Six years "normal" ...

Eddy Edson

Eddy Edson

Well-Known Member
Relationship to Diabetes
Type 2
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But HbA1c and LDL-C ticking up. To the extent this means anything, maybe because of lots of stress & lack of sleep over the last few months, or maybe it's because I'm getting really frikkn old & this is the start of my body, like the world, going to hell in a handbasket 🙂
 
Congratulations on another great result and 6 years of normal readings. Long may it last.... well apart from the stress and lack of sleep. Hope you are able to remedy that soon.
 
That's impressive progress, but I'm curious about the 27, which looks a bit out of place.

I'm also wondering why, with a hba1c of 83, my fasting glucose was in the high 6s upon diagnosis.
 
harbottle said:
That's impressive progress, but I'm curious about the 27, which looks a bit out of place.

I'm also wondering why, with a hba1c of 83, my fasting glucose was in the high 6s upon diagnosis.
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The 27 is a puzzle. I bet 20c it was a lab glitch. Failing that, maybe something to do with being in the middle of change in RBC numbers due to smoking cessation? weight loss? and average RBC age out of whack compared to steady state.

Fasting glucose: that sounds a bit odd??
 
Eddy Edson said:
The 27 is a puzzle. I bet 20c it was a lab glitch. Failing that, maybe something to do with being in the middle of change in RBC numbers due to smoking cessation? weight loss? and average RBC age out of whack compared to steady state.

Fasting glucose: that sounds a bit odd??
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I didn't think of anything of it at the time, as it was the day after I got diagnosed so I just did a morning reading.

I was definitely diabetic, as I'd had blurred vision that came on a few months before diagnosis.

I'm wondering if just meant I didn't have much liver insulin resistance but couldn't cope with my then high-carb diet.
 
Eddy Edson said:
But HbA1c and LDL-C ticking up. To the extent this means anything, maybe because of lots of stress & lack of sleep over the last few months, or maybe it's because I'm getting really frikkn old & this is the start of my body, like the world, going to hell in a handbasket 🙂
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Well maybe. My guess is A1c up from 35 to 37 and weight up from 64 to 65 are related.

Update: @Eddy Edson says his weight fluctuates between 64 and 65 so no need for speculation.
 
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JITR said:
Well maybe. My guess is A1c up from 35 to 37 and weight up from 64 to 65 are related.

I took my eye of the ball June 23 - July 24 and look what happened.

View attachment 32277
I hadn't seen this view of my energy consumption until yesterday. It explained why my A1c went up from 32 to 39 while my weight increased by 3-4 kg after my weight loss diet.

View attachment 32278
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My weight bounces around between 64 and 65 as it has for years. The difference in the avg over the two periods would have been way too small to cause any noticeable metabolic differences.

I'm about 10kg below my "personal fat threshhold", assuming that it hasn't changed over the last 6 years.
 
Eddy Edson said:
View attachment 32272

But HbA1c and LDL-C ticking up. To the extent this means anything, maybe because of lots of stress & lack of sleep over the last few months, or maybe it's because I'm getting really frikkn old & this is the start of my body, like the world, going to hell in a handbasket 🙂
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Aging, the gift that never stops giving.
 
Is hba1c totally accurate? Could different tests on the same sample on different days might give slightly different?
 
Eddy Edson said:
My weight bounces around between 64 and 65 as it has for years. The difference in the avg over the two periods would have been way too small to cause any noticeable metabolic differences.

I'm about 10kg below my "personal fat threshhold", assuming that it hasn't changed over the last 6 years.
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OK. Wait for one or two more years results to see if anything significant is happening.
 
harbottle said:
Is hba1c totally accurate? Could different tests on the same sample on different days might give slightly different?
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The machines used in the labs are not entirely accurate. This article from 2015 from Germany illustrates some of the problems - Link

"At a target value of 39.1 mmol/mol (5.7%) for sample A, the median of all measurements is 39.6 mmol/mol (5.8%). This appears quite good, but the extremes were 28 mmol/mol (4.7%) and 89 mmol/mol (10.3%)! The acceptable limits in the interlaboratory comparison (18% according to RiliBÄK) are also quite far apart, at 32 mmol/mol to 46.2 mmol/mol (5.08% to 6.38%)."

A long read but the bottom line is that lab HbA1c machines of the same type can very often give results that are between 2.2 to 3.3 mmol/L off the mark, and occasionally provide wildly inaccurate results. The typical variation between machines of different types used in different labs is considerably higher than this, or it least it was in 2017. Given the trend that is apparent in Eddy's HbA1c results I would guess that the May 2019 result was a testing error. It doesn't fit the trend.

Never mind that though, congratulations @Eddy Edson!! Six years of true remission and stability - longer than the median time from T2 diagnosis to needing insulin injections according to the most recent study I could find on the subject, from 2017 - Link. I would hazard a guess that Roy Taylor might be onto something. 😉 It takes commitment and disciple to maintain true remission, something you should be rightly proud to have achieved! I only hope that I can do so well.
 
This paper (which I've really only skimmed) finds that the median coefficient of variation CV = StDev/Mean for repeated HbA1c measurements is 0.07. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0289085

For my record since Sep 2018, excluding the funny May 2019 reading, mean HbA1c is 35.0, StDev is 1.2 and CV is 0.03.
But this is obviously sketchy as a comparison - my record is readings over time, not repeated readings at the same time.
Anyway ...

Assuming I have a steady mean HbA1c of 35.0 then according to the paper repeated readings might be expected to produce a StDev corresponding to a CV of 0.07. So StDev = 0.07 X 35 = 2.5. So a reading of 37 would be within one StDev of "true" mean according to the expected distribution. So on this story, the variance looks like noise.

Again, that's very sketchy, but apart from anything else, I really don't believe that the CV for my lab, exluding obvious outliers, is nearly as high as 0.07.

Assuming it's not just noise, obviously 35 -> 37 is still clinically meaningless, so this all just nerding out - but anyway the cause of the rise is surely obscure with the info available. It might be the result of higher average blood glucose, it might be due to perhaps transient changes in RBC average age.

On that last point, my RBC count went from 4.8E12 to 4.5E12 per l. Naively, you might look at that and guess that the avg age of my RBC's increased over the period, because old cells weren't being fully replaced with new cells. But these are just point measures on specific days and there is no info about ups and downs during the period. So you can't really draw any conclusions.

Anyway, the moral of the story that we are dealing with squidgy biology and precision isn't to be expected.
 
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This looks like a nice recent study, seeking to quantify some effects of RBC lifespan on HbA1c measures, for well-controlled T2D's. No surprises but nice to see some quantification.

The influence of shorter red blood cell lifespan on the rate of HbA1c target achieved in type 2 diabetes patients with a HbA1c detection value lower than 7% - PMC

Variations in the red blood cell (RBC) lifespan can affect glycosylated hemoglobin (HbA1c) test values, but there is still a lack of evidence regarding how and to what degree the RBC lifespan influences HbA1c in the type 2 diabetes mellitus (T2DM) ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

As you'd expect, where RBC average lifespan is relatively short, measured HbA1c underestimates average BG (expressed here as "estimated HbA1c", the estimate of HbA1c from actual BG meaurements using the standard best-fit formula derived from the early studies).

It doesn't look at the dual case, where average RBC lifespan is relatively long, but no doubt measured HbA1c will overestimate avg BG in that case.

EDIT:

Figure A below is a good summary:

1730364469443.png

HGI is the difference between HbA1c estimated from BG measurements and measured HbA1c (with HbA1c expressed in US style % units).

I guess one interesting thing is the number of people with RBC lifespans considerably less than ~100 days, and measured HbA1c underestimating the true BG situation by 1% or more (so more than 10 mmol/mol in UK-style units).

Also, the the asymmetry with the dual case - long RBC lifespan, measured HbA1c ovestimates true BG situation - where the variances seem to be a lot less.
 
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Great results @Eddy Edson and an interesting nerdy discussion.

But I’m with you on the squidgy biology.

@harbottle re: your fasting glucose at Dx, I’ve heard something (probably a decade ago) about high glycators and low glycators - essentially the propensity for different people to make more or less glycated haemoglobin from the same level of circulating glucose. More squidginess it seems!
 
Eddy Edson said:
This looks like a nice recent study, seeking to quantify some effects of RBC lifespan on HbA1c measures, for well-controlled T2D's. No surprises but nice to see some quantification.

The influence of shorter red blood cell lifespan on the rate of HbA1c target achieved in type 2 diabetes patients with a HbA1c detection value lower than 7% - PMC

Variations in the red blood cell (RBC) lifespan can affect glycosylated hemoglobin (HbA1c) test values, but there is still a lack of evidence regarding how and to what degree the RBC lifespan influences HbA1c in the type 2 diabetes mellitus (T2DM) ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

As you'd expect, where RBC average lifespan is relatively short, measured HbA1c underestimates average BG (expressed here as "estimated HbA1c", the estimate of HbA1c from actual BG meaurements using the standard best-fit formula derived from the early studies).

It doesn't look at the dual case, where average RBC lifespan is relatively long, but no doubt measured HbA1c will overestimate avg BG in that case.

EDIT:

Figure A below is a good summary:

View attachment 32308

HGI is the difference between HbA1c estimated from BG measurements and measured HbA1c (with HbA1c expressed in US style % units).
Click to expand...

Changes in RBC would explain why my HbA1c was stable at 32 for a year (June 23 - June 24) then shot up to 39 in three months (Sept 24). Reason: bad stomach upset in May 24 reducing RBC for the June 24 test.
 
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