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Ideal A1c

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#1
moorejames

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My recent A1c was 5.5, which near as I can tell is about as good as you could hope for, 3.5 months in from diagnosis.

I see a lot of conflicting information on what an ideal A1c should be. I believe the ADA recommends keeping it below 6.5, which seems a little high to me.

But, how low should you go? Basically, I don't want to take any more medication than I have to. We're going to try backing off on my metformin dose just a little to see what happens. Even if it goes up a little, I'd probably be ok with it, since the offset is fewer drugs.

Any idea what the benefit would be of having an A1c of 5.0 vs 5.5. Would a 6.0 be just about as good as a 5.5? Or should I push even harder to get at or below 5.0?

I feel a little guilty, since I know so many of you struggle to get into the 6's or 7's , but I'm obviously capable to keeping it pretty low, so how low should I go?

jim

#2
princesslinda

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I think it's great that you've managed to get your A1C to this level in such a short time. You asked how low you should go, IMHO, I think the lower you can go the better you're going to be longterm. I have thought about asking the doc to increase my metformin to see if I can get to an even better A1C than my last 6.2. I wanted to share the information below with you. I think it's very interesting. Again, you should be commended on getting such great control so soon.


"a new study from the university of cambridge school of clinical medicine has recently discovered that non-diabetics are also at much higher risk of heart disease and other fatal illnesses if their blood hba1c levels are above normal.

the study, headed by kay-tee khaw, m.d., appears in the september 21 issue of annals of internal medicine.

4,662 men and 5,570 women between the ages of 45 and 79 years old participated in the study from 1995 to 1997, with a follow-up period to 2003.

it was discovered that for both men and women there is a strong relationship between high average blood sugar levels and cardiovascular disease. in fact, high hba1c levels appear to be a risk factor for deaths from all causes. the study found that this is true even for people who do not have diabetes.

"normal" hba1c levels range from 4% to 6%. three-fourths of the 521 deaths from all causes among study participants were people with moderately elevated average blood sugar levels between 5% and 6.9%. those with the lowest rates of heart disease and death had hba1c levels below 5%."

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#3
moorejames

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Perfect. That's exactly the kind of info I was looking for.

I'm a little concerned with using 'normal" levels (especially normal levels in the USA), since there are SO many pre-diabetic people running around.

I want to know what a "normal" a1c is for a 40 year old guy with a great diet, who's in fantastic shape. That's the number I want to shoot for.

(and no, I'm not quite 40 (yet) don't have a "great" diet (yet) and I'm in anything but fantastic shape (yet).

I just want to make sure that the bar I'm shooting for is high enough. (or in this case low enough).

#4
dbc

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Perfect. That's exactly the kind of info I was looking for.

I just want to make sure that the bar I'm shooting for is high enough. (or in this case low enough).


Trouble with this kind of discussion (I think) is that there is no such thing as one number that fits everybody. Normal is defined as 4-6%. I read that to mean if you have an A1c of 5.9% and no other health indications of diabetes, then 5.9% is OK for you.

There are many low-carbers out there who will insist that a diabetic should aim at an A1c below 5%. I simply don't believe that is achievable for ALL diabetics.

I'm about to start insulin. My initial objective is an A1c below 6%, with a minimum of highs/lows (preferably none....)

And yes, I eat lo-carb, fairly strictly - that's just my way of managing things.

#5
moorejames

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Trouble with this kind of discussion (I think) is that there is no such thing as one number that fits everybody. Normal is defined as 4-6%. I read that to mean if you have an A1c of 5.9% and no other health indications of diabetes, then 5.9% is OK for you.


I'm in the insurance biz, so I tend to think of things in terms of risk vs reward and cost vs benefit.

If a 5 is long term healthier than a 6, and I can live with what it takes to achieve it then I'll shoot for a 5.

If a 4 is even better than a 5 and has proven benefits, and I can personally accept the limitations in lifestyle that it would take to achieve, then I'll do that as well.

If there's no information on the benefit of a 5 vs a 6 or a 4 vs a 5, then I'm missing the piece of information that would allow me to make the decision. I might know what I'd be giving up in order to achieve it (the cost) but I won't know what the benefit is.

One of my favorite quotes is:

“The greater danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.”
- Michelangelo



I think it holds true here as much as anywhere.

#6
princesslinda

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Love that quote by the way. Working in the medical field myself, I feel that most doctors feel that most people aren't going to deny themselves much of anything and will do whatever they want, and think that as long as there is a pill for it, that's all that counts. Not just in diabetes, in most illnesses. We have patient's who think their meds are all they need and can live as they wish. I think that's why they make an A1C level of 7 to be considered a "success." In my internist's office there is a big poster on the way stating that "83% of our patient's are successfully meeting our goal of A1c of 7%).

I'm in no way minimizing the struggle many of my forum family have in achieving good A1c's, as I struggle with this myself. I also think those of us on the forums are not "typical" patients, so please, no one here take offense.

On another post, someone said that if we can keep our levels the same as a non-diabetic (whether with pills, insulin, diet, etc), then we run the same risk of complications as a non-diabetic....and it makes perfect sense to me...Unfortunately, this may not be possible for many folks...but, knowing you've done the best you possibly can has to make a mental difference.

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#7
soso

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There is something else about A1c's that is a bit perplexing..people who toe the line, test frequently, get low numbers and still never get a number below 5%..or my DH who is T2, eats and exercises moderately well, but still eats plenty of spike inducing foods...when he tests after meals he is often a lot higher than I would be OK with...and yet his A1c is 4.7% Also, while I get fastings in the mid 4's his are usually high 5's to 6...
Go figure.
ss

#8
princesslinda

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Soso, I know exactly what you mean. My coworker eats anything she wants and often drinks sugared sodas. She's T2 as am I. She takes Glipizide, Metformin XR and Byetta, I take metformin 500 mg 2 times a day and am for the most part, very anal about what I eat. I had my last A1c drawn and it was 6.2...I was happy as it was down from the 9.6 at diagnosis. She has 200 and above fastings most mornings, yet after she takes her meds, she'll drop down to 70-80, even eating burger on bun, fries or baked potatoes, and dessert with sugared coke. Her A1c was 6.8, not much higher than mine with all the abuse. I think if someone plays with their meds as she does (extra pill when she eats what she thinks is "bad") that the A1c can be low and the doctors would never know the huge fluctuations in BS levels she has. In her case, the A1c is not as indicative of control as someone who is very consistent and have the numbers to prove it.

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#9
Lloyd

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I think we should all get our A1c's as low as we can, up to the point where we start having serious or frequent lows. If you find that happening, back off a bit.

Lows can be very dangerious. You don't want to try to get a good average by having lots of lows, but rather by having few highs.

2014 A1c 5.4 5.6   2013 5.3 4.9 5.2 5.2
2012 5.3 5.2 5.1 5.0
2011 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<---Pump 6.9 (Mix)
2006 (Lantus) 7.8 8.5 8.7 7.1
2005 8.4 6.9 7.4 2004 6.2 5.6 6.4 6.0 (Pills)


#10
orpy

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I believe that the ADA says anything under 7%...this is not low enough according to Richard Bernstein who advocates that diabetics need to achieve "normal" levels. I cannot believe that I will ever be able to achieve this, at least not by any drugs I've taken by far, and definitely not by lo-carbing it.

I eat lo-carb and no matter what, my a1c has not been normal since I started getting an A1C test.

It really freaks me out when people talk about having A1Cs below 5% because I am simply so jealous, and at the same time, scared to death for my future health. I am only 51.

I am in excellent shape...not overweight and I eat very few carbs. So, let me know how I can achieve an A1C of under 6% please.
Orpy

A1C changes: 6.8-->6.6-->6.5-->6.1-->6.4-->7.2 --> 6.0-->6.4-->6.3-->5.9!!! (June 2009) (I am so happy I made the 5 club)-->6.2.

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#11
slipperyelm

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Moorejames, I like your thinking.

Let em tell you my experience, hopefully as a WARNING to do what you can to keep those BGs and A1cs down from now on.

I was diagnosed about 14 years ago with A1c 13.2. I worked my butt off to eat right, excercise, and lose a lot of weight. At the end of three months, my A1c was down to 5.4! This was with no medicine and following the ADA diet. I kept it down like that for a while. But then I started very slowly slipping, eating more, exercising less, gaining weight, until I was back up to 9.(something). At that time, this was years after initial diagnosis, I went on medicine and renewed my better eating, more excercise, and weight loss. But I was never able to get back down to that initial 5.4 or the general state of health I'd achieved when first motivated to turn it all around.

Eventually I was on two oral meds, then added in Glipizide, an oral which causes increased insulin secretion. Evidently, I could still produce prodigious amounts of insulin becuase I would have hypos anywhere from three times a weeks to three times a day. I could not excercise with out a hypo. I couldn't balance my diet and the glipizde. My A1c looked okay (6.4) during that year on Glipizide, but clearly my health was getting over all worse.

I had already started cutting back carbs and eating only low glycemic index carbs just before going on Glipizide. I had seen promising results from that. So, I told my doctor that I wanted to ditch the Glipizide and see what very low carb eating really could do for me.

Well, I was down to 5.4 (just like my very first great A1C 14 years ago) on last check! I have done even better with BGs since then, so I am hoping the next A1c will be around 5.0.

But I beleive that had I not slipped in those first years after diagnosis, had I not gained weight, fallen away in exercise, and eaten the atrociously high carb, high glycemic index foods in large amounts---had I not screwed up like that, I would not have to be eating in such an extreme way to have good A1cs. Maybe I would not yet even need oral meds--who knows. I really suspect that an ADA style of eating would have been just fine for me for life, _if_ I had stuck with it. But I ate, well, gluttonously. Instead, by losing control of all the good things I should have done, I pushed my insulin resistance to a state where it takes the extreme measures of oral meds plus low carb eating for me to achieve better numbers.

By the way, I am grateful as Heck to still have the option of low carb. Going low carb has done so much for me. I am much more healthy now in many ways.

So, my overall warning, is stick to your best practices to keep A1c and BGs low. If you keep it low, you can probably stay healthy and not make your diabetes worse. If you let it get worse, it will take even more effort, neds, and dietary restrictions to renew control.

I am in the camp of those who think that you should always shoot for the lowest A1c possible. But it should be an A1c balanced with health and satisfaction with how you are conducting your life. For different people, that will mean different things. At different times in your life it may mean different things, too.

#12
FTW

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Hi,

I think you'll find the information here very interesting:

http://www.phlaunt.com/diabetes/15945839.php

FTW

#13
princesslinda

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Thanks for the interesting (and scary) article FTW.

I think what this tells us is that even if some of us cannot attain the perfect A1c, the lower we can get it the better we'll be, even if it's not at the "perfect" level. I'm sure that health-wise 6 is better than 7, 7 better than 10 as well. No one should be too discouraged if they are managing to steadily improve their A1cs. I really want something under 6.

I am reading the Bernstein Diabetes Solution now, and it gives me hope that I might just be able to get close to perfect at some point.

I think the previous poster is right about finding a lifestyle that you can stick with and you'll do better overall. We've all heard about the dangers of yo-yo dieting, i'll bet yo-yo BS levels are just as bad. Consistency is probably key, it's just finding a way to stay consistent that seems so hard to do.

Great posts guys!

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#14
moorejames

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Hi,

I think you'll find the information here very interesting:

http://www.phlaunt.com/diabetes/15945839.php

FTW


Thanks! I'd found other articles that referenced that same study today as well. It does give me some insight to my original questions.

Moorejames, I like your thinking.

Let em tell you my experience, hopefully as a WARNING to do what you can to keep those BGs and A1cs down from now on.


thanks for sharing. Glad to hear you've found something that works for you to control it, even if it was a long road to get there.

Interesting that a lot of the things I've been reading lately indicate that a truly healthy non-diabetic person who eats right has sub 5.0 A1c's.

Seems like that should be the long term goal. Maybe it's unrealistic for a lot of people given their history, but if someone is really on top of it, and hasn't progressed too far, shouldn't they be shooting for 5 or below, rather than settling for a sub 6.5? (that's all rhetorical, by the way).

#15
rwmetcalf

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I had my last A1c drawn and it was 6.2... Her A1c was 6.8, not much higher than mine with all the abuse.


Hi Princess,

Just want to take a moment to congratulate you on getting your sugars down. I am sure you will see continued positive results with all the good changes you have made since diagnosis. I want to point out to you a small fallacy with the quote I pulled from your post above: You are doing much better than your coworker. An A1c of 6.2 doesn't seem like a big difference from an A1c of 6.8, but the difference is huge. Your average BG level is 120 while hers is 140. Looked at another way (besides the risk of heart attack linked to A1c), many people feel that damage occurs to our systems when BG is above 140 for any length of time (I feel any time it is above 140 some damage occurs). Your friend stays at or above 140 about half of the time. Don't feel discouraged because of the seeming little difference between you two, you're doing great.

Roger

#16
Cyborg

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My recent A1c was 5.5, which near as I can tell is about as good as you could hope for, 3.5 months in from diagnosis.

I see a lot of conflicting information on what an ideal A1c should be. I believe the ADA recommends keeping it below 6.5, which seems a little high to me.

But, how low should you go? Basically, I don't want to take any more medication than I have to. We're going to try backing off on my metformin dose just a little to see what happens. Even if it goes up a little, I'd probably be ok with it, since the offset is fewer drugs.

Any idea what the benefit would be of having an A1c of 5.0 vs 5.5. Would a 6.0 be just about as good as a 5.5? Or should I push even harder to get at or below 5.0?

I feel a little guilty, since I know so many of you struggle to get into the 6's or 7's , but I'm obviously capable to keeping it pretty low, so how low should I go?

jim



That's a great a1c! I think any doctor would be tickled pink with those results. From what I understand, ever 1.0% drop in a1c equates to approximately a 24% reduction in you chance for complications. If you can achieve a lower a1c without going hypo, go for it. Personally, 5.5 is good enough...
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#17
cheryl

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I have to say I think in the five's are the best if you can go lower go for it....I am trying to work my way down, but since I was so off for a long time.....it has been a slow process of weaning myself off certain things i love to eat, and I guess that stubborness still shines thru with me.............well if I haven't had any complications yet when will it start, but then again, I just hope I don't get any cause of poor control for almost as long as i had diabetes, and I kind of get bummed out reading these posts kind of makes me feel bad that my a1c is 6.6 like I am still gonna be a goner if it isn't better the next time even though I am trying so hard, kind of a downer to read, makes me a little sad now......:(
Don't know who I want as president, but I know I don't want to live like a communist....ENOUGH SAID.....

March a1c 6.4
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#18
LancetChick

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According to John Walsh (Using Insulin, Pumping Insulin), glucose instability is independent of the A1c and of glucose exposure, and is now coming to the forefront as a separate risk for diabetic complications. I'll tell you this: I developed retinopathy and frozen shoulder with unstable A1c's in the low 6's (meaning A1c in the 6's with widely varying sugars). I've since managed to get stable A1c's in the low 5's, with 5.0 being the lowest, and my complications have vanished. I have an A1c home meter, the kind they have in the endo's office, and measured my non-diabetic sister's A1c, which was 5.0. I'd like to get stable A1c's below that level, but I draw the line at slavery to my cause. Still, my 5.0 is different from my sister's 5.0, because I'm fairly sure she never experiences the lightheadedness of a hypo or an occasional 200+ as I do.

#19
moorejames

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I have an A1c home meter, the kind they have in the endo's office, and measured my non-diabetic sister's A1c, which was 5.0. I'd like to get stable A1c's below that level, but I draw the line at slavery to my cause. Still, my 5.0 is different from my sister's 5.0, because I'm fairly sure she never experiences the lightheadedness of a hypo or an occasional 200+ as I do.


Can I ask where you got that home A1c machine and how much it cost?

...and I kind of get bummed out reading these posts kind of makes me feel bad that my a1c is 6.6 like I am still gonna be a goner if it isn't better the next time even though I am trying so hard, kind of a downer to read, makes me a little sad now......:(


Cheryl,

Sorry, that's why I almost didn't want to start this thread. But, I'm becoming convinced that the ADA's 6.5 is way too high and I really wanted to know what to shoot for as a best case scenario.

I've got my sights set on sub-5 now. I'm willing to give up whatever it takes to get there.

Keep fine tuning that control. You'll get there eventually.

#20
cheryl

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Cheryl,

Sorry, that's why I almost didn't want to start this thread. But, I'm becoming convinced that the ADA's 6.5 is way too high and I really wanted to know what to shoot for as a best case scenario.

I've got my sights set on sub-5 now. I'm willing to give up whatever it takes to get there.

Keep fine tuning that control. You'll get there eventually.


No, it's ok...........I think mine is more personal too......I have so many different days of different activity levels and stress in my life that honestly unless i can predict what every day for me is gonna be like I don't think I am ever gonna get below 6 without other means of controlling my diabetes.......I so don't want to say it cause I got a little blasted for it before, but my opinion is I need a pump...............so when I wake up on those days where oh I am not feeling like jumping around like a jack rabbit, I can set my basal on oh my lazy day basal lol................and vice versa............i know i can get my a1c lower, but really low i'll need a pump for myself in my opinion.

Thanks for the comment I just was depressed about being so tired yesterday and taking a nap and my sugars went up cause I wasn't moving around and all and it is fustrating for me but i didn't know what my day was going to be like and after crying my eyes out and wanting to report my endo and kind of losing my mind I feel a little better this morning.....

Cheryl
Don't know who I want as president, but I know I don't want to live like a communist....ENOUGH SAID.....

March a1c 6.4
Pumper 522 with Humalog




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