HBA1C

[Ashaway]

Good morning. I am new here and hope I am posting in the right place.
I am an 80 year old female who has been prediabetic for about 7 years. I have managed to be well controlled and indeed sometimes my readings have been below 40. Recently I have realised that my levels were rising although my low carb diet has not changed. They especially crept up after two bouts of Covid. The last infection was in September 2024.Just over two weeks ago I had a test and my results were 50. ( they were 41 a year ago) I was told to repeat the test yesterday which I thought was a bit soon but the results have come back this morning still at 50. I have tightened up my diet somewhat by cutting out alcohol completely ( I was only having a glass of wine with Dinner each day), plus the usual no bread, potato,pasta etc.I really don’t know what else to do. How long should it be before the Hba1c comes down? Any help would be greatly appreciated.

 

[Ieva DUK]

Hi and welcome to the forum @Ashaway - you’ve absolutely posted in the right place, and I’m really glad you’ve joined us. You’ve done such a great job managing things over the years, especially keeping your levels well within the prediabetic range for so long. It must feel quite disheartening to see that number creep up despite your efforts - and I can imagine the double bout of Covid didn’t help. A number of people here have noticed their glucose control becoming more challenging after illness or Covid in particular, so you're definitely not alone in that experience.
The changes you’ve made - like cutting out alcohol and tightening your already low-carb diet - are all really positive steps. That said, HbA1c reflects your average blood sugar over the past 2 to 3 months, so it may take a little longer for any recent adjustments to show in the numbers. Two weeks is quite soon for a retest, and it’s unlikely to show a meaningful shift that quickly.
Something else that might be worth looking into - especially given your long-term stability until now - is whether there’s anything else going on in the background: changes in activity levels, sleep, medications, stress, or even shifts in hormones or insulin sensitivity that can happen with age. If it would feel helpful, you might want to ask your GP about checking things like liver and kidney function or even thyroid, just to rule anything else out. That pre-diabetes HbA1c range tends to be increased for people as they age as well, so it might be worth checking with your doctor where you fall on it considering your age.
Mostly I just want to say: you’re doing really well, and it’s clear how proactive and thoughtful you are about your health. Please don’t feel discouraged by that number - you’re still right on the cusp and there's still a lot you can do to keep things steady or even bring them back down a bit. If you don't have any negative effects and you're keeping yourself healthy - that's what matters most.
You're very welcome here and I hope you’ll keep us posted on how you’re getting on.

 

[Ashaway]

Thanks so much, apparently my other blood tests were OK. Onwards and upwards, watch this space!!

 

[Docb]

Hi @Ashaway and welcome to the forum. We are in the same age bracket and my HbA1c has been around 50 for a year or two now and I just say fair enough. I'm not getting any of the short term problems of high blood glucose and I am not too bothered about the risks of doing long term damage from blood glucose at this level, something else is going to get me first.

I watch the carbs and weight and take some medication to keep my Hba1c where it is and take the view that any benefit to be gained by reducing it is not worth the hassle involved. In addition I don't want to do anything to destabilise the rest of my system which is beginning to creak.

 

[Leadinglights]

For someone of your age then NICE guidelines suggest a more lenient HbA1C for diagnosis is more appropriate as the risks of too extreme actions like change in diet or adding mediations may do more harm than good, so as long as your other blood tests were OK and you are generally eating a healthy diet which it sounds as if you are then leave well alone unless of course you start to experience any symptoms and feel unwell.

 

[JITR]

For someone of your age then NICE guidelines suggest a more lenient HbA1C for diagnosis is more appropriate as the risks of too extreme actions like change in diet or adding mediations may do more harm than good, so as long as your other blood tests were OK and you are generally eating a healthy diet which it sounds as if you are then leave well alone unless of course you start to experience any symptoms and feel unwell.

@Leadinglights
Would you be good enough to point me to the guideline suggesting 'a more lenient HbA1C for diagnosis' is appropriate for me as an 80 year old? I have looked and could not find it; only treatment targets for medication.

@Ashaway
I found my HbA1c was all over the place, down then up, for six months after an infection. If it had not stabilised again three months later I would have ordered a CGM to see exactly what was going on. Very worrying, then a huge sigh of relief.

 

[Leadinglights]

@Leadinglights
Would you be good enough to point me to the guideline suggesting 'a more lenient HbA1C for diagnosis' is appropriate for me as an 80 year old? I have looked and could not find it; only treatment targets for medication.

@Ashaway
I found my HbA1c was all over the place, down then up, for six months after an infection. If it had not stabilised again three months later I would have ordered a CGM to see exactly what was going on. Very worrying, then a huge sigh of relief.

Post #8 in this thread. https://forum.diabetes.org.uk/boards/threads/need-guidlines-please.114436/#post-1385048

 

[everydayupsanddowns]

Onwards and upwards, watch this space!!

Welcome to the forum @Ashaway

Look forward to your future updates 🙂

 

[JimG]

I was surprised that a second HbA1c was requested in such a short period. As this test looks at the average over the past, there would have been a really big drop for the reduction to have any impact on the results and the various guidelines I have found warn against too rapid a fall for the older patient.
I am 71 and my HbA1c hovers around the 47-50 mark and even a 51 did not cause concern. The various guidelines shown in a search of the web do suggest that there is some expectation of a higher HbA1c in the elderly but I'm not sure that this means that a higher HbA1c on its own is acceptable. It does seem to be a recognition that there are other health conditions that may mean that too rigid a target of a low HbA1c may be counter productive. My GP seems to be concerned if there is a creeping up of the level between tests and, although we have to take ownership of our own HbA1c, I rely more on discussion with the GP than on what can be found on the web.

 

[Robin]

For someone of your age then NICE guidelines suggest a more lenient HbA1C for diagnosis is more appropriate as the risks of too extreme actions like change in diet or adding mediations may do more harm than good, so as long as your other blood tests were OK and you are generally eating a healthy diet which it sounds as if you are then leave well alone unless of course you start to experience any symptoms and feel unwell.

Splitting hairs here, but I think it’s that the HbA1c target is more lenient for older people, not the actual cut off for diagnosis.
In other words, you are still diagnosed as diabetic if your HbA1c is over 48, but then told you don’t have to struggle to keep it as low as would be expected for younger people.
I think this may be what @JITR was getting at.

 

[JITR]

Splitting hairs here, but I think it’s that the HbA1c target may be more lenient for older people, not the actual cut off for diagnosis.
In other words, you are still diagnosed as diabetic if your HbA1c is over 48, but then told you don’t have to struggle to keep it as low as would be expected for younger people.
I think this may be what @JITR was getting at.

Yes, after substituting 'target may be' for 'target is' as here: 'the HbA1c target may be more lenient for older people'.

The Nice Patient Decision Aid diagram shows the range of choices very well:



Link to Nice Guidance

When I was diagnosed just after my 80th birthday, I decided to follow a real food version of the Newcastle VLC diet. My aim was to see if I could reverse my fatty liver, put my T2D into remission and return to a healthy weight.

Referring to the questions on the left hand side (after the event): I was not worried about hypos as the Newcastle diet stops medication on day 1; no medication so no side effects; no need for other medications; I had been diagnosed with hemochromatosis at the same time and had been advised by the radiologist who detected my fatty liver to 'treat it by diet'; regardless of age, my quality of life in the long term was the reason I had looked for an alternative to taking Metformin and 'getting used to being a type 2 diabetic for the rest of my life', as prescribed by my GP; my target was a normal HbA1c but I did not know whether this was achievable. Fortunately it was.

I think GPs should invite anyone of any age, who is in a position to do so, to consider aiming for remission.

@Ashaway, one thing you could do is discuss your answer to the questions in the Patient Decision Aid with your GP. Are you to the right like @Docb or the left like me?

 

[everydayupsanddowns]

I was surprised that a second HbA1c was requested in such a short period.

Having read the experiences of many forum arrivals over the years it seems there are some HCPs that like to double-check a single elevated HbA1c reading to confirm a diagnosis - just in case the initial result was an anomaly/error/lab mix-up.

We also have a member @Sharron1 whose initial HbA1c was lost… then found… and came out really high. But then all results since have been substantially lower, and very stable, but whose Dr does not seem to want to adjust the initial T2 diagnosis from that one result.

 

[Lucyr]

I was surprised that a second HbA1c was requested in such a short period. As this test looks at the average over the past, there would have been a really big drop for the reduction to have any impact on the results and the various guidelines I have found warn against too rapid a fall for the older patient.

The second test soon after is to confirm the diagnosis of T2 diabetes, not to see if it’s fallen.

Just over two weeks ago I had a test and my results were 50. ( they were 41 a year ago) I was told to repeat the test yesterday which I thought was a bit soon but the results have come back this morning still at 50

As previously Ashaway was only diagnosed as prediabetic then having an a1c of 50 is over the diagnosis of T2 threshold. Following the second test confirming it is 50 they’ll be diagnosed with T2 diabetes now.

 

[Lucyr]

I have tightened up my diet somewhat by cutting out alcohol completely ( I was only having a glass of wine with Dinner each day)

What kind of wine were you having? Wine doesn’t usually have many carbs in it and can actually reduce blood sugars so I don’t see any need to have cut that out.

 

[JimG]

The second test soon after is to confirm the diagnosis of T2 diabetes, not to see if it’s fallen.




As previously Ashaway was only diagnosed as prediabetic then having an a1c of 50 is over the diagnosis of T2 threshold. Following the second test confirming it is 50 they’ll be diagnosed with T2 diabetes now.

Actually, the second test, if it is for HbA1c will not, of itself, confirm type 2. For that you would need an antibody test. Also, a second HbA1c only two weeks apart should not show any change, up or down, unless there is a drastic change. The test is based on an average over the last few months. Everydayupsanddowns probably has it correct when he says that the second test is simply to confirm the first test. Though it does beg the question, why is the first test not trusted. Also, I wonder why we are we not routinely told what specific blood tests are being done e.g. HbA1c, U&E, LFTs, LDH etc. and why they are being done unless we ask.

 

[Leadinglights]

Actually, the second test, if it is for HbA1c will not, of itself, confirm type 2. For that you would need an antibody test. Also, a second HbA1c only two weeks apart should not show any change, up or down, unless there is a drastic change. The test is based on an average over the last few months. Everydayupsanddowns probably has it correct when he says that the second test is simply to confirm the first test. Though it does beg the question, why is the first test not trusted. Also, I wonder why we are we not routinely told what specific blood tests are being done e.g. HbA1c, U&E, LFTs, LDH etc. and why they are being done unless we ask.

I certainly know what tests are being done as they are on the paper print out I get from the GP and then take to a pharmacy who take the blood to be sent to the hospital lab, results back and on my Patient Access in 2 days where I can then view them with the actual result and the normal range annotated as Normal or abnormal if outside that.

 

[JimG]

I certainly know what tests are being done as they are on the paper print out I get from the GP and then take to a pharmacy who take the blood to be sent to the hospital lab, results back and on my Patient Access in 2 days where I can then view them with the actual result and the normal range annotated as Normal or abnormal if outside that.

As seems often to be the case, different areas do things differently. My GP practice take the blood samples and send them off. I can check what is requested and see the results by going online to my GP records but it would be nice if the nurse could say which test is which apart from, they go into sample tubes with different coloured tops. There I can also see the letters and reports sent by the various hospitals to the GP (in fact that is the only way I can access the results of the eye clinic scans and examinations) and I know that others cannot see the correspondence in their GP records. I can't see the results on the NHS app.

 

[everydayupsanddowns]

Actually, the second test, if it is for HbA1c will not, of itself, confirm type 2. For that you would need an antibody test. Also, a second HbA1c only two weeks apart should not show any change, up or down, unless there is a drastic change. The test is based on an average over the last few months. Everydayupsanddowns probably has it correct when he says that the second test is simply to confirm the first test. Though it does beg the question, why is the first test not trusted. Also, I wonder why we are we not routinely told what specific blood tests are being done e.g. HbA1c, U&E, LFTs, LDH etc. and why they are being done unless we ask.

I had a look at the NICE guidance for diagnosis of T2 in adults, and antibody tests are rarely recommended (sadly they are not as sensitive and specific as we would want them to be!). False positives / false negatives from antibody tests mean that they are best used to help inform classification where the clinical factors are a little confusing/mixed.

This is an excerpt (my emphasis)

• Possible clinical features of type 2 diabetes include:
  • Symptoms such as polydipsia, polyuria, blurred vision, unexplained weight loss, recurrent infections, and tiredness. Note: these may be mild or absent.
  • Signs such as acanthosis nigricans (a skin condition causing dark pigmentation of skin folds, typically the axillae, groin, and neck), which suggests insulin resistance.
  • The presence of risk factors.
• Persistent hyperglycaemia is defined as:
  • HbA1c of 48 mmol/mol (6.5%) or more.
  • Fasting plasma glucose level of 7.0 mmol/L or more.
  • Random plasma glucose of 11.1 mmol/L or more in the presence of symptoms or signs of diabetes.
    • If the person is symptomatic, a single abnormal HbA1c or fasting plasma glucose level can be used, although repeat testing is sensible to confirm the diagnosis.
    • If the person is asymptomatic, do not diagnose diabetes on the basis of a single abnormal HbA1c or plasma glucose result. Arrange repeat testing, preferably with the same test, to confirm the diagnosis. If the repeat test result is normal, arrange to monitor the person for the development of diabetes, the frequency depending on clinical judgement.
  • Note: be aware that severe hyperglycaemia in people with acute infection, trauma, circulatory or other stress may be transitory and is not diagnostic of diabetes.

Diagnosis in adults | Diagnosis | Diabetes - type 2 | CKS | NICE

Diagnosis in adults, Diagnosis, Diabetes - type 2, CKS

cks.nice.org.uk

I think the second check is just a confirmation to avoid any potential issues with a lab error / errant reading / whatever.

I note that NICE recommend more scrutiny/caution if a person is asymptomatic. Which seems entirely sensible to me 🙂

 

[JimG]

Basically, that is what I was saying. There was a second test and one post said it would decide if she was type 2 and I said that it would not.

 

[Lucyr]

Actually, the second test, if it is for HbA1c will not, of itself, confirm type 2. For that you would need an antibody test.

In an 80 year old that has had prediabetes for 7 years before developing diabetes, and with a1c only slightly high at 50, an antibody test won’t be done as the signs all indicate T2 diabetes.