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Hba1c

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K

karenratcliffe

Active Member
Relationship to Diabetes
Type 1
When i last had my HBA1C done, it was 69.4 - I belive this is about 8 or something along those lines. The doctors have told me this is very high. I used to go to clinic in the hospital, however since i have moved house, i now just go to the clinic in the doctors.
When i was in the hospital, my HBA1C was always between 7-10, they said this was fine, as long as it was under 10.
I am so confused now though, as my doctor is telling me that 8 is very high. Can anyone help please. I feel really down at the moment, as i have always thought i had great control (from the hospital). :confused:
 
Hi karen. Welcome. 🙂

I'm with your GP and think your hospital weren't doing much to help you.

The reccomended HbA1c is below 7, but below 8 is on the way to it. There is a sliding scale of risk of complications that gets greater in line with your HbA1c.

If you can get below 7, it's reckoned that the benefits are greater without impacting too much on your daily life to acheive the necessary control.

Below about 6 and you're almost on a par with a healthy non-diabetic. Providing you don't have too many hypos to acheive it.🙂

What sort of regime are you on ? (ie. MDI, pump, etc)

Rob
 
According to my calculator, 69.4 = 8.5%

I'd go quiz your consultant - I suspect he hasn't explained something very well. Usually it's the blood glucose self testing that is expected to be in the range 4 - 10 mmol/L.

I don't know exactly the numbers for a Type 1, but I believe that NICE expects your HbA1c to be less then 7.5% - only being under 10 sounds very high to me.

Edit: Robster of course knows more then me 🙂 7% then!
 
Hello Karen and welcome to the forum

if you try this link there is a conversions tool

http://www.diabetes.org.uk/Professi...-and-resources/Tools/Changes-to-HbA1c-values/

It looks like your HbA1c is about 8.5.

The Drs, DSNs I see want the figure to be below 7.5. The problem is that the higher the HbA1c the more likely you are to suffer complications. Did your Dr suggest speaking to a DSN. You could ask for a referral to a clinic as most GPs come across very few Type 1s they mainly see people with Type 2.

What kind of regimen are you on and do you carb count ?
 
Hi Karen, welcome to the forum 🙂 Ideally, your HbA1c should be 6.5% or below in order to minimise the risks of diabetes complications like eye and kidney disease, so saying that 'as long as it is below 10 it is OK' is wrong, in my opinion. 8% is reasonable, but still could benefit greatly from improvement. Have they given you any advice on how you might be able to reduce it? Have you ever been on a diabetes education course, such as DAFNE? What insulins are you on?
 
As I'm sure you know the risk of complications rises with a higher A1c (note this is risk, and not certainty that something will happen).

The good news is that the shape of the curve of increasing risk means that even small improvements on your 8.5% can make a big difference to the likelihood of developing any nasties.

So moving from 8.5 to 7.5 might not sound much, but it would reduce risk big time. (someone with an A1c at 10 would have a 16% chance of developing some retinopathy over 5 years, while at 7 it's only 2.5% chance). http://www.diabetes-support.org.uk/info/?page_id=211

Just keep chipping away at it (as long as you are not having many hypos).
 
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Ok, im on Humulin M3 Insulin and i take this twice a day. The doctor hasnt really said much, just that i need to do something about it. I have asked him if i can see a dietition, as i think i need some help. I have been diabetic now for 18 years (im 25) and have always been with the hospital, thinking that i had good control. Thanks so much to everyone who has relplied to this, as now i know that obviously i am not very well controlled. Gosh this is going to be hard, after 18 years of thinking i have good conrol. I love my food so much, i know that that will probably be one of the things that they will cut me down on. x😡
 
karenratcliffe said:
Ok, im on Humulin M3 Insulin and i take this twice a day. The doctor hasnt really said much, just that i need to do something about it. I have asked him if i can see a dietition, as i think i need some help. I have been diabetic now for 18 years (im 25) and have always been with the hospital, thinking that i had good control. Thanks so much to everyone who has relplied to this, as now i know that obviously i am not very well controlled. Gosh this is going to be hard, after 18 years of thinking i have good conrol. I love my food so much, i know that that will probably be one of the things that they will cut me down on. x😡
Click to expand...

You should ask about MDI, Multiple Daily Injections, so a slow acting insulin once or twice a day and then a quick acting insulin before each meal...........on this regime can eat what you like, when you like................:D
 
karenratcliffe said:
Ok, im on Humulin M3 Insulin and i take this twice a day. The doctor hasnt really said much, just that i need to do something about it. I have asked him if i can see a dietition, as i think i need some help. I have been diabetic now for 18 years (im 25) and have always been with the hospital, thinking that i had good control. Thanks so much to everyone who has relplied to this, as now i know that obviously i am not very well controlled. Gosh this is going to be hard, after 18 years of thinking i have good conrol. I love my food so much, i know that that will probably be one of the things that they will cut me down on. x😡
Click to expand...

Hi Karen

Everyone is different so what I'm going to suggest may not suit you... but I would say it would be well worth talking to your GP/hospital/clinic about moving to MDI (multiple daily injections). Bimodal (mixed) insulins suit some people, but because there is no way of separating the action of the insulin my experience (20-odd years ago) was that they required to be fed to a timetable, with little opportunity to vary quantities of food.

MDI allows you to choose much more freely and (with a little moderation) you can eat pretty much anything you want to by adjusting your doses to match the carbs in the meal. Not hungry or eating later? No problem, simply delay the meal dose or miss it altogether.

Have you tried MDI before?

M
 
Thanks for that, i have a clinic appointment next week, so i will speak to them and ask them about MDI. Thanks xxx🙂
 
karenratcliffe said:
Ok, im on Humulin M3 Insulin and i take this twice a day. The doctor hasnt really said much, just that i need to do something about it. I have asked him if i can see a dietition, as i think i need some help. I have been diabetic now for 18 years (im 25) and have always been with the hospital, thinking that i had good control. Thanks so much to everyone who has relplied to this, as now i know that obviously i am not very well controlled. Gosh this is going to be hard, after 18 years of thinking i have good conrol. I love my food so much, i know that that will probably be one of the things that they will cut me down on. x😡
Click to expand...

Karen, you are on quite an old insulin regime there. Most people these days are on MDI (Multiple Daily Injections), also known as basal/bolus. This involves injecting a slow-acting insulin once or twice a day, and a fast-acting insulin with your meals. It would be a big change from what you are used to, but will give you much greater control and flexibility and you will quickly get used to it. I would suggest asking your GP to refer you to a consultant-led clinic where you can discuss regimes and have access to a fully-qualified DSN for advice. Also, ask about courses such as DAFNE.

We've had a lot of long-diagnosed people join here who have not been made aware of the new regimes since they have been assumed to be 'doing OK', but once they have changed their lives and control have improved hugely! Make an appointment with your GP now so you can get things underway and find out about the alternatives available to you 🙂

edit: looks like we're all saying the same thing! 😉
 
I would agree with novorapidboi re asking about multiple daily injections. The idea is that you have a basal insulin that is injected once or twice a day (depends on how long it lasts for you), that gives you a background level to cope with the constant trickle of glucose that goes into your blood stream. You then inject fast acting insulin with meals to cover the carbs you are going to eat.

Ask your GP to refer you to a clinic so that you can change regimes.
 
No never tried MDI before, it sounds alot better. Although its going to mean taking more injections in one day, i dont know if that is something that i would really want to do, but to be honest, i am willing to try anything, i am so cross the fact that i have been told 2 different things. But i want to thank you all so much for all your advice that you have given me today, you have all been really helpful. xxx
 
The benefits from MDI (4 or 5 per day) outweigh any inconvenience by 10 fold.

You can still eat what you want, when you want (more so on MDI) as lng as you balance your carbs with insulin and don't overeat (same for non-diabetics) you'll be fine.

I've given nothing up, but have refined my portions slightly in the past few years, but middle aged spread isn't an issue for you !:D

Rob
 
Haha thanks Rob. I have been on Diabetes website, and there is a link that says something like find a group near you. I have clicked on this, and found Carmarthen, however there are no details on there as to where and when these meetings are held. Do you know where i would find this information?
 
I've never known anything different to MDI, but for me it seems more natural to inject with food rather than inject and then have to eat the right amount of food to match the insulin, if you see what I mean! After a week or two you would hardly notice the extra injections but the benefits will will be there from the start 🙂
 
Hopefully the MDI will help me out. I will definately be asking the doctor about these, when i go next week x
 
Hi Karen

I echo what everyone else has said. 2 a day was old fashioned 12 years ago - I went from ONE a day porcine insulin to MDI in 1994-ish. And it wasn't a particularly new thing then.

It does sound daunting but it gives you so much more freedom with meals and mealtimes and improves control so much, the issue of extra jabs fades into insignificance because you feel so much better and also know - with the lower A1cs - you are hopefully laying up less risk for complications in the future. I've escaped em completely so far (except background retinopathy in both eyes; which apparently hasn't advanced since they took the first photos!) and of course as I get older, I worry about getting em quite a lot more than I did pre-40th, then pre-50th, then pre-60th birthdays. Not that I dwell on it, but ....

Ooops, nearly forgot - send Diabetes UK an email (or ring them) and ask for the contact details for the Camarthen group or, if you do get seen by a Diabetes clinic, you could ask there. Often groups will have posters up at clinics.
 
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