Hello :) How to further reduce HBA1C?

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Geekesse

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At risk of diabetes
Hello 🙂. My late mum and all her siblings had LADA, so I have always known I was at risk, but I had a very laid back attitude to diet, weight and lifestyle all my adult life. I didn’t even own bathroom scales. Over the last few years my HBA1C has crept up, but it was only last year when I had an A&E visit for something quite unrelated and a doctor asked me how long I had been diabetic that I decided the time had come to get a grip.

I now have a formal diagnosis of pre-diabetes. I’ve made lifestyle changes that are sustainable. I’ve followed a lowish carb (average less than 100g a day), calorie counted diet to lose two and a half stone to 12st, BMI now 27. HBA1C has reduced from 46 to 41. I have a moderately active lifestyle as a result of my job. I’m 63.

I believe I need to lower my blood sugar further to minimise the risk of developing diabetes, but I need advice on how to further reduce carb intake without making life so miserable that I can’t sustain it.
 
Geekesse said:
Hello 🙂. My late mum and all her siblings had LADA, so I have always known I was at risk, but I had a very laid back attitude to diet, weight and lifestyle all my adult life. I didn’t even own bathroom scales. Over the last few years my HBA1C has crept up, but it was only last year when I had an A&E visit for something quite unrelated and a doctor asked me how long I had been diabetic that I decided the time had come to get a grip.

I now have a formal diagnosis of pre-diabetes. I’ve made lifestyle changes that are sustainable. I’ve followed a lowish carb (average less than 100g a day), calorie counted diet to lose two and a half stone to 12st, BMI now 27. HBA1C has reduced from 46 to 41. I have a moderately active lifestyle as a result of my job. I’m 63.

I believe I need to lower my blood sugar further to minimise the risk of developing diabetes, but I need advice on how to further reduce carb intake without making life so miserable that I can’t sustain it.
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Welcome to the forum
I must be worrying with the family history of diabetes and good that you are now taking action to reduce your HbA1C. Losing the weight is going to help and you have now achieved 41 with is just below the pre-diabtes threshold which is fantastic.
I would think by continuing to do what you have been doing to lose some more weight your HbA1C will drop a bit further in another few months. Managing diabetes is often referred to as being a marathon not a sprint so sometimes patience is needed.
 
LADA is considered by some forum members/doctors to just be Type 1 so may not be "preventable" as such.

It sounds like you have done a great job of giving your liver and pancreas the best chance to keep communicating well and I wouldn't personally be worried about an HbA1c of 41 in your 60s - that's within the normal range and there is some evidence that the top of the normal range should actually be considered to increase slightly as we get older
 
Welcome to the forum @Geekesse

Sounds like you’ve been making some careful adjustments to try to help your body and metabolism keep your glucose levels in a happy place.

41mmol/L is below the level where people would typically be told they are at increased risk of diabetes, but with your family history of diabetes I can understand why you are being extra careful.

LADA (sometimes called type 1.5) can appear to be quite like T2 to begin with, and people with LADA may not need to start on insulin straight away. It is an autoimmune condition in which the immune system gradually destroys the insulin-producing beta cells in the pancreas. As such, while a moderate or low carbohydrate diet may help to an extent, ultimately a ‘tipping point’ will be reached where the body is no longer able to produce sufficient insulin because of beta cell loss.

There are some who suggest that with LADA it can actually help to move to insulin earlier rather than later, so that the remaining beta cells aren’t having to work double-time to make up for their falling numbers.

Have you had Antibody checks to see if you have evidence of GAD antibodies?
 
Hello,

You are all so helpful, thank you. Although my HbA1c is within tolerance, and evening pinstick readings are OK, fasting readings during the morning, whatever time I take them, are consistently high (7-8mmol). I never eat breakfast (prefer a few extra minutes in bed!) so by default I have a 16:8 diet. I haven’t had a test for GAD antibodies, so that’s something I shall chase up. I’ll have a chat with the GP now my latest blood results are back. I really appreciate the information you’ve all given me.
 
Geekesse said:
You are all so helpful, thank you. Although my HbA1c is within tolerance, and evening pinstick readings are OK, fasting readings during the morning, whatever time I take them, are consistently high (7-8mmol).
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When you say your fasting readings are high whenever you take them, does that include trying before you set foot out of bed. The reason I ask is that many of us find that our liver starts pumping out more glucose as soon as we sit upright and swing our legs out of bed. My BG can rise by several mmols due to this mechanism, which is believed to date back to prehistoric times when we didn't have kitchens with food and had to hunt or forage for our first meal of the day and therefore needed energy to do so. If our insulin regulation is compromised due to diabetes our bodies struggle to deal with this morning surge of glucose from the liver. Interestingly, eating something switches the mechanism off, so not having breakfast may be causing your BG levels to remain high throughout the morning until you eat.... presumably at lunchtime.
So that is a third of the day with elevated BG that perhaps could be avoided by having breakfast.
We are all different and whilst some people will benefit from an extended fast others do not, so experimenting with having a small low carb breakfast might prove beneficial and testing as soon as you wake up and before you get out of bed and then once you have got washed and dressed, will give you an indication of whether this is a Foot on the Floor/Dawn Phenomenon issue. Exercise on an evening can also help to reduce the effect of FOTF/DP the next morning, so you could experiment with that as an option. Other people find that a small protein rich bedtime snack like cheese or nuts can help to stop the liver from splurging in the morning, or indeed having a similar snack as soon as they wake, so that is something else you can try to see if your body will respond to one of those strategies.
 
Goodness, I knew of the dawn phenomenon thing, but it never occurred to me that breakfast might actually help! I haven’t tested on waking, so I’ll try that as well. Your support is awesome - thank you.
 
Yes, it can be a bit counter intuitive, but eating something not only switches the liver surge off but food hitting your stomach also signals the pancreas to release insulin I believe, so it is definitely worth experimenting with a light breakfast and see if it helps. I would be surprised if you don't get a lower reading by testing as soon as you wake up rather than after you are up and about.... but we are all different and you might be one of the odd ones that doesn't experience that glucose dump or it happens before you wake up

Let us know how you get on with your experiments.
 
OK, just 3 days' results, but some indication that I need to keep exploring this.
Friday - wake-up 5.7 mid morning 6.8 (nothing to eat, black coffee no sugar to drink)
Sat - wake-up 5.6 mid morning 5.6 (This was the only day I had breakfast - 30g cheese)
Sun - wake-up 6.4 mid morning 6.2 (nothing to eat, black coffee no sugar to drink) (woke up an hour later than weekdays)

According to this site, a normal fasting level should be below 5.4; anything above indicates pre-d or impaired tolerance.

I hit my target weight today, but it looks as if I'll need to keep losing a bit more and see if that impacts the results. I'm waiting for a response to the referral to the 'Preventing Diabetes' programme, and I have a phone appointment with the GP later this month, when I shall ask about a test for GAD antibodies.

Am I allowed to say that just once in a while, I'd kill for a big fat pizza and some garlic bread...?
 
Well those results all look better than the 7s and 8s you were concerned about...
 
Geekesse said:
OK, just 3 days' results, but some indication that I need to keep exploring this.
Friday - wake-up 5.7 mid morning 6.8 (nothing to eat, black coffee no sugar to drink)
Sat - wake-up 5.6 mid morning 5.6 (This was the only day I had breakfast - 30g cheese)
Sun - wake-up 6.4 mid morning 6.2 (nothing to eat, black coffee no sugar to drink) (woke up an hour later than weekdays)

According to this site, a normal fasting level should be below 5.4; anything above indicates pre-d or impaired tolerance.

I hit my target weight today, but it looks as if I'll need to keep losing a bit more and see if that impacts the results. I'm waiting for a response to the referral to the 'Preventing Diabetes' programme, and I have a phone appointment with the GP later this month, when I shall ask about a test for GAD antibodies.

Am I allowed to say that just once in a while, I'd kill for a big fat pizza and some garlic bread...?
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This site diabetes.org.uk suggests 4-7mmol/l as fasting before eating level. So you are well within that.
 
Fasting levels in the morning are not ideal, as they can higher than 5.6 in non-diabetics due to the changes in hormones that occur. What do you get in the afternoon if you don’t eat for say, four hours?

These sites that give these precise figures need to be treated with caution, as BG changes a lot, and the meters aren’t really accurate enough to determine the difference between 5.6 and 6.3 reliably.

Those figures look good, though, Not sure you have anything to worry about.

Once you’ve been ’diabetic’ the term pre-diabetic is meaningless.
 
harbottle said:
Fasting levels in the morning are not ideal, as they can higher than 5.6 in non-diabetics due to the changes in hormones that occur. What do you get in the afternoon if you don’t eat for say, four hours?

These sites that give these precise figures need to be treated with caution, as BG changes a lot, and the meters aren’t really accurate enough to determine the difference between 5.6 and 6.3 reliably.

Those figures look good, though, Not sure you have anything to worry about.

Once you’ve been ’diabetic’ the term pre-diabetic is meaningless.
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Unless I've missed something in @Geekesse original post, I don't think they've ever been formally diagnosed as diabetic - it was an A&E doctor that asked them about being diabetic and we don't know what caused them to suggest that Geekesse was diabetic
 
Following my A&E visit my GP labelled me ‘pre-diabetic’ and asked me to lose weight and monitor blood sugar. He also suggested looking here for advice and referred me to an NHS diabetes prevention programme - though I have yet to hear from them. I have lost weight (over2.5st) and only half a stone to go to my ideal weight now.

Monitoring results seem to be all over the place. I’m recording activity and food to try and figure out what makes it go up, but the same activity (or lack of) and meal (or lack of) can produce very different results. Lunch on Monday & today was exactly the same (measured amounts of identical food), and both were moderately active working days, but two hours after lunch, the reading on Monday was 5.1 and today was 10.1. I’m way too old for monthly hormonal fluctuations, so that can’t explain it.
 
Did you retest after getting a 10.1 - I once got a reading over 10 after a meal that was low carb - I realised I hadn't washed my hands (I'd been peeling oranges for the food) and they were covered in orange juice. A retest followed by a hand wash gave me a result in the 5s.
 
Never thought to re-test, but I always wash my hands immediately before testing. I’ll do that for future unexplained spikes. Thank you for the suggestion.
 
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