What is a ‘normal’ HbA1c reading?

[Northernerinnorfolk]

Hi

I have just had my diabetic check and my HbA1c reading was 41 (I’m happy and work hard on that). I was told by the Diabetic nurse that this was pre-diabetes and that the pre-diabetes range for a T2 diabetic is 37-42. Has anyone else heard that? The Diabetes UK website says normal is below 42. Who is right?

And before you say anything I’m never going to be cured, or stop doing what I’m doing!

thanks

 

[bulkbiker]

Pre diabetes in the UK is 42-47 mmol/mol and 48 mmol/mol and higher is "full blown" T2.

Your Diabetes Nurse is wrong.

I'd prefer to be sub 40 mmol/mol so keep up the hard work it's going in the right direction!

 

[Robbity]

World Health Organisation/UK recommended non-diabetic/normal is below 42: https://www.diabetes.co.uk/hba1c-test.html#:~:text=HbA1c testing in diagnosing diabetes&text=HbA1c below 42 mmol/mol,or over: Type 2 diabetes

So it would appear that your DN is a little confused, but if you can keep your HbA1c around 41 you're doing OK regardless.

But taking this as "acceptable" recommendations and NOT absolute gospel, I think it depends on what levels you are personally comfortably able achieve and maintain over time. As a still overweight, inactive old woman my "normal" is between 40 and 43. This is where my T2 body is comfortable and I can keep my glucose levels stable within this range long term without much hassle - just odd blips when mainly non dietary issues, e.g. stress, other health problems, some non diabetic medications, etc , may interfere.

 

[EllieM]

The Diabetes UK website says normal is below 42. Who is right?

The official dividing lines do vary a bit from country to country eg in New Zealand prediabetes ranges from 41 to 49 and in the US it's 38 to 47....

Plus there's the fact that someone with a seemingly normal hba1c can have abnormal blood sugars which are masked by having both high and low readings....

Personally, as a long term T1, I'd be overjoyed to have an hba1c of 41, though my diabetic specialist would complain that it was too low and could be leading to serious hypos and potential loss of hypo awareness. (Actually a valid complaint and if I didn't self fund a dexcom continuous glucose monitor I personally would aim for an hba1c of 50 or thereabouts, because I have lost hypo awareness in the past ). But my T1 levels are not directly relevant to your situation, though indirectly they demonstrate that hba1cs can mean different things to different people.

Anyway, congratulations and keep up the good work.

 

[Brunneria]

Yes, as @EllieM says, different parts of the world have different cut offs for labelling Pre-D.

but it also looks like your nurse is confusing preD with D.
PreD is a description, a grey zone suggesting that there is glucose dysregulation developing.
D is an official diagnosis - a pin stuck on a line by a committee within the health service (of whatever country). The place they stick the pin is governed by priorities such as budgets, cost of treatment, cost of healthcare checks, v cost of treatment of future complications if interventions come too late.

the reality is that glucose dysregulation is on a continuum and anywhere in the higher 30s to early 40s is nudging on escalating upwards. The higher you go, the harder it is to stop the upward momentum. It is MUCH easier for someone in the 40s to move back into the 30s (a few diet and lifestyle changes), than for someone with full blown T2 to move back down to preD (which may require a total diet overhaul and escalating medication).

 

[Resurgam]

My Hba1c doesn't seem to match my estimated BG levels - I'd have expected it to be lower, but as everything seems to be quite close to normal levels I just try to continue in the same way year on year. People vary, so near enough is good enough.

 

[EllieM]

My Hba1c doesn't seem to match my estimated BG levels - I'd have expected it to be lower, but as everything seems to be quite close to normal levels I just try to continue in the same way year on year. People vary, so near enough is good enough.

Using an hba1c to estimate blood sugar levels assumes that your red blood cells live on average for 90 days. It's a pretty crude tool, but it's an easy test to do. If your red blood cells live a little longer, or a little shorter, it's going to distort the estimate slightly. So it may well be that your blood sugar levels are in fact a bit lower than that predicted by the hba1c. Long term, as continuous glucose monitors become available to more diabetics, I suspect that time in range will be a more important marker than hba1c.