Fasting sugar falling, HBA1C steady

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elpirata

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At risk of diabetes
Good morning Newbie here,

Around 2 years ago my fasting sugar was found to be around 7.7 and the HBA1C was 6.6.

Since then I lost 32kg weight and am now 75kg with BMI 21.4, also 1 hour walking per day since then.

Also since the start I have been taking around 1500mg Metformin / day.

Around 1 year ago my fasting sugar was down to around 5.5 - 5.6 and my HBA1C was 5.5.

Now 1 yr later the fasting sugar is around 5.0 but the HBA1C is still 5.5.

I asked the doctor but didn’t really get a good explanation of why it the HBA1C hasn’t fallen further..

Any good explanation please ?

Many thanks…
 
Fasting glucose doesn't really accurately predict hba1c. In fact, I believe using FBG to predict hba1c leads to lower values than the real value.
 
5.5% converts to 37mmol/mol in new money which is NORMAL.
So is pretty consistent with a fasting level of 5.5mmol/l
They are measuring different things in the HbA1C takes account of blood glucose levels 24/7 for 3 months whereas you fasting test is a moment in time.
 
As @Leadinglights says, you are now in the "Normal" HbA1c range. You can't expect it to continue to drop as a lower HbA1c may not something that your body can achieve, nor need to achieve. 37 is excellent, so many congratulations on achieving that.

There is no direct correlation between average BG and HbA1c let alone fasting BG and HbA1c, it depends on your blood make up... ie the amount of red blood cells in your blood and their current lifespan and as you get older they are not replaced as quickly. HbA1c is a measure of the amount of glucose molecules stuck to your red blood cells (haemoglobin) during their lifespan and they tend to average about 12 weeks hence the mention of a 3 month average BG which isn't completely accurate, but gives people an idea. Hope that makes sense.
 
Nothing to worry about as said. Fasting blood sugar is not the same as your average level during the 24 day, let alone over 3 months, even if that was what HbA1c measures (which it doesn't)!!!
 
Thanks all for the replies. Super helpful.
I am wondering if I should start to reduce the Metformin and see what happens, my doctor seems to be of the opinion that Metformin is a wonder drug and it’s just better to keep going; I wondered what’s the collective wisdom on this..
 
I am with you.

After some research I decided to diet instead of taking Metformin. My FBG came down a normal level in 7 days. See this video for the explanation:

The collective wisdom of the experts advising the World Health Organisation, as expressed in their 2020 protocol, was not to prescribe Metformin until diet had proved ineffective in achieving an agreed target.
 
I have heard several people on the forum mention that there are benefits to taking Metformin, but a healthy person should not need it, so if you have improved your health by changing your diet and lowering your BG and HbA1c then to my mind you don't need it. It can also have drawbacks like potentially preventing the absorption of vitamin B12 which leads to a deficiency and can cause all sorts of issues, particularly with your nerves and coordination and it can upset your gut biome, which can then have an impact on many other aspects of your health.
My consultant stopped my Metformin as soon as I was diagnosed Type 1 (I was initially assumed to be Type 2). I would have thought that they would keep you on it if there was believed to be some overall benefit. It is pretty cheap by comparison to other diabetes drugs.
My view is that the drug company reps spin the doctors a good tale about the benefits of their products but mostly omit any negative issues, so doctors end up believing that there is an overall benefit, when there may well not be.
 
The OP is on 1500mg of metformin which can make a fairly significant improvement to hba1c and FBG in people with T2D. (Even a low dose can make a difference.)

Until the OP stops taking it, it's not clear how much Metformin is contributing to to the reduction in hba1c.

The other supposed benefits of Metformin are mainly speculation and not verified by any research yet.

It seems that there's no real guidelines on stopping it. I was told to reduce it when hba1c came down to the 30s and it has been suggested since then I stop it completely. A friend of mine who is a GP didn't really know. He said it hba1c got to the 30s he might stop it. I guess this is where GPs need to use their knowledge of the condition and the treatment to make a judgement.
 
Welcome to the forum @elpirata

Hope you have found the shared experiences of other forum members reassuring 🙂
 
Hello @everydayupsanddowns , reassuring and helpful yes, but you know how these things are, one answer leads to another question….

Before I was thinking that ultimately the Fasting sugar and the HBA1C would drift up and down with similar values.

But now as a result of yesterdays answers I am thinking that as fasting sugar should be lower as it’s a “low point” and the HBA1C should be higher as it’s an average.?

Is that too simplistic as they are measuring different things? As in my case the fasting sugar has drifted down to 5.0 typically but the HBA1C remains at 5.5

Best wishes
 
Yes, it is too simplistic! Waking fasted readings are often the highest fasted readings of the day rather than the lowest due to Dawn Phenomenon where the liver releases extra glucose to give you energy for the day ahead. If your liver and pancreas have significantly improved their function then you can sometimes see very low morning BG nearer 4 and be your pancreas be able to deal with that tidal swell of glucose from the liver in the morning, but not everyone will achieve those sorts of low levels, not need to.
Secondly I think you would do yourself a big favour by using the new units for HbA1c (37mmols/mol in your case) instead of the old units ( your 5.5%) as there is too much temptation to compare that HbA1c number with BG even if you have previously been told about it, especially when you have numbers in the 5s like you have for both.
 
The two testing method have different units, blood glucose from your monitor mmol/l and HbA1C in mmol/mol or old in %. The reason why the Hba1C results were changed to be given in mmol/mol was to avoid confusion with numbers that could be very similar but are measuring different things.
I believe there is some very complicated formula that can convert but need to know molecular mass and stuff like that.
There is a conversion table to convert % to mmol/mol on the main DUK site.
 
Thanks for answers, I will do my best to use the correct units, actually I was converting to get to those units, my home unit actually measures in mg/dl as I bought it in Africa, so I keep having to divide by 18.
But the HBA1C results were given to me in %, I will be more careful in future.
3 different measures, what could possibly be confusing 🙂
 
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