What should I be aiming for

[awj sompting]

My latest HbA1c is 44.3 and it is a question of whether this is as good as I should expect to get it. Have had some interesting experiences with the Diabetes Nurse at the surgery and GPs also seem to be content with higher levels.
In Febuary 2016 I had got down to 45 although I was not keeping track of the precise numbers and when in March 2017 the level was 46 the Nurse stated that my control had improved and discontinued the Gliclazide. When I gained electronic access to my test resuls I realised that there had actually been a slight worsening and went to see GP and a further HbA1c showed that it had jumped to 62. GP agreed to put some Gliclazide back in but not at the previous level which brought the next test to 51 which GP was happy with. Annual Reviews in 2018 & 2019 gave HbA1c figures of 52 and 50.8 At the 2019 review the Nurse suggesting replacing the Gliclazide with Linagliptin but wanted me to finish the Gliclazide before organising the Linagliptin prescription. After my experience with the previous change by the Nurse I went to see the GP who agreed to me having the Linagliptin prescription immediately in readiness befor the Gliclazide ran out. When I got another HbA1c done three months later the reading was 51.9 which suggested that the Linagliptin was not working as well as the Gliclazide so went to GP and explained to him that because of the Macular Oedema I wanted to get back to the 45 level that I had achieved in 2016. GP agreed with me and prescribed 40 mg of Gliclazide with has brought my HbA1c to the 44.3 level at the start.
I probably can't realistically ask the GP to increase the Gliclazide to bring the HbA1c figure further and I suspect that if I tried to be stricter on the diet front which would cause tensions with my wife all that would happen is that they would reduce the medication to balance it out.
I do worry because the Doctors at the Eye Clinic are always questioning me as to whether my Diabetes is under control when the Macular Oedema is not clearing as quickly as they would like and each time my Diabetes medication has been changed by the Nurse there has been a set back of differing degrees on the Macular Oedema front.

Alun

 

[Kaylz]

Hi 🙂

How restricted is your diet? What amount of carbs do you get through per day?

44 isn't a bad hba1c but it also depends what your levels through the day are like, I presume you do test as your on gliclazide so what are your levels throughout the day? pre and post meals?

The doctors should know that there are other factors to diabetic macular oedema and it doesn't all just boil down to control, I was diagnosed with it less than a month after being diagnosed Type 1 and had to start the injections immediately and have had quite a few now, I have also required lasering to both eyes for proliferative retinopathy last November despite having good hba1c's throughout this time, the consultants say it may be because my hba1c dropped too quickly or I was just extremely unlucky

xx

 

[everydayupsanddowns]

As a type 1 it is suggested that I aim for an HbA1c of 48 or lower as long as I can achieve that without having lots of hypos (for me this means ideally having most days a week with no readings below 4.0 and as few readings in the low 3s as Incan manage).

A major clinical trial and follow-up (DCCT and others) showed that this offered good protection against developing long-term complications.

there are no guarantees of course. And as @Kaylz suggests 2 people with exactly the same A1c can have very different risk of developing complications depending on the different glucose variability and instability which underlies their HbA1c. And also some people can have great BGs and *still* develop some complications much earlier than could ever be expected through no fault of their own.

 

[awj sompting]

I do not regularly test myself as my wife sees that as being obsessive. I have only experienced 1 Hypo since being on medication when I had salad for both lunch and evening meal. I avoid any risk in terms of driving by delaying taking my medication if I am going out in the car first thing in the morning such as to collect grandchildren.
Unfortunately when my wife accompanied me to the introductory talk at the hospital for newly diagnosed diabetics it was full of the then generic NHS Healthy Eating message rather than any emphasis on low carb eating even with reference to the Diabetic having treats. This left my wife convinced that little needed to change other than cutting out sweets etc. and that potatoes were part of a healthy diet.
When I did in the early days do a lot of testing my wife was concerned that I was going to starve myself to death by eliminating things from my diet.
I have managed in recent times to discretely reduce some items in my diet which has resulted in reducing my weight by 2.2 kg in the past year and I am 11.2 kg lighter than when the earliest date ( 2012) that my weight is recorded in the electronically accessible patient information but because I seem to have lost an inch in my height as I moved into my 70s my BMI still sticks just in the overweight category.

Alun

 

[everydayupsanddowns]

It sounds to me like you may need to try to have an open conversation with your wife about your worries over food. Your wife clearly cares for you and wants you to have the best quality of life, and is concerned about you becoming consumed with focussing on diabetes management. You clearly love her and don’t want to upset her because you are trying to hide the fact that you are not eating the portions that are being served.

Your level of 44 offers good protection, and it seems like your diet is suiting you fairly well, but you are clearly concerned over some aspects of your glucose management.

for what it’s worth, my feeling is that living with diabetes is always about establishing a balance between the changes and effort you are able or willing to make and the results (level of risk) you are happy to accept. Diabetes management is a very individual and personal thing, and it is easier if you and your significant other are pulling in the same direction.

Wishing you all the best. Keep us posted with how you are getting on.

 

[Ditto]

You can't eat to please your wife, you have to eat for your health. She wouldn't be pleased if you lost a foot or popped off would she? 😱

 

[SueEK]

Sounds like you are on the right track and I agree that a gentle conversation with your wife is needed, she is obviously concerned about your eating but if you can explain all the benefits of low carb perhaps she will have a little more understanding.
PS are you in Sompting near Worthing?