Hyper Question and HBA1c

[astbury1]

What is actually classed as hyperglycimia? Is it continual high blood sugars through the whole day and not reducing? or does it include the spike after food?

I get quite high readings after food and then come back in to normal range when novorapid kicks in. I would not class this as hyper?

Is it when you have all the other symptoms too like constant peeing?


Also with the HBA1c blood test. How is this measured? I mean is the spike after food taken into consideration? Or the pre meal reading? Is it the longer the spike the higher the HBA1c? Confused!

 

[trophywench]

Any time your BG goes over 7.8 it's technically always hyperglycaemia, the same as under 4 (or 3.7 or whatever LOL) is always hypo.

If it's just a food spike, then I won't say it doesn't matter, but nobody would be concerned about it, unless it was every meal every day every week and it didn't soon return to normal ....

As a health condition, it describes prolonged too high BG.

The HbA1c doesn't measure what a meter measures, which is purely a snapshot of what's in your finger right now this very minute. It measures glycosulated haemoglobin. That is to say, it measures the amount of glucose that has actually 'stuck' permanently to your haemoglobin over the previous 10 - 12 weeks. It isn't exactly an average either!

Because haemoglobin molecules die after approx 100/120days to be replaced by nice new ones which obviously don't have anything stuck to em at all - what yours did in the last 4 or so weeks prior to the blood being drawn, counts for approx 55% of the result, the next month back counts for about 30% of it and the month furthest back (those that are about to die) counts for the balance.

 

[everydayupsanddowns]

Do you know in terms of technical definition I'm not sure!

I suspect it is *any* high reading, but that is not what is really important IMO.

The way I look at it, we each (in consultation with our clinic/team) need to decide what levels we are happy seeing, and which we think put us at increased risk complications and/or make us feel rotten.

Whatever levels you aim for, they are *much* easier to work towards if you own them yourself, rather than feeling "they" (whoever they are) have forced them on you. And once you've put strategies in place to hit those levels most of the time you might consider tightening a notch every so often to improve your long term chances (or even giving yourself some slack for a time).

There is some compelling recent research that suggests that overalls and averages are only part of the picture. The day to day stability of levels is also very important, and trying to keep your variation down to a minimum is arguably just as important as getting a lowish A1c. Keeping 'spikes' after meals down to reasonable levels is obviously important in this regard - but this is something to work towards (you've only just started on MDI after all!).

The HbA1c test measures how much glucose has stuck to your red blood cells. Blood always has some glucose in it, and the more it has the more haemoglobin molecules combine with glucose molecules to form 'glycosylated haemoglobin'. Since red blood cells last 120 days or so, by measuring the amount of HbA1c in a sample you can make an assessment of how much glucose there has been present in the bloodstream over the last 120 days.

More detail here: http://medweb.bham.ac.uk/easdec/prevention/what_is_the_hba1c.htm

In terms of how post-meal levels will impact on HbA1c... well I guess you just have to consider the hours spent 'coming back into range' from higher levels. The higher you get to, and the longer it takes to get back to 'normal' the more time you will be spending in double figures. Given that 3x meals a day with 4hr bolus doses for each make up 12 hours that could have a significant impact on how much excess glucose you have sloshing around in your bloodstream 🙂

EDIT: Posted at the same time as TW - who was much more short and sweet!

 

[Northerner]

I believe that non-diabetic people may get levels above the normal 3.3-6.0 mmol/mol, maybe up into the 8s depending on what they have eaten and also if they are developing some insulin resistance. However, I would personally consider a 'hyper' to be in the mid to high double figures at least, especially for someone on insulin as this would be the point at which you may start developing ketones. If you are getting spikes after eating the best way of dealing with them is to either adjust the timing of your insulin injections so the novorapid is beginning to peak as the food does, or stop eating whatever it is that causes the spikes 😉 If it happens with most things you eat then the timing of injections will really help - I aim to inject around 15 mins before eating.

Symptoms may only appear at different levels for different people, so it's not really a guide. I would say that if your levels are generally above 7 all the time, including fasting levels, then you could also class that as hyperglycaemia, as you suggest.

The HbA1c is quite different from the fingerprick tests - it measures the amount of glucose that clings to red blood cells. These cells have a lifespan of around 6-12 weeks, so the test will show the level of glucose that has been in your blood over that sort of time span, weighted towards more recent weeks as those cells will be 'fresher'. I'm sure that's not a good scientific explanation! 🙂 If your blood has generally higher levels of glucose then your HbA1c will be higher. If you only have the occasional spike this won't really feature over the long time period. What is important is if you are spending a lot of time overnight, for example, as if your levels are high overnight and when you wake then this means you will have spent a third of your day with high glucose - a food spike might only be for half an hour or so.

Sorry for rambling, I hope you get the gist!

 

[astbury1]

I think I must be hyper pretty much most of the time then! Oh well, asyou say just started MDI. I do still have the problem with spiking and taking a while to get back into range however have seen a slight improvement with cutting the carbs and trying to inject 5 mins before eating and trying different foods! I suppose I was expecting immediate great results. I must admit though am happy if I see a 8-7 pre meal and morning at the moment as I would rather get to know what my patterns are without going hypo and then deciding i want to be back on insultard! Think I just need to gain my confidence and realise that Ive only had this 3 months!😱

 

[everydayupsanddowns]

...Oh well, asyou say just started MDI. I do still have the problem with spiking and taking a while to get back into range however have seen a slight improvement with cutting the carbs and trying to inject 5 mins before eating and trying different foods! I suppose I was expecting immediate great results. I must admit though am happy if I see a 8-7 pre meal and morning at the moment as I would rather get to know what my patterns are without going hypo and then deciding i want to be back on insultard! Think I just need to gain my confidence and realise that Ive only had this 3 months!😱

Couldn't agree more! I've been at this 20 years and I still learn new things most weeks. You are doing brilliantly! And a more gradual 'tightening' of overall levels will be mush easier on your microvascular system than crashing from high to low the whole time.