HbA1c 79 - don’t fully understand

[s'nic]

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.

you just reminded me of this old thing

 

[Proud to be erratic]

Isn't HbA1c simply a measure of the amount of surviving hemoglobin glycated in a particular way at the time of the test?

Yes, just that.

In the absence of BG measurements the result is open to interpretation based on the 3-4 month dietary history of the subject.

No. Interpretation is subjective, potentially very misleading and is not commensurate with the science.

 

[JITR]

Interpretation is subjective, potentially very misleading and is not commensurate with the science.

My GP interpreted my HbA1c of 104 at diagnosis as a constant level over the three months before the test and ordered me to take a maximum dose of Metformin to bring it down. She paid no attention to the extra sugar/carbs in my diet during the previous two weeks, roughly six times what it was in the 12 weeks before that. When I looked into T2D science I found Roy Taylor and his Counterpoint team at Newcastle University had shown the fastest way to bring blood glucose levels down was to reverse fatty liver by diet. So I followed a real food version of the Newcastle diet. My FBG was down to normal in 7 days as predicted. The diet brought my HbA1c down to 39 after three months. It also restored my liver function to normal, as confirmed by a Fibroscan six months later. What are often not commensurate with science are the current treatments of T2D with drugs instead of diet.

 

[harbottle]

I believe that a hba1c can actually be interpreted a range of values of 'mean' glucose levels.
People with the same hba1c may be have different average glucose levels.

 

[Twisty2229]

Hi, just a quick update. Since being told I am T2D with a measured A1C of 7.9% at the end of March I have worked hard at losing weight and eating low carb. When I had my appointment back in mid-April the practice nurse offered me metformin which I said I would do some research on and come back to them.

I contacted my GP today asking for a metformin prescription and they asked if I would come in on Tuesday for a follow-up blood test. It has been 2 months and 3 days since my first A1C blood test.

Given the blood test request I used a A1CNow Self Check at-home kit just now and followed the guide, my A1C was 5.1% and in the optimal range according to a provided chart (104 mg/dl, 5.8 mmol/l). I did not think my A1C reading would drop as quickly with life style adjustments. I also started a private prescription of Mounjaro (GLP-1 & GIP) which will also have clearly helped.

Feedback from some personal research (mostly YouTube and ChatGBP) is that Metformin should be something I take and not delay. That the Metformin benefits need to be considered seriously. I will go now and search the forums here for further information about Metformin.

 

[John Gray]

@Twisty2229 - What does your doctor think about your "private prescription" of Mounjaro? Surely if s/he thinks it's necessary, as well as metformin, then s/he would prescribe it to you on the NHS? That would save you a vast amount of money.

 

[Twisty2229]

@John Gray I chatted to them about Mounjaro and it is not available here in my area in Scotland (NHS Lothian). The practitioner nurse said if I join a multi-step program that they can offer I am probably about 18 months away from getting the option to get Wegovy (Semaglutide). We did not go in to much more detail than that about it.

semaglutide (Wegovy®)
Semaglutide (Wegovy ®) has been approved for use in NHS Scotland to support weight management for health reasons. The criteria for NHS Scotland has been agreed however this medication has yet to be added to NHS Lothian prescription list so we cannot accept referrals for Wegovy® at this time.

tirzepatide (Mounjaro®)
Tirzepatide (Mounjaro®) is currently being assessed by the Scottish Medicines Consortium for use in NHS Scotland. We are expecting a decision to be made in June 2024 and will update the website as soon as we have the updated information available.

 

[John Gray]

Hmmm. I'd have been happier if the practitioner nurse had suggested Ozempic (for diabetes) rather than Wegovy (for weight loss), even though they are 'almost identical'!
In any event, Mounjaro is a 'next level' drug - but if you can't get in on the Scottish NHS you are left with shelling out a couple of hundred pounds a month for it.
[Have you thought of moving to England?!]

 

[Leadinglights]

Hi, just a quick update. Since being told I am T2D with a measured A1C of 7.9% at the end of March I have worked hard at losing weight and eating low carb. When I had my appointment back in mid-April the practice nurse offered me metformin which I said I would do some research on and come back to them.

I contacted my GP today asking for a metformin prescription and they asked if I would come in on Tuesday for a follow-up blood test. It has been 2 months and 3 days since my first A1C blood test.

Given the blood test request I used a A1CNow Self Check at-home kit just now and followed the guide, my A1C was 5.1% and in the optimal range according to a provided chart (104 mg/dl, 5.8 mmol/l). I did not think my A1C reading would drop as quickly with life style adjustments. I also started a private prescription of Mounjaro (GLP-1 & GIP) which will also have clearly helped.

Feedback from some personal research (mostly YouTube and ChatGBP) is that Metformin should be something I take and not delay. That the Metformin benefits need to be considered seriously. I will go now and search the forums here for further information about Metformin.

Your 7.9% converts to 63mmol/mol so actually not desperately high so it doesn't surprise me that if you made some serious dietary changes that it should not have come down a fair bit in 2 and a bit months but to a level that would not be in the diabetic zone in fact it would be low even for normal would perhaps be a bit odd. Those home tests can underestimate what the actual level is.
The medication looks as if it is working for you but consider carefully whether you need metformin as well. It would be better to wait to make your decision on an official HbA1C.

Be careful when you quote units as in an earlier post you said your Hba1C was 79 but you just now say 7.9%, they are different. % is the old units and mmol/mol would be the new units which GPs should be using.

 

[Twisty2229]

Your 7.9% converts to 63mmol/mol so actually not desperately high so it doesn't surprise me that if you made some serious dietary changes that it should not have come down a fair bit in 2 and a bit months but to a level that would not be in the diabetic zone in fact it would be low even for normal would perhaps be a bit odd. Those home tests can underestimate what the actual level is.
The medication looks as if it is working for you but consider carefully whether you need metformin as well. It would be better to wait to make your decision on an official HbA1C.

Be careful when you quote units as in an earlier post you said your Hba1C was 79 but you just now say 7.9%, they are different. % is the old units and mmol/mol would be the new units which GPs should be using.

Thank you for the feedback. I’ve been wearing a CGM since the beginning of April and eating about 20g carbs a day. I’ve lost about 50lbs since early March which helps and I run 3 miles every second day. The CGM reports 4.9 mmol/ml average since recording began. I’d like to increase my carb intake a bit, probably with a bit of extra fruit. I track everything with Carb Manager and weigh all my food. I eat 120g of either strawberries or pear a day. I guess it’s one long learning process.

 

[Leadinglights]

Thank you for the feedback. I’ve been wearing a CGM since the beginning of April and eating about 20g carbs a day. I’ve lost about 50lbs since early March which helps and I run 3 miles every second day. The CGM reports 4.9 mmol/ml average since recording began. I’d like to increase my carb intake a bit, probably with a bit of extra fruit. I track everything with Carb Manager and weigh all my food. I eat 120g of either strawberries or pear a day. I guess it’s one long learning process.

That sounds to be quite restrictive on the carbs, strawberries would account for about 9g carbs but unless it is a small pear that might be the whole of your 20g. What else are you eating. 4.9mmol/l (not ml) as an average looks pretty low. Have you felt OK and or had any wobbly moments as some people find reducing blood glucose quickly can cause a few issues with their eyes and nerves.
Low carb is no more than 130g carbs per day so you really are going to keto levels.

 

[Twisty2229]

That sounds to be quite restrictive on the carbs, strawberries would account for about 9g carbs but unless it is a small pear that might be the whole of your 20g. What else are you eating. 4.9mmol/l (not ml) as an average looks pretty low. Have you felt OK and or had any wobbly moments as some people find reducing blood glucose quickly can cause a few issues with their eyes and nerves.
Low carb is no more than 130g carbs per day so you really are going to keto levels.

The pear is typically all my carbs for the day. I think Carb Manager has them at about 19g carbs. I tend to have protein and 20g of cheese with the fruit to try and improve the overall GI rating. My eyes are good, I had an eye test in May and got new glasses as my eyes are improving with age (short sighted). I’ve not noticed wobbles but I’ve been light headed a couple of times when I’ve gone an extended period without food (maybe 18 hours). This is not the norm though.

Edit: I’m not aiming for keto level, I just read Dr Fungs book and listened to a lot of Dr Unwin. I might try and add more carbs as I’d like to have the odd roll or little bit more fruit.

 

[Twisty2229]

I have just returned from giving a blood sample to a nurse at my local medical center and they confirmed my blood A1C reading from the end of March was 79 Mmol/mol.

I am to phone in a week to get the results from today's blood test.

Just so I fully understand, if someone can comment, the reading last week from my "A1CNow Self Check at-home kit" was 5.1. Would I be correct to understand this is % and this would translate to a Mmol/mol reading of 32? I know there is a margin of error, I just want to confirm my understanding.

 

[harbottle]

The margin of error on these home devices is pretty high, I believe.

 

[Twisty2229]

The margin of error on these home devices is pretty high, I believe.

Yes, I completely understand that. Would I be correct to understand the result presented to me (5.1) is in % and this would translate to a Mmol/mol reading of 32?

The very first day I joined Diabetes UK I read that if you have a home kit if is a good idea to take a home test just prior to getting a NHS test so you can track a level of accuracy. I am just following advice I read here.

 

[harbottle]

Yes.

 

[rebrascora]

It will say on the information you got with it what measurements it uses. Very few people here on the forum use home HbA1c kits, so it is not something we are familiar with.

 

[Twisty2229]

It will say on the information you got with it what measurements it uses. Very few people here on the forum use home HbA1c kits, so it is not something we are familiar with.

Thank you, I'm defiantly going to save my money in the future and just go with the scheduled blood tests at my medical center.

 

[rebrascora]

Home Blood Glucose meters are much more helpful for most people, be they trying to manage their diabetes through diet, diet and oral meds or those of us on insulin.

 

[Leadinglights]

I have just returned from giving a blood sample to a nurse at my local medical center and they confirmed my blood A1C reading from the end of March was 79 Mmol/mol.

I am to phone in a week to get the results from today's blood test.

Just so I fully understand, if someone can comment, the reading last week from my "A1CNow Self Check at-home kit" was 5.1. Would I be correct to understand this is % and this would translate to a Mmol/mol reading of 32? I know there is a margin of error, I just want to confirm my understanding.

To have expected your HbA1C to have dropped from 79 mmol/mol at the end of March to 32mmol/mol (5.1%) would be highly unlikely so I would be very suspicious of that reading.