# How low can you go.(hbA1c)



## Steff (Feb 17, 2010)

I was just wondering what peoples perception of there hbA is for example i was told 6.5 is spot on but anything under 7.0 was good, even when i got a hbA of 7.2 my doc was really pleased, also what level hbA is considerd to be  dangerous.I  have spoke to Northerner already about this in pm(hope you dont mind me mentioning your name)and he was saying   some us sites say aim for 4.5% that to me seems low . .What does everyone else think, and are you always pushed to improve your hbA when you get the results .


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## SilentAssassin1642 (Feb 17, 2010)

hi steff. Last time i was at clinic, consultant told me that my 6.5% was too low (frikken muppet) and that I should be aiming for something like 8-9% for the next one as she wanted me to stop having hypos and to run myself really high

I think she was a fraud...


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## Steff (Feb 17, 2010)

salmonpuff said:


> hi steff. Last time i was at clinic, consultant told me that my 6.5% was too low (frikken muppet) and that I should be aiming for something like 8-9% for the next one as she wanted me to stop having hypos and to run myself really high
> 
> I think she was a fraud...



Ty Sam i just think it would be of interest to find out what we where all told regarding the aim for our hbA1c .


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## katie (Feb 17, 2010)

Your A1c should be below 6.5%


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## SilentAssassin1642 (Feb 17, 2010)

Steff2010 said:


> Ty Sam i just think it would be of interest to find out what we where all told regarding the aim for our hbA1c .



definitely. Doc told me that 6-6.5% was perfect. As did DSN. No idea where the consultant got the 8-9% thing from


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## Northerner (Feb 17, 2010)

salmonpuff said:


> definitely. Doc told me that 6-6.5% was perfect. As did DSN. No idea where the consultant got the 8-9% thing from



That might be 'old knowledge'. I think children/teenagers are generally expected to have higher HbA1c than adults, and also they used to think that the risk of hypo outweighted the risk of complications. I was told to get it below 6.5% and personally feel comfortable in the mid-5% range (last one 5.6%) with relatively stable levels (few highs and lows). If it fell below 5% I would start taking a serious look at if I was being too obsessive and tight with my control.

As I said to Steff, some US sites in particular regard 4.5% as a figure to aim for (largely due to the influential diabetic Dr. Bernstein). However, this article makes intersting reading:

http://www.healthcentral.com/diabetes/c/17/59130/normal-a1c-level

So, really, it could be anything from 4.5-6% and be 'normal' or equivalent to a non-diabetic.


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## Freddie99 (Feb 17, 2010)

HbA1c for a non diabetic ranges between four and seven percent. Ideally we should aim to get into that zone to inhibit future complications from arising. That said, the targets for HbA1c should be tailored to an induviduals circumstances. There are times when perhaps a marginally higher HbA1c would be of greater benefit for an induvidual. Don't qoute me on that as I'm not a medic. Personally I am not comfortable with a finger prick blood test being below 5 mmol/L. I can't comment upon having an HbA1c below five percent as I've never been able to get the damn thing below eight percent.


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## Old Holborn (Feb 17, 2010)

Steff2010 said:


> I was just wondering what peoples perception of there hbA is for example i was told 6.5 is spot on but anything under 7.0 was good, even when i got a hbA of 7.2 my doc was really pleased, also what level hbA is considerd to be dangerous.I have spoke to Northerner already about this in pm(hope you dont mind me mentioning your name)and he was saying some us sites say aim for 4.5% that to me seems low . .What does everyone else think, and are you always pushed to improve your hbA when you get the results .


 

I was told to aim for something between 6 - 6.5%.


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## squidge63 (Feb 17, 2010)

I was told 6 - 6.5 % as well... my last one was 9.4%  but at least it was down from 9.6%.. get my next result on Tues when I go for my appt with the dr.. best I have had was 6.1%


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## wallycorker (Feb 17, 2010)

Steff2010 said:


> ..........some us sites say aim for 4.5% that to me seems low..........


4.5% is achievable - I know certain people on these diabetes forums who manage to maintain levels as low as that - both Type 1 and Type 2.

My last one was 5.1% but I'm taking mine lower.

Best wishes - John


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## Steff (Feb 17, 2010)

wallycorker said:


> 4.5% is achievable - I know certain people on these diabetes forums who manage to maintain levels as low as that - both Type 1 and Type 2.
> 
> My last one was 5.1% but I'm taking mine lower.
> 
> Best wishes - John



Is they no dangers in wanting to go lower wallycorker?


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## LisaLQ (Feb 17, 2010)

Mine was 6.7 (I think), and they said that was really good, but they'd prefer it under 6.5.

I think to get it under 5 you'd have to eat a diet of cardboard, mind you, how many carbs is in the average cardboard box...?


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## SweetGuy (Feb 17, 2010)

According the the NICE type 2 guidelines <6.5% is like the gold standard  but >7.5% is trigger level before intervention with insulin or other non-oral medications should be considered.

This is the script that most GPs work from: 

http://www.nice.org.uk/nicemedia/pdf/CG66FullGuideline0509.pdf

This if for type 2 only


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## sofaraway (Feb 17, 2010)

I think generally type 2 can go lower, if they are not on hypo inducing meds as there isn't the same danger as insulin users.

For me personally I was aiming to be 6-6.5, Have run as low as 5.4% and really that was too low for me, I was having 3-5 hypos a weeks running that A1c. 

My last was 5.9% and I was happy with that as were my team, I don't want to go any lower. I need to run at a level that i can work in a demanding stressful job, drive, exercise and running as I do vastly reduces the chance of severe hypos.


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## wallycorker (Feb 17, 2010)

Steff2010 said:


> Is they no dangers in wanting to go lower wallycorker?


Firstly, I'm a non-insulin dependent Type 2 on metformin and diet only. Also, I do not suffer from hypo' symptoms in any way whatsoever that are obvious to me.

As regards whether there are any dangers in wanting to go lower then, quite frankly, I don't know. However, personally, I have absolutely no concerns about taking my blood glucose levels to those found in a non-diabetic person. 

What I do know is that there are real dangers in running blood glucose levels too high at levels where mine used to be when my HbA1c was as high as 9.4%. Most of us are well aware that such levels put diabetics at risk of all sorts of health problems - the most serious of those being heart disease, eye problems that can lead to blindness, amputations, kidney damage that can result in dialysis becoming necessary etc, etc.

Even relatively minor problems and symptoms have all disappeared since I have lowered my blood glucose levels - and some of them I hadn't even recognised as being connected with my diabetic condition. All I know is that they aren't those things aren't there any longer - e.g. thrush, itching, getting up in the night to go to the toilet, night time cramp in the calves, pins and needles in my hands and forearms etc, etc.

Personally, I'm a great deal happier now that my blood glucose levels have become consistently lower. In fact, very, very much happier!

Best wishes - John


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## xxlou_lxx (Feb 17, 2010)

Mine is 4.1 well was last time I  was checked! my bloods run at 4 all day and night with ocasional dip that I know to expect so am prepared to eat at that time, never any major hypos but in pregnancy id prefer to be this low im usually around 5.6% 
The docs are fine with it tho just tell me my hba1c is better than theirs lol 
9th of march and ill become more human again


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## Steff (Feb 17, 2010)

xxlou_lxx said:


> Mine is 4.1 well was last time I  was checked! my bloods run at 4 all day and night with ocasional dip that I know to expect so am prepared to eat at that time, never any major hypos but in pregnancy id prefer to be this low im usually around 5.6%
> The docs are fine with it tho just tell me my hba1c is better than theirs lol
> 9th of march and ill become more human again



This thread was started in honour of your hbA actually Lisa it got me to thinking about the levels of hbAs and when they go low is they any dangers .x yours was the lowest i had ever seen since i joined .


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## Northerner (Feb 17, 2010)

Steff2010 said:


> This thread was started in honour of your hbA actually Lisa it got me to thinking about the levels of hbAs and when they go low is they any dangers .x yours was the lowest i had ever seen since i joined .



The bottom line is that you NEED glucose in your blood, otherwise your brain is starved of energy - this is the only source of energy it can use. If it doesn't have enough then you can go into coma and die. It seems logical that repeated, extreme hypos are going to have a cumulative, detrimental effect on the brain, although I'm only speculating there. There is a limit to how low you can safely drive it and that will vary from person to person - so some people will have a 'natural' and sustainable level of 4.x%, others will need a higher level. For me, it's a bit like cholesterol - we keep getting told to drive it lower and lower, but we still need a certain amount of it or we will be in serious trouble. Safe lower levels of these numbers seem to be neglected when advice is given out.


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## wallycorker (Feb 17, 2010)

xxlou_lxx said:


> Mine is 4.1 well was last time I  was checked! my bloods run at 4 all day and night with ocasional dip that I know to expect so am prepared to eat at that time, never any major hypos but in pregnancy id prefer to be this low im usually around 5.6%
> The docs are fine with it tho just tell me my hba1c is better than theirs lol
> 9th of march and ill become more human again


Hi, 

That is an achievement! Well done! I think that is the lowest that I've come across. However, the situation is very different for you as a Type 1 than it is for a non-insulin dependent Type 2 such as me. More of an achievement for you I would have thought because of the risk of hypos that you need to deal with as well.

The other Type 1 who I communicate with on another forum - and manages his situation in the mid-4s - recently told me that he has less hypo' incidents at the lower level compared when his levels were higher. Is that the same for you?

The doctors and nurses all tell me the same thing - i.e. that my HbA1c is better than their own.

I hope that your pregnancy goes well. Is it your first?

Very best wishes - John


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## xxlou_lxx (Feb 17, 2010)

No, I just think that when u have ur bms a bit lower then u lose ur hypo awareness. I notice a hypo more if I have spent most of the day on 6 as opposed to 4. Once this little madam arrives then ill be running my bms at 7/8 for a few days in order to get my awareness back. 
It has not been too much of a problem though as I take my blood sugar way more now than before pregnancy so i have noticed the pattern of my bloods better throughout the day and am prepared for it. 

I reckon id be a bad type 2 though, at least if i want chocolate i can take some insulin so I wouldnt really have ur will power!! 
I think you have a harder job to keep ur sugars stable than I do lol


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## Knapweed (Feb 18, 2010)

I have to agree with John here. For me as a T2 my objective is to avoid complications and ruining whatever insulin production I still have. I don't know if I can get lower than my last reading because I really haven't been eating to a plan, I just restrict my carbs and it has worked for me.


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## wallycorker (Feb 18, 2010)

Knapweed said:


> I have to agree with John here. For me as a T2 my objective is to avoid complications and ruining whatever insulin production I still have. I don't know if I can get lower than my last reading because I really haven't been eating to a plan, I just restrict my carbs and it has worked for me.


................and doing a great job of it too Knapweed from looking at your signature. 

Great stuff! Keep on track!

Very best wishes - John


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## rhall92380 (Feb 18, 2010)

After diagnosis I got my HbA1c down to 5.2% which my GP said a non diabetic would be pleased with - without medication or insulin - just healthy eating and lots of exercise (mainly running). Since then I got it down to 4.5%, 4.4% then 4.9%. Another test due tomorrow. I lost 4 stones and definitely feel better.

Richard


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## wallycorker (Feb 18, 2010)

rhall92380 said:


> After diagnosis I got my HbA1c down to 5.2% which my GP said a non diabetic would be pleased with - without medication or insulin - just healthy eating and lots of exercise (mainly running). Since then I got it down to 4.5%, 4.4% then 4.9%. Another test due tomorrow. I lost 4 stones and definitely feel better.
> 
> Richard


Great stuff that Richard! Well done!

I'd be interested to know what sort of diet you eat?

Best wishes - John


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## Northerner (Feb 18, 2010)

rhall92380 said:


> After diagnosis I got my HbA1c down to 5.2% which my GP said a non diabetic would be pleased with - without medication or insulin - just healthy eating and lots of exercise (mainly running). Since then I got it down to 4.5%, 4.4% then 4.9%. Another test due tomorrow. I lost 4 stones and definitely feel better.
> 
> Richard



Blimey, that's terrific Richard - hope the next one goes as well! I don't think there's anything wrong with having such low levels, but I do doubt that they can be applied to everyone as a goal. As long as you're fit and healthy, that's great, but I do worry that some people who will never attain that without possibly compromising other areas of their health or quality of life will feel as though they are failing if they get a result of 5.x or 6.x


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## rawtalent (Feb 18, 2010)

4.1 is very impressive. Mine varies from 5.2 to below 6.5 which feels ok for me. I don't believe i could get it lower without suffering hypo regularly. Like everything else, it's about balance and we're all different. 
When i'm running a bit high i swear i can 'feel' the sugar in my system. I itch and start to feel generally sluggish. 
My doc thinks i'm mad when i say this but i know i'm right. My kids often play a guess dad's level game with me before i test and we're all bloody good at it now. In fact, the kids are as good as me! I know my body better than doc does . He's not diabetic!


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## falcon123 (Feb 18, 2010)

The problem I have with targets is that they are ever being lowered. This seems to apply to HbA1c, cholesterol and BP for instance. You seem to be chasing a moving target. My BMI is below 25 and yet last year my DSN said I was overweight! The cholesterol one has been well documented here. Mine is 4.1 but I am offered statins regularly. Statins seem to have become a ?cradle to grave? drug. Initially the starting level for taking statins was above 6.0, then 5.0 and now 4.0, but then it also varies between clinics. My target HbA1c is set at 6.5 and I struggle to achieve it. I have been told people on insulin running much lower are in danger of losing symptoms of hypos, which could in some circumstances lead indirectly to injury or even death. People on diet and tablets, or diet alone, have a far far lower risk of having a hypo so can achieve lower HbA1c levels than those on insulin. This is of course ?on average? as we are all different


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## xxlou_lxx (Feb 18, 2010)

I agree, by running my bms at 4.0 all day I have less hypo awareness. all I get these days is feeling a little tired but nothing as extreme as the sweating shaky feelin I used to get, I was in the diab antenatal clinic yest and when the nurse tested my bm it was 2.1 and i was having a normal coversation with her, so is a bit scary to think u can appear completely normal at that level!!

But as I say I will be running at 7/8 the days after her birth so I can get my symptoms back lol (eventhough they do suck)

I thought it was weird that the last 4 times I had my bp tested it was 98/60 ish and they only say something if its sky high lol soooo hard to be diabetic tho seems like these days the only place I can go without a urine sample is to my sisters for a cup of tea lol


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## bev (Feb 18, 2010)

http://en.wikipedia.org/wiki/Glycated_hemoglobin

I think its also worth remembering that there is a difference between how people glycate - and according to this link there can be as much as a 3% difference in hba1c even when 2 people have the same 'average' blood meter readings. So you could be trying as much as the next person - but your body dictates whether its able to be as efficient at glycation as the other person. 

There is a parent on the other list who has 2 diabetic children and they are both on pumps. She often achieves 96% in range for both children and their hba1c is 7.1. This isnt awful, but you would think they would be in the 5's with a result like this. Bev


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## rhall92380 (Feb 18, 2010)

Northerner said:


> Blimey, that's terrific Richard - hope the next one goes as well! I don't think there's anything wrong with having such low levels, but I do doubt that they can be applied to everyone as a goal. As long as you're fit and healthy, that's great, but I do worry that some people who will never attain that without possibly compromising other areas of their health or quality of life will feel as though they are failing if they get a result of 5.x or 6.x





wallycorker said:


> Great stuff that Richard! Well done!
> 
> I'd be interested to know what sort of diet you eat?
> 
> Best wishes - John



Thanks Northerner and John

I agree such low levels are unacievable for some. I was fortunate to be diagnosed when my HbA1c was (only) 7.7.

My diet:
Breakfast - Muesli (no added sugar, 3 spoons) with fat free natural youghurt, and a banana, then porridge with semi skimmed milk (when I get to work).

Lunch - soup (low saturated fat fat), a M&S cold pasta (usually with sun dried tomatoes and goats cheese) and an apple.

For Dinner , soup, a main course (varies but low saturated fat) and fresh fruit salad with fat free natural yoghurt.

For supper, a slice of burgen bread with cottage cheese.

I drink tea (herbal) with no milk or sugar, snack on dried fruit and nuts. Rarely eat sweets chocolate, etc. 

Richard


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## wallycorker (Feb 18, 2010)

Thanks for that summary Richard - I find it useful!

That sounds a very well balanced diet to me. A little more starchy carbohydrate than I'd have expected you to say but most of the rest of your diet is quite similar to what I eat. 

As you know, by keeping doing what you are doing and your results in that general area should keep you well clear of diabetic complications. That's what I'm trying to achieve!

Very best wishes - John


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## rhall92380 (Feb 19, 2010)

wallycorker said:


> Thanks for that summary Richard - I find it useful!
> 
> That sounds a very well balanced diet to me. A little more starchy carbohydrate than I'd have expected you to say but most of the rest of your diet is quite similar to what I eat.
> 
> ...



Thanks, John. It is fairly high in starchy carb, so I guess that may be the next area to address if my HbA1c goes up. For the time being I'm probably balancing it with exercise.


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## Northerner (Feb 19, 2010)

rhall92380 said:


> Thanks, John. It is fairly high in starchy carb, so I guess that may be the next area to address if my HbA1c goes up. For the time being I'm probably balancing it with exercise.



It's an important point Richard - it you are very active, your body will work best using carbs as an energy source and eating them won't compromise your control - this is what I have found also.


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## wallycorker (Feb 19, 2010)

rhall92380 said:


> Thanks, John. It is fairly high in starchy carb, so I guess that may be the next area to address if my HbA1c goes up. For the time being I'm probably balancing it with exercise.


Yes Richard - It's great that you are in front so to speak and know what you would do next. 

However, maybe because of the short time that you had been diabetic before you got things sorted out could mean that you will never need to do anything more than you are doing now.

It's a great inspirational story - keep telling it! Shout it from the rooftops!

Best wishes - John


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## rhall92380 (Mar 1, 2010)

wallycorker said:


> Yes Richard - It's great that you are in front so to speak and know what you would do next.
> 
> However, maybe because of the short time that you had been diabetic before you got things sorted out could mean that you will never need to do anything more than you are doing now.
> 
> ...



Just got my latest HbA1c - 4.3%!

It can be done via healthy eating and exercise, though in my case I was diagnosed relatively early I hope others can take inspiration to lower theirs as far as they can. 

Richard


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## Steff (Mar 1, 2010)

Well done Richard


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## wallycorker (Mar 1, 2010)

rhall92380 said:


> Just got my latest HbA1c - 4.3%!
> 
> It can be done via healthy eating and exercise, though in my case I was diagnosed relatively early I hope others can take inspiration to lower theirs as far as they can.
> 
> Richard


An absolutely marvelous result Richard - 4% Club! 

Now that really is a very exclusive Club! I hope to join you there before very long at all. Hope that I will make it!

Very best wishes - John


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## rhall92380 (Mar 2, 2010)

wallycorker said:


> An absolutely marvelous result Richard - 4% Club!
> 
> Now that really is a very exclusive Club! I hope to join you there before very long at all. Hope that I will make it!
> 
> Very best wishes - John



Thanks John and Steff. 

I'm sure we'll be welcoming you to the 4% club soon, John. Think positive!

Richard


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## cherrypie (Mar 2, 2010)

Congratulations on your HBA1c Richard.
It may well be impossible for me to join you because I show all the symptoms of hypoglycemia if I go lower than 4.5.
Doctor tells me to carry on doing what I am doing as I feel great and my numbers are at a reasonable level I think his advice works for me.  The saying, "we are all different" springs to mind.
You must feel so positive about this excellent result and I notice that your diet is very similar to mine.

Maisie.


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## rhall92380 (Mar 3, 2010)

cherrypie said:


> Congratulations on your HBA1c Richard.
> It may well be impossible for me to join you because I show all the symptoms of hypoglycemia if I go lower than 4.5.
> Doctor tells me to carry on doing what I am doing as I feel great and my numbers are at a reasonable level I think his advice works for me.  The saying, "we are all different" springs to mind.
> You must feel so positive about this excellent result and I notice that your diet is very similar to mine.
> ...



Thanks, Maisie

I am really pleased. Agree we're all different though and it looks like you've found the right balance too - well done! 

The other positive for me is that I prefer to eat what I do now to what I used to eat. After giving up sweets, for example, for a couple of weeks I don't like them now so don't miss them

Richard


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## wallycorker (Mar 3, 2010)

Hi again Richard,

It'd be very interesting to find reliable statistics that show where you now are on a national scale of people with diabetes - i.e. how many achieve or get below your current level. I keep looking round to try to find the statistics on this but haven't found any so far.

In fact, it would be interesting to see where your 4.3% fits into the full scatter of non-diabetic people. My GP and a DSN that I met both commented to me that my HbA1c was lower than their own and that was when I reached 5.3%. If you ever come across any staistics then I'd be interested to hear.

Best wishes - John


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