What is an acceptable HbA1c ?

staffsmatt said:

My last one was 7.5% which is right at the top end of the "Good" level. I've been between 7 and 7.5 for as long as I can remember...

I do worry sometimes that I should be a bit lower (I've been diabetic for 32 years now and, barring a miracle cure, hope to have it for much more than that again!) BUT I know i couldn't get much lower without hypoing all of the time.

I think the most useful bit of the new NICE guidelines is the individual targets. There are always going to be things that we can't change that affect levels, whether that be "Monthly Hell" (which I'm thankful I don't have to deal with!) or having a 17 month old that takes up all of your time (something that I wouldn't change for the world) or a job where you have unpanned / no notice bouts of exersion.

I'm a firm believer that a diabetics life shouldn't be totally about diabetes, yes it's important to try as hard as you can, and yes a HBA1C of 6.5 with no hypos would be brillaint but we're only here once and there's so much more to life than blood sugar readings.

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I'm firmly of the belief that whilst you can't let diabetes run your life you do have to hold it's hand constantly and take it with you. There is so much more to life but I'd like to stick around long enough to see it and to enjoy it. The odds are firmly stacked against us in all sorts of directions so control what you can as best you can!

Completely agree, you can't ignore it. It's finding the right balance for yourself that's the tricky part!

I would say that the only way to avoid complications is to always have your sugars in the 'non-diabetic' range. Including after meals.

HbA1c's are a handy tool, but keeping them low does not exempt you from complications later in life. Post meal, and short duration glucose spikes will damage cells while leaving your HbA1c relatively unchanged.

Being a ~3 month 'average', the HbA1c wont be effected by 1 or 2 hours of high sugars every day, but your cells will. So having that number as low as possible is always best, it is no guarantee.

My HbA1cs have all been around 5.6% since diagnosis, and i can you I still peak above 8mmol/l for roughly 1-2 hours after any meal with greater then 30g of carbs regardless of when i inject my pre-meal bolus. because of this i have just recently (maybe 3 weeks ago) given up eating more then 30g of carbs in meal, and only now have i be able to keep my readings below 7.8mmol/L around the clock.

noblehead said:

As @tim2000s says a good level to aim for would be the Nice Guidelines of 6.5%.

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I'm hypo unaware and I did the DAPHNE course and they recommend 6.5 mine at the moment is 4.8% and that's only because I'm not eating as I should.c

Diamattic said:

I would say that the only way to avoid complications is to always have your sugars in the 'non-diabetic' range. Including after meals.

HbA1c's are a handy tool, but keeping them low does not exempt you from complications later in life. Post meal, and short duration glucose spikes will damage cells while leaving your HbA1c relatively unchanged.

Being a ~3 month 'average', the HbA1c wont be effected by 1 or 2 hours of high sugars every day, but your cells will. So having that number as low as possible is always best, it is no guarantee.

My HbA1cs have all been around 5.6% since diagnosis, and i can you I still peak above 8mmol/l for roughly 1-2 hours after any meal with greater then 30g of carbs regardless of when i inject my pre-meal bolus. because of this i have just recently (maybe 3 weeks ago) given up eating more then 30g of carbs in meal, and only now have i be able to keep my readings below 7.8mmol/L around the clock.

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There's no average or "average" in HbA1C. It's a measure of glycation and when cells become glycated they stay glycated.

May I ask, are you on levimir?? I switched from levimir to lantus and it has really improved my levels.... Worth considering? I find it has steadied my levels so I'm no longer spiking...fewer hypos and a lower average ...

Diamattic said:

I would say that the only way to avoid complications is to always have your sugars in the 'non-diabetic' range. Including after meals.

HbA1c's are a handy tool, but keeping them low does not exempt you from complications later in life. Post meal, and short duration glucose spikes will damage cells while leaving your HbA1c relatively unchanged.

Being a ~3 month 'average', the HbA1c wont be effected by 1 or 2 hours of high sugars every day, but your cells will. So having that number as low as possible is always best, it is no guarantee.

My HbA1cs have all been around 5.6% since diagnosis, and i can you I still peak above 8mmol/l for roughly 1-2 hours after any meal with greater then 30g of carbs regardless of when i inject my pre-meal bolus. because of this i have just recently (maybe 3 weeks ago) given up eating more then 30g of carbs in meal, and only now have i be able to keep my readings below 7.8mmol/L around the clock.

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I agree - i never have thought spikes a good thing - but the thing is how to do it safely long term - you are new diagnosed, possibly may have residual insulin and therefore the other hormones that come with that, and will have ok hypo symptoms . I see you are on the pump, and maybe a vibe is a CGM?

without these tools , and also after many years of type one controlled using very basic and inadequate tools mostly, it may not be possible to keep control like this. And as yet only a tiny proportion of Type ones in the UK even have a pump. I wanted one years ago, it was frustrating knowing i could feel a lot better, but without being able to. Here in the uk in the past you would have had to have a private doctor to refer you to a private consultant all on top of very high pump costs.

Also, for everyone, this sort of control long term - over many years - entails a great deal of effort , and enormous self control. I am fine until i walk into a supermarket - i have to avoid them completely.
i imagine more responsive systems will be in soon, hopefully, allowing the sort of control you describ, but their cost will be a problem at the beginning.

P.S. re carbs, again, i agree, the 30 CHO meal , max 40 CHO, was the advice given to me years ago! when i was diagnosed the advice was to keep meals about this, 3 meals of 30, or 2 of 30 max and one of 40 and at least 3 or 4 snacks of fruit or plain biscuit of 10 carbs to reach a total around 140 carbs, i strayed when the new advice came in, then came back to this, now a bit less.

ann34+ said:

Also, for everyone, this sort of control long term - over many years - entails a great deal of effort , and enormous self control. I am fine until i walk into a supermarket - i have to avoid them completely.
i imagine more responsive systems will be in soon, hopefully, allowing the sort of control you describ, but their cost will be a problem at the beginning.

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The 30th year is the kicker isn't it!

staffsmatt said:

The 30th year is the kicker isn't it!

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Yes! And the 35th is not much better. Problem not helped by the supermarkets - they seem to compete to offer even more enticing high carb food. Or maybe i am just carb starved.....having a bit of sweet tooth does not help...

ann34+ said:

Yes! And the 35th is not much better. Problem not helped by the supermarkets - they seem to compete to offer even more enticing high carb food. Or maybe i am just carb starved.....having a bit of sweet tooth does not help...

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****** I was hoping it would get miraculously easy next year . Super markets don't bother me so much, now chip shops on the other hand...!

@ann34+ - Yes I am newly diagnosed (15months ago), and yes, my doctor put me on a pump. But sadly an 'acceptable HbA1c' has nothing to do with 'effort' or difficulty, or time spent living with diabetes. Our body only sees damage or no damage, it doesn't get that someone is trying their best and its really hard, so it won't give that person complications.

I understand that in the long term I (or others) may not be able to maintain my current level of control, but that doesn't change what is acceptable, it just means that my HbA1c is no longer acceptable, at that point it will suck seeing that on paper, but it will either mean i need a large change in my life, or learn to live with a 'non-acceptable' HbA1c and what that means health wise.

Regardless of what we deem as acceptable everyone's bodies reacts differently, and its still very possible to have a 6.5% and get complications, or early death. So someone saying "X.X% is acceptable" doesn't really make it so. We just have to shoot for as close to normal as possible, and the farther you are away from that, the higher the risk.

Juicyj said:

What can I do if i'm already trying my hardest...

Well i've come to the conclusion then that I have to have a hysterectomy as this gives me hell for one week of the month with surging hormones that despite increased basal and correction doses is incredibly hard to reign in, I have to give up work as I am on my bum whilst i'm working and this gives me insulin resistance, give up my 3/4 glasses of red wine a week and probably think about having all my teeth removed so I don't have dental infections.

Then I might/just might achieve the 'NICE' guidelines..

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one can only try ones best - that was me when i was younger - it was much more than a week every month, daily insulin needs going from 17 to 43! i did graphs to show the docs but no one was interested., they were well aware of the issues, there was just nothing they could do other than put women on the pill. - more strips would have helped as we did not get many then, but not sure the pump could have helped me much other than even things a bit. and reducing some of the hypos/ making adjustments easier....a closed loop system is needed...... it may not be what you want to hear, but if you continue having teeth infections having a lot out may be the way to go - i had easier control when i had all my molars out, i wish i had done so years earlier

Diamattic said:

@ann34+ - Yes I am newly diagnosed (15months ago), and yes, my doctor put me on a pump. But sadly an 'acceptable HbA1c' has nothing to do with 'effort' or difficulty, or time spent living with diabetes. Our body only sees damage or no damage, it doesn't get that someone is trying their best and its really hard, so it won't give that person complications.

I understand that in the long term I (or others) may not be able to maintain my current level of control, but that doesn't change what is acceptable, it just means that my HbA1c is no longer acceptable, at that point it will suck seeing that on paper, but it will either mean i need a large change in my life, or learn to live with a 'non-acceptable' HbA1c and what that means health wise.

Regardless of what we deem as acceptable everyone's bodies reacts differently, and its still very possible to have a 6.5% and get complications, or early death. So someone saying "X.X% is acceptable" doesn't really make it so. We just have to shoot for as close to normal as possible, and the farther you are away from that, the higher the risk.

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Hi, Diamattic, i agreed with your original post - i imagine you were answering the question rationally, and using the word 'acceptable' in a particular way, i agree we dont know what the level of HbA1c is which will prevent or at least reduce complications in any one individual, and that, anyway, HbA1c does not measure temporary spikes, which may harm some, and that the only way is to keep blood glucose under 8.0 at all times in an ideal world.
But its not an ideal world - speak to any diabetic organisation careline, or meter careline - a large number, i think still a majority, of type ones in the uk at least, do not reach the target. I think you are in Canada - i dont know the situation there?
I was using the word acceptable more in the everyday sense as 'acceptable to the particular individual' and i cant split that off from the effort thats willing to be made /difficulties that are able to be put up with, etc or what is acceptable in order that the person prevent hypos, etc, . i personally treat the HbA1c as a workable number to aim for, as long trials have shown the figure will greatly lessen complications in a large proportion of people, but i factor my individual issues in to my decisions.

ann34+ said:

Hi, Diamattic, i agreed with your original post - i imagine you were answering the question rationally, and using the word 'acceptable' in a particular way, i agree we dont know what the level of HbA1c is which will prevent or at least reduce complications in any one individual, and that, anyway, HbA1c does not measure temporary spikes, which may harm some, and that the only way is to keep blood glucose under 8.0 at all times in an ideal world.
But its not an ideal world - speak to any diabetic organisation careline, or meter careline - a large number, i think still a majority, of type ones in the uk at least, do not reach the target. I think you are in Canada - i dont know the situation there?
I was using the word acceptable more in the everyday sense as 'acceptable to the particular individual' and i cant split that off from the effort thats willing to be made /difficulties that are able to be put up with, etc or what is acceptable in order that the person prevent hypos, etc, . i personally treat the HbA1c as a workable number to aim for, as long trials have shown the figure will greatly lessen complications in a large proportion of people, but i factor my individual issues in to my decisions.

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That's the way I view HbA1c too. It's an indicator, a target, but people can only do their best. Compared to T1, people with the common or garden variety of T2 like what I have, have it easy. I can work at getting my HbA1c down and I have a good chance at achieving that. But from what I have read online and seen in my T1 friends and family, it's complex. There are many things that make it hard to lower HbA1c in T1. To all of you who are doing your best... well done.

Diamattic said:

@ann34+ - Yes I am newly diagnosed (15months ago), and yes, my doctor put me on a pump. But sadly an 'acceptable HbA1c' has nothing to do with 'effort' or difficulty, or time spent living with diabetes. Our body only sees damage or no damage, it doesn't get that someone is trying their best and its really hard, so it won't give that person complications.

I understand that in the long term I (or others) may not be able to maintain my current level of control, but that doesn't change what is acceptable, it just means that my HbA1c is no longer acceptable, at that point it will suck seeing that on paper, but it will either mean i need a large change in my life, or learn to live with a 'non-acceptable' HbA1c and what that means health wise.

Regardless of what we deem as acceptable everyone's bodies reacts differently, and its still very possible to have a 6.5% and get complications, or early death. So someone saying "X.X% is acceptable" doesn't really make it so. We just have to shoot for as close to normal as possible, and the farther you are away from that, the higher the risk.

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I think there’s a degree of pedantry clouding the OP. Saying 6.5% is an acceptable HbA1c level is, in my opinion, perfectly ok. You will be diagnosed as diabetic if you are over 6.5% thus, if you are not over, then your level is acceptable.
Now, technically, 6.0 – 6.5% will get you a pre-diabetic diagnosis so you could argue that the acceptable level would then be 6.0%.
Further, a “normal” persons HbA1c should be <5.5% so you could further argue that this is the acceptable level.

I would rule out that last one as diabetics are not “normal” in pancreatic circles. I would say anything 6.5% or under is acceptable. For individual cases a Doctor may agree that higher figures are acceptable and these can only be judged on an individual basis. The risks run by someone having a target of 7.0% may be far outweighed by other conditions they suffer from. You just don’t know.

Aiming for normal levels is the obvious goal for any diabetic but no diabetic can do that safely without a CGM to tell them they are not suffering regular episodes of hypo’s. Without that evidence, then I would argue that sustained HbA1c levels of 5.4-5.7% would only be achieved through numerous hypo’s. Near normal readings suggest that BG levels are almost never raised for prolonged periods of time leading to glycosylation which simply flies in the face of what diabetes is and does.

In the first two years after diagnosis I was never above 6.3% and I know I suffered regular hypo's.

A lot of people with sub 6 A1Cs are doing it via low carbing, you don't get the highs and the lows, if you have a cgm or Libre on you can see how little eating a meal affects your levels. My A1C is 6.1 and should be in the 5s when tested next week if my software is correct. Very few hypos, probably under 10 in 15 months of taking insulin and most of those were late 3s. I don't have a CGM and have only had a Libre on for 28 days just to see what's what. No pump either, MDI 5 or 6 times a day on average.

Not everybody wants to or can low carb, each to their own, but I am aiming to keep mine in the 5s.

Ali

Ali H said:

A lot of people with sub 6 A1Cs are doing it via low carbing, you don't get the highs and the lows, if you have a cgm or Libre on you can see how little eating a meal affects your levels. My A1C is 6.1 and should be in the 5s when tested next week if my software is correct. Very few hypos, probably under 10 in 15 months of taking insulin and most of those were late 3s. I don't have a CGM and have only had a Libre on for 28 days just to see what's what. No pump either, MDI 5 or 6 times a day on average.

Not everybody wants to or can low carb, each to their own, but I am aiming to keep mine in the 5s.

Ali

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My other concern would be that without a CGM how do you know your hypo awareness hasn't diminished? I could go see my Doc and say, yay no hypo's for ages now but in reality could be having several without noticing.

CGM's for all.

It's been interesting for me. Libre plus switch of insulin from Lantus to Levemir has resulted in improved Hypo awareness , in that I generally feel them now at around 4, where previously I was at around 3 and better Hba1C. I put this down to two things:

1. Catching drops earlier and treating them before they are low.

2. Having a much more even absorption profile with Levemir than I ever achieved with Lantus.

Scardoc said:

My other concern would be that without a CGM how do you know your hypo awareness hasn't diminished? I could go see my Doc and say, yay no hypo's for ages now but in reality could be having several without noticing.

CGM's for all.

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Agreed, i remember a study where children first had some form of overnight glucose monitoring overnight for several nights in a research study - i think the children were in hospital for the tests - and a large proportion of them were dipping too low over some of the nights, sometimes several times and sometimes for quite long periods, most had no knowledge that they had. I dont remember the name of the study but it confirmed my experience - when, some years into diabetes, i stopped waking in the night with good hypo symptoms, I tested more overnight for a short while, and i realised I also was dipping too low a lot - i found it very hard to wake when i was around 3.0. or lower. I just had to raise my numbers as i felt my brain was at risk - without any CGM and an alarm, or even a pump to lower base rates at specific times , I was literally at sea with no protection and no compass.