HBA1c improvement but is it good?

[Natalie123]

My HBA1c has come down from 61 to 48. I'm obviously pleased with the improvement but is 48 actually a good result? I'm afraid I haven't really made much of an effort over the last 5 or so years due to mental health issues and I can't remember what is good and what isn't!

 

[rebrascora]

Congratulations! Yes 48 is a great result for those of us who are insulin dependent.
These days, I believe Time in Range (TIR) from your CGM is considered a better assessment of your diabetes management because an HbA1c of 48 could be achieved by lots of highs and lows cancelling each other out or by nice stable BG levels mostly hovering around the 6s and 7s and the HbA1c number itself doesn't give any indication of that.
The TIR target is to achieve 70% of your time between 3.9 and 10mmols/L with no more than 4% below 3.9. If you can manage that you are doing fab.

Individual HbA1c targets can sometimes be set by clinic staff taking into account age and frailty. I believe older or more infirm people are encouraged to aim for a higher HbA1c as hypos and the risk of a fall from them become more of a threat to their health than more elevated levels causing long term complications.

 

[Natalie123]

Thanks Rebecca, that's great. I guess that's why they didn't give me an HbA1c to aim for then, just asked me to concentrate on my TIR as you said. I'm about 85 % in range over the last 3 months and a few more hypos than I'd like but still only 3- 4% below target. I still think of HbA1c in the old format when they were in percentages

 

[rebrascora]

85% TIR is absolutely nailing it, so massive WELL DONE!

Are you managing to maintain that level of TIR OK or is it a struggle? The thing with diabetes management is that you have to balance it with your mental health and living life, so if maintaining that 85% is or becomes a mental strain, there is absolutely no harm in easing off and letting it drop a bit for a while or even long term. 70% is easily good enough. If you can do better, great but don't beat yourself up if it drops a bit even below 70%. Even with modern technology we can't always be achieving better and better results and it can be a temptation to want to do that or be disappointed if you don't or slip back a bit. I know I can sometimes feel like that and it is important to understand that life throws stuff at us from time to time and makes it more challenging to balance things, so you have to be objective and congratulate yourself that even when you don't do as well as usual, you are still doing really well at what is a very challenging and frustrating 24/7 365 days of the year task!

 

[Natalie123]

85% TIR is absolutely nailing it, so massive WELL DONE!

Are you managing to maintain that level of TIR OK or is it a struggle? The thing with diabetes management is that you have to balance it with your mental health and living life, so if maintaining that 85% is or becomes a mental strain, there is absolutely no harm in easing off and letting it drop a bit for a while or even long term. 70% is easily good enough. If you can do better, great but don't beat yourself up if it drops a bit even below 70%. Even with modern technology we can't always be achieving better and better results and it can be a temptation to want to do that or be disappointed if you don't or slip back a bit. I know I can sometimes feel like that and it is important to understand that life throws stuff at us from time to time and makes it more challenging to balance things, so you have to be objective and congratulate yourself that even when you don't do as well as usual, you are still doing really well at what is a very challenging and frustrating 24/7 365 days of the year task!

Sorry Barbara, I don't know why I called you Rebecca I think I saw the first and last letters of your username and 'auto completed' the rest

To be honest, it's a bit of a struggle so I think it might get a bit less tightly managed in future. I'm needing to eat quite a lot to prevent hypos which I don't really like doing especially when I'm not hungry because it affects my weight. But the improvement has at least shown me that it's possible and I can relax a little knowing that it's ok. Thanks for your words of wisdom! You are most definitely right. I think medical professionals (at least at my hospital) are putting more emphasis on quality of life and balancing good control with mental health needs which has been a really positive change in attitude.

 

[everydayupsanddowns]

Well done on your cracking HbA1c reduction and TIR @Natalie123

I think in. Your shows I’d be tempted to try to target reducing the number of low BGs (even if that meant a few more above-range results). As @rebrascora says, you have a bit of ‘wiggle room’ in that TIR, and you may even find that reducing the lows down to 1-2% rather than 3-4% reduces some rebound highs too - so in the end your TIR improves after a bit of a settling-in period.

4% below 4.0 could be around an hour spent hypo every day (or near hypo if you don’t count the 3.9s etc). And in the long term that’ll probably put a dent in your warning signs, and the lows will become trickier to spot earlier. Which can lead to even more time spent low, and nastier lows too

But huge congrats on your great results. 85% TIR and 48mmol/mol HbA1c are amazing!

 

[SB2015]

Thanks Rebecca, that's great. I guess that's why they didn't give me an HbA1c to aim for then, just asked me to concentrate on my TIR as you said. I'm about 85 % in range over the last 3 months and a few more hypos than I'd like but still only 3- 4% below target. I still think of HbA1c in the old format when they were in percentages

Wow @Natalie123
Well done. Those are great results and have clearly led to the improvement in your HbA1c especially as they show that you are having fewer hypos too.
You already have some useful suggestions above, and I hope that they help.

 

[Natalie123]

Thanks @SB2015 and @everydayupsanddowns

That's what I'm worried about @everydayupsanddowns - losing hypo awareness. And the obvious problem that being hypo for an hour a day feels rubbish (since I do still have full hypo awareness!). I also don't appreciate the amount of sugar I'm needing to eat! Next time I see my diabetes team I'll bring it up with them but at the moment they don't see the problem.

 

[everydayupsanddowns]

Ah yes! That familiar feeling at an appointment when they aren’t worried about something that concerns you, but are fussing about something that you don’t think is a problem.

Sometimes I just find this frustrating.

But sometimes I do reflect much later, have to recognise that they may have had a point all along.

My hypo-avoidance techniques of late have been:

Be more trusting of my ratios / bolus calculator. If making a change make a small one there - but actually stick to what it says. Don’t override if I think “that doesn’t seem enough”. I am often my own worst enemy.

Prebolus timings - hugely effective. But Set An Alarm!! Way too easy to get distracted. Plus factor in the time it takes to make the sandwich / toast / whatever. Food isn’t always instant.

Correction factors, ratios, and improved target to aim for do change. Keep tweaking!

(These are notes to myself really)

 

[SB2015]

Prebolus timings - hugely effective. But Set An Alarm!! Way too easy to get distracted. Plus factor in the time it takes to make the sandwich / toast / whatever. Food isn’t always instant

Allowing time for the preparation of the meal has caught me out too Mike.
I now set my alarm on the phone and lop of 5 mins for prep.

I get it wrong mostly when it is my week to cook. I get so engrossed in the cooking that I forget to prebolus, so then need to delay things where possible (or not ….)