# Stupid HbA1c!



## beckyp (Aug 24, 2011)

Hi guys!  It's been so long since I logged in to diabetessupport (sorry!) but I wanted to rant...and you're probably the only people that 'get' where I'm coming from!

My husband has been offered a job in New Zealand (it was a joint decision for him to apply so it wasn't a surprise!).  Part of the immigration process is to have medicals.  I needed a HbA1c which was 8.3!!!!!!!!!  The doctor wrote ABNORMAL on my medical form and when I looked at the range that I was meant to be in it's 3.5 - 7 which seems REALLY strict  ...and low...and annoyingly the form says that it's uncontrolled diabetes when it's above 7!  It took me months to get under 7 in order to be given the go ahead to start trying for a baby!!!!!  Jeez....

I just really feel like I've let everyone down.  My husband because he'll have the chance for a better job in NZ where he'll not be working all the hours under the sun, my daughter because she'll see her Daddy more and then me...because I've practically packed and was on the plane rolleyes.  I'm just so disappointed with myself.

I've really struggled to keep my levels straight since having my daughter 5 months ago and have woken up high EVERY morning since having her and put her first instead of the diabetes.  I was planning on waiting til I finish breastfeeding (another month or so to go) before I started being really strict again but it looks like I'll need to start setting night time alarms again. 

*sigh* Sometimes I hate diabetes....and doctors with high expectations!

Rant over. 

Also - does anyone know of any type 1 diabetics that have emigrated?!  It'd be useful to know what they went through!


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## Northerner (Aug 24, 2011)

Must admit that I'm really surprised at the range they accept as 'controlled'. I've never, ever come across anyone who was anywhere near 3.5 %, I can't imagine that;s normal even for a non-diabetic! I think the lowest I'e heard was someone who used to post here and she was in the mid 4s, but very unusual.

So sorry that this is an obstacle to your emigration, it does seem very unfair  Does this actually mean that they won't accept you?  Once again, we have members who have had diabetes for decades but never been below 7. Are they worried that they will haveto pay out extra healthcare costs for you?

I hope that there is some way around this and that perhaps your consultant can help. I'm really sorry that your plans have been spoiled


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## Pumper_Sue (Aug 24, 2011)

Hiya,
sorry for your disapointment. But yep can see where they are coming from as your A1c is way to high and will cause their health service a lot of money in the long run and you a lot of health problems and complications.
7% is not that strict for control.
So what can you do?
Sit down and decide on how you can acheive better control.
So do you carb count and adjust your insulin as needed? Have you been on DAFNE or somethinglike it provided by your local hospital?
Do you log all your results so a pattern can be seen?
If you do all this and your A1c is still high, ask for a pump.
There will always be jobs out in New Zealand. I doubt the door is permantly shut to you.
If your hospital team is of no help to you then ask to change to another hospital.

Your challenge is to get your A1c down  Good luck I'm sure you can do it.
There are many people on the forum who will I am sure be able to help you reach your goal.
There are a couple of good books to be had as well, Using insulin and think like a pancreas. Both to be had from amazon.

Think of it as a challenge


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## Robster65 (Aug 24, 2011)

I was going to write something similar to Sue although I'm surprised they are as strict as they are and 3.5% would be a good result for a non-D.

If there's any hints or tips you could do with, shout up and we can all chip in to try and get you there.

I'm sure you know all the right stuff from before you were pregnant and just need some you time to put it into place. It can change very quickly, so maybe a couple of months of testing 5-8 times a day and making necessary corrections as and when can give you an average below about 7.3mmol/l, which will probably translate to a sub-7% HbA1c.

Good luck with it.

Rob


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## beckyp (Aug 24, 2011)

Pumper_Sue said:


> Hiya,
> sorry for your disapointment. But yep can see where they are coming from as your A1c is way to high and will cause their health service a lot of money in the long run and you a lot of health problems and complications.



Thanks for the replies!  

I'm not sure that I'd agree that it is WAY to high and that I will cost their health service in the long run as I will have a lot of health problems!  I've had diabetes for 20 years and am lucky enough that I've had no complications because of it and get my eyes and kidneys checked regularly - neither of which have any problems expected.  Sorry if I've misinterpreted what you've written and I don't mean to take offence but....well...way too high?...you should have seen me in my teens! 

The health service in NZ is different to here as you pay for your prescriptions (including insulin) & doc appointments and as far as I can see from researching this afternoon (albeit not a lot of research in a couple of hours so I may be wrong!) they are wary of letting people in if they think that you'll cost them NZ$25,000 per year in healthcare.  Lots of Type 1's have emigrated over there (according to expat forums) and it would appear to be quite common so I'm much more relaxed now and it'll give me a chance to start setting the night time alarms for if they test again!  It's always within 'range' during the day which is why it's so disappointing.

Fingers crossed for next time.


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## RSVP (Aug 24, 2011)

Hi Becky 

I am really sorry to hear this and hope that it isn't the end of your hopes to get over there.

Have you tried contacting the firm your hubby got the job offer from? They may be able to offer more advice.

My Uncle lives out there and does occasionally come over head hunting. I know he would bend over backwards to help a new family going out there to work. They may just be able to put you in touch with people who have been in similar positions  

It may be worth a try. 

Take care & try not to get too stressed about it as you know what that'll do  Looking after a littley is stress enough 

Sarah x

Ps have you seen this site>>>
http://www.diabetes.org.nz/


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## Lizzzie (Aug 25, 2011)

Hi Becky

I just wanted to add that I had 5.5s since I was diagnosed and was feeling really pleased with myself, until I saw a specialist diabetologist who said that this was far too low even if I was pregnant at the time of meeting him, that he suspected I was spending a lot of time 'hypo' without realising it and he'd be much happier if my next score came in at 6.

I realise from reading this forum that not all doctors agree with this, but it does suggest that 3.5 would be a bit unrealistic


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## Northerner (Aug 25, 2011)

Lizzzie said:


> Hi Becky
> 
> I just wanted to add that I had 5.5s since I was diagnosed and was feeling really pleased with myself, until I saw a specialist diabetologist who said that this was far too low even if I was pregnant at the time of meeting him, that he suspected I was spending a lot of time 'hypo' without realising it and he'd be much happier if my next score came in at 6.
> 
> I realise from reading this forum that not all doctors agree with this, but it does suggest that 3.5 would be a bit unrealistic



I would say that 3.5 is completely unrealistic as it would imply that you would be hypo most of the time! How that can be termed 'normal' for a diabetic I just can't see  My lowest was a 5.2% which did involve quite a lot of hypos and probably a lot of obsessive behaviour in the early days after diagnosis. Once I got a handle on things I went up to 5.6% with much more stable levels.


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## Mark T (Aug 25, 2011)

Lizzzie said:


> Hi Becky
> 
> I just wanted to add that I had 5.5s since I was diagnosed and was feeling really pleased with myself, until I saw a specialist diabetologist who said that this was far too low even if I was pregnant at the time of meeting him, that he suspected I was spending a lot of time 'hypo' without realising it and he'd be much happier if my next score came in at 6.
> 
> I realise from reading this forum that not all doctors agree with this, but it does suggest that 3.5 would be a bit unrealistic


My father who is on insulin, recently had his HbA1c back, it was 6.8% which is apparently the best that it ever has been.

He actually had a verbal telling off from the Doctor as that is apparently “too low” and they would much prefer it if he was above 7%


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## Pumper_Sue (Aug 25, 2011)

I don't think it's the lower number that Becky has to aim for but the 7% level can be achieved as Becky has already shown 
The 3.5% would be abnormal in anyones books.


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## Northerner (Aug 25, 2011)

Pumper_Sue said:


> I don't think it's the lower number that Becky has to aim for but the 7% level can be achieved as Becky has already shown
> The 3.5% would be abnormal in anyones books.



Quite! But I would have thought that an HbA1c of below 4% would suggest just as many potential problems (if not more!) as one just above 7%  I wonder what committee came up with that!


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## Pumper_Sue (Aug 25, 2011)

Northerner said:


> Quite! But I would have thought that an HbA1c of below 4% would suggest just as many potential problems (if not more!) as one just above 7%  I wonder what committee came up with that!



Perhaps it was a typo?
Here's a link to what's normal for non diabetics as well as diabetic ranges
http://www.leedsth.nhs.uk/sites/diabetes/tips/HbA1c.php

It sounds as if the medical that was done stated abnormal due to it being outside both accepted diabetic range and obviously non diabetic range.

This one say normal is 3.5% for a non diabetic http://medweb.bham.ac.uk/easdec/prevention/what_is_the_hba1c.htm so you pays your money and takes your choice. But as we all have diabetes it's daft to even think about obtaining numbers like that.


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## beckyp (Dec 19, 2011)

*Update!*

Sorry for this VERY late response but I just wanted to update you.

As you know from my previous messages my HBA1C came back as 8.3% (which my hospital were absolutely fine about as I was bf'ing my daughter and it is to be expected from a diabetic to have highs after giving birth - they suggest a year's recovery) but this highlighted lots of things on my NZ medical and because it was out of their ideal range they said that my diabetes was uncontrolled (not that I'm bitter about that or anything!!!).

NZI came back and said that they wanted more information from my local hospital so a letter was written and stated that I was well controlled and had no other medical conditions caused by the diabetes - dates and details were given of past blood tests and eye examinations.  This was then sent off and it took, what felt like, ages to get a result! 

WE'RE IN!!!!!  So to cut a long story short, we emigrate in early January.  It's all very scary at the moment but also incredibly exciting.  We'll be going for the two year work visa and then reviewing where we're at and how we think it's going before making a final decision on whether to stay or come home.  

The ranges stated were correct in my original email.  NZI range is 3.5%-7.0% and my hospital's ideal range is 6.5-7.5% - I have been within my hospital's ideal for years - it was just after having an ikkle one that got me off track so I'm pleased to report that I'm back to normal now - just bad timing for medicals.  I've got a good feeling about 2012!

Thanks for your advice in the previous post and Merry Christmas to you all!


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## Northerner (Dec 19, 2011)

beckyp said:


> ...The ranges stated were correct in my original email.  NZI range is 3.5%-7.0% and my hospital's ideal range is 6.5-7.5% - I have been within my hospital's ideal for years - it was just after having an ikkle one that got me off track so I'm pleased to report that I'm back to normal now - just bad timing for medicals.  I've got a good feeling about 2012!
> 
> Thanks for your advice in the previous post and Merry Christmas to you all!



Oh that's wonderful news Becky!  I still find it incredible to think that they have such a low lower limit. I have never encountered a person with diabetes who had an HbA1c below 4.5% (and that 4.5% was clearly very out of the ordinary). You would have to have VERY uncontrolled diabetes to achieve anywhere near their lower limit - who on earth sets such a range 

Anyway, great to see that you have been accepted and I guess you have an awful lot of planning to do before January  Remember, this is the interweb, so we will expect to hear from you once you are all safely esconced on the other side of the world!

Have a wonderful Christmas, and a very special 2012!


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## beckyp (Dec 19, 2011)

*Update!*

Doh!  Double posting - sorry!


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## Copepod (Dec 19, 2011)

Great news BeckyP - and best wishes for your life in New Zealand for 2 years or longer. Thanks for the update - always good to hear the next stage of the story.  

Please be sure to go swimming with my friends, the Dusky Dolphins and NZ Fur Seals of Kaikoura, South Island! They're wild animals, who only swim with / play with humans if they feel like it! The Duskies often get bored and swim off, as if to rub in the inadequacy of human swimming skills, eeven with wet suits for warmth & bouyancy. 

There are also pods of Bottlenose Dolphins in Bay of Islands, North Island, and other places, but I haven't personally got to know any of them.


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## beckyp (Dec 19, 2011)

Northerner said:


> You would have to have VERY uncontrolled diabetes to achieve anywhere near their lower limit - who on earth sets such a range



Thanks!

I can only assume that it's someone that doesn't have diabetes or know anyone that has!!!  

I just hope that someone doesn't read their targets and try to get down to 3.5 to avoid these delays.  I really do think that it would have been referred to a "specialist" in NZ even if it had come back as controlled.


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## PhoebeC (Dec 19, 2011)

Great news becky.

My blood suagrs are still recovering from having Jemima nearly a year ago. and i didnt breastfed. It changes your body having a baby not to metion running around after them non stop.

I got mine to down 4 when was pregnant, but i was hypo-ing all the time. could not stop. But all they care about is that magic number sometimes.

p.s go and dont come back


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## beckyp (Dec 19, 2011)

Copepod said:


> Please be sure to go swimming with my friends, the Dusky Dolphins and NZ Fur Seals of Kaikoura, South Island! They're wild animals, who only swim with / play with humans if they feel like it! The Duskies often get bored and swim off, as if to rub in the inadequacy of human swimming skills, eeven with wet suits for warmth & bouyancy.



We travelled NZ in 2009 and went to Kaikoura - it was by far my fave place.  We went on the whale watching tour (and were lucky enough to see 3 sightings of sperm whale) and lots of duskies swimming alongside our boat and on our drive away we had to stop because there were *loads* of seals at the bottom of the cliff!  We couldn't leave without eating some crayfish too!  

My second fave place was Curio Bay where we saw 2 sealions in our campside - scared the heebyjeebies out of me but was worth it - New Zealand is truly amazing and I'm really looking forward to calling it home - even if it's just a couple of years!


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## Northerner (Dec 19, 2011)

beckyp said:


> Thanks!
> 
> I can only assume that it's someone that doesn't have diabetes or know anyone that has!!!
> 
> I just hope that someone doesn't read their targets and try to get down to 3.5 to avoid these delays.  I really do think that it would have been referred to a "specialist" in NZ even if it had come back as controlled.



To me it sounds like they are using the 'normal' range for a non-diabetic fingerprick test, which would be between those numbers depending on whether fasting or not. I have just used an online calculator and in order to have an HbA1c of 3.5% you would have to have had an average fingerprick level of 2.6 mmol/l for the previous 6-12 weeks!


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## beckyp (Dec 19, 2011)

PhoebeC said:


> My blood suagrs are still recovering from having Jemima nearly a year ago. and i didnt breastfed. It changes your body having a baby not to metion running around after them non stop.
> 
> I got mine to down 4 when was pregnant, but i was hypo-ing all the time. could not stop. But all they care about is that magic number sometimes.



Thanks Phoebe!  Hospitals advise that you take a year to recover after having a baby and that's without diabetes so don't put any pressure on yourself - it'll happen when it's ready.  I found that the breastfeeding and section just took it's toll and I'll be the first to admit that I put Evelyn before the diabetes - as any mother would!  

I remember your levels dropping during pregnancy - mine started doing the same thing and I ended up having Evelyn early due to it.  I'm loving life as a Mummy...how are you finding it?  I bet Jemima is keeping you on your toes!  We had our first tooth last week (8 1/2 months!) so I imagine the next one will come on the flight over on 8th!


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## beckyp (Dec 19, 2011)

Northerner said:


> I have just used an online calculator and in order to have an HbA1c of 3.5% you would have to have had an average fingerprick level of 2.6 mmol/l for the previous 6-12 weeks!



Oh. My. Word.

Craziness!  When I'm settled, I might write a letter to them to point this out!!!  I'll wait till I'm 'in' first though....don't wanna rock the boat and get kicked out just yet!


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## imtrying (Dec 19, 2011)

Northerner said:


> To me it sounds like they are using the 'normal' range for a non-diabetic fingerprick test, which would be between those numbers depending on whether fasting or not. I have just used an online calculator and in order to have an HbA1c of 3.5% you would have to have had an average fingerprick level of 2.6 mmol/l for the previous 6-12 weeks!



 you couldn't drive 6 - 12 weeks prior to the blood test then!!! lol


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## Pumper_Sue (Dec 19, 2011)

Congratulations, glad everything is sorted. Hope you enjoy your new home


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## RSVP (Dec 19, 2011)

Just wanted to add our congratulations 

Been twice and it is all that and more. 

Hope that everything goes smoothly for you.


Sarah & Rob


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## GlucoseGary (Dec 19, 2011)

Congratulations, Becky.
Is it possible they've confused BG levels (where 3.5-7 sounds like a decent range) with HbA1c?

PS Just read Northerner's post and am probably saying the same thing. Don't mind me


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## beckyp (Dec 19, 2011)

GlucoseGary said:


> Congratulations, Becky.
> Is it possible they've confused BG levels (where 3.5-7 sounds like a decent range) with HbA1c?
> 
> PS Just read Northerner's post and am probably saying the same thing. Don't mind me



Just had a quick check of the results sheet and it says:

_Haemoglobin A1C (standardised) range 3.5-6.0 - mine was 8.3
IFCCmmol/mol range 0 - 53 - mine was 67
Glucose range 3.5-7.5 Rand - mine was 8.11

**Interpretation**
Non diabetics 3.9 - 5.7%_

My sugars on the day were ridiculously good - if I do say so myself!    I was fasting for the blood tests, breastfeeding and strolling around Southend waiting for my appointment!  My levels didn't go above 5 all day which I guess is why I was so angry about being called uncontrolled!


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## Copepod (Dec 19, 2011)

beckyp said:


> We travelled NZ in 2009 and went to Kaikoura - it was by far my fave place.  We went on the whale watching tour (and were lucky enough to see 3 sightings of sperm whale) and lots of duskies swimming alongside our boat and on our drive away we had to stop because there were *loads* of seals at the bottom of the cliff!  We couldn't leave without eating some crayfish too!
> 
> My second fave place was Curio Bay where we saw 2 sealions in our campside - scared the heebyjeebies out of me but was worth it - New Zealand is truly amazing and I'm really looking forward to calling it home - even if it's just a couple of years!



That's good! While operators are careful to keep to the rules, the marine mammals don't read the regulations, and, for example, mother Dusky Dolphins seemed a bit put out when we had to motor away from their babies who they'd apparently brought to see the boat, because rules say keep away from nursery groups! Also, several people in Kaikoura Peninsula car park were taken aback by growls from under their campervans, when fur seals had decided to sleep while the humans were away. 

My boss at the seal & dolphin swimming & viewing company in Kaikoura came into the office one day with a newpaper package and said I could have it for my tea, but only if I could correctly sex it - fortunately, I knew about telson shape and so had a crayfish meal that night.


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## Abi (Dec 19, 2011)

Just to wanted to add my best wishes for a successful future

Regarding the previous HbA1c "uncontrolled" is such a perjoratiive term- I'm glad they cleared you to emigrate- and hope you get those nightme readings down- and that "all important number"
Just a word of caution- New Zealand health care provision is quite good but you have to pay a very small subsidy for prescriptions- and funded pumps are extremely rare- usually  for people with extreme hypos or during pregnancy- most New Zealanders who pump are self funding- so bear this in mind if you feel that you need  a pump


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