hba1c at 65 years old - is it possible to lower only with diet & excercise?

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Jarboy

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Type 2
Hi,

I was diagnosed with type 2 diabetes 5 years ago, with an elevated blood glucose level of 66 mmol/mol.

I lost a load of weight quickly and at my next test a year later it had gone down to 46.

5 years later, my weight crept up and last year my hba1c level was 50.

Over the last 2 months, I've tried hard and lost maybe 10kg (24lbs) in weight. My daily tests give me a blood glucose level of between 6 and 7 consistently. I had hoped my diet would help, but my recent hba1c test came back at 51.

My question is, do you think if I continue with improved diet and weight loss, that level should come down over the next few months? OR do you think it's an age thing I have to give in and take metformin or similar?

I have a 10 minute telephone appointment with a doctor scheduled in 3 weeks from now (welcome to the UK health system) and I'd love to get some background advice before that from anyone with some knowledge if possible.

TIA, Tony
 
What diet regime are you following.. your HbA1c levels are (whilst still in the T2 range) fairly low so a few diet tweaks could well help you a lot.
 
Hi @bulkbiker , thank you for replying.

Mostly very low carb - fish and vegetables. But also lots of stir-fry - chicken or fish - lots of vegetables. But maybe too much oil and noodles!
 
Jarboy said:
Hi @bulkbiker , thank you for replying.

Mostly very low carb - fish and vegetables. But also lots of stir-fry - chicken or fish - lots of vegetables. But maybe too much oil and noodles!
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Noodles definitely won't be helping and depending on the oil that could also be quite deleterious to your health.

Also depending on the type of veg ...

I aimed for less than 20g of carbs per day to achieve ketosis also reduced my eating window.
Worked extremely well for me in the early days post diagnosis and has kept HbA1c low ever since even though I may have had some "carb creep"!
 
Only a thought, but if you've already adapted to a low-carb diet, maybe the next step is to up your daily exercise? It is exercise, from what I've learnt here on the forum, that tackles the root issue of insulin resistance.
 
Jarboy said:
Hi,

I was diagnosed with type 2 diabetes 5 years ago, with an elevated blood glucose level of 66 mmol/mol.

I lost a load of weight quickly and at my next test a year later it had gone down to 46.

5 years later, my weight crept up and last year my hba1c level was 50.

Over the last 2 months, I've tried hard and lost maybe 10kg (24lbs) in weight. My daily tests give me a blood glucose level of between 6 and 7 consistently. I had hoped my diet would help, but my recent hba1c test came back at 51.

My question is, do you think if I continue with improved diet and weight loss, that level should come down over the next few months? OR do you think it's an age thing I have to give in and take metformin or similar?

I have a 10 minute telephone appointment with a doctor scheduled in 3 weeks from now (welcome to the UK health system) and I'd love to get some background advice before that from anyone with some knowledge if possible.

TIA, Tony
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Hi Tony, Don't wish to rain on your parade, but, as I have found, Type 2 diabetes is a progressive condition which is expected to worsen with age... something is not working properly and as you get older it tends to deteriorate. I am 67. I kept medication at bay for 13 years, but eventually, despite all my exercise and careful control of my diet, I could not keep my HbA1c down to a level the GP (nor I) considered acceptable. I am now on Sitagliptin 100mg, which seems to have brought my background blood glucose levels back down to an acceptable level, while I continue the diet and exercise routine.
As you're more recently diagnosed, you may yet have scope to alter your diet further, as others are suggesting.
(Sitagliptin worked for me, but Metformin might work for you, given you have needed to reduce weight also...be guided by your doc, not me!)
Good luck. Nick
 
Jarboy said:
Mostly very low carb - fish and vegetables. But also lots of stir-fry - chicken or fish - lots of vegetables. But maybe too much oil and noodles!
Click to expand...
This makes me wonder if you fully understand low carb because noodles are a high carb food? Have you tried konjac noodles and konjac rice as they are very low carb alternatives, but you do have to rinse them well before heating. "Bare Naked" are a well known brand of konjac products, but there are others. I picked several pouches of a different brand up at B&M stores the last time I was in there. I think it was "Kuo Chef". To be honest I am quite happy just having curry on a bed of vegetables or bolognaise on broccoli or shredded cabbage or courgetti, but I will have a packet of konjac if I haven't got time to prep veg. or I have run out.

I find exercise helps lower my morning waking readings so as @Callista says, that is something to experiment with if you haven't already and will help to get the weight shifting again. A good brisk daily walk is ideal if you can manage it, especially after your evening meal and now we are coming into lighter warmer evenings it should be easier to motivate yourself.
 
I use Konjac noodles all the time. They're great. @rebrascora I picked up some of those in B&M and liked them a lot (Nice and thick) but the next time I went in they had gone! For the moment I've got a box of Emma Basics.
 
Nick Cliff said:
Hi Tony, Don't wish to rain on your parade, but, as I have found, Type 2 diabetes is a progressive condition which is expected to worsen with age... something is not working properly and as you get older it tends to deteriorate. I am 67. I kept medication at bay for 13 years, but eventually, despite all my exercise and careful control of my diet, I could not keep my HbA1c down to a level the GP (nor I) considered acceptable. I am now on Sitagliptin 100mg, which seems to have brought my background blood glucose levels back down to an acceptable level, while I continue the diet and exercise routine.
As you're more recently diagnosed, you may yet have scope to alter your diet further, as others are suggesting.
(Sitagliptin worked for me, but Metformin might work for you, given you have needed to reduce weight also...be guided by your doc, not me!)
Good luck. Nick
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From your figures I see that you never managed to get out of the pre-diabetes range and I wonder whether during all this time there remained some excess pancreatic fat which has blocked re-differentiation of the beta cells and led to some of them giving up, hence the a1c rising. Perhaps had the weight reduction at the start been not 7kg but 10-12kg the trajectory might have been different. But that would have been a tough target when already underweight, as I think you were. Despite your own experience I think you should not describe T2D as progressive, but rather progressive for some and not for others.
 
childofthesea43 said:
From your figures I see that you never managed to get out of the pre-diabetes range and I wonder whether during all this time there remained some excess pancreatic fat which has blocked re-differentiation of the beta cells and led to some of them giving up, hence the a1c rising. Perhaps had the weight reduction at the start been not 7kg but 10-12kg the trajectory might have been different. But that would have been a tough target when already underweight, as I think you were. Despite your own experience I think you should not describe T2D as progressive, but rather progressive for some and not for others.
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Point taken, and thanks for your concern. I have low BMI so GP has advised further weight loss inadvisable. Re "progressive" am reiterating what the GP said regarding my blood glucose levels rising slowly over time, despite my best efforts. I agree that for some people with scope to lose weight, reversing that trend is possible, according to what I read on this forum. Regards Nick
 
Nick Cliff said:
Point taken, and thanks for your concern. I have low BMI so GP has advised further weight loss inadvisable. Re "progressive" am reiterating what the GP said regarding my blood glucose levels rising slowly over time, despite my best efforts. I agree that for some people with scope to lose weight, reversing that trend is possible, according to what I read on this forum. Regards Nick
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One other point is that owing to changes in red cell turnover as one ages and the algorithm used to compute A1c from the raw lab meaurements, the proper A1c range for pre-diabetes should be about 48 to 55 for a 70-year old. So I think you may not actually have become significantly more diabetic, if at all. The standard range was fixed long ago from a very small trial with subjects all under the age of 40. Most GPs are unaware of this. There has been a very large trial establishing that people over 65 are being treated as diabetic when they’re not, owing to this reference range error.
 
childofthesea43 said:
One other point is that owing to changes in red cell turnover as one ages and the algorithm used to compute A1c from the raw lab meaurements, the proper A1c range for pre-diabetes should be about 48 to 55 for a 70-year old. So I think you may not actually have become significantly more diabetic, if at all. The standard range was fixed long ago from a very small trial with subjects all under the age of 40. Most GPs are unaware of this. There has been a very large trial establishing that people over 65 are being treated as diabetic when they’re not, owing to this reference range error.
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Very, very true.
Far too many seem to think a hba1c of a twenty year old is the gold standard for a near enough pensioner like me.
(The same as the " four club")

But it sells books.

I just want to enjoy life, enjoy food, go out symmetrical, with no complications, in a hideous messy accidental sports related way that makes passer-by's sick.
 
travellor said:
Very, very true.
Far too many seem to think a hba1c of a twenty year old is the gold standard for a near enough pensioner like me.
(The same as the " four club")

But it sells books.

I just want to enjoy life, enjoy food, go out symmetrical, with no complications, in a hideous messy accidental sports related way that makes passer-by's sick.
Click to expand...
Me likewise, on my 90th birthday I will wolf down ten bars of dark chocolate with unbounded glee and relish, then attempt a solo unprotected winter ascent of Scafell Central Buttress and go out in a five-second plunge of glory, none of this moaning and gasping for days in some grotty A&E corridor.
 
childofthesea43 said:
Me likewise, on my 90th birthday I will wolf down ten bars of dark chocolate with unbounded glee and relish, then attempt a solo unprotected winter ascent of Scafell Central Buttress and go out in a five-second plunge of glory, none of this moaning and gasping for days in some grotty A&E corridor.
Click to expand...

Yes, I'm not going to cling onto the last dregs.
And my packed lunch is going to be a Greggs Steak Bake!
 
travellor said:
I just want to enjoy life, enjoy food, go out symmetrical, with no complications, in a hideous messy accidental sports related way that makes passer-by's sick.
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I'm with you, with the proviso it can't involve being eaten alive by wild animals, sharks or killer whales.
 
Eddy Edson said:
I'm with you, with the proviso it can't involve being eaten alive by wild animals, sharks or killer whales.
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Or in my part of the world, Surrey pumas.
 
Eddy Edson said:
I'm with you, with the proviso it can't involve being eaten alive by wild animals, sharks or killer whales.
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I want to see what kills me.
I don't what to end my life asleep.
That would be so boring.
If God exists, I'd be bugging him/her for a rerun.
 
travellor said:
I want to see what kills me.
I don't what to end my life asleep.
That would be so boring.
If God exists, I'd be bugging him/her for a rerun.
Click to expand...
If He does, I shall demand compensation, or at least a refund.
 
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