Normal a1c is 4.6%??

[peacelover]

I came across an interesting article. I guess my 5.5 isn't as fantastic as I thought...:mad:

A1c Predicts Heart Attack (http://www.phlaunt.com/diabetes/15945839.php)

Does anyone have an a1c under 5? Just curious how you do it.

[princesslinda]

According to the lab my A1C is read by, a normal A1C is between 4 and 6. Your 5.5 sounds quite good, right around the middle of normal. If it was 4, it would be low normal, 6 would be high normal, but still within normal range.

An A1C of 4 correlates to a 90 day avg blood sugar of 65; 6 correlates to an average 90 day avg blood sugar of 136. If you had 4, you'd certainly be having several hypos.

Personally, I aim for an A1C in the 5 range.

[Tropo]

Peacelover, I'm curious as to why you joined a diabetic forum with a level as good as 5.5. Were you much higher before and brought it down?

[princesslinda]

It is possible for some newly diagnosed diabetics to have A1C within normal limits and still have some blood sugars that are in the diabetic level, as the A1C is merely an average.

For example...if someone only checked 3 times a day and had
160 fasting, 140 after lunch and 100 random, that would be an average of 133...which correlates to an A1C of 5.9...technically still within "normal limits," though overall control is not good. I have a co-worker who is rarely under 200 fasting, yet she takes her meds and drops to 60-70 on a daily basis. Her A1C indicates that her control is much better than it actually is. That's why we can't rely only on A1C...it's an average, testing a few times a day, on the other hand will point out any spikes, signifying lack of good control better than an A1C might.

[Tropo]

Princesslinda, you seem have a good grasp of the numbers. I know what the "normal" levels are, but what would be considered optimum post-prandial readings?...1 and 2 hour.

[princesslinda]

When diagnosed, I was told that my fasting level should be 110 or less, 2 hr post-prandial should be 140 or less. I was told that if I kept my levels as close to that of a non-diabetic as possible, i'd have the same risk of complications as a non-diabetic....I don't know that this is true, but it makes sense to keep them as close to normal as possible. Personally, I try to stay under 120 at my 2 hr level, as I don't like my blood sugar to go over 140 (because i've read that's where damage can start to occur). I do occasionally get over 140 when i've eaten more carbs than usual. I don't generally check a 1 hr level, so I don't know what the "optimal" number should be. If my 2 hr level is higher than I think it should be, i'll retest in 30 minutes to make sure it's coming back down. I've found different foods will keep #s higher longer.

Someone recently mentioned in another post reading that your post meal blood sugar should not go more than 50 points over your pre meal #s. That might be a good rule of thumb to follow.

Its interesting to compare your pre and post meal #s with that of a non-diabetic. I'll do this with my husband (when he'll let me) and the biggest difference is that he's back in the 80's 2 hrs after eating, and i'll be 115 or 120. Seems non-diabetics get back to pre-meal numbers much quicker than diabetics.

[Tropo]

Its interesting to compare your pre and post meal #s with that of a non-diabetic. I'll do this with my husband (when he'll let me) and the biggest difference is that he's back in the 80's 2 hrs after eating, and i'll be 115 or 120. Seems non-diabetics get back to pre-meal numbers much quicker than diabetics.

I know what you mean about "when he'll let me". I'm often interested to see normal readings from my partner, but she'll never submit to a finger prick.

Does your husband get back to the 80's even after a high-carb meal? Does he control what he eats as you do?

[princesslinda]

Yes, even after a high carb meal, he'll get back into the 80's. He eats what I eat at home, but he eats what he wants when we go out. He's lost about 45 lbs since I was diagnosed, as we have a "junk-food" free home. He has a family history of diabetes as well, so he's more careful than he used to be about what he eats.

I'm going to have him get an A1C at his next physical, just to see what it is, as he's never had one before.

[JediSurfer]

I wouldn't worry about it too much the "4.6%" is an average of an average anyway.
Recent studies have shown that high BG or HbAC1 don't actuall cause the heart failure and Ishaemic heart desease. The cause of this is autonomic neuropathy which is caused by high by BG's. The nerves become damaged and the blood supply to the hearts valves is affected.


Personally I think hitting a % under five is a pretty unobtainable goal using the insulin we have at the moment unless you were to do nothing else but control BG's all day long.

Most of the non diabetics I know who have had the AC1 test as a precaution have alway come back in the 5's.

[wiseguy]

This excerpt from Diabetes In Control (http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=5147) sums up what I believe about A1c results and blood glucose levels.
Below 7%, below 6.5% OR NORMAL?
When do we get honest with the public and tell them the truth? To reduce your risks as if you did not have diabetes, then you need an A1c that represents a healthy individual without diabetes. The studies have shown that a normal A1c for a healthy person without diabetes should be 4.3 to 4.6%. In the Epic-Norfolk study they showed that an A1c of 5% compared to an individual with an A1c of 6% had an increased risk of cardiovascular death of 28% higher.

In all of the recommendations they say that the A1c should be as low as possible without hypoglycemia. The ADA sticks with 7% or below, AACE stays with 6.5% or below, what does below mean? When we say it should be 7 or below then that is usually where most medical professionals stop being aggressive. We hear 7% we hear 6.5 % we even sometimes hear 6%.

If your child had diabetes, would you be satisfied at 6.5% or would you want it Normal, as if they did not have diabetes? Or would you like to wait 15 years and see what the studies tell us?

[Ronin]

Peacelover, et al.,

A good question indeed. If you read the article closely, and just happen to be aware of what the Medical Community is callling the "Metabolic Syndrome" then you have a clue as to what the article is talking about.

As one who was first diagnosed with hypercholesterolimia (high cholesterol that did not respond to diet changes) and was put on statin drugs early on I know the problem of focusing on just one facet of the equation. Even though my Cholesterol responded well to the statins, my Triglycerides remained high and my weight was in the low end of the obese range, yet my MD was happy. I, however, was not because I knew I was not fit or truly healthy.

The following measures are used to diagnose the "Metabolic Syndrome" they are

A1c < 6.5
Blood Pressure <120
LDL cholesterol < 80
HDL Cholesterol > 55
Triglycerides < 80
Microalbumin < 30
Annual Eye Exam

The above represent the "ideal" values. The reality is that no single aspect is going to be the total culprit in causing heart disease. The author of the article Peacelover cited is also an apostle of the famous/infamous Dr. Richard Bernstein who has some rather extreme views of what BG levels should be that are not shared by the rest of the medical community. (Let's not get into an argument about him -- we've all done that before.)

There is also the age factor involved. The addition of Pre-Diabetic to the diagnostic catalogue has swept up a large percentage of the "over-50" folks who are otherwise healthy.

What is clear is that diabetes of any type seems to have a strong genetic element and if you are genetically inclined to developing the condition it is likely that you will develop it. You can, through diet and lifestyle modification lessen or delay the nasty effects, but it is likely to happen. Does this increase your probablity of heart disease? Well, if all the factors noted above are high, then it is likely that you will.

On the other hand, it is not likely that anyone keeping their numbers in check will suddenly develop diabetic induced heart disease.

Oh yes, it is interesting to note that all of the factors have one common relationship and that is to the condition of your liver.

[RobiJo]

I think an A1c that low would be dangerous. That would mean a lot of lows for me. A non-insulin dependent individual might be able to have a number that low... but for someone trying to manually balance food/insulin/excerise I think an A1c in the 5's would be perfect.

[BlueSky]

I think an A1c that low would be dangerous. ...
That whole discussion is of only academic interest to us T1s ;) . Our blood sugars tend to be a lot higher, but there is an important difference between T1s and T2s that seldom gets taken into account. Even moderately raised blood glucose caused by insulin resistance is accompanied by very high insulin levels. And high insulin levels are thought to be an independent cause of heart disease, just like high levels of stress hormones (adrenalin an cortisol). While high blood sugar is not good, it is not the only issue here.

So, as a T1, don't feel too threatened by reports that an HBA1c above 5% increases heart attack risk. If you don't have insulin resistance, it probably doesn't apply to you. Once again, sweeping T1s into the same basket as T2s causes misunderstandings.

[Lloyd]

That whole discussion is of only academic interest to us T1s ;) . Our blood sugars tend to be a lot higher, but there is an important difference between T1s and T2s that seldom gets taken into account. Even moderately raised blood glucose caused by insulin resistance is accompanied by very high insulin levels. And high insulin levels are thought to be an independent cause of heart disease, just like high levels of stress hormones (adrenalin an cortisol). While high blood sugar is not good, it is not the only issue here.

So, as a T1, don't feel too threatened by reports that an HBA1c above 5% increases heart attack risk. If you don't have insulin resistance, it probably doesn't apply to you. Once again, sweeping T1s into the same basket as T2s causes misunderstandings.

This is all true. But... how much your bg's vary, is almost as important as what the average is. High variance, as measured by Standard Deviation, irrespective of average, is a cause of higher risk of complications.

-Lloyd