Whats a sensable HbA1c to acheive?

[pav]

I have just had the stuffing knocked out of me by a doctor saying my HbA1c is to low at 44.

I think I can achieve a better HbA1c and would like it lower, but if I follow doctors advice I would be a lot heavier and BS will end up sky high again, really brassed off at the moment. 😡

 

[LeeLee]

There's a difficult balancing act to contend with, weighing the risk of a serious hypo that could cause irreparable damage very quickly, against the long-term risks of running higher and suffering the chronic effects. I don't have the experience to be able to help, but I sympathise with the position you're in. Can you get referred to a consultant endocrinologist for a second opinion? You're within your rights to ask for that much.

 

[Northerner]

Pav, I think this is one of those outdated thinking things from some GPs - they assume that if your HbA1c is low then it must be because you are having lots of hypos. They seem to regard this as worse than having higher levels, but within range. From what I have gathered from your posts, you do have tight control, but not an excessive amount of hypos, so personally I would keep on doing what you are doing and are happy with 🙂

 

[Mark T]

I agree with Northerner here. Certainly I see the same with my father (on Insulin) where it seems that they nag him to have his HbA1c in the 7% range.

I believe this is because he has a few hypos (nothing severe) and instead of working with him to tighten his control they just shift him up a bit so with his normal variance in readings he doesn't have (m)any hypos.

 

[pav]

I got the same impression, stop the hypos by moving the goal posts upwards and stuff the consequences.

Though I can't reverse the nerve damage in my feet, they are far better running at the lower BS. I can tell when my BS goes high as my feet start tingling more.

 

[Redkite]

Are you on insulin Pav? Even if you are, it's a great a1c as long as you don't get too many hypos from running your levels too close to the wire. If you are happy with your control, carry on as you are. It's you who is living with the diabetes and managing it, not your doctor, and it's not he/she who will risk complications later on if you loosen your control like they are advising.

Btw, it's not the case that hypos lower the a1c. High levels of blood glucose cause more glucose to bind to the haemoglobin in the red blood cells, but low BG levels don't take any away. So a reduced a1c is never due to an increase in hypos.

 

[everydayupsanddowns]

Funnily enough my recent pump clinic notes to my Dr used very positive and congratulatory terms to describe my A1c (with a note of caution about low level hypos and hypo awareness) - my result was THE SAME as yours!

I wouldn't necessarily push to get it lower, but just see if you can lose half of your low readings and keep your overall A1c the same - that's what I'm trying to do at the mo!

 

[pav]

I am not on insulin, on metformin gliclazide and trying to get better control of the peaks in BS. I do have complications from diabetes and don't want them to get worse.

A lot hypos I have had recently appear to have been down to the hot weather as its been knocking me all over the place along with a few others. Now its getting cooler hypos are decreasing to a more acceptable level, I do get the odd unexpected one, some are down to me and not eating at the right time the 3.9 ish ones.