HBA1C

[James Ross]

Afternoon All,

Fairly new here so just putting the feelers out having recently introduced myself in the newbie thread. I have a question about HBA1C levels. As a newly diagnosed type 1 my levels were as you would expect very high prior to starting MDI (120mmol/mol if I remember correctly). I am lucky enough to have the libra flash which has a handy little function about expected HBA1C based on blood sugar levels recorded since I have had the libra and injecting. I am happy to say that (due to prior knowledge of what to do with my son being type 1) that I am currently 94% in range (10mmol or under) and my expected HBA1C on the Libra report is 7.5% or 58mmol/mol. Admittedly I have only been on the libra for 3 weeks and the figure keeps going down so I do expect it to drop further.

My question is is this a good figure or not? Everywhere I look I see that I should be aiming at 6.5% or lower but I personally don't think I am doing to bad given how quickly I have turned it around? Is this a difficult level to reach and will the NHS put the pressure on to achieve lower than my estimate? I am completely clueless here regrettably as my son is not a benchmark being so little his levels are more difficult to control.

Thanks in advance.

James,

 

[Proud to be erratic]

Afternoon All,

Fairly new here so just putting the feelers out having recently introduced myself in the newbie thread. I have a question about HBA1C levels. As a newly diagnosed type 1 my levels were as you would expect very high prior to starting MDI (120mmol/mol if I remember correctly). I am lucky enough to have the libra flash which has a handy little function about expected HBA1C based on blood sugar levels recorded since I have had the libra and injecting. I am happy to say that (due to prior knowledge of what to do with my son being type 1) that I am currently 94% in range (10mmol or under) and my expected HBA1C on the Libra report is 7.5% or 58mmol/mol. Admittedly I have only been on the libra for 3 weeks and the figure keeps going down so I do expect it to drop further.

My question is is this a good figure or not? Everywhere I look I see that I should be aiming at 6.5% or lower but I personally don't think I am doing to bad given how quickly I have turned it around? Is this a difficult level to reach and will the NHS put the pressure on to achieve lower than my estimate? I am completely clueless here regrettably as my son is not a benchmark being so little his levels are more difficult to control.

Thanks in advance.

James,

Hi James, welcome
I'm only 2 yrs in so still learning. But my experience is that the "power" lies with your Endocrinologist and mine has no expectation for me to achieve better than my current 53. Indeed he's strongly suggested that I back off from my current level of diligence and pitch my optimum target at 7 rather than the 6 that I currently strive for. But I am over 70, so perhaps he anticipates that natural old age will get to me before diabetes related ailments!
In my opinion I think you've done extremely well to date and should pat yourself on the back. I'm sure others will be along to offer their views. Good luck.

 

[helli]

Hi @James Ross
Libre uses a different algorithm to estimate HbA1C. It's a good indication but not something I would ever rely on. Andfbear in mind HbA1C is a result of the last 3 months of levels.
58 is better than most people with Type 1 so, from that perspective, you are doing well.

However, do NOT try to reduce your level too fast. Your body will be used to higher levels, especially as our insulin production dies slowly as an adult compared to children. If you reduce your levels too fast you may experience issues with small blood cells such as those in your eyes and extremities which can cause neuropathy and retinopathy.

Take it easy and, whilst I never strive for perfection in my blood sugar levels (it's not great for my mental health to obsess about it), I would add an extra note of caution in your first few months.

 

[Jacen017]

I second that. I brought my BG down to fast as I was determined to do everything right and I've ended up with some fairly painful (hopefully temporary) neuropathy.

 

[Leadinglights]

I third that, if there is such an expression as my vision was affected and it lasted several months, I didn't anticipate the problem as HbA1C was only 50mmol/mol dropping the 42 in 3 months.

 

[everydayupsanddowns]

Sounds like you are doing really well @James Ross

Ideally HbA1c recommendations should be individually agreed with your clinic / consultant / Dr.

Unfortunately this doesn’t always happen.

The NICE guidelines shifted the general recommendation to ‘support adults with T1 to aim for’ 6.5%, from a previous recommendation of 7.5%.

These aren’t really targets as such, but the idea behind the change (I was a lay member of the guideline development group) was to recognise that there were still modest benefits in the reduction, and also to support those who were able to aim for 6.5% rather than being told their A1c was “too low” and they should raise it.

Data from the DCCT suggests that there is a reduced risk of long term complications at lower A1c levels, but below 7.5-8% (if memory serves) that curve begins to bottom out, and while risk does still fall, it needs to be balanced with the additional extent of management effort, plus a potential additional risk of exposure to hypoglycaemia.

I think you should feel very proud of your success so far, and keep doing what you're doing - without putting extra pressure on yourself 🙂

Oh, and welcome to the forum!

 

[Wolder]

I second that. I brought my BG down to fast as I was determined to do everything right and I've ended up with some fairly painful (hopefully temporary) neuropathy.

Same here. I was diagnosed with T1D in December 2021 with a HbA1c of 110mmol/mol. Four weeks later I began to experience excruciating pain in my feet. Two months after diagnosis my HbA1c had dropped to 41mmol/mol. Still living with very painful feet (I believe it's called Treatment Induced Neuropathy in Diabetes - TIND), but have been told the pain should begin to subside within the next few months. Gabapentin helps.

 

[zippyjojo]

Crikey this really is a minefield isn't it! I'm now worrying that my blood sugars have come down too quickly (started measuring 3 weeks ago and have definitely reduced my carbs and have started Metformin). My blood sugars (do we say BSG, BM, BS?) today were 5.9; 5.5; 7.5 & 6.3 and on the first day of measuring they were 9.3, 7.3, 7.6 & 11.4 - I know we're all different. Also seeing the comment above about vision - my eyes felt really strange about 10 days ago for a few days as though I couldn't see quite properly with my glasses. I went to the optician and had a thorough eye test including scan at the back of the eye behind the retina - all fine with that but my prescription has definitely changed so I've sent off two of my pairs of glasses to be corrected. Realised today that my eyes feel fine now although this lunchtime I had an aura (2nd time in a year) - I hope I'm not going to find that my glasses are worse when they come back 😳

 

[rebrascora]

Crikey this really is a minefield isn't it! I'm now worrying that my blood sugars have come down too quickly (started measuring 3 weeks ago and have definitely reduced my carbs and have started Metformin). My blood sugars (do we say BSG, BM, BS?) today were 5.9; 5.5; 7.5 & 6.3 and on the first day of measuring they were 9.3, 7.3, 7.6 & 11.4 - I know we're all different. Also seeing the comment above about vision - my eyes felt really strange about 10 days ago for a few days as though I couldn't see quite properly with my glasses. I went to the optician and had a thorough eye test including scan at the back of the eye behind the retina - all fine with that but my prescription has definitely changed so I've sent off two of my pairs of glasses to be corrected. Realised today that my eyes feel fine now although this lunchtime I had an aura (2nd time in a year) - I hope I'm not going to find that my glasses are worse when they come back 😳

Any good optician should have refused to make you new glasses during this early stage of diabetes diagnosis and if the glasses are no good I think you will be well within your rights not to accept them. The advice is to wait at least 3 months after diagnosis but ideally until levels have stabilized in range before getting a new prescription. Most of us made use of ready readers from the pound shop etc during the interim period.

 

[zippyjojo]

Any good optician should have refused to make you new glasses during this early stage of diabetes diagnosis and if the glasses are no good I think you will be well within your rights not to accept them. The advice is to wait at least 3 months after diagnosis but ideally until levels have stabilized in range before getting a new prescription. Most of us made use of ready readers from the pound shop etc during the interim period.

Thanks @rebrascora it’s strange because we spoke all about the diabetes and he didn’t charge me for the test. I popped in today to see if they’re ready and they’re not yet so I’ve put a post-it note on the fridge to call them tomorrow to put a hold on it. It’s my distance that was affected more and they’re bi-focals so ready-readers can’t really help. Luckily I’ve still got one pair.

 

[zippyjojo]

Slightly annoying that my DN didn’t mention that too. I’ve got my diabetes eye screening scheduled but that obviously different. Another great thing about having found these forums (although not great for my lights out time!)

 

[Proud to be erratic]

Slightly annoying that my DN didn’t mention that too. I’ve got my diabetes eye screening scheduled but that obviously different. Another great thing about having found these forums (although not great for my lights out time!)

Could I please ask, is the DN actually a DSN, ie a Diabetes Specialiat Nurse from a Hospital based Specialist team - or a local Nurse from either your GP surgery or District Nurse who visits patients after referral from your GP? If a DSN, then not just annoying, but disappointing. If a GP Nurse, then not so surprising; they are usually the person within the GP Surgery who looks after the T2 patients and generally have limited experience of diabetes related problems.

 

[Proud to be erratic]

Crikey this really is a minefield isn't it! I'm now worrying that my blood sugars have come down too quickly (started measuring 3 weeks ago and have definitely reduced my carbs and have started Metformin). My blood sugars (do we say BSG, BM, BS?)

Best to say BG, since Glucose from carbs is at the centre of diabetes.

It is often also referred to as BS, not wrong as such, but that misleads newly diagnosed diabetics to think that if they alter their diet and reduce sweet, sugary, food then their diabetes will go away - without the basic understanding that all carbs convert into Glucose, not just sugars.

Not sure where BM comes in. But medical notes sometimes refer to DM for Diabetes Mellitus.🙂

 

[silentsquirrel]

Best to say BG, since Glucose from carbs is at the centre of diabetes.

It is often also referred to as BS, not wrong as such, but that misleads newly diagnosed diabetics to think that if they alter their diet and reduce sweet, sugary, food then their diabetes will go away - without the basic understanding that all carbs convert into Glucose, not just sugars.

Not sure where BM comes in. But medical notes sometimes refer to DM for Diabetes Mellitus.🙂

HCPs refer to BMs rather than BGs. The company that made the first BG meter and the strips to go in it were called something like Boehring Mannheimer (someone will no doubt correct me!), hence BM sticks (strips) and the measurement became BMs.

I doubt most HCPs have a clue why they say BM. BG makes more sense!

 

[zippyjojo]

Could I please ask, is the DN actually a DSN, ie a Diabetes Specialiat Nurse from a Hospital based Specialist team - or a local Nurse from either your GP surgery or District Nurse who visits patients after referral from your GP? If a DSN, then not just annoying, but disappointing. If a GP Nurse, then not so surprising; they are usually the person within the GP Surgery who looks after the T2 patients and generally have limited experience of diabetes related problems.

It's the nurse at my GP surgery. I've got an appointment with the Diabetes Medicine department at the hospital in a couple of weeks.

 

[zippyjojo]

Best to say BG, since Glucose from carbs is at the centre of diabetes.

It is often also referred to as BS, not wrong as such, but that misleads newly diagnosed diabetics to think that if they alter their diet and reduce sweet, sugary, food then their diabetes will go away - without the basic understanding that all carbs convert into Glucose, not just sugars.

Not sure where BM comes in. But medical notes sometimes refer to DM for Diabetes Mellitus.🙂

I might be getting confused from when I worked in Maternity - maybe BM for a measurement of something there to do with the bloods

 

[zippyjojo]

HCPs refer to BMs rather than BGs. The company that made the first BG meter and the strips to go in it were called something like Boehring Mannheimer (someone will no doubt correct me!), hence BM sticks (strips) and the measurement became BMs.

I doubt most HCPs have a clue why they say BM. BG makes more sense!

Aha - so I had heard it somewhere and not just made it up!

 

[Leadinglights]

Slightly annoying that my DN didn’t mention that too. I’ve got my diabetes eye screening scheduled but that obviously different. Another great thing about having found these forums (although not great for my lights out time!)

The first I heard about issues with eyes from reducing carbs and the resultant lowering of blood glucose was reading through a fug was on here. My distance was fine but close up, it felt as if my eyes were in different head and didn't work to focus together. It took many months for them to return to normal but I still needed a change in prescription.

 

[Lucyr]

Aha - so I had heard it somewhere and not just made it up!

The first time i was asked how my BMs had been in a medical appointment i assumed they meant my bowel movements and answered accordingly...

 

[rebrascora]

Like Lucy, I always assumed BM meant bowel movement. At first I was quite bemused by people using it here on the forum so frequently until someone explained the Boehring Mannheimer reason.
I like Blood Glucose (BG) because it is scientifically correct and not misleading like Blood Sugar (BS) which plays into the popular myth of diabetes being all about sugar.