy are all caused and made worse by high levels of glucose in the blood. I wouldn't advise deliberately raising your BG just to convince your nurse you should stay on Mounjaro. I'd hope the nurse would take the view that things are going well and should continue. Don't forget that metformin and mounjaro are prescribed for different purposes.
 
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