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High HbA1c

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Laura D

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Type 1
Hi All,

Just wondered if anyone has some useful anecdotes about times when their HbA1c was higher than they are used to and how it was resolved.

I have recently been referred from my GP to the Diabetes Clinic and am due to see a consultant for the second time in April, but it's really getting me down at the moment and I just want to know it can get better. Doing everything I can think of to get it better but it doesn't always work.

Had diabetes for nearly 20 years so know what I'm doing day to day, GP thinks putting on weight gradually over last few years has affected my control, could that be it?

Any advice appreciated x
 
Hi Laura, HbA1c's can certainly improve. What sort of insulin regime are you on? Knowing this might help people make some suggestions. Often when you have been diagnosed for a long time, and especially when under the care of a GP, some of the most upto dfate thinking and methods don't get passed on. Weight can affect your insulin requirements as a general rule, but you ought to be able to adjust accordingly. Have you ever done a diabetes education course, such as DAFNE?

edit: I see you are on NR and lantus - same as me!
 
Last edited:
Laura D said:
Hi All,

Just wondered if anyone has some useful anecdotes about times when their HbA1c was higher than they are used to and how it was resolved.

I have recently been referred from my GP to the Diabetes Clinic and am due to see a consultant for the second time in April, but it's really getting me down at the moment and I just want to know it can get better. Doing everything I can think of to get it better but it doesn't always work.

Had diabetes for nearly 20 years so know what I'm doing day to day, GP thinks putting on weight gradually over last few years has affected my control, could that be it?

Any advice appreciated x
Click to expand...

If you are putting on weight you might be suffering from increasing Insulin Resistance.
Its called "Double Diabetes" - Type 1 with T2 features.
Hopefully you are not and the medics can resolve these problems for you.
 
Thanks both for ideas.

Have done a course similar to Dafne called Insight and it was really good at the time, but the principles have not really helped long term. Trying to lose some weight at the moment which may help. My GP did say he suspected I was having T2 features but the weight gain was so gradual I think it's nothing a good diet and exercise regime can't address. More concerned that recent HbA1c was 9.1 :(
 
Laura D said:
Thanks both for ideas.

Have done a course similar to Dafne called Insight and it was really good at the time, but the principles have not really helped long term. Trying to lose some weight at the moment which may help. My GP did say he suspected I was having T2 features but the weight gain was so gradual I think it's nothing a good diet and exercise regime can't address. More concerned that recent HbA1c was 9.1 :(
Click to expand...

I always think that, when things appear to be changing for the worse and you are trying to get a handle on it, it is worth keeping a food diary for a couple of weeks, with carbs etc. recorded (leaving nothing out!) and with insulin doses and pre- and post-meal readings. Best way to spot possible areas for improvement or perhaps substitution of certain foods for lower GI equivalents etc., plus it will give you something good to discuss with your DSN at the clinic.

Do you do much exercise? I have found this helps me in several ways - not only does it make me fitter and healthier, but it also means I can reduce my insulin doses as I become much more sensitive to it. Less insulin generally means less margin for error when carb counting and gives tighter control. In addition, lower insulin doses can also mean that you are less likely to store excess calories/glucose as fat. What would your average insulin meal and background doses be per day?

What sort of exercise regime did you have in mind?
 
Laura D said:
Thanks both for ideas.

Have done a course similar to Dafne called Insight and it was really good at the time, but the principles have not really helped long term. Trying to lose some weight at the moment which may help. My GP did say he suspected I was having T2 features but the weight gain was so gradual I think it's nothing a good diet and exercise regime can't address. More concerned that recent HbA1c was 9.1 :(
Click to expand...

If it is Double Diabetes you might need meds according to this report ...
http://www.everydayhealth.com/type-1-diabetes/double-diabetes.aspx
 
Hi Laura,
basicaly to lose weight you need to reduce the amount of carbs and fat you eat and up the exercise a bit 🙂
Are you also using Lantus as a basal? I ask because this basal is well known for causing weight gain as well :(
Many also do find they have to work harder on control the longer they have had diabetes as well.
You sound as if you have made a good start in sorting things out though 🙂
 
Pumper_Sue said:
Hi Laura,
basicaly to lose weight you need to reduce the amount of carbs and fat you eat and up the exercise a bit
Are you also using Lantus as a basal? I ask because this basal is well known for causing weight gain as well
Many also do find they have to work harder on control the longer they have had diabetes as well.
You sound as if you have made a good start in sorting things out though 🙂
Click to expand...

I've read elsewhere about Lantus causing weight gain but only anecdotally. Is there any science behind it or is it just calories exceeding expenditure and/or increased resistance as McD suggested ?

I've been on lantus for a fair few years and never gained weight unless I upped my calories or stopped exercising so much.🙂

I would certainly second Northerner's suggestion of keeping a diary or EVERYTHING that goes in and include exercise, illness, etc.

You may find that your overnight BGs are a bit high as an example. They can account for a third of your daily BGs and if they're constantly slightly high, they'll make a big difference to your HbA1c.🙂

Rob
 
I wasn't aware of gaining weight on Lantus Rob, but when I changed to Levemir I did lose half a stone without doing anything. And it was the half stone that had gradually crept on over the previous however long. So dunno if there's anything in it or not!

When was the last time you tested your basal, Laura? Because it doesn't stay the same ...... more about basal insulin and testing your dose here ......

http://www.diabetes-support.org.uk/info/?page_id=120
 
Laura D said:
Hi All,

Just wondered if anyone has some useful anecdotes about times when their HbA1c was higher than they are used to and how it was resolved.

I have recently been referred from my GP to the Diabetes Clinic and am due to see a consultant for the second time in April, but it's really getting me down at the moment and I just want to know it can get better. Doing everything I can think of to get it better but it doesn't always work.

Had diabetes for nearly 20 years so know what I'm doing day to day, GP thinks putting on weight gradually over last few years has affected my control, could that be it?

Any advice appreciated x
Click to expand...

Yes, essentially fat makes your body more resistant to insulin. Which consultant at the Churchill? Mine's quite decent. She's house trained haha.
I wouldn't trust my GP with anything other than signing my repeat prescriptions let alone diabetes care. Give me a message if you want to catch up as I'm in Cowley. I'm happy to cast my eye over things for you.

Tom
 
Thanks all for responses.

I think getting the basal insulin right would help. The consultant said to reduce this to avoid hypos, but I've found I still get them sometimes and have needed to increase Novorapid to compensate. I know this isn't right, but if I go to bed at less than 9 mmol/l I end up having a hypo around 6am.

Average doses are 20 Lantus in the morning, 9 Novorapid at lunch and dinner (on 60g Carbs) and 12 for evening meal (on 80g Carbs). Before recent change it was more like 24 Lantus, 6 6 8 or when I increased the Novorapid, 7.5, 7.5, 10.

Tom, I'm in Kidlington but work in Cowley so meeting might be poss sometime, will see how I get on. Thanks for offer of support.

I do keep a detailed diary of food, carb content and insulin taken. Alas I am not doing any exercise right now as am having trouble committing to something that is at an appropriate time. Any tips on how to squeeze some in? I walk for 20-30 mins at lunchtime and a long walk at weekends but know this is nowhere near enough exercise. I leave for work at 8am, work 9 to 5.15, fight through traffic to be home for 6.30 when I need to start cooking. I tried some 6pm yoga / pilates classes but ended up too hungry/hypo by the time they finished!

Thanks guys! 🙂
 
Nobody should have to go to bed with a 9 Laura - it's ridiculous to have to do that.

Having said that - BTDTGTTS.

Then I changed to Levemir ...... and for the first time EVER I could go to bed with a BG around 5 and know I wasn't going to die.
 
Thanks Tom!

Trophywench, Haha, glad you didn't die from a 5 at bed! 🙂 Quite new to forums, what's BTDTGTTS? Looks a bit like a musical scale! Also, what's it like using an insulin pump and what made you decide to do so?
 
Laura D said:
Thanks Tom!

Trophywench, Haha, glad you didn't die from a 5 at bed! 🙂 Quite new to forums, what's BTDTGTTS? Looks a bit like a musical scale! Also, what's it like using an insulin pump and what made you decide to do so?
Click to expand...

Been There Done That Got The Tea Shirt? just guessing like lol
 
Hi Guys, good news, changed to Levemir this morning after a pretty speedy referral to Diabetes Specialist Nurse, no hypos today for first time in months! Relief! Also joined a gym up the road and feeling better already. Now, to work on that 9.8%, watch this space. Thanks for your support when I really needed it xx :D
 
Laura - it hasn't been accorded miracle status, but for many of us, it has been that.

Twice a day, I hope?
 
Laura D said:
Hi Guys, good news, changed to Levemir this morning after a pretty speedy referral to Diabetes Specialist Nurse, no hypos today for first time in months! Relief! Also joined a gym up the road and feeling better already. Now, to work on that 9.8%, watch this space. Thanks for your support when I really needed it xx :D
Click to expand...

That's great news Laura! Hope you continue to see good improvements 🙂
 
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