What is an acceptable HbA1c ?

[yingtong]

I have totally lost my hypo awareness,but with a pump and cgm I am now able to sleep at night and so can my wife. Why oh why couldn't I have had this 53 years ago.I believe all type 1's should receive a cgm as standard issue.

 

[Diamattic]

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.

I guess it depends on much you test each day. If you test 3 times daily, then yes, you will be missing massive chunks of your day, and a hypo/hyper can easily result.

I was told when i was diagnosed (yes, here in Canada) that i had to keep my Pre-meal level <5.5mmol/L and 2 hours after every meal i had to check and make sure that it was below 7.8mmol/L, as well as keeping my waking test below 6mmol/L and my before test below 6.5mmol/L

Those were the doctors orders right in the ER before they released me, and they have stuck with that on every appointment. They gave me the long 'complications' speech, wrote this all down for me, gave me her number and sent me on my way with my glucometer and MDI.

I have yet to have a hypo in which i have felt 'bad' - have had 'lows' in which i had symptoms to warn me, but never anything beyond that.

As someone pointed out - low carb has SIGNIFICANTLY helped maintain a flat profile all day, without deviating below 4, or above 8. at thats only at 30g per meal, some people go much lower and see even better results.

I really feel that the treatment for T1D should be insulin, low carb, exercise.

 

[Ali H]

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.

Because you test regularly. I test on waking, before driving, injecting etc etc and as soon as you get any symptoms of a low you test. Hence I have caught any hypos around 3.9. I put my results into On Track software on my phone and my A1C tallies up with the results on there so I pretty much know all is ok. I had a Libre on for 28 days which confirmed that. If you low carb you don't end up with much margin for error for your doses, you don't have the interaction of fats with carbs causing delays etc, it just makes for a much smoother ride.

 

[Ali H]

Because you test regularly. I test on waking, before driving, injecting etc etc and as soon as you get any symptoms of a low you test. Hence I have caught any hypos around 3.9. I put my results into On Track software on my phone and my A1C tallies up with the results on there so I pretty much know all is ok. I had a Libre on for 28 days which confirmed that. If you low carb you don't end up with much margin for error for your doses, you don't have the interaction of fats with carbs causing delays etc, it just makes for a much smoother ride.

Plus I belong to several LC FB groups most of whom are overseas. They mostly have pumps and cgms and you can see the lines are smooth day in day out. My hypo awareness is totally intact thus far.

 

[staffsmatt]

Thing is though there are always going to be things that you just can't calculate for. Stress and worry for example. Every time my son goes off his food I worry and stress about it (first time parent plus I'm a worrier anyway!) guaranteed my levels will go up. Now I can try upping my ratios a bit but how much? How do you quantify exactly how worried you are about something and how much hormones your body is pumping out?

The more of that type of thing you've got going on in your life the less likely you are to have a great hba1c. Something just has to give..

 

[staffsmatt]

I should probably point out that my life isn't really that stressful so I can't really use that excuse!

 

[Ali H]

Thing is though there are always going to be things that you just can't calculate for. Stress and worry for example. Every time my son goes off his food I worry and stress about it (first time parent plus I'm a worrier anyway!) guaranteed my levels will go up. Now I can try upping my ratios a bit but how much? How do you quantify exactly how worried you are about something and how much hormones your body is pumping out?

The more of that type of thing you've got going on in your life the less likely you are to have a great hba1c. Something just has to give..

I care for both my parents and work part time, life is uber stressful pretty much all of the time. Low carbing enables you to have less room for error with dosing and also lower doses in general. The result is that you don't get the rollercoaster ride you would on a normal level of carbs. If you don't have the insulin in large quantities in your body you have less room for error and consequently the peaks are flattened out and so are the troughs. It is hard to explain but put a Libre or a CGM on for a couple of weeks, eat normally, then do the same eating low carb and you would see what I mean.

 

[staffsmatt]

Might give it a go if Abbot ever tell me I can have one!

 

[Ali H]

Might give it a go if Abbot ever tell me I can have one!

If you want any help and guidance shout out on the low carb section on here or PM me. Lots of recipes online, cauli rice is lovely for instance.

 

[ann34+]

Thing is though there are always going to be things that you just can't calculate for. Stress and worry for example. Every time my son goes off his food I worry and stress about it (first time parent plus I'm a worrier anyway!) guaranteed my levels will go up. Now I can try upping my ratios a bit but how much? How do you quantify exactly how worried you are about something and how much hormones your body is pumping out?

The more of that type of thing you've got going on in your life the less likely you are to have a great hba1c. Something just has to give..

some years ago i went to a diabetes uk day where one talk was highlighting the difficulties regarding Type one and diabetes control and unavoidable stress and the effects, the researcher said they had found that in some people stress would lead to them needing less insulin, and in others to them needing more (they said their research had found people were usually in either one or the other of these categories, though some people said they could react either way, and that they could not predict which ). The only advice seemed to be to try to be aware of how your diabetes would react .

 

[Pipsqueak15]

Thanks Tim, not sure how I can ever get to this, been diagnosed 3 years now and best result was 56 before I started rebelling against Levemir and went haywire, just had another month of elevated results so working with my DSN to get a pump. I eat low carb I cycle 2-3 times a week for 20kms a time, test regularly, not sure what else I can do..

Why not try going on a "Herbal Life" diet. Two milkshakes a day plus your normal evening meal. It took me from 80 down to 50 in two months. There are similar "liquid" diets which vary in price. There are many different flavours and are very pleasant to imbibe. Not cheap but one you get down to an acceptable HbA1C you can ease up a bit. You also need to keep up the exercise!

 

[Juicyj]

Thanks @Pipsqueak15 i dont think I could ever do that, I tried a liquid diet when I was younger and ended up at the doctors completely washed out so its a bit too much for me !!

 

[foxhaven19]

Between 42 and 64 in new money is acceptable (6-8%)

 

[Xan2cv]

Stress is a big part of this for me, I am disabled myself because of multiple blood clots in my legs 27 in 25 years and multiple blood clots in my lungs 5 in all I got type 2 about 10 years ago but I believe it could have been avoided by a GP that said BS of 7.0 wasn't anything to worry about, a year in a wheelchair and it signed my contract with type 2 and I had massive weight gain I went from 17 stone to 27 stone in that year. back down now to 19 stone out of the wheelchair and on sticks and crutches and holding my weight down my Hb1ac's are never as low as the health professionals would like and in all this time I have had about five hypos one last winter was so serious I thought I was going to die it felt awful and living alone it can be terrifying my sugars dropped to 1.0 yes and I was still conscious just about.
I will never let this happen again. It was very hard to breathe when it happened. remaining on my feet and taking very deep controlled breaths kept me from passing out just.

I also cook and wash up and clean house for my parents as I am the only child my Mother has Alzheimer's
and my Father has Cancer and he is very ill vomiting at least three times a week with the treatments.

I do my best by them both but I do sometimes get so stressed that I just break down in the end fortunately tomorrow is another day and I carry on, it is horrible old age (Don't Get old) and when it comes to a point that you have to undress your parents to put them to bed at night it starts to grind you down. I used to thrive on stress it was in my job description but it is harder and harder to deal with every day.

People keep saying oh but you can get some rest bite care No you cant if have a family that don't want outside interference
from others or are to proud to ask for that help, so I'm plodding along and it is affecting my health slowly but surely and people keep saying look after yourself because they depend on you ha that's the most difficult thing to do of all, especially if your the type of person that likes to put other people first.. I come home at about 7 to 8pm absolutely knackered and people say that people out of work are lazy they should think again. I think if I did have a full time Job my Parents would be dead by now. and as for my Diabetes well I am just about coping with it. even if my Hb1ac's are to high I will know at the end of each day that My parents are safe in bed fed and as clean and comfortable as they can be.
That is the very least they deserve for bringing me up. I am aware that all this will come to an end at some point so I am prepared and if I still have some health ive got a bucket list of things to do one being to drive or ride route 66.another is to see Scotland because they say it is beautiful and I have never been there. it is so hard to realise how nice it is at the end of a typical day to drink coffee and sit outside in peace and quiet, I think I will like the tranquillity of the countryside very much.

 

[drakman]

mine went up to 67 and my GP said I now have to use insulin as it had slowly been creeping up, I do not have a level on insulin yet but my SDN is happy withmy daily tests which have come down from 11.1 average to 5.6 average and I can adjust my insulin up or down depending on my pre-meal result, if it is in the 5 range I use 10 if I am over 6 then I use 12 units, pretty easy really, I am aiming for an average of 58 in new money

 

[Ali H]

Stress is a big part of this for me, I am disabled myself because of multiple blood clots in my legs 27 in 25 years and multiple blood clots in my lungs 5 in all I got type 2 about 10 years ago but I believe it could have been avoided by a GP that said BS of 7.0 wasn't anything to worry about, a year in a wheelchair and it signed my contract with type 2 and I had massive weight gain I went from 17 stone to 27 stone in that year. back down now to 19 stone out of the wheelchair and on sticks and crutches and holding my weight down my Hb1ac's are never as low as the health professionals would like and in all this time I have had about five hypos one last winter was so serious I thought I was going to die it felt awful and living alone it can be terrifying my sugars dropped to 1.0 yes and I was still conscious just about.
I will never let this happen again. It was very hard to breathe when it happened. remaining on my feet and taking very deep controlled breaths kept me from passing out just.

I also cook and wash up and clean house for my parents as I am the only child my Mother has Alzheimer's
and my Father has Cancer and he is very ill vomiting at least three times a week with the treatments.

I do my best by them both but I do sometimes get so stressed that I just break down in the end fortunately tomorrow is another day and I carry on, it is horrible old age (Don't Get old) and when it comes to a point that you have to undress your parents to put them to bed at night it starts to grind you down. I used to thrive on stress it was in my job description but it is harder and harder to deal with every day.

People keep saying oh but you can get some rest bite care No you cant if have a family that don't want outside interference
from others or are to proud to ask for that help, so I'm plodding along and it is affecting my health slowly but surely and people keep saying look after yourself because they depend on you ha that's the most difficult thing to do of all, especially if your the type of person that likes to put other people first.. I come home at about 7 to 8pm absolutely knackered and people say that people out of work are lazy they should think again. I think if I did have a full time Job my Parents would be dead by now. and as for my Diabetes well I am just about coping with it. even if my Hb1ac's are to high I will know at the end of each day that My parents are safe in bed fed and as clean and comfortable as they can be.
That is the very least they deserve for bringing me up.

You are no good to your parents when you are too sick to care for them, you need to grab the bull by the horns and get carers in morning and evening to help you. That is not respite care that is day to day care in the home and if you want to stick around for your folks, you really need to get that help! I have carers in to my Mum twice daily.

 

[LizzieNI]

Hi
My diabetes psychologist thinks the ideal Hba1c is wrong. It causes so much upset when diabetes is already difficult. He thinks below 8% is fine for making life liveable. Above 9% is where the problems really start.
Interesting non-medical perspective. Mental health is just as important.

 

[Ali H]

Hi
My diabetes psychologist thinks the ideal Hba1c is wrong. It causes so much upset when diabetes is already difficult. He thinks below 8% is fine for making life liveable. Above 9% is where the problems really start.
Interesting non-medical perspective. Mental health is just as important.

Except there are plenty of studies around that show A1Cs above 6 start to correlate to various problems such as retinopathy, cardiac events, neuropathy etc.

 

[LizzieNI]

Yeah for perfect health. But people without diabetes don't follow every single health advice they're given - they enjoy themselves too. It's really only about reducing risk not definitely saving you.

 

[Buxton1998]

The only thing to bear in mind with this though is that very low HbA1c's for T1's can often result in serious hypo issues. Over the last few years mine have ranged from 35-45 but I often had serious night time hypo's when I was unconscious as well as a much reduced hypo awareness.

Things have improved for me since I went onto a pump in May (after 6 weeks of some very bad teething problems) so it will be interesting to see what mine is at my next appointment in about a months time. I have been told that slightly elevated results do not exponentially increase the risk of complications though.

I was at 39 but my consultant was worried it months,as too low and I did have a lot of nightime hypos which resulted with ambulances being called, and reduced hypo awareness, my next one was 51 which was after major surgery and my bs were very up and down, and I was told that it should be lower, it's easier said than done! Always juggling those doses!!!!