A1c How do hypo's bring them down?

[soso]

We all know that high blood sugars are reflected in the A1c... that high bg results in sugar being 'stuck to the cells' after a certain period and stay there for the life of the cell..

Also that one can have a good looking A1c, even if running high numbers, if one also has a lot of hypos... my question is why? does being hypo somehow remove the sugar from some of the blood cells?

Anyone know how that works?

[fgummett]

As I understand it, the A1c gives an average/mean of your blood sugars over the last 90 days or so. I didn't think the highs "stick" anymore than the lows or normals. So in theory, if you are high every morning and low every afternoon you could end up with what looks like an healthy A1c :)

http://www.ianblumer.com - A1c... (http://www.ianblumer.com/definitions%20&%20test%20interpretation.htm#hemoglobin%20A1C%20(g lycosylated%20hemoglobin))

[Stuboy]

which is why when you can only achieve an A1c of less than 8% by having lots of hypos, they start to t hink about pumping...

[Evermont]

I don't know if this is right but...

I think of it like a car's air filter. If you drive on dusty roads a lot your filter gets dirtier faster. On less dusty roads the filter stays clean longer. So lower A1c's would result from the lower concentration of BG because there's less opportunity for bad stuff to stick to the cells. It's not just that you go low, it's the time you spend being low and the extent of it.

Just a guess.

[Lloyd]

which is why when you can only achieve an A1c of less than 8% by having lots of hypos, they start to t hink about pumping...

I beg to differ.

I have been under 60 once in 6 months (56) and my A1c is 4.9.

I have not been over 140 in about 9 months, THAT is how you achieve great control.

-Lloyd

[Real4]

does being hypo somehow remove the sugar from some of the blood cells?
The glucose and the hemoglobin protein that it binds with reach a equilibrium point determined by the glucose level of the blood; that is the basis for the test. So, yes, glucose will unbind from the protein when ambient blood glucose levels are low enough.

[BlueSky]

I beg to differ.

I have been under 60 once in 6 months (56) and my A1c is 4.9.

I have not been over 140 in about 9 months, THAT is how you achieve great control.

-Lloyd
I'm with Loyd on this. The popular notion that having a low HBA1c necessitates lots of hypos sounds logical, but actual experience suggests otherwise. I find the exact opposite to be true. The number of lows increases as HBA1c goes up. This happens because blood glucose becomes more volatile (standard deviation increases) as control deteriorates. The converse is also true. The number of hypos comes down as HBA1c is reduced because control is improving.

The effect of hypos on average blood glucose is also limited. Hypos don't last long because we treat them promptly. On the other hand, highs often last for hours (like when we are asleep).

[JungleJim]

I beg to differ.

I have been under 60 once in 6 months (56) and my A1c is 4.9.

I have not been over 140 in about 9 months, THAT is how you achieve great control.

-Lloyd


Lloyd,

You might want to re-read Stu's post before you beg to differ, he said:

"which is why when you can only achieve an A1c of less than 8% by having lots of hypos, they start to t hink about pumping..."

Your control is great and obviously you work hard at it, but I think you missed the word "when" in Stu's post.

[Lloyd]

Lloyd,

You might want to re-read Stu's post before you beg to differ, he said:

"which is why when you can only achieve an A1c of less than 8% by having lots of hypos, they start to t hink about pumping..."

Your control is great and obviously you work hard at it, but I think you missed the word "when" in Stu's post.

Oh, yes, that's clear as mud. :)

-Lloyd

[Gary_W]

I beg to differ.

I have been under 60 once in 6 months (56) and my A1c is 4.9.

I have not been over 140 in about 9 months, THAT is how you achieve great control.

-Lloyd

I believe Stuboy is making a reference to the guidelines for pump therapy over here in the UK which some hospitals stick to rigidly. In essence, such places will only consider you for a pump if your attempts to get your HBA1c below 8 give you unpredictable and disabling hypos as a side order. The definition of 'disabling' has been 'needs the assistance of another person'. The fact that not many people fall into that category is one of the main reasons why pumpers in the UK account for around 1 in 50 T1s compared with 1 in 8ish for some other places in Europe which have public healthcare systems.

Gary

[Lloyd]

I believe Stuboy is making a reference to the guidelines for pump therapy over here in the UK which some hospitals stick to rigidly. In essence, such places will only consider you for a pump if your attempts to get your HBA1c below 8 give you unpredictable and disabling hypos as a side order. The definition of 'disabling' has been 'needs the assistance of another person'. The fact that not many people fall into that category is one of the main reasons why pumpers in the UK account for around 1 in 50 T1s compared with 1 in 8ish for some other places in Europe which have public healthcare systems.

Gary

.... and about 5% here in the USA
And I take HUGE issue with their stance that a pump has not been shown to help T2's, therefore they are not eligible.

I'm a T2, and my fasting glucose dropped 100 points (5.55) from the first night pumping on, due to the ability to control my Dawn Phenomenon via pump.

[Funnygrl]

I beg to differ.

I have been under 60 once in 6 months (56) and my A1c is 4.9.

I have not been over 140 in about 9 months, THAT is how you achieve great control.

-Lloyd
But you're pumping....which totally defeats the point Stuboy was making. He's saying that's WHY pumping is good. You're essentially agreeing with him.

[solox316]

But you're pumping....which totally defeats the point Stuboy was making. He's saying that's WHY pumping is good. You're essentially agreeing with him.

Funny, you are correct. It was in his wording "when"...

I applaud those with low A1Cs who aren't hypo all the time... I sure cannot do it.

[Funnygrl]

Funny, you are correct. It was in his wording "when"...

I applaud those with low A1Cs who aren't hypo all the time... I sure cannot do it.
I have a decent a1c, but have a fair amount of hypos too. I think type 1s physiologically see a lot more variance.

[solox316]

I have a decent a1c, but have a fair amount of hypos too. I think type 1s physiologically see a lot more variance.

I was thinking that... but couldn't figure out the right way to say it. thanks :)

[Lloyd]

I have a decent a1c, but have a fair amount of hypos too. I think type 1s physiologically see a lot more variance.

I agree with that.

-Lloyd

[soso]

Thanks for all the replies.. I was just wondering...