Disappointing HbA1c result.

[Sulfate]

I have just had results of my HbA1c one year on from my diagnosis of Pre diabetes. I'm so disappointed as it has only gone down 1 from 44 to 43.
I was convinced it would have gone down. I have lost weight and gone from a size 12 to a 10 and BMI is 19.9. I have been using a glucose monitor and thought my sugars were doing much better. On average before meals the readings are 5.1-5.8 approximately.
Last March hbca1 was 44. In October 43 and 6 months later still 43. I really am at a loss to know what to do now?
I walk everyday, go to the gym twice a week and pilates. Any advice would be very much appreciated.

 

[Leadinglights]

I have just had results of my HbA1c one year on from my diagnosis of Pre diabetes. I'm so disappointed as it has only gone down 1 from 44 to 43.
I was convinced it would have gone down. I have lost weight and gone from a size 12 to a 10 and BMI is 19.9. I have been using a glucose monitor and thought my sugars were doing much better. On average before meals the readings are 5.1-5.8 approximately.
Last March hbca1 was 44. In October 43 and 6 months later still 43. I really am at a loss to know what to do now?
I walk everyday, go to the gym twice a week and pilates. Any advice would be very much appreciated.

You say before meals are less than 6 but what about 2 hours afterwards, that would tell you if there are any problem foods if the increase is more than 2-3mmol/l.

 

[Sulfate]

You say before meals are less than 6 but what about 2 hours afterwards, that would tell you if there are any problem foods if the increase is more than 2-3mmol/l.

The increase is usually 1.5 to 2.5. Sometimes a little more or a little less. I have lost weight due to changing my diet too.

 

[Sulfate]

You say before meals are less than 6 but what about 2 hours afterwards, that would tell you if there are any problem foods if the increase is more than 2-3mmol/l.

Usually 1.5 to 2.5 approximately 2 hours after food. My weight loss is due to me changing my diet too.

 

[janw]

How many grams of carbs are you eating per day? It is usual to have no more than 130 grams in order to reduce your BG, Do you keep a food diary so you can log everything you eat and drink?

 

[Leadinglights]

Usually 1.5 to 2.5 approximately 2 hours after food. My weight loss is due to me changing my diet too.

If you can keep the increase less than 2mmol/l you may get your level down a bit more.

 

[Sulfate]

How many grams of carbs are you eating per day? It is usual to have no more than 130 grams in order to reduce your BG, Do you keep a food diary so you can log everything you eat and drink?

I have Nutracheck food diary which I always fill in. I'm looking at an average 7 days and it can be lower than 130 but also more working out an average its 168

 

[Sulfate]

If you can keep the increase less than 2mmol/l you may get your level down a bit more.

Thankyou. I will try it's all very difficult

 

[janw]

I have Nutracheck food diary which I always fill in. I'm looking at an average 7 days and it can be lower than 130 but also more working out an average its 168

I think you are on the right track, just needing to reduce the daily carb level should do the trick to get your blood glucose down that wee bit more, but you are almost there. Just a few tweaks of your daily food should make all the difference.
Your HbA1c did only increase by 1, so that is nowhere near a disaster by a long shot - and you have the power to change it.
Do let us know how it goes and if your levels are doing well. Best of luck, but I think you have this all but cracked. 🙂

 

[Sulfate]

I think you are on the right track, just needing to reduce the daily carb level should do the trick to get your blood glucose down that wee bit more, but you are almost there. Just a few tweaks of your daily food should make all the difference.
Your HbA1c did only increase by 1, so that is nowhere near a disaster by a long shot - and you have the power to change it.
Do let us know how it goes and if your levels are doing well. Best of luck, but I think you have this all but cracked. 🙂

Thanks for your lovely reply. My HbA1c reduced from 44 to 43.

 

[Leadinglights]

Thanks for your lovely reply. My HbA1c reduced from 44 to 43.

I think just a bit more tweaking of your carbs to bring you average intake down to nearer 130g per day, maybe some substitutions of some of the higher carb foods or reducing the portion size and having some extra veg or salad. I seem to need be nearer to 70g per day to keep my level down.
Maybe this link will give you some new ideas. https://lowcarbfreshwell.co.uk/

 

[Eddy Edson]

I'd keep in mind that HbA1c correlates only approximately with average BG levels, and how closely it correlates can vary widely between individuals. The main factor is the variation in average age of red blood cells between individuals.

The important thing here is that HbA1c is a really unreliable marker of whether you have strayed into "at risk" territory, when the HbA1c level is close to the 42 dioviding line.

You can certainly have an HbA1c of 44 with completely normal BG levels.

The wikipedia entry on HbA1c reproduces a table from the original study setting out the approximate correlations, which also illustates the point:


HbA1c Avg BG
31 5.4 (4.2–6.7)
42 7.0 (5.5–8.5)
53 8.6 (6.8–10.3)
64 10.2 (8.1–12.1)
75 11.8 (9.4–13.9)
86 13.4 (10.7–15.7)

The figures in () are the 95% confidence intervals. So eg when your HbA1c is 42 it probably means you have a 95% chance that your average BG levels are in the range 5.5 - 8.5. In other words, a range between completely normal and definitely NOT diabetic.

[NOT added by moderator .... I think you left it out, @Eddy Edson , hope that is OK]

If you test frequently, in yr situation I would tend to trust my meter more than the HbA1c result. The numbers you report look completely normal to me, but if you want to investigate further, maybe consider self-funding Libre sensors for a couple of weeks to get a more accurate BG picture? Anyway, I'd certainly do that before making extreme & perhaps completely unnecessary changes to diet.

 

[Sulfate]

I'd keep in mind that HbA1c correlates only approximately with average BG levels, and how closely it correlates can vary widely between individuals. The main factor is the variation in average age of red blood cells between individuals.

The important thing here is that HbA1c is a really unreliable marker of whether you have strayed into "at risk" territory, when the HbA1c level is close to the 42 dioviding line.

You can certainly have an HbA1c of 44 with completely normal BG levels.

The wikipedia entry on HbA1c reproduces a table from the original study setting out the approximate correlations, which also illustates the point:


HbA1c Avg BG
31 5.4 (4.2–6.7)
42 7.0 (5.5–8.5)
53 8.6 (6.8–10.3)
64 10.2 (8.1–12.1)
75 11.8 (9.4–13.9)
86 13.4 (10.7–15.7)

The figures in () are the 95% confidence intervals. So eg when your HbA1c is 42 it probably means you have a 95% chance that your average BG levels are in the range 5.5 - 8.5. In other words, a range between completely normal and definitely diabetic.

If you test frequently, in yr situation I would tend to trust my meter more than the HbA1c result. The numbers you report look completely normal to me, but if you want to investigate further, maybe consider self-funding Libre sensors for a couple of weeks to get a more accurate BG picture? Anyway, I'd certainly do that before making extreme & perhaps completely unnecessary changes to diet.

Thanks very much. How do I find about a Libre sensor please?

 

[Eddy Edson]

Thanks very much. How do I find about a Libre sensor please?

freestylelibre.co.uk/libre/

But should say that in any case, even if it corresponds to a slightly elevated avg BG, an HbA1c of 43 is not something to stress about too much: sod-all risk of diabetes-related complications, probably, and it doesn't mean that you're on an inevitable slide towards diabetes. Most people don't progress from "at risk" to "diabetic".