non-diabetic hba1c

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Good point Bev !! thanks for the link 🙂🙂🙂🙂
 
bev said:
I was going to ask what the hba1c of a non-diabetic is supposed to be - and i googled it and found this link. I am surprised that we are aiming at 6.5% for a diabetic when a non-diabetic is between 3.5 and 5.5!

http://medweb.bham.ac.uk/easdec/prevention/what_is_the_hba1c.htm

Quite an interesting link i thought.🙂Bev
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The way a fully-functioning pancreas works is truly astonishing (like everything we have that has evolved naturally!). Our methods of mimicking it - even the pump - are incredibly crude in comparison. I think the DCCT study showed that the problems are marginal below 6.5, so this is the best area to aim for as diabetics, to avoid the associated problems of hypos. This is why I regard 3.5 as 'low' not 'hypo' too, as a lot of 'normal' people are quite able to function at 3.5.
 
Hi Bev

If a diabetic had an HbA1c as low as 5.5 then the chances are this is due to too many hypos and this would be right especially on injections.

The majority of people on injections are not well controlled and just dream about HbA1c's of 6. something or even 7. something and even then it could because of the swings of lots of lows and lots of highs when what is really needed is lots of great middle readings of 4.0 to 8.0.

I bet this thing you found was written a while ago (as much as just over a year go). I bet it was based on diabetics on injections.

I bet in 5 or 10 years time when there has been a big revolt in the diabetic world (and I think that is coming) and most type 1's and 2's are on a pump then the HbA1c will be lower for all diabetics.

You met some of the kids at Hoburne with great HbA1c's they were all on pumps. It is with the pump that you can get these good results as you can manipulate the insulin to hour each day. One of those children had a result of 5.something and it was not because of lows. It was purely because of the pump in connection with sensors and a lot of intervention from the parents. We could all potentially achieve this if we were all given pumps and sensors.
 
Northerner said:
The way a fully-functioning pancreas works is truly astonishing (like everything we have that has evolved naturally!). Our methods of mimicking it - even the pump - are incredibly crude in comparison. I think the DCCT study showed that the problems are marginal below 6.5, so this is the best area to aim for as diabetics, to avoid the associated problems of hypos. This is why I regard 3.5 as 'low' not 'hypo' too, as a lot of 'normal' people are quite able to function at 3.5.
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Hi

With kids and I would presume with adults as well, the reason we treat under 4.0 as hypo is generally if 4.0 or under they will continue going down. We cannot leave a 3.5 or a 3.7, we have to treat it as a hypo.

Also another reason is that you may not really be 3.5. You could actually but 2.5 or 2.9 because no meters are accurate down there at all. The One Touch's have been proved to be the most accurate but nothing is as good as a lab result.

Just thought I would point that out as we can't have newly diagnosed 'parents' thinking that their child is ok at 3.5 when it could potentially be a 2.9 instead. They should always treat everything under 4.0.
 
Are we aiming for 6.5??

Surely we are just aiming to improve to understand how our body reacts to different situations etc, and if we do manage to get to 6.5, we wouldn't stop there human nature will force us to get better, I've no idea what my next score will be but I'm getting better at being single figures, and I hope to one day soon be as good as northener, and maybe surpass him!

I take your points but if the health care said aim for 4.0 we would have more hypos, and some would get down more as it would take a long time to get there!
 
Estimates of non-diabetic A1cs vary considerably, mostly because measurements are not standardised.

The DCCT study defines the top end of non-diabetic A1c as being 6.0 Bernstein defines it as 4.6. The obvious explanation for this is that the labs work to different standards and different methods (there are at least 3 commonly used). This should be resolved to some degree by the upcoming international standards for A1c.

However, all labs in the UK should be standardised against the DCCT study. So technically, non-diabetic A1c is 6.0 or under.

However there are smaller scale studies taken in particular locations on a regular basis, still standardised to DCCT that come out with a top level of 5.7 and 5.5.

But the upshot of all this is basically that under 6 is the target and the lower the better.

There seems to be a fear from medics that if your A1c is under 6 you are in a constant state of hypo. This is nonsense, whether you are on insulin or not. It is possible for either to be well controlled and not be in frequent hypo.

It needs to be looked at on an individual basis

And frankly since most medics can't be bothered to look at BG diaries and base everything on the A1c alone, how on earth would they know how often you have hypos?

The first time I clocked a 5.6 A1c, I was warned emphatically that I should not go any lower. My next was a 5.5. The number of hypos where the symptoms were more serious than a slight dizziness? None. Most serious hypo ever? I had to sit down for 10 mins. They overreact a bit.

Incidentally I know at least two non-pumping T1s who have clocked a 5.1 A1c. Lots of hypos? Nah.
 
p.s. Northerner mentioned complications stats. I don't have the DCCT stats to hand but I know northerner is correct.

But another example: Over 15 years with an a1c of 6%, the chances of third-stage retinopathy are 2%. Increase the A1c to 7% and the chances are 11%. With an A1c of 9%, the chances are 89%.
 
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Northerner said:
This is why I regard 3.5 as 'low' not 'hypo' too, as a lot of 'normal' people are quite able to function at 3.5.
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By dafne 'rules' a hypo is 3.5 and below, that's not to say you don't treat a reading of 4 for example, just not in the same way. For example, my targets are to be between 4.5 and 7.5, a hypo is 3.5 and below so for a reading between 3.6 and 4.4 I would probably have a snack to bring it into target, but I wouldn't treat it as a hypo, ie have quick acting carbs.

Of course that's not to say that everyone should on treat hypos at these levels, it's all about what's agreed for you individually.
 
VBH said:
p.s. Northerner mentioned complications stats. I don't have the DCCT stats to hand but I know northerner is correct.

But another example: Over 15 years with an a1c of 6%, the chances of third-stage retinopathy are 2%. Increase the A1c to 7% and the chances are 16%. With an A1c of 9%, the chances are 89%.
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Dear All,

I don't post much on threads initiated by type 1s or parents, but I would just like to support Northerner's and VBH's position. When you choose an HbA1c target you are gambling that in the long term that decision will not lead to complications. Fifteen years seems like a long time for someone my age but for youngsters it may well be only a small proportion of their lives. So, read VBH's last paragraph again ( and that's just for retinopathy - there are other complications to consider) and ask yourself what chance do you want to take! I am not trying to be alarmest, and I don't underestimate how difficult it is to achieve a lower level, but as Northerner has shown - it can be done

Regards Dodger
 
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Incidentally I know at least two non-pumping T1s who have clocked a 5.1 A1c. Lots of hypos? Nah
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I sometimes wonder about the claims of some people with very low HBA1cs not to have hypos. I was offered a pump with an A1c of 5.3% because my doc, not I, considered I was having too many hypos and was becoming hypo unaware. She was right.
The test just before my pump was even lower, at 4.9%, (wow the 4% club!) but thats an estimated average glucose of 5.2mmol. As most meals will produce a rise at least of 1-2mmol it follows there must a corresponding number of times when the level falls below 4 or even much lower(and to be honest there were).

My lows were almost all exercise related, on my pump I've eliminated some but by no means all of them My A1c is higher (5.6%) ie estimated average glucose of 6.3mmol but I actually feel a lot better for it. If I eliminate almost all of them, then I'll probably be slightly higher still but probably still well within the lower levels of risk found by the DCCT

Reading some diabetes forums (not this one) can make one develop a kind of blindness. There is sometimes a pressure to achieve levels that are for many (most?) people with type 1, too low.
 
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You may well be right in many cases, but I think part of that is due to the view that the A1c is an "average". For example, through management of quantity and type of carbs in a similar way to that of controlled T2s, a T1's overall insulin requirements fall and leave much less margin for error. Factor in knowledge of insulin profiles and there's a useful set of tools.

Since the margin of error is reduced its possible to maintain a level of control closer to a flatline rather than a series of swings from high to low. While its impossible to factor out the unpredictability of the body's various moods and the slight random element that creeps in, its quite possible to achive a low A1c without massive swings.

But as mentioned above, it should be looked at on an individual basis, not assumptions based on others. Its quite possible for an individual with an A1c of 5.1 to have much less in the way of highs and lows than someone with an A1c of 5.6 or higher. The A1c is not the be-all-and-end-all of glycemic control. How the A1c is achieved can be just as important as the final number.

And we should always bear in mind of course that there has to be a balance between glycemic control and quality of life. If someone is prepared to have a higher A1c with all the risks for complications that entails, thats up to them. If someone is prepared to have more highs while maintaining a low A1c despite the increasing view that its highs that cause the damage, that is also their choice. But where an individual draws the line is up to them. The consequences are also up to them.
 
My A1C in January was 5.3%, my current one is 5.2%, but this latest one was achieved with far fewer hypos and swings than the last one. What I have succeeded in doing is lowering my bedtime levels to with normal range by getting my basal sorted. Before I would either have to go to bed with a number in double figures, or have a snack which would push it higher. I only have a snack now if I am below 5, or if I have had a drink or a run earlier on in the day.

So yes, it is possible to have a low A1C without a lot of lows - I'm having fewer lows and my A1C has improved!🙂
 
VBH said:
The first time I clocked a 5.6 A1c, I was warned emphatically that I should not go any lower. My next was a 5.5. The number of hypos where the symptoms were more serious than a slight dizziness? None. Most serious hypo ever? I had to sit down for 10 mins. They overreact a bit.
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Just as an aside on this, I think it's important to recognise the causes behind the hypo. Of course anyone can become hypoglycemic, and therefore there are various different causes for it. However a 'medication induced' hypo (eg caused by too much insulin for food/activity etc, although of course tablets can also do it)is likely to give more cause for concern than this, so the response to it may be less of an overreaction than it would be based on this experience.
(please forgive me for the gross generalisation but hopefully you get where I'm coming from!)


Northerner said:
My A1C in January was 5.3%, my current one is 5.2%, but this latest one was achieved with far fewer hypos and swings than the last one. What I have succeeded in doing is lowering my bedtime levels to with normal range by getting my basal sorted. Before I would either have to go to bed with a number in double figures, or have a snack which would push it higher. I only have a snack now if I am below 5, or if I have had a drink or a run earlier on in the day.
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I think this is one of the key issues in good control, getting that pesky basal sorted as so much else hangs on that. A good basal means you're keeping steady at night, giving you good levels for at least a 3rd of the day! And of course helps to get everything else in order. I've recently seen an improvement in my a1c (I still want to be lower but it's a good result for me and these things are relative!) and I do think a lot of that is down to finally having a reliable basal level, I can go to bed on a good number and wake up the same, rather than having to snack and so spike myself up at bedtime etc. Of course I'm very lucky in that I have my basal sorted on MDI, some will find this is only really achivable when pumping.
 
Using standard deviation is a method suggested by Dr Irl Hirsch of University of Washington Diabetes Care Center. He suggests that diabetics should aim for a SD of one-third of their mean blood glucose readings. This should demonstrate the variability
Incidently my SD with the 4,9% and testing an average of 6 times a day, was 20.1mg/dl, less than a quarter so under this definition very well controlled yet as i said, it still included hypos.

As to overnight rates, I agree with that, I've been lucky never to have a problem and tend to go to bed with what many people would say is a very low level because on the whole it doesn't move much overnight.
 
HelenM said:
Using standard deviation is a method suggested by Dr Irl Hirsch of University of Washington Diabetes Care Center. He suggests that diabetics should aim for a SD of one-third of their mean blood glucose readings. This should demonstrate the variability
Incidently my SD with the 4,9% and testing an average of 6 times a day, was 20.1mg/dl, less than a quarter so under this definition very well controlled yet as i said, it still included hypos.

As to overnight rates, I agree with that, I've been lucky never to have a problem and tend to go to bed with what many people would say is a very low level because on the whole it doesn't move much overnight.
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Interesting - I've never understood standard deviation! Looking at my accuchek software, my SD is 1.7 with average tests of 6.1 per day, which from what you are saying is good, right? Your 20 mg/dl translates to about 1.1 mmol/l?
 
Interesting - I've never understood standard deviation! Looking at my accuchek software, my SD is 1.7 with average tests of 6.1 per day, which from what you are saying is good, right? Your 20 mg/dl translates to about 1.1 mmol/l?
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Yes, ......but actually I've just looked him up again and found a set of slides which says at very low levels the sd is irrelevant! (I'm not sure if he means statistically or that its not worth investigating!) The slides make the point about variability being as important (or more so?) as A1c
not sure how to link as its a powerpoint doc. This is the google reference.
[PPT] Slide 1 - Children with DiabetesFile Format: Microsoft Powerpoint - View as HTML
Irl B. Hirsch, M.D.. University of Washington. Question ... I. Hirsch. Standard Deviation. A measurement of glycemic variability; Can determine both overall ...
www.childrenwithdiabetes.com/presentations/updownhandout.ppt
 
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aymes said:
(please forgive me for the gross generalisation but hopefully you get where I'm coming from!)
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No problem at all. You're quite right. It was just an example of the reaction I got really. Of course its down to the individual and the severity of hypos which is more serious in T1 anyway.
 
Hi Bev...

I just looked this question up in the Dr Ragnar Hanas....Bible.....He states that.. "In a person without diabetes....DCCT method and equivalent is 4.1 - 6.1 %".


Heidi
🙂
 
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