Puzzled HbA1c

[happydog]

I am monitoring my BG levels using a meter (Bayer Contour next). I met a nurse today who is a friend of a colleague and who had heard about my diagnosis. I told her that I am optimistic because now quite a lot of my results before meals are between 6.00 and 7.00. and I am staying at about 9.00 or less after meals and it is early days yet. She said those results don't count at all, the only thing that matters is your next HbA1c test in December, because that shows the levels over a period rather than just one test. She also said that meters are on the whole not very accurate. I am now puzzling over whether or not what she said is true. She also said that I should have gone straight on the medication as it reduces the risk of later complications rather than try diet and exercise. She said that less than 10% of people can control it this way and that even if it starts off well it does not continue.
Any views?

 

[Northerner]

What a charmer! She is speaking with a part of her anatomy not normally used for the purpose (if you get my drift!) BOTH types of reading are important because it is important to know the fingerprick readings as they inform you about your meals and day-to-day control, which will have a direct impact on what HbA1c you can expect. An HbA1c alone will tell you information you could otherwise only gather through doing lots more fingerpricks, but it won;t tell you if you went very high one day and very low another - it will smooth out those peaks and troughs. Meters are reasonably accurate or they couldn't sell them.

Also, how defeatist to suggest that you might not be able to stay off medication for some considerable time? Some find the adjustments they make to their diet and activity levels transforms their health and becomes very much a part of their lives. I suspect she is so cynical because she doesn't think she could do it!

Keep doing what you are doing, you're doing great! 🙂

 

[everydayupsanddowns]

[sigh!] Where to start...

If you had been diagnosed T1 an put straight onto insulin and carb counting by a forward thinking clinic, those very same results (as inaccurate as they admittedly are) would be the ones you rely on to maintain your control and make critical decisions every day. 95% of the time your meter will read near enough the same as a lab result (give or take an acceptable margin for error)

Yes the HbA1c is a useful marker... But it is hopelessly imprecise in terms of practically making diet changes to control your BG. Perhaps one of the reasons why this nurse sees dietary changes as of little use are in part down to their attitude to self-testing. Or possibly they think that a 'healthy diet' for T2s is full of starchy carbs? If that is their advice, then no wonder they have such a dim view of diet & exercise.

I know several people here and elsewhere who buck the perceived trend of an inevitable slide into complications via ever increasing meds. Lots here have usd meds while useful but have found that by limiting carbs in the diet their metabolism can cope fine without. Diabetes is very personal, and D&E will not work for everyone, but I have seen too many people doing too well by 'eating to their meter' to ignore the powerful impact of carb reduction.

 

[bev]

Hi happydog,

Was this nurse a 'specialist diabetes nurse'? If not - she shouldnt be advising you at all. Firstly - test test and test again - that is the only way to know what foods are affecting you. The HBA1C is an average of the previous 90 days - but it doesnt tell you whether your evening meal sent your levels soaring does it! It is an overview and whilst it is really important to know - the daily readings are the levels to take note of and give you more of a picture in terms of changing foods.

Meters can sometimes be as much as 20% out - but they are far more accurate than a wee stick that was used years ago!

As far as telling you you should be on medication - she really wasnt trying to motivate you was she! Lots of people do this on diet and exercise - I dont know the actual numbers - but it makes sense that if you can do it without the need for medication it is a bonus.

Keep doing what you are doing and you wont go far wrong - test test and test again.🙂Bev

 

[Andy HB]

I was diagnosed in October, 2009. I was started on gliclazide for around one month to kick start my recovery and then went on to metformin. After three months or so I stopped taking the metformin too.

I have not taken any medication since and my last HbA1c (six months ago) was 42 mmol/mol (or 6% in old money).

Of course the spot BG checks are useful and important. They give an immediate check on progress or how you react to different meals. That is something that an HbA1c value can never do.

What a twerp that nurse is!

Andy 🙂

 

[Blythespirit]

They do persist in the theory that Type 2's don't need to test, and to insist that there's no purpose in it. My GP's will not be moved from the idea that testing is only necessary to detect hypos and has nothing to do with detecting what foods do the damage or to pick up on patterns. My advice would be to keep testing and prove her wrong. It's by keeping those daily readings down that you will get good HbA1c results and enjoy a healthy life. She doesn't know what she's talking about and it's your diabetes at the end of the day. Sounds like you're doing great so keep it up. XXXX

 

[happydog]

Thank you all for your encouragement, it means a lot. Yes she was saying at least 4 pieces of fruit per day such as 10 grapes for onte of the portions, yikes for the sugar content! She was also on the carbs at every meal advice too. Today I got an invitation to go on a DEAL (Diabetes Education Adult Learning) course. Of course I'll go just hope they won't be on the same wavelength as this "diabetes" nurse. You are all wonderful to take the time to help me, I really appreciate it 🙂.