HbA1c to low?

[Jacen017]

Hi guys,

I just had my review with DSN and she said my HbA1c was now to low?

I had one about 2 months ago and it was 48 and had one on Friday which is now 36 which I thought would have been a good result being outside of the diabetic range.

I'm not having regular hypos and I'm not understanding why she was so concerned.

Can anyone explain why this is a problem in simple terms so I can understand?

 

[helli]

If you are using a Libre or a CGM and they are not showing hypos, the simple term is that your DSN is out of date and ignoring time in range.
Unless you are achieving this by letting diabetes control take over your life. This may not be the case for you but I have seen some people achieve amazing HbA1c by putting their life on hold, greatly restricting their diet and doing very little more than keeping their numbers in range but forgetting that they are more than a diabetic.
As long as your mental health is ok and you are not obsessedby your blood sugar numbers, that is an amazing hba1c.

 

[Ian68]

Thanks for posting this Jacen its a very good question, I was wondering the same thing as my libre is saying 90 day average is 34mmol/mol but not sure how reliable the A1C is on the libre. like you I dont have many hypos the libre sometimes goes off in the night but it always seem to be from laying on it.

 

[helli]

Thanks for posting this Jacen its a very good question, I was wondering the same thing as my libre is saying 90 day average is 34mmol/mol but not sure how reliable the A1C is on the libre. like you I dont have many hypos the libre sometimes goes off in the night but it always seem to be from laying on it.

I wouldn't get too hung up on the HbA1C from Libre. It uses a different algorithm which is only useful to compare with itself.
In my experience, Libre reports an Hba1c constantly about 10 less than a blood test.
That said, an Hba1c of 44 is pretty good ... as long as it is not achieved with hypos or through "diabetes obsession"

 

[Ian68]

I wouldn't get too hung up on the HbA1C from Libre. It uses a different algorithm which is only useful to compare with itself.
In my experience, Libre reports an Hba1c constantly about 10 less than a blood test.
That said, an Hba1c of 44 is pretty good ... as long as it is not achieved with hypos or through "diabetes obsession"

Thanks Helli thats good info to know.

 

[grovesy]

I wouldn't get too hung up on the HbA1C from Libre. It uses a different algorithm which is only useful to compare with itself.
In my experience, Libre reports an Hba1c constantly about 10 less than a blood test.
That said, an Hba1c of 44 is pretty good ... as long as it is not achieved with hypos or through "diabetes obsession"

Me too!

 

[Jacen017]

If you are using a Libre or a CGM and they are not showing hypos, the simple term is that your DSN is out of date and ignoring time in range.
Unless you are achieving this by letting diabetes control take over your life. This may not be the case for you but I have seen some people achieve amazing HbA1c by putting their life on hold, greatly restricting their diet and doing very little more than keeping their numbers in range but forgetting that they are more than a diabetic.
As long as your mental health is ok and you are not obsessedby your blood sugar numbers, that is an amazing hba1c.

Heya,

Thanks for your reply.

I don't think that I'm obsessed with my numbers, I don't even know how to do a correction for high sugars.

The only thing that I would consider not as healthy as it could be is that I'm terrible with needles still and I weigh up whether it's worth it to inject before I commit to eating now. Which if anything has just helped me to make healthier food choices and cut down on snacking.

 

[Jenny105]

Hi guys,

I just had my review with DSN and she said my HbA1c was now to low?

I had one about 2 months ago and it was 48 and had one on Friday which is now 36 which I thought would have been a good result being outside of the diabetic range.

I'm not having regular hypos and I'm not understanding why she was so concerned.

Can anyone explain why this is a problem in simple terms so I can understand?

 

[Ian68]

If you are using a Libre or a CGM and they are not showing hypos, the simple term is that your DSN is out of date and ignoring time in range.
Unless you are achieving this by letting diabetes control take over your life. This may not be the case for you but I have seen some people achieve amazing HbA1c by putting their life on hold, greatly restricting their diet and doing very little more than keeping their numbers in range but forgetting that they are more than a diabetic.
As long as your mental health is ok and you are not obsessedby your blood sugar numbers, that is an amazing hba1c.

pretty much what my DSN just told me 🙂 her reply was

In the past when people did multiple daily injections or mixed injections and capillary (finger) prick testing was our main way of knowing what was going on.

So we generally worried if HbA1c under 48 people might be having hypos and not realising it, with the libre because we know what is happening this is not so much a concern.

So really it’s the % spent in the low or very low that counts now

 

[rayray119]

One of the dsn was concerned at 47 at my last one. But when I saw the consultant was impressed. I'm suspecting I might have gone up now though

 

[nonethewiser]

Heya,

Thanks for your reply.

I don't think that I'm obsessed with my numbers, I don't even know how to do a correction for high sugars.

The only thing that I would consider not as healthy as it could be is that I'm terrible with needles still and I weigh up whether it's worth it to inject before I commit to eating now. Which if anything has just helped me to make healthier food choices and cut down on snacking.

With needle phobia pump would be ideal for you & ease your anxiety.

 

[rayray119]

With needle phobia pump would be ideal for you & ease your anxiety.

Pumps are to hard get unfountty.

 

[Jacen017]

With needle phobia pump would be ideal for you & ease your anxiety.

Had the pump brought up today actually, they think I might be allergic to something in basal insulins that make it long acting and think a pump would be better because it's just fast acting.

 

[nonethewiser]

Had the pump brought up today actually, they think I might be allergic to something in basal insulins that make it long acting and think a pump would be better because it's just fast acting.

Nice one, all makes sense so good luck.

 

[Jacen017]

Update to this, she was apparently so concerned that she arranged an urgent call back from the specialist team in the hospital and told them to review all my libre data.

The result? Great job Jacen, you're managing your diabetes fantastically well.

 

[Wolder]

I'm not sure what to expect when I have my HbA1c tested in a fortnight's time. I'm a Libre 2 user and my estimated HbA1c (admittedly, with only 39 days of data on record) is currently 29. Prior to my most recent HbA1c result I was told by one DSN that a HbA1c of >48 was dangerous, and another told me to go as low as possible without experiencing regular hypos. My TIR (4.0mmol/l - 7.8mmol/l) is 96% and the remaining 4% is >4mmol/l unfortunately, but I've never experienced a severe hypo. I once got as low as 3.3mmol/l, but it only took me 3/4 of a Lift tablet to climb back up to 5.4mmol/l within an hour.

 

[trophywench]

That hypo recovery took too long for safety! If you do have a hypo lower than that, you'll need to treat it more aggressively.

You'll still be in your honeymoon period ie your own pancreas is most likely still chucking out random bursts of insulin at random times, so you shouldn't think your control will always go as well as it has so far - sorry, not wanting to depress you, just try and rule out you having false expectations is all.

 

[Benny G]

(Snip) estimated HbA1c is currently 29. My TIR (4.0mmol/l - 7.8mmol/l) is 96% and the remaining 4% is <4mmol/l unfortunately, but I've never experienced a severe hypo. I once got as low as 3.3mmol/l, but it only took me 3/4 of a Lift tablet to climb back up to 5.4mmol/l within an hour.

Such great, easy control, (no doubt on low insulin doses) shows you are enjoying the benefits of your honeymoon. CGM use currently helps you to keep very tight control, which may provide a respite for your ailing pancreas and even extend your honeymoon, but type 1 diabetes is autoimmune, and destruction of the remaining beta cells is relentless. The honeymoon will eventually come to an end.

I was diagnosed in my late 20's, had great control for the first couple of years which tapered off as my honeymoon ended. Throughout the past 20 years, (the last 5 using libre), my best Hba1c has been 50.

Prepare yourself, diabetes progresses over time.

 

[Wolder]

That hypo recovery took too long for safety! If you do have a hypo lower than that, you'll need to treat it more aggressively.

You'll still be in your honeymoon period ie your own pancreas is most likely still chucking out random bursts of insulin at random times, so you shouldn't think your control will always go as well as it has so far - sorry, not wanting to depress you, just try and rule out you having false expectations is all.

I typically take 1/4 Lift tab at a time to treat a low. On this occasion I took 3 x 1/4 Lift tab, each taken 20 minutes apart. From now on, if I ever go lower than 3.5mmol/l I will treat it more aggressively.

I'm no longer in my honeymoon period. I've had my C-Peptide levels tested three times since my diagnosis. I was in DKA upon diagnosis and told by my endo at the time that I came within 40 minutes of passing on - my C-Peptide levels were lower than some of his patients of his who'd the condition for a decade. On the two following tests my DSNs have commented on how low my C-Peptide levels are for somebody who was only diagnosed 5 months ago.

 

[Wolder]

Such great, easy control, (no doubt on low insulin doses) shows you are enjoying the benefits of your honeymoon. CGM use currently helps you to keep very tight control, which may provide a respite for your ailing pancreas and even extend your honeymoon, but type 1 diabetes is autoimmune, and destruction of the remaining beta cells is relentless. The honeymoon will eventually come to an end.

I was diagnosed in my late 20's, had great control for the first couple of years which tapered off as my honeymoon ended. Throughout the past 20 years, (the last 5 using libre), my best Hba1c has been 50.

Prepare yourself, diabetes progresses over time.

I wouldn't say it's easy to maintain this level of control. I'm no longer 'honeymooning', but instead I follow the Bernstein regimen, which I attribute to tight control. I also treat BG levels >6.7mmol/L. My daily basal (Tresiba) requirements are 24 Units. My daily basal/correction requirements vary day to day due to carb intake. Today I consumed 21g Carbs and required 2 Units for breakfast, 2 x 2 Units for lunch (2 to cover the carbs, then 2 2 hours later to cover the protein spike), and then 6 Units for dinner (2 to cover carbs, 3 2 hours later to cover the protein spike, and then 1 more an hour after that to 'kill off' the tail of the protein spike). I then took 3 units to correct 'highs' (1 unit mid afternoon, and then 2 units after evening exercise).

I'm in regular contact with lots of others who follow Bernstein's regimen (mainly in the US) who've had T1D for 10, 20 or 30 years or more who have HbA1cs which are lower than my predicted result. For example, one guy who has really helped me out with insulin dosage and exercise has had T1D for 17 years, has been low carb for 8 years, and his HbA1c has been consistently below 29mmol/L (4.8%) for over 5 years. His most recent HbA1c was 26mmol/L (4.5%).