Hba1c getting better, but can I do it earlier? *

[Newbie777]

Hello,

My last HBa1c was done on 22 Oct 2024 and were 76 ( down from 113).

Unfortunately, the reads also included 3 week of high BG as Metformin was reduced from 2000mg to 1000mg per day, due to my CKD.

I know that the HBaic reads are done very 3 months, due to the way the test measure what's in the blood.

According to my CGM my average over the 4 weeks is 6.8 (hba1c 61) and thwn 2 weeks gao it was 6.3 and now last week it 5.9 (HBa1c 41). My target is 60 or below.

Some context, I saw the DN yesterday and she was impressed at what I had achieved with my reds and BG control, and will inform my GP (who is always worried) and also now has the proof as she download the data from my CGM app onto her computer. She was concerned about the 3.7 hypo reads which I had only yesterday and I told her that my blood test strip showed 4.3 so it's actually higher. So I will remain on the medicine I am, which makes me happy (next target will be reducing Glicizide from 80mg to 40mg). But she would not allow a Hba1c test to be done before the 3 months, so it will Jan 2025.
Question. Is there any point doing the HBa1c 1 month earlier (19 Dec 2024) as I am thinking is that the very high BG would not show?

Also I wanted to point out for me the HBa Ic results are the most important indicator by far, as every health services looks down on me and mentions your BG are too high so we can't help you kind of thing, so it will be a personal achievement to hit 48 and being on lowest level of medicine in over 10 years.

Thanks

 

[Anna DUK]

Hey @Newbie777, I think the fact your HbA1c has come down from 113 to 76 is really great news. Really well done.

Your appointment with your nurse sounds thorough and I am pleased you're being supported, with another HbA1c in the new year.

Generally, the HbA1c measures the amount of glucose which sticks onto your red bloods cells over the past 2-3 months. Technically, yes, it can be repeated in 2 months time but I think given you are looking to continue lowering your HbA1c and that you have set yourself a new target to aim for, I'd say give yourself the whole 3-months to continue with your low-carb diet and see how the new dose of Metformin is working for you.

Are you under the nephrology team for your kidneys?

 

[Lucyr]

Question. Is there any point doing the HBa1c 1 month earlier (19 Dec 2024) as I am thinking is that the very high BG would not show?

No there isn’t any point doing a hba1c earlier since you sound happy with your levels, and so no changes likely as a result of the hba1c anyway

 

[Newbie777]

Hey @Newbie777, I think the fact your HbA1c has come down from 113 to 76 is really great news. Really well done.

Your appointment with your nurse sounds thorough and I am pleased you're being supported, with another HbA1c in the new year.

Generally, the HbA1c measures the amount of glucose which sticks onto your red bloods cells over the past 2-3 months. Technically, yes, it can be repeated in 2 months time but I think given you are looking to continue lowering your HbA1c and that you have set yourself a new target to aim for, I'd say give yourself the whole 3-months to continue with your low-carb diet and see how the new dose of Metformin is working for you.

Are you under the nephrology team for your kidneys?

Thank you very much.
No am still waiting for my appointment, also waiting for a scan on my kidneys but will get results of eGFR later this week so hoping better than 48.

 

[Newbie777]

No there isn’t any point doing a hba1c earlier since you sound happy with your levels, and so no changes likely as a result of the hba1c anyway

Thanks I understand, deep down I am not happy.. Over the years I have had no guidance or support, just increase my meds and also DN would not touch me as I am not in insulin, what a joke! Never seen a Dietician either.

So thanks to the help and support from everyone on this forum, learned a great deal.

But will only be happy when I get to the ideal 48 range so that I can enjoy my food again and importantly will noy be treated harshly by the health experts.

One consultant once told me that even if I starved my BG would never drop, idiot!

Will get off my high horse now and yes will continue the journey, but feel like am past the uphill struggle and just a bit level, before it's all downhill. Yuppee

 

[Anna DUK]

Thank you very much.
No am still waiting for my appointment, also waiting for a scan on my kidneys but will get results of eGFR later this week so hoping better than 48.

I'm hoping that for you too. Keep us posted on how you get on.

 

[Drummer]

Thanks I understand, deep down I am not happy.. Over the years I have had no guidance or support, just increase my meds and also DN would not touch me as I am not in insulin, what a joke! Never seen a Dietician either.

So thanks to the help and support from everyone on this forum, learned a great deal.

But will only be happy when I get to the ideal 48 range so that I can enjoy my food again and importantly will noy be treated harshly by the health experts.

One consultant once told me that even if I starved my BG would never drop, idiot!

Will get off my high horse now and yes will continue the journey, but feel like am past the uphill struggle and just a bit level, before it's all downhill. Yuppee

I would caution that just because you have dropped below the diagnostic numbers, it doesn't mean that you can't increase again.
I just found out that the fasting and low calorie shakes diet did not work for me. I am in need of smaller clothes, but my HbA1c is back up to 48. That wasn't in the script.

 

[Newbie777]

Thank you very much, my kidney results were 48, then 43, then 58 and now 48.

My focus has been on BG control, not eating the right foofs for my kidneys, but need to see what the experts say.

At least dropped off two Metformins, that is good news 🙂

 

[Newbie777]

I would caution that just because you have dropped below the diagnostic numbers, it doesn't mean that you can't increase again.
I just found out that the fasting and low calorie shakes diet did not work for me. I am in need of smaller clothes, but my HbA1c is back up to 48. That wasn't in the script.

What is wrong with 48, I find it ideal number.

But I am going to the gym regular too, so it is a about lifsteyle choices now. think I would still keep me mindful of carbs , but less restrictive and try out more stuff.

Somebody asked once... What would you prefer being miserable and dying old.. Or being content and dying young,.. For me the latter anytime 🙂

 

[Anna DUK]

What is wrong with 48, I find it ideal number.

I think @Drummer has been in remission of type 2 diabetes for some years now with HbA1c results below 48mmol/mol, so for Drummer, the figure has slightly crept up.

 

[Newbie777]

Oh I see.

I know a Dr, (will be a professor soon) and he lectures Manchester University, he specialises in Diabetes research here in the UK and abroad.

I met up with him1 year ago and ironically at a kebab shop.

He asked about about my BG and told him how poor it was. He told he also now has Diabetes and 6 months ago wentb through a strict regime and then it fell into regression, however this is the key bit.He told me he back with Diabetes and accepted that he just needs to keep it under control and this is a Dr who specialises in the disease.

We are both Asian nd also Black people are much more likely to get Diabetes, so it seems unfair, but that is life and you have accept as it comes.

But, we'll done Drummer for your hard work and perseverance, I know I could not do it. Z

Anyway, we had an interesting conversation both eating seekh kebab. Lol

 

[Newbie777]

I'm hoping that for you too. Keep us posted on how you get on.

Got my eGFR result today and gone up from 48 to 55, so good result, just waiting g for scan now.

On a sperate note, ai will not be increasing my carbs as I am getting low BG raeds if 3.7 in the evening AND early morning, but I know the strip reads are 4.2, 4.4,so have decided will cut down my one 80mg Glicizide to 40mg and monitor the situation, my weekly BG average is dropped to 5.9 now.

 

[Anna DUK]

That's really positive news about your kidneys @Newbie777.

I get your logic with cutting the Gliclazide dose in half due to the the low blood sugars but I wonder if slightly increasing your carb intake would help to avoid the lows. You're on a low carb diet of 80g per day. Anything under 130g per day is still considered a low carb diet. From a DUK perspective we'd definitely encourage you to speak to your diabetes team about reducing the Gliclazide dose.

 

[Newbie777]

Thank you, I think may not even not be on 80g carbs a day more like 60g.

I saw the DN recently and she told me to continue with 80mg Glicizide, but she is not aware of the low BG in the evening AND also early morning.

So today I have had more carbs and my BG is 7.7 but had food about 30mins ago, so my BG does increase.

I would be happy if... my true BG reads are around 5.5 to 6. 0 before I go to bed and 4.0 to 5.2 in the morning.

At the moment I am not too concerned about going down to 40mg, as I will be seeing my GP in 4 days time, worse case scenario will go back to 80mg as I know that works.

Another ootion which I did not go for was to replace the 80mg Glicizide with 5mg Linagliptin , but in the end decided I have more flexibility and BG control using Glicizide, not sure about that now as my worry is low BG cannot be all that good for me either!!

 

[Newbie777]

So 1.5 hours after my evening meal, my BG is now 5.6, so expect this to drop further below 4.0 at night to 3.7 or lower, but true read will be 4.2 to 4.4, which I don't want plus I had more carbs today. I feel the 80g Glicizide is helping produce too much insulin

 

[Leadinglights]

So 1.5 hours after my evening meal, my BG is now 5.6, so expect this to drop further below 4.0 at night to 3.7 or lower, but true read will be 4.2 to 4.4, which I don't want plus I had more carbs today. I feel the 80g Glicizide is helping produce too much insulin

More like too much insulin for the amount of carbs you are eating. One of the problems with medications which advise that people should not go too low carb is it is never easy to find out what they mean by too low and really it can only be the experience of the individual that they can find what is fine for them.
I would think if that balance of carbs and meds is resulting in too low blood glucose for comfort that one or the other needs adjusting.

 

[Anna DUK]

Thank you, I think may not even not be on 80g carbs a day more like 60g.

I saw the DN recently and she told me to continue with 80mg Glicizide, but she is not aware of the low BG in the evening AND also early morning.

So today I have had more carbs and my BG is 7.7 but had food about 30mins ago, so my BG does increase.

I would be happy if... my true BG reads are around 5.5 to 6. 0 before I go to bed and 4.0 to 5.2 in the morning.

At the moment I am not too concerned about going down to 40mg, as I will be seeing my GP in 4 days time, worse case scenario will go back to 80mg as I know that works.

Another ootion which I did not go for was to replace the 80mg Glicizide with 5mg Linagliptin , but in the end decided I have more flexibility and BG control using Glicizide, not sure about that now as my worry is low BG cannot be all that good for me either!!

Keep us posted on how you get on with the GP

 

[Newbie777]

More like too much insulin for the amount of carbs you are eating. One of the problems with medications which advise that people should not go too low carb is it is never easy to find out what they mean by too low and really it can only be the experience of the individual that they can find what is fine for them.
I would think if that balance of carbs and meds is resulting in too low blood glucose for comfort that one or the other needs adjusting.

I agree, thank you.

Hence reducing the 80mg Glicizide to 40mg. This is a cautious approach though. I am also going gym every 2 or 3 days and maybe affecting my BG levels. My issue I know is I don't measure my carbs.

I also don't want to increase my carbs too much as may over do it and start to get mega hungry and racking up 300 carbs a day is quite easy for me.

If this smaller dosage works, then no more changes and will wait 2 or 3 months for the key Hba 1C result.

 

[Newbie777]

Keep us posted on how you get on with the GP

GP will not be happy I know, but.. the indicators are there, low Hba1c,lower protein levels, slightly better eGFR, weight loss, less medicine and no reliance on insulin, lifestyle change like going gym etc etc
Still to work on, higher Triglycerides and waiying to see kidney specilist.

Just the final hurdle of keeping my BG away from the hypo area, which is 40mg Glicizide may help with.