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Why why why

Discussion in 'Type 1 Diabetes' started by Wurst, Oct 6, 2014.

  1. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    @SamJB and @hale710 - I pretty much agree with both your comments. I either mis-read @Wurst 's profile or his T1 status has been added since I did. Frankly, it could be either!.

    But, as a non-medicated T2, I am very comfortable in the 4s, and have no symptoms or apparent loss of physical or cognitive capacity (by observation and challenge by my OH) down to 3.4. Lower than 3.4 and I become stroppy and demanding,............... in particular, for food. Ahem. I wonder why. ;). Probably because food is usually due or overdue.

    Having sorted out an easy way of living, which is largely followed by my fit, non-diabetic, OH, I'm not going to carb up just to raise my HbA1c or potentially make me more aware of 4s or high 3s unless I could be persuaded I am doing harm to myself, running well into the non-diabetic ranges. Do you have views on that?
     
  2. smc4761

    smc4761 Type 1 · Well-Known Member

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    I would have thought a level of 4% would be a tad on the low side to be honest. Non diabetics are typically around 5.5 %

    I have been diabetic for over 30 years and if I have a level of 4% I start getting the warning s signs of a hypo.

    Reading of 5% are excellent and you should be thankful that you have such determination and drive to obtain this. Relax enjoy life and do get not hung up about hitting 4%, seriously that is a little dangerous
     
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  3. CollieBoy

    CollieBoy Type 2 · Well-Known Member

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    @smc4761,
    I think you may be misreading!
    @Wurst appears to be trying to get in the "4% club" i.e. a HbA1c of 4.x not that he wants a HbA1c or B.G. of 4.0%
     
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  4. pavlosn

    pavlosn Type 2 · Well-Known Member

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    I think that despite the misunderstanding regarding whether the 4 per cent club relates to glucose fasting levels or as you rightly state hba1c score, the substance/sentiment of the post still holds true.

    Both 5,0% and 4,x% hba1c scores are well into the non diabetic range. Probably most non diabetics will have higher scores. It is my understanding that there is no medical evidence of any additional health benefits associated with lowering your A1c from 5 to these magical 4,x numbers so I fail to see the importance of doing so.

    It sounds to me like trying to hit a number just for the sake of it.

    It is good to have targets if this keeps us motivated but I do not think that this should reach the point where it becomes an obsession and source of stress and frustration.

    Pavlos
     
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    #24 pavlosn, Oct 18, 2014 at 9:06 AM
    Last edited by a moderator: Oct 18, 2014
  5. Ali H

    Ali H Type 2 · Well-Known Member

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    I am new to basal/bolus and I found if I got tight control I was too low to get in the car to drive. As I care for my parents as well as work part time that just wasn't feasible. My first A1C came in at 7.1, a drop from 9.2 in 3 months, my software is now saying 6.5. If that pans out then I will be happy to try and keep it there. If you get low A1Cs I can't see how you are in the correct range to drive a lot of the time and the last thing I wanted to do was keep on having to eat unnecessarily.

    Ali
     
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  6. donnellysdogs

    donnellysdogs Type 1 · Master

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    My consultant would be horrified if my bloods came in any lower than 5.8. She goes bonkers at me for being that low because of hypo recognition and my driving licence. She wants them to be upward from 6.5 to 7.2 in old money...
     
  7. hale710

    hale710 Type 1 · Well-Known Member

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    No I agree with you, a T2 not on insulin should of course be aiming for a lower hba1c. The addition of insulin, be it to a T1, T2, LADA etc is the important bit. That's when it can get dangerous
     
  8. Brunneria

    Brunneria Other · Guru
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    I'm sorry if you, or anyone is offended by this, but I rarely feel moved to express such vehemence.

    For heaven's sake, get a grip!

    The number on a bit of paper (slightly inaccurate by necessity), which may or may not be affected by 'nerves' is a guideline as to how well controlled your blood glucose is.

    Whether you are 4.9, 5.0 or 5.1 is totally irrelevant to anything other than your ego.

    Do you really believe that a low, slightly in accurate number, the accuracy of which you will never know, affects your chance of being prescribed medication or developing complications?

    I absolutely respect and appreciate your dietary control, exercise regime and fine tuned medication (if any), but please, get another hobby.
     
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  9. Dazza1984

    Dazza1984 Type 1 · Well-Known Member

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    Errr, totally unnecessary comment!
    I think u need to take ur own advice and if u have nothing constructive to say just close the thread and not comment!
     
  10. angelicbaby

    angelicbaby Type 2 · Well-Known Member

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    I dare to agree with Brunneria's comment. This thread is all about the OP's ego. There is absolutely no health benefits of getting a HbA1c of 4-4.9% and in fact I would deem this to bordering on dangerous. A bit like playing a form of russian roulette - "how low can you go". Honestly, this condition is not a game and the OP should be delighted to have a HbA1c in the non-diabetic range.
     
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  11. donnellysdogs

    donnellysdogs Type 1 · Master

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    I personally fear for anybobies anility to recognise hypo's well on low hba1c's. This is my concern, from my own experience and my consultants warnings.

    My consultant also told me to be less "anal" on my control.. So @Brunneria advice actually runs along the good advice my consultants give to me.

    Why would any diabetic of any type want to run the risk of losing hypo control or getting results that are lower than non diabetics. That is insane.

    You have to live..... Live life to the full, if you are too anal about diabetes you aren't enjoying the life around you...and seeing beautiful things and doing wonderful things.
     
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  12. noblehead

    noblehead Type 1 · Guru
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    Whilst I wholeheartedly agree with you there DD it's Wurst's personal choice to which bg levels he chooses to aim for.

    I myself value keeping my hypo awareness symptoms so could never hope to aim for such low levels without comprising them.
     
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  13. donnellysdogs

    donnellysdogs Type 1 · Master

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    I do agree its down to every individual to choose their levels to aim for. I wouldn't however wish for this person to come back at anytime having lost their awareness and saying that nobody warned me. Losing awareness can have dire effects on your life and for others around you.

    Just trying to say that from my experience only (and 4 years ago with my driving licence issue posted on here). I would hate for anybody else to go through the same. So many people on here have posted about losing awareness and some not feeling good enough to be alone, some looking at hypo alert dogs. I was lucky, i was aware with my driving and pulled off the road. I still had a major battle to keep my licence. Even from a consultant shouting at me and telling me I deserved to lose it!!

    People have to be aware that low hba1c's can be restricting their life's either currently from being too anal, or in the future if they lose their awareness.

    I do totally agree it is every persons choice to set their on targets for hba1c, just as high hba1c's can adversely affect health, so can lower ones. Life is about balance.
     
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  14. Wurst

    Wurst Type 1 · Well-Known Member

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    I can see your arguments for and against having a HBa1C in the 4%'s. My target is to have non-diabetic levels at all times the (non-diabetic range being 4 % to 5.9%). By achieving this it shows I am in control of my diabetes and it does not control me :) No ego involved , I am not 'gloating'. As for going low, I don't regularly, I try to keep my levels stable i.e. around the 4.6 mmol mark. I still have full hypo awareness and I've been doing this for 2 year.
     
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  15. angelicbaby

    angelicbaby Type 2 · Well-Known Member

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    Thank you for trying to clarify your position, however by likening your results to wanting to be in a "4% club" you indicate that this is desirable exclusive position to be in. It really is not and my concern is that there may be emotionally vulnerable people that use this forum who may try to join you. This may result in them becoming part of the "dead in bed" club rather than the "wonderful" 4% club.

    I have checked the HbA1c converter on this site and found that a HbA1c of 4% would indicate an AVERAGE of 3.8 mmol/L, a 4.9 result would indicate an average of 5.2.mmol/L, even after eating.

    Please. You have excellent control. You don't need to prove yourself to anyone. You certainly don't need your levels lower than what they are now. Take care and enjoy life to the full.
     
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  16. Wurst

    Wurst Type 1 · Well-Known Member

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    Where in any of my posts have I indicated I don't enjoy life ? Do you need higher blood sugar to enjoy life ? Is enjoying life eating high carb foods and not exercising ? Not for me!

    There are numerous books and internet sources on normalizing blood sugars i.e. to keep them in the non-diabetic range 4 % to 5.9 % , have you written to them with your concerns ?
     
  17. SamJB

    SamJB Type 1 · Well-Known Member

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    I think people are just concerned that others will read this will not be aware of the risks regarding a Type 1 maintaining such low blood sugars. Those risks have been well discussed; losing hypo symptoms, risk of a serious hypo, losing driving licence because of these higher risk levels and quality of life factors.

    If you're happy with those risks, then genuinely, good for you. But other T1s do need to be made aware of these risks on an open forum like this.
     
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  18. Wurst

    Wurst Type 1 · Well-Known Member

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    I see your point but 'Such low blood sugars' are actually non-diabetic levels. Non-diabetic levels = no diabetic complications ! I've based my control around Bernstein's recommendations , I have had very few hypo's and never a serious ones Using low carb , high exercise and low insulin doses it is very difficult to hypo :)
     
  19. AndBreathe

    AndBreathe I reversed my Type 2 · Expert
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    This isn't a challenge or a sneer, as I run my sugars pretty low too. Although as an un-medicated T2, my challenges and physical issues differ from yours.

    Are you measuring the hypos you have based on readings sub-4, or symptoms and sub4?
     
  20. phoenix

    phoenix Type 1 · Expert

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    I'm also concerned at suggesting that it is necessary to have an HbA1c in the 4s to be truly normal, whatever Dr Bernstein says there is no objective evidence to say this is the case .
    Acutally, very few people have HbA1c levels of below 4.5 % and these are often associated with health problems. ( some types of anaemia can cause low HbA1cs)
    David Mendosa interviewed the head of the NGSP (the organisation that standardised tests) He said that that in non diabetics 99% of the values are between 4.5 and 6% .95% are between 4.7% to 5.7% with a slight skew towards the higher end http://www.healthcentral.com/diabetes/c/17/59130/normal-a1c-level/
    see also Low Hemoglobin A1c and Risk of All-Cause Mortality Among US Adults Without Diabetes where the least risk was at an HbA1c of between 5% and 5,4% (on either side it increased , levels below 4.0% were actually a far bigger risk factor than those of 6-6.4%) http://circoutcomes.ahajournals.org/content/3/6/661/T2.expansion.html

    It also isn't normal to stay at below 5mmol/l all day long .

    The non diabetics in the International trial from which the estimated average glucose levels are derived wore continuous monitors for part of the time. 100% of them went above 6.1%, 99% of them went above 7mmol/l and 93% of them above 7.8mmol/l.

    Whilst the median time above 7.8mmol/l was only 31mins, there were people within the middle group (interquartile range) that spent up to 81 min at this level.
    The median time that all of the people in the trial spent above 6.1% was almost 7 hours (395 mins) , sonot a short time (IQR 273-688min) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892065/?report=reader#!po=50.0000


    Lastly, estimated average levels given for any HbA1c are just that: estimated and average. One persons 5% may reflect very different real average glucose levels than anothers.You'll find a convertor on this site using the algorithm worked out from the trial mentioned above. In the UK and many countries you won't get given that estimated average along with your HbA1c result.. That's because for many people it won't be right
    At each end of the spectrum there are people who glycate more or less haemoglobin for any given glucose level. .
    Individual variation means that someone with a true average glucose level of 9.4mmol/l could have an HbA1c as low as 6.5% or as high as 9% http://care.diabetesjournals.org/content/32/1/e11.long

    This means that a person who is a high glycator would have to have achieve far lower average levels to achieve an HbA1c in the 5s (let alone the 4s) than someone who was lucky enough to be a low glycator. This is nothing people can do about this (may well be genetic)
    Something to bare in mind when looking at different peoples HbA1c levels

    Edited to add. I reckon I'm lucky enough to be a low glycator and I have had an HbA1c in the 4s and yes I was warned by professionals and people on forums that I could lose hypo awareness. When I got off my bike, felt a bit hypo and tested to find that my glucose meter said 'lo' ie too low to measure for the second time that week I realised they were right. I now keep my levels at around 5.8-6% and have good hypo awareness.




    .
     
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    #40 phoenix, Oct 22, 2014 at 8:02 AM
    Last edited by a moderator: Oct 22, 2014
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