HbA1c 79 - don’t fully understand

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It sounds like the high result from Lloyds was a mix-up or glitchy in some way @Twisty2229 ? Everything else seems to suggest you are not living with diabetes to my (medically unqualified) eye.

HbA1c would move slowly. It checks red blood cells which last 3-4months, so results taken more frequently than every 3 months have quite a lot of overlap.
 
Just back from a meeting with an Advanced Nurse Practitioner with the Diabetes Support Program at the medical center and she has confirmed I have T2 diabetes. The ANP explained the support program I will be part of (blood tests each 3 months and a yearly meeting etc). The ANP talked about lifestyle changes and weight loss etc. I was reasonably well prepared having watched several Dr Unwin presentations and read The Diabetes Code.

I have reached out to a couple of pharmacies about mounjaro (private prescription) for weight loss and the ANP was supportive of the use of GLP-1. No medication has been prescribed as the ANP is happy for me to continue with lifestyle changes, weight loss and exercise at this time.

I bought First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed a couple of weeks ago following a recommendation on the forum here. I will start reading that today.

It is a bit of a blow having thought I was given the all clear, the ANP is going to look in to what happened with the information the health centre's receptionist provided me. Thank you for all the support so far, I am hoping I can become a long term member of this community.
 
Yes, it's a blow, but you are being really positive. My suggestion would be to adopt a healthy real food diet from the start, one you would be happy with during weight loss and future maintenance. Such as David Unwin's. No hunger, no drugs, no side effects. Good luck.
 
Sorry to hear it was confirmed but you’ve made a great start to remission and as said a positive response to the diagnosis.
Did they in the end confirm your HBA1c?
 
Twisty2229 said:
Hi Mitchsi, thank you for the message. They mentioned 78 mmol/mol (9.3%).
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Sorry you've had to joint our club. Many of us were diagnosed with a much higher HbA1c than yours, sometime in 3 figures, but were still able to get it back into normal range through a combination of diet, exercise, weight loss and medication. Good that no medication has been prescribed at this time - that doesn't always happen. Stick with what you're doing and hopefully you won't need it at all.
 
mitchsi said:
As you’re wearing a CGM, you could check your response if you ate a chocolate bar or some carb heavy food (as long as it’s safe for you to do so) then your response I would expect, would indicate if your diabetic or not.
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Wouldn't a faster acting carb food type be better than chocolate where the fat will slow down the carb absorption to the extent that it may be possible for someone with prediabetes to manage?
 
@Twisty2229.

Just to clarify HbA1c averages, using made up numbers to make the point. Let's say it covers 3 months and that you changed your diet at the beginning of month 3. The first two months would have glycated more red cells say 90 units each, 180 units together. With your dietary changes, month 3 would have glycated fewer cells say 60 units. That's a combined total of 240 units altogether. The three months would average out at 80. You will need 3 months on a steady diet for a meaningful result.
 
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helli said:
Wouldn't a faster acting carb food type be better than chocolate where the fat will slow down the carb absorption to the extent that it may be possible for someone with prediabetes to manage?
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They used orange juice and the graph was flat, which sounds like possibly a cgm issue as even non diabetics should see a short spike from orange juice.

Either way you have the diagnosis now so I’d see what the next a1c is, as that will suggest whether diet changes are working for you. There are things that can make a1c unreliable so if a1c is still high next time that could be worth looking into, but there’s no harm in improving diet and exercise in the meantime
 
JITR said:
I suspect HbA1c results are more dependent on spikes than averages. My diagnosis result of 104 early in December 2022 was certainly largely due to huge spikes over a two week period of over eating in Novmber 2022, but my GP was not interested in talking about that. I'd say you and your GP really need your next HbA1c result before considering any changes to what you are already doing, unless there is something else not disclosed in this thread.
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That is interesting what you say about "spikes". I went pre-diabetic a few years back at hba1c 42. Thanks to advice from here I reduced the carbs and eventually got back to normal, albeit the higher side at 40. This year it has crept back to 42. I was a bit baffled as I had not changed my diet much apart from a bit of cheating with desserts when I went out but that was only three times in three months. It was though in the 3 months that the hba1c would have registered.

I have wondered if there were a few "spikes" that made the hba1c that bit higher as I didn't really have a lot of leeway anyway having regular readings of 40. Some of my friends are amazed I cannot get it down any further as I eat healthily and a lot better than them.

GP put it down to increased insulin resistance with age (I am 70) as I do not carry weight. in fact, I am underweight but only slightly.

I have given up regular cappuchinos and lattes for a while to see if that helps. I didn't have chocolate on the cappuchinos or flavours in the lattes but DN did agree with me it may have been just too many of them. She wasn't really sure. I asked for an appointment with the DN as the GPs were not too concerned and said they would check it again next year.
 
JITR said:
I suspect HbA1c results are more dependent on spikes than averages.
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@JITR I am not sure that this is correct. The HbA1c result is an average after comparing glycated cells with non-glycated cells.
JITR said:
My diagnosis result of 104 early in December 2022 was certainly largely due to huge spikes over a two week period of over eating in Novmber 2022, but my GP was not interested in talking about that.
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Since such cells remain in our bloodstream for c. 3 months no-one can prove that huge spikes in a recent period did anything other than influence the final average at the moment the HbA1c sample was taken and sent for analysis. There would have to be HbA1c samples taken every fortnight for 4 months which could then be compared with CGM data over the same 4 months to provide the basis of your conclusion.

In practice that is unlikely to occur and if someone were to embark on such a scrutiny the trial would need to be done on more than a sample of 1 person.

We are in a period where CGM data now potentially exists in a sufficiently large number of people that there is increasing opportunity for such a study to be done with confidence. But whether that is now necessary is questionable since such metabolic behaviour is by no means a common and predictable behaviour for most people with diabetes, and is such retrospective analysis particularly beneficial?
JITR said:
I'd say you and your GP really need your next HbA1c result before considering any changes to what you are already doing, unless there is something else not disclosed in this thread.
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@Twisty2229 given the current status of a formal confirmation of T2 but no meds prescribed so far, along with the promising results from your G7 analysis and Clarity predictions, I would agree. Continue the lifestyle changes (well done by the way) and see what emerges after the next HbA1c.
 
@Proud to be erratic
Please note I looked into how varying blood glucose levels affect glycation and HbA1c results. Much higher levels for two weeks shortly before the test will have a marked effect on the result.
 
Only chronically high levels.
Not natural 'spikes' (i.e. up then down) after a meal.
 
In 2011 Makris and Spanou reported about 50% of HbA1c comes from the last month before the test, 25% from the month before, and 25% from the two previous months (months 3-4). Thisb assumes mean blood glucose is steady over the four months. Let's say my result was 6.0%. I continue for two months then drastically increase my sugar and carbs intake for a month doubling my mean blood glucose level. Result my HbA1c comes out at more than 9.0%. This comprises 6.0% plus from the month up to the test and 3.0% from the three previous months. There are some complicating factors. One is higher glucose can reduce the number of older hemoglobin cells.
 
JITR said:
In 2011 Makris and Spanou reported about 50% of HbA1c comes from the last month before the test, 25% from the month before, and 25% from the two previous months (months 3-4). Thisb assumes mean blood glucose is steady over the four months. Let's say my result was 6.0%. I continue for two months then drastically increase my sugar and carbs intake for a month doubling my mean blood glucose level. Result my HbA1c comes out at more than 9.0%. This comprises 6.0% plus from the month up to the test and 3.0% from the three previous months. There are some complicating factors. One is higher glucose can reduce the number of older hemoglobin cells.
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I have definitely seen something about the result being 'weighted' towards the most recent period of time in the algorithm that is used by the machine which does the analysis.
 
Leadinglights said:
I have definitely seen something about the result being 'weighted' towards the most recent period of time in the algorithm that is used by the machine which does the analysis.
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I remain confident that my original hesitation about over-interpreteting HbA1c data was sound. This long-standing process is founded on relatively simple biochemistry - measuring glycation of haemoglobin using quite modest calculus.

Once "clever" people start to tamper with the process (no doubt originally with good intentions and probably in the spirit of finding economies) and use algorithms (where we laypeople are unable to see the formula) or "virtual" complex analysis, totally dependent on computing (again behind hidden formulae): I worry. I am a Civil Engineer that has seen far too many young engineers believing that something must be right because the computer generated the answer - even though the answer either defies common sense or creates an answer that is not buildable or is refined to an excess that cannot endure with time.

It is my simple view that an average degree of glycation from a sample of blood cannot be unilaterally reconstructed to tell anyone much more than just that - it is an average from a 3-4 month period of natural glycation. Spikes (which in themselves need a lot better definition than just this visual description) might non-scientifically and thus arbitrarily explain an apparent change or influence on an HbA1c result - but can not be placed in any form of chronological accuracy after the event, unless scientifically recorded as a precursor to the blood sample analysis.

Perception might well lead to over interpretation, as it does in so many strands of everyday life; but scientific work comes from rigorous examination within defined parameters. Right now the sun is shining and I don't intend to persist in gently rebutting the idea that more can be made from HbA1c results than they actually are.
 
Isn't HbA1c simply a measure of the amount of surviving hemoglobin glycated in a particular way at the time of the test? In the absence of BG measurements the result is open to interpretation based on the 3-4 month dietary history of the subject.
 
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