remission 'headroom'?

[Amyfaith]

Hi all,

Lucky to have managed remission now. My GP was reticent to say I was in remission till I told him I understood it didn't mean 'gone', just sort of on 'pause', then he was fine with the label (though my records don't show this, which is mildly annoying). One thing he said I thought was interesting was that at a hbA1c of 35, I have a lot of 'headroom' and should losen up my control a little. (My reading of this is that he felt I was probably being a little too careful and he was concerned in terms of quality of life but if he saw the amount of chocolate I manage to eat with a hbA1c of 35, he'd probably change his mind! ) But is the idea of having headroom to be a bit freer with my glucose control at a hbA1c of 35 remotely an accurate description? I don't especially want to be popping well into the 40s next year, even if the relative risk to myself is low. I totally expect it to creep up over time due to age/etc., but I found the slightly loose approach to my hbA1c a bit odd. His aim was to stay under 52, if memory serves, whereas I'd like to stay in well below diagnosis (and ideally pre-diabetic) levels if possible. Thoughts? Ideas?

 

[trophywench]

Personally I think you're right to trust your own instincts, meself.

 

[Martin.A]

I got as low as 35 on my way to remission but I was ruthless with my diet during those 5 months. More relaxed now and my last 5 HbA1cs have sat just below 'At Risk', where I'm happy to be. You could say I've used the headroom I created. My day-to-day diet is still tightly controlled but I allow myself the occasional treat, but only if it's something my wife's baked, or we're eating out.

 

[Taighnamona]

Hi all,

Lucky to have managed remission now. My GP was reticent to say I was in remission till I told him I understood it didn't mean 'gone', just sort of on 'pause', then he was fine with the label (though my records don't show this, which is mildly annoying). One thing he said I thought was interesting was that at a hbA1c of 35, I have a lot of 'headroom' and should losen up my control a little. (My reading of this is that he felt I was probably being a little too careful and he was concerned in terms of quality of life but if he saw the amount of chocolate I manage to eat with a hbA1c of 35, he'd probably change his mind! ) But is the idea of having headroom to be a bit freer with my glucose control at a hbA1c of 35 remotely an accurate description? I don't especially want to be popping well into the 40s next year, even if the relative risk to myself is low. I totally expect it to creep up over time due to age/etc., but I found the slightly loose approach to my hbA1c a bit odd. His aim was to stay under 52, if memory serves, whereas I'd like to stay in well below diagnosis (and ideally pre-diabetic) levels if possible. Thoughts? Ideas?

Well done on that reduction! Trust yourself. I followed medical/dietary advice for decades and made everything worse. Now I’m low carb and last A1c was 38 but I need a little insulin to reach that… have reduced it but stopping it raises my levels again. Haven’t quite worked out what’s happening. Meeting with the dietician before Christmas and she wanted me to have carbs with every meal. I thanked her for her input and told her I’d never felt better in decades and would be sticking with what I was doing.
And that’s what it’s about. Feeling good and being healthy and if your way is right for you then stick with it. If you have a treat at a celebration then you know you can do that happily without causing long term damage to yourself. Carbs are harmful to us and I’m not sure how long it’s going to take the medical profession to agree with us.
Best wishes.

 

[everydayupsanddowns]

One thing he said I thought was interesting was that at a hbA1c of 35, I have a lot of 'headroom' and should losen up my control a little. (My reading of this is that he felt I was probably being a little too careful and he was concerned in terms of quality of life but if he saw the amount of chocolate I manage to eat with a hbA1c of 35, he'd probably change his mind! ) But is the idea of having headroom to be a bit freer with my glucose control at a hbA1c of 35 remotely an accurate description? I don't especially want to be popping well into the 40s next year, even if the relative risk to myself is low. I totally expect it to creep up over time due to age/etc., but I found the slightly loose approach to my hbA1c a bit odd. His aim was to stay under 52, if memory serves, whereas I'd like to stay in well below diagnosis (and ideally pre-diabetic) levels if possible. Thoughts? Ideas?

I think I understand where your GP is coming from, and I suspect it’s advice that comes from years of experience and watching others travel the same journey.

I’m pleased your HbA1c wasn’t described as being “too low”.

The evidence which underpins much of the HbA1c guidance in terms of reducing complications began with the DCCT trial and follow-ups. These generally showed a sort of J shaped curve for complication risk, which rises very steeply above a certain point, but it levels out as you get down to around 48mmol/mol, and the risk reduces much less dramatically below that.

The HbA1c target used to be 58mmol/mol (often called 7.5% at the time), and there was some resistance to lowering it to the current 48mmol/mol (6.5%) especially for those on glucose-lowering meds like insulin, because of the possible increased risk of hypos when aiming a little lower. Was the relatively modest additional risk reduction “worth it”. I’m pleased to say that it was decided that it was worthwhile, as long as hypoglycaemia was kept in check.

At 35mmol/mol you are cruising a good way below the ‘at risk of diabetes’ zone, so if your current management strategies feel at all restrictive, then it’s possibly good to know that you perhaps have a little ‘wiggle room’?