Lack of progress in reducing Hba1c

[Aitchelle]

Sept 23 Hba1c 43 weight 57kgs
Dec 23 41
March 24 42
Aug 24 42
Dec 24 43 weight 50 kgs, has been lower, BMI 19.3

I have been following this forum for a year now. I have learnt a lot and been encouraged by reading how folk have reduced their Hba1c level. Unfortunately I am unable to post a success story of my own......

I am surprised at my lack of progress and am at a loss to know what to try next. I aim to be under 130 g carbs per day, usually around 90 gms, with a vegetarian diet. My diet has always been healthy, I don't have a sweet tooth which helps.
I have been finger prick testing and results are usually good. Morning fasting results are under 5.5. Pre and 2hr post meal testing usually show a variation around 0,5 to 1.4 and well under 8, typically in the sixes or low sevens.
I cannot afford to lose any more weight.
I am feeling very discouraged at the moment. I am wondering whether I have been wasting my time and effort, have I stopped it increasing or is this where my natural level is?

 

[Leadinglights]

Sept 23 Hba1c 43 weight 57kgs
Dec 23 41
March 24 42
Aug 24 42
Dec 24 43 weight 50 kgs, has been lower, BMI 19.3

I have been following this forum for a year now. I have learnt a lot and been encouraged by reading how folk have reduced their Hba1c level. Unfortunately I am unable to post a success story of my own......

I am surprised at my lack of progress and am at a loss to know what to try next. I aim to be under 130 g carbs per day, usually around 90 gms, with a vegetarian diet. My diet has always been healthy, I don't have a sweet tooth which helps.
I have been finger prick testing and results are usually good. Morning fasting results are under 5.5. Pre and 2hr post meal testing usually show a variation around 0,5 to 1.4 and well under 8, typically in the sixes or low sevens.
I cannot afford to lose any more weight.
I am feeling very discouraged at the moment. I am wondering whether I have been wasting my time and effort, have I stopped it increasing or is this where my natural level is?

That may just be your natural level, take heart from had you not been doing what you have then your HbA1C may have gone up whereas it has remained stable.
If you want to prevent further weight loss then you should make sure you are eating enough protein and healthy fats.
Sometimes people who are vegetarian can be anaemic and if you are that does affect to accuracy of the HbA1C test.
That may be an acceptable HbA1C depending on how old you are.

 

[Docb]

Hi @Aitchelle. I am with @Leadinglights and it could be that you are simply one of those people for whom the label "at risk of diabetes" is not something you need to react to. It was invented as a means of giving a jolt to those who were heading for a diabetes diagnosis and to encourage them to make changes before that is the case. Simply ask yourself whether you fall into that category. 😎

 

[JITR]

@Aitchelle
Well, maybe you have reached your natural base level, maybe not. There are other things to check other than HbA1c and BMI. Such as dietary details, carbohydrate tolerance, eating patterns (timing of meals, time between meals and snacks), waist measurement (now v what it once was), sleep etc.

 

[Eddy Edson]

Just a fundamental thing: HbA1c is a pretty fuzzy measure of your average blood glucose. Your 42 level could very easily be "the same" as somebody else's 35 HbA1c. in the sense that you both have the same average blood glucose.

The wikipedia entry for HbA1c https://en.wikipedia.org/wiki/Glycated_hemoglobin gives this table based on the original study looking at the relationship between average blood glucose and HbA!c:

​

5	31	5.4 (4.2–6.7)	97 (76–120)
6	42	7.0 (5.5–8.5)	126 (100–152)
7	53	8.6 (6.8–10.3)	154 (123–185)
8	64	10.2 (8.1–12.1)	183 (147–217)
9	75	11.8 (9.4–13.9)	212 (170–249)
10	86	13.4 (10.7–15.7)	240 (193–282)

​

Parentheses show 95% confidence intervals, so (roughly speaking) with your 42 HbA1c, there's a 95% chance that your average blood glucose is somewhere between 5.5 and 8.5 mmol/l. At the low end of that rage, the numbers are completely "non-diabetic". At the high end, they shade into actual diabetes.

This has nothing to do with eg having anemia or being in any way "unusual". The variation is due mainly to natural variations between people as to the average age of their red blood cells. Without knowing what your average red blood cell age is, the most you can infer from your HbA1c level of 42 is (roughly) that there's a 95% chance that your average BG is in the 5.5-8.5 range, straddling the separation between "normal" and "diabetic".

HCP's really should know this & explain it properly, rather than treating "42" as some kind of magical border between normal & diseased.

To get better insight, it may be worth self funding a Libra sensor or something similar for a couple of weeks. In your position. But I guess the real bottom line is that you are probably nowhere near levels which are likely to result in any complications.

 

[JITR]

Just a fundamental thing: HbA1c is a pretty fuzzy measure of your average blood glucose....
HCP's really should know this & explain it properly, rather than treating "42" as some kind of magical border between normal & diseased.

Yes, we all rely too much on HbA1c.

This version of the table from the original study (2012) may help to see what is going on:

https://diabetesjournals.org/care/article/31/8/1473/28589/Translating-the-A1C-Assay-Into-Estimated-Average

Data in parentheses are 95% confidence intervals​

Also this plot of Average Glucose v A1c from the same paper.


Linear regression eAG(mmol/l) = 1.59 × A1C − 2.59.

 

[Lucyr]

Not sure what formatting you’ve done @JITR but that’s totally invisible

 

[JITR]

Not sure what formatting you’ve done @JITR but that’s totally invisible

Please look again.

 

[victorhamesse]

Sept 23 Hba1c 43 weight 57kgs
Dec 23 41
March 24 42
Aug 24 42
Dec 24 43 weight 50 kgs, has been lower, BMI 19.3

I have been following this forum for a year now. I have learnt a lot and been encouraged by reading how folk have reduced their Hba1c level. Unfortunately I am unable to post a success story of my own......

I am surprised at my lack of progress and am at a loss to know what to try next. I aim to be under 130 g carbs per day, usually around 90 gms, with a vegetarian diet. My diet has always been healthy, I don't have a sweet tooth which helps.
I have been finger prick testing and results are usually good. Morning fasting results are under 5.5. Pre and 2hr post meal testing usually show a variation around 0,5 to 1.4 and well under 8, typically in the sixes or low sevens.
I cannot afford to lose any more weight.
I am feeling very discouraged at the moment. I am wondering whether I have been wasting my time and effort, have I stopped it increasing or is this where my natural level is?

My 2p worth in this is to look at the carbs you are eating and try variations in diet. Maybe some of the carbs are causing a higher glucose reaction than others. In my case, bread and porridge are to be avoided.

 

[Aitchelle]

That may just be your natural level, take heart from had you not been doing what you have then your HbA1C may have gone up whereas it has remained stable.
If you want to prevent further weight loss then you should make sure you are eating enough protein and healthy fats.
Sometimes people who are vegetarian can be anaemic and if you are that does affect to accuracy of the HbA1C test.
That may be an acceptable HbA1C depending on how old you are.

That's the positive way at looking at it, I will think of it like that too and stick with what I am doing.

I was hoping for a reduction as the finger prick readings have been coming down over the year, especially the last few months. My fasting pre breakfast readings are usually between 4.5 and 5.4, pre meals usually around 5.0 to 5.5, a few in the 4's, and post prandial increase of 1 to 1.4. That is well under 8 and a variation of less than 2. The MySugr app showing an estimated Hba1c of 34, although I realise that is only an estimate and not calculated in quite the same way as the standard Hba1c test.
Full blood count, liver function, serum lipids etc etc all okay, anaemia is not an issue.

Thank you to all of you for your encouragement.