[shabbie6247]

my family doctor, the hospital specialist and the D nurse have all expressed concern over my A1c (its 6.2 btw). the specialist even told me to have a diabetes 'holiday' (from testing so much) actually i only test 4 times a day, with extras if i 'dont feel right'. he also said he would prefer my A1c to be 6.8.

i queried this with the nurse on the phone today, she explained that people who consistantly manage their Bg's at lower levels to achieve lower A1c's are far more likely to develop hypo-unawareness in say 10 years time.

for the record i (touch wood) never have had a BG lower than 3.4 (still touching wood). but these medics just wont have it. they insist i'm obviously putting myself at risk with an A1c of 6.2!!!

i wonder what they would say about a lot of the even lower A1c's seen on DF!

just thought i'd share.

[CaptainMike]

It sounds to me like they are living in the past. As more evidence comes in it certainly seems that lower is better. I know a lot of Richard Bernstein's evidence is anecdotal, and his views on many things are quite extreme, but you can't argue with results, and he tries to get all his patients into the 4.5-5.5 range.
The ACE and other medical organizations are now saying that 6.5 should be everyone's (Maximum)target. I think only the ADA is still saying 7.0 is OK (and medical professionals who have been listening to the ADA for the past 20 years)

I say good for you with a 6.2, keep up the good work . It is my understanding that having lots of Hypos causes Hypo unawareness, not running 'normal' blood glucose levels.

Cheers, Mike

[Chris Graham]

I would get a new endo. Keep up the good work!

[CindyO]

Your 6.2 is awesome as long as you're not experiencing frequent hypos - more than once or twice a week. I've had problems with severe hypoglycemic events ever since I was diagnosed 40 years ago. And my biggest problem with control now is severe hypo unawareness. My endo says that a hypo event will kill me much faster than any complications from a 7.0A1c. That statement caused me to be a bit less obsessive about a lower number.

[LancetChick]

That kind of thinking makes me steam, because I know it's patently false. My last A1c was 4.9%, and I do NOT go stumbling through life in a hypoglycemic fog! Non-diabetics don't need to wait a chunk of the day to make sure their hyperglycemic tendency is caused by hormones before they inject their Lantus, and they don't get high blood sugar from a stressful situation. There are many ways in which my blood sugar will rise and a non-diabetic's won't, and in order to have a non-diabetic A1c I need to balance that somehow. So I make sure I don't spike after eating, which is something non-diabetics can and often do. I'm lucky because my digestion is slow, but the others I know that have A1c's in the low 5's or upper 4's use diet and a combination of insulins to make sure they don't spike after a meal. I work at home in my office, and if my blood sugar is in the upper 60's and I don't feel like eating anything, I don't...... I just let it be, which is also something non-diabetics don't usually experience.

BUT I test like a fiend, and make sure I treat any blood sugars below 65 so that I maintain my hypo-awareness, which I consider vital. I can feel when I'm in the 60's, and if I'm driving a long distance, I want that alarm clock! Correcting the medical profession is an exhausting chore, and after 21 years of witnessing a never-ending series of mistakes made by them, it's shocking to see people take their word as gospel. But that's just what I did the other day when I went in with an arm covered in cellulitis from an insect bite. I didn't know anything, and thought it was Lyme disease. At least they got the diagnosis right (as far as I know), but they actually had the cheek to summon the doc to give her approval before I shot up.

[klpants]

Forget what the "specialists" say or at least take with a pinch of salt. You are much more likely to avoid all the beautiful diabetes complications with a lower A1C. An A1C of 6.2 doens't neccessarily mean you are always having lows! If your BS doens't go lower than 3.4 then I wouldn't worry about hypo unawareness. I think the reason the docs will say A1C is too low is that they are used to seeing so many patients with A1C's over 7.5 so 6.2 just "seems" low to them.

I've noticed the tendancy amongst UK doctors to overreact if you have good control or wanting to acheive the best control you can and say things like "are you obsessing about your control"!!
Wouldn't the docs and nurses rather see you with an A1C of 6.2 and living a good life (of course not always being in a hypo state) than 16.2!!?

[HelenM]

I sympathise Shabbie.
My doctors are also concerned about my low HBA1c. They say that they would like it to be nearer 6%(!!) They too measure good control as being less thatn 7%. and think I must be overcontrolling or testing but I only test 4-6 times a day.
Mines been 5-5.2% consistently since I was diagnosed just over 2 years ago. I put it down to possibly producing some of my own insulin still and also to exercise. Like you I am a 1.5. and I'm not certain that we have the same control difficulties, at least in the early years,as type 1 There are too few of us and not much research so no-one has actually described the course of the disease.
[Unlike you I do have some hypos but they are recognisable, predictable (after exercise) and at the moment easily remedied.They are the main reason that I'm getting a pump so I can reduce or eliminate basal during exercise]


Should you aim for a higher HBA1c? How would you do it? How do you make sure that your overall BS rise is restricted to a few percentage points.?
I've thought about this from a personal point of view and I don't think its as easy as doctors imply. I know that if I miss out exercise then I have a higher pre meal and fasting BS. If I reduce the insulin for mealtimes or eat less healthily I have higher post prandial BS. Together these would translate very quickly into a much higher HBA1c. It seems to be counter intuitive to do this and I would find it extremely difficult mentally to try to.

[duck]

I'm glad to see there are so many well-mannered members here...My first reaction to reading shabbie's post took me back to my days in college, when watching a basketball game in the arena, the ref makes a bad call and the entire crowd chants for minutes on end "Bulllllllspiiiiiiiiiit"...or something like that.

Shabbie, as long as you are not wildly fluctuating, or suffering extreme hypos you should be fine. I would challenge anyone who said what was said to you for documented evidence of such claims.

[shabbie6247]

[quote]
Should you aim for a higher HBA1c? How would you do it? How do you make sure that your overall BS rise is restricted to a few percentage points.?
QUOTE]

been thinking about this one. my post meals would have a tendancy to be higher if i mess with my I:C ratios, but if i increased my target pre-meal BG from say 4.5-5.0 to 5.0-5.5...? thereby not putting myself at risk of pre-meal hypos.

Originally Posted by klpants

Forget what the "specialists" say or at least take with a pinch of salt. You are much more likely to avoid all the beautiful diabetes complications with a lower A1C. An A1C of 6.2 doens't neccessarily mean you are always having lows! If your BS doens't go lower than 3.4 then I wouldn't worry about hypo unawareness. I think the reason the docs will say A1C is too low is that they are used to seeing so many patients with A1C's over 7.5 so 6.2 just "seems" low to them.

I've noticed the tendancy amongst UK doctors to overreact if you have good control or wanting to acheive the best control you can and say things like "are you obsessing about your control"!!
Wouldn't the docs and nurses rather see you with an A1C of 6.2 and living a good life (of course not always being in a hypo state) than 16.2!!?

youve got the uk docs spot on there!!! the nurse said they arent used to seeing a D with such a good A1c in the clinics here!
and "obsessing about good control" was actually one of the specialists comments!

Originally Posted by Chris Graham

I would get a new endo. Keep up the good work!

wish that were an option here, but sadly ~ only a choice of one!


i quite honestly dont feel that i should be concerned about myself having hypos, (aware yes but not concerned!)

i spend more time fighting to keep my Bg's rocketing after meals. my carb counting is fine. post prandials are mostly back in range.

thanks for all your support as usual

[Alice]

My endo says that the A1C doesn't tell the whole story...high or low. Especially in the lows. She says she can have two patients with low numbers...lets say 6.0 and lower. One has even daily numbers, while the other has extreme lows with insulin reactions several times a week.

She would rather see a low 6.0-7.0 than a 5.5 that is experience emergency room visits, severe hypo's, etc.

So, you have to see what your own situation looks like...if your 6.2 is without chronic lows, then you are doing great.

I had never thought about the "flip" side of a low A1C until she mentioned this to me. I was upset over my 6.9 that had increase from 6.5.

My goal is to get down to 6.0 and stay there...5.5 would be a nice second goal...But I don't push the "low" envelope too often and have never had an ER visit. So, it may be a trade-off for me.

I have a bigger problem with doctors telling their patients anything under an 8.0 is good.

[LancetChick]

Alice, you are dead right about that. When my A1c's were in the 6's (never higher than 6.5) I developed retinopathy and frozen shoulder. But my blood sugars were all over the place, and lows were a way of life, and highs weren't 150, they were much more spectacular. The retinopathy scared me, and I really thought I would go blind, but I buckled up and straightened out, and when I lowered my A1c AND stabilized my blood sugars, I was able to reverse those complications. I'm very sure that fluctuating blood sugars were the reason I developed complications in the first place.

[notme]

Alice, that is exactly what my endo told me as well. Daily numbers will tell you a lot more than your A1c. Your A1c can only confirm those results or give a doctor a general picture if a patient choses not to log tests. Some people will intionally have lows to get a good A1c result. The opposite can occur if you have an unexpected high number before your test. An A1c is only a general picture.

Congratulations on your great numbers.

[Wildbill]

When I went through cardiac rehab one nurse told me that they like 5.5 or lower instead of <7. For what it's worth. My last was 6.2 and my doc was very happy.

[Alice]

One thing I would love to see A1C research numbers on:

The A1C national average of Type I's and Type II's. Maybe by type, age, regional area, etc.

I'm also curious (I don't thing there was any tracking done back then) of what the national average of diabetics was before the popularity and prescription of meters. I think we were all happy we were walking on two feet back then!

I would like to see how the national numbers improve year-to-year in a national survey. We can get an idea of how diabetic treatment is getting better and better...if for anything else, a moral boost that things are getting better and we are getting healthier.

I have always felt the cure was in our hands...or at least, it's a partnership between patient, doctors & researchers.

If anyone knows of a national database that tracks A1C's in the US or any country...I'd love to know.

[Gary_W]

Hi Sharon,

Before I found this place, my A1c was 8.1 and my daily routine was to bounce between 18 and 2.5 and back again. My eyes permanently looked dreadful, I weighed too much, I felt lousy. My hospital team told me 'below 7.5 A1c would be better, but you're doing fine'. I thought that was my lot in life and got on with it.

When I saw the nurse a couple of months after finding this forum, I explained to her I was testing around 7 or 8 times a day, doing correction shots etc. I was told that I was testing excessively and doing it all wrong. My A1c came back as 6.5 which she told me was the lowest she'd seen in a type 1....

When I went back a couple of months ago I told them I regularly test 6-10 times per day and that I eat anything I like. I had lost 35lbs in weight and felt fantastic. My A1c was 5.5. Once they had picked their jaws from the floor they asked 'Don't you mind testing that many times a day'. I told them I'd rather not but it was better than losing my legs.

Hypo unawareness bothers me as a concept. It is something that MAY happen if you sail close to the wind all the time. At the moment, I am feeling the best I have in years and (if what I read is true) have pretty much wiped out my chances of complications long term. That feels good. If I ever go hypo where I didn't know it was coming then I'll re-think my statergy. AFAIK, you can get hypo awareness back by running a bit higher so I'll cross that bridge if I ever come to it. I know that an A1c of 8.1 was harming me, both now and in the future. I cannot trade that for a 'what if' with hypo unawareness.

I would also argue that my basal is now correct at 18u per day. The hospital had me on 35u per day which was why I was always ticking down. I had far greater chance of a hypo in the night putting me in A+E doing things there way than I ever do now with my new fangled ways.

I think so many diabetic clinics see loads of patients that just do not take care of themselves whatsoever. Some people with this disease don't do a blood test from one week to the next, don't bother injecting etc. When someone goes in that actually knows a thing or two I believe it scares them As far as blood tests go, I would argue that a blood test 2-3 hours after eating is a good idea so as you can correct if needed with either insulin or food! They told me to just do 4 a day, but then again they think that an A1c of 8 is alright so I find it a little tricky to take them seriously.

You actually CAN change clinics if you wish; your GP can provide you with a list of alternative clinics you can attend. I notice you live in North Wales so your choice may be rather limited by Geography / time taken to get there. Ysbity Gwynedd? I used to go there occasionally with work. Pretty drive, took forever though!

Gary