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NativeLady_2010

Can an A1C be too low?

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While I was talking with my nurse she mentions that an a1c lower then 5.0 might not be healthy. I really didn't think about it until now. Mine is 5.8. Down from DX 8.7. What are the safe numbers?

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Dr Bernstein recommends an A1C below 4.8.

 

If you haven't already, get and read Dr Bernstein's Book "Diabetes Solutions" - It is the ultimate book for any newly diagnosed Diabetic.

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Sorry, but WTF? UNDER 4.8?

 

Sorry but Bernstein's well off on that one. The normal range is believed to be about 4.5-5.5. To be honest, once you've got your A1C below 6 there's absolutely no benefit whatsoever in reducing it further. 5.8 is bloody great A1cm, your work is done and don't let some miserable little doctor who is terrified of bread and hasn't even heard of Lantus tell you otherwise.

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I am with Dues on this one as if you were to go lower you will have more instances of lows so you don't want that. I would aim at 6 so keep up the good work. :D

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We really don't know what the impact of going sub-5 vs sub-6 is. It may be marginal for most, but it may be significant for others. For people like me with no margin for error when it comes to eye health, I'd not hesitate going as low as possible.

 

A low A1C cannot be unhealthy. That's just nonsense. There's nothing good about cell glycation. It only serves to kill you. The pain comes from getting there. Hypos are a danger. If you don't follow best medication practices, it is a foolish target. Even with best practices it may not be achievable. If you can get off all meds, yes, go for it.

 

Another pitfall may be general nutrition. Controlling food intake is a vital tool to getting low, but there's a fine line between control and deprivation. Our bodies need fuel and nutrients. If you sacrifice these to get a low A1C, then of course it's probably not good for you.

 

One thing I think you have to do to get under 5 is to eliminate all fructose (HFCS, sugar, fruit) and galactose (dairy, beet sugar) from your diet. These substances are much more glycable(a word?) than glucose. Glycation - Wikipedia, the free encyclopedia

 

Bernstein does it by going extreme low carb and extreme low food quantity. He's managed to find a balance that works for him. I'd bet large sums of money that his basal profile is nearly flat.

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Bernstein also spends his entire working and personal life panicking about his diabetes. Is that really the sort of life anyone of us wants?

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According to a recent study, risk for CVD starts increasing at an A1c of 5. (Annals of Internal Medicine: "Association of Hemoglobin A1c with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk".)

 

Excerpt:

In men and women, the relationship between hemoglo- bin A1c and cardiovascular disease (806 events) and between hemoglobin A1c and all-cause mortality (521 deaths) was continuous and significant throughout the whole distribution. The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality.

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Susan, it sounds like you've done a great job and seen great improvement in your #'s. Personally, i'm happy with any number in the 5's range.

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Mine was 4.8 as I sat in the hospital bed awaiting open heart surgery. Of course it was a lot higher just 6 months prior to this, and it was high for years with out Dx. I do feel like my CVD was exasberated by the rapid reduction in my BG levels.

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I was also warned about rapid reduction of my BG by my doctor. I honestly do not want to obsess about having an A1c below 4.8, but would like to stay in the low six or high five range. When I started on the pump, I did have a rapid reduction in my A1c and I did end up with some background retinopathy. I haven't heard it linked to CVD, but if it effects your eyes that way, then I suppose it can effect your heart also. I am sorry to hear this MCS.

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Not to worry, was a very good thing to happen. I was a reflection of my self before the open heart surgery. With in 2 weeks I was able to walk farther then before the surgery. 8 months post surgery, I am moving 400lbs of dirt around and working in 110 degree heat index all day long. Life is good. I stress my heart on a daily basis, rev up to 140-145 BPM, that feeling, you know when your heart is working and you can feel all that blood coursing thru your viens, I hadn't felt that in quite some time.

 

 

 

I was also warned about rapid reduction of my BG by my doctor. I honestly do not want to obsess about having an A1c below 4.8, but would like to stay in the low six or high five range. When I started on the pump, I did have a rapid reduction in my A1c and I did end up with some background retinopathy. I haven't heard it linked to CVD, but if it effects your eyes that way, then I suppose it can effect your heart also. I am sorry to hear this MCS.

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My endo said that a study shows higher mortality rates with low A1c's but then she said the study was done with old people who also had various illnesses.

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Bernstein also spends his entire working and personal life panicking about his diabetes. Is that really the sort of life anyone of us wants?

 

I would not call it a panic. He reminds me of a major nudgenick (*) . Some obsess about clothing, others about money, still others about health. It's a good obsession for him.. it led to control of his health problem. Not all of us want to ( or even need to) act in a similar manner

 

 

(*) obsessive compulsive

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I would not call it a panic. He reminds me of a major nudgenick (*) . Some obsess about clothing, others about money, still others about health. It's a good obsession for him.. it led to control of his health problem. Not all of us want to ( or even need to) act in a similar manner

 

 

(*) obsessive compulsive

Bernstein was fighting for survival in an age when medical resources were primitive. That will focus your attention! His book is full of information: one of the best around. It may not be up to date on the most recent medicines, but for what it is, it has a lot of value. His obsession was a gain for the community.

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Bernstein also spends his entire working and personal life panicking about his diabetes. Is that really the sort of life anyone of us wants?

 

DeusXM - Wow...that is a tough statement, and I most strongly disagree with it.

 

I have read his entire book, and I definately would not say he is "panicking about his Diabetes." He is in control. I would certainly describe Dr Bernstein as being very strict and uncompromising in his approach to diabetes. However, having read his story, I understand why he adopted this approach.

 

Plus, you need to remember that many of his current patients come to him after they have further Diabetic complications after following the guidance from their PCP's, ADA guidelines, and CDE dieticians. So, he has very close and personaly knowledge of how "modern medicine" is failing many in the Diabetic community.

 

His latest book is very up-to-date. He also gives a free monthly webcast, that anyone can write in questions (he answered a question I sent in...). I enjoy listening to these Podcasts, and hearing the newest trends on treatment.

 

I hate to think of where my Diabetes battle would be at today without the influence and wisdom of Dr Bernstein.

 

To me, he is a role model to the Diabetic Community.

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While I was talking with my nurse she mentions that an a1c lower then 5.0 might not be healthy. I really didn't think about it until now. Mine is 5.8. Down from DX 8.7. What are the safe numbers?

 

 

Did you ask the nurse why an A1c lower than 5.0 may not be healthy? What did the nurse say were the safe numbers?

 

 

For me, less than 6% is a good number to aim for.

 

Is below 5% a safe number? I don't know, but frankly that is not a concern for me. I hit 4.9% last year, and a number of people congratulated me on that "achievement," but it was a miserable time getting to that number. So, no, I did not congratulate myself but learned a valuable lesson. I've decided that an A1c in the 5% range works well enough for me because it allows me to be in control while enjoying myself. Eating and drinking are a major part of life's enjoyment for me, and getting to a number below 5% requires me to avoid things that I want to enjoy (fruits for instance). Although I worry about amputations, heart disease and other complications, I will not spend the next decades obsessing about these complications, panicking at every single rise in my blood glucose, and depriving myself of what I enjoy the most.

 

I think that once you found the answer to your question "What are safe numbers", the next question you should ask (yourself this time) is what number can you live with.

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Did you ask the nurse why an A1c lower than 5.0 may not be healthy? What did the nurse say were the safe numbers?

 

If you are insulin they are going to be worrying about hypos, if you are on diet they are going to worry about what you are (or are not) eating. Just my guess.

 

Although I worry about amputations, heart disease and other complications, I will not spend the next decades obsessing about these complications, panicking at every single rise in my blood glucose, and depriving myself of what I enjoy the most.

That is a very sane approach. Realistically the difference of risk is so tiny it can be ignored.

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...per my doc, my A1C of 5.7 is fine and random glucose average of 90 is great. Those are non-diabetic #s and so I'll be satisfied with that. Likewise, per another doc a study indicates that long term usage of insulin by type 2'ers can eventually damage your eyes while somebody else says that Metaphormin can damage the kidneys/liver. Who's right--I don't know but there appears to be a lot of conflicting information out there. So, whether you follow Dr. Bernstein, the ADA, or whatever I guess the trick is to stay within, or as close to, then non-diabetic #s as possible and live a normal life.

 

No Meds & I consider myself lucky

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Likewise, per another doc a study indicates that long term usage of insulin by type 2'ers can eventually damage your eyes while somebody else says that Metaphormin can damage the kidneys/liver. Who's right--I don't know but there appears to be a lot of conflicting information out there.

I don't know how insulin could damage your eyes directly. There is a sort of side effect of insulin in that a rapid drop in your A1c worsens retinopathy - it's odd but well documented going back to the DCCT. I would worry more about IGF-1 which is an insulin-like growth factor and independent (as I read it) of insulin and seems to be fairly predictive of retinopathy amongst insulin users at least.

 

Metformin can cause liver and kidney damage but the chance is vanishingly small. On the plus side it noticeably protects against colon cancer.

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Metformin can cause liver and kidney damage but the chance is vanishingly small. On the plus side it noticeably protects against colon cancer.

 

I've never heard that, Tribbles. Is there a certain dosage of merformin that causes that kind of protection? Or is it any size dose?

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The way I look at it, if "normal" is 4.5 - 5.5 then a 5 is probably about perfect. The 5.5's are most likely middle aged folks who are pre-diabetic and the 4.5's are probably young male college atheletes.

 

I'd like to end up somewhere in the middle :)

 

The closer to 5 I get, the better I feel. I've only ever made it 5.3, but I felt fantastic when I was at that level. Realistically, I'm very happy with anything under 5.5 and wouldn't really push to try to get much lower than that.

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I wish we had type listed under our names, again.

 

The OP indicates they are T2 and I see no indication of insulin use. No insulin, no iatrogenic hypos. So ... where is the danger in a low A1c?

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A1c above 8 = long term damage to organs, eyes, footsies, etc.

A1c below 5 = long term damage to brain (see any of DR. Bernstein books or see DR. Bernstein for that matter)

 

straight from CDE last week (except opinion of Bernstein) who lectured me a great length about how I'm too low at 5.8. She wants me in the mid 6s

 

 

 

 

also

 

Can Hemoglobin A1c go too low?

 

http://egmnblog.wordpress.com/2010/01/29/can-hemoglobin-a1c-go-too-low/

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