# Hba1c?!



## Rosiecarmel (Aug 20, 2015)

Hi! Can anyone help me understand what the results of my hba1c are? I didn't see the doctor for my results, but the sister at my surgery. She said it was "101" but didn't give me any more info apart from saying it was "atrocious" and she's started me on metformin immediately (I only found out last week I was type 2 diabetic) and I'm very confused! My fasting finger prick test was 19.1 yesterday morning. Is this related to the blood test? I've tried to google it but it's only confusing me more!

Thanks for any help


----------



## Mark T (Aug 20, 2015)

You can find some more information here: https://www.diabetes.org.uk/Guide-to-diabetes/Monitoring/Testing/#HbA1c

Basically the HbA1c is an average of your blood glucose levels, 101 sounds like a measurement in mmol/mol.  101 equates to 11.4% in old units - which isn't ideal!

Ideally you are aiming to be below 48.


----------



## Amigo (Aug 20, 2015)

Hi Rosie,

101 on the HbA1c test is 11.4

Diabetes is usually diagnosed on that test at 48 or over which is 6.5 so you can see why yours is well outside the desired range at the moment.
That HbA1c test is different in the way it measure blood levels to the finger prick test and when I was diagnosed Type 2 in Feb, it certainly confused me at first.

Others will come along and give you excellent links to information and advice that will help you Rosie.

19.1 is a very high fasting morning reading on the meter. The guidelines suggest it should be no more than 7 before food and no more than 8.5 two hours after food to avoid diabetic complications. But it's not unusual to have high levels at diagnosis.

My advice would be to try and test yourself morning and after meals initially to get an idea of how foods affect your levels (we are all different). I'm not sure if you've been offered a meter, often type 2's are not.
But push for this if you can.

Have you been experiencing any symptoms from the diabetes? You can get this under control but it needs a fair bit of effort and commitment. Good luck!


----------



## pottersusan (Aug 20, 2015)

Hi Rosie

It's incredibly confusing even four years in. Your hba1c shows your average blood sugar over the last three months. I only discovered a couple of weeks ago that a nondiabetics would be about 58. Mine was 68. It's a very blunt instrument and certainly doesn't tell the whole story. Don't panic!

There are a lot of much more experienced people than me out there. I haven't yet come up with a question that someone hasn't been able to answer. I find the forum much more knowledgeable than the medics!

Good luck


----------



## DeusXM (Aug 20, 2015)

Erm....58 is definitely not a non-diabetic A1c. <40 is non-diabetic and to be honest. 30 is really what you'd expect.


----------



## Ralph-YK (Aug 21, 2015)

Hi
Just seen diabetec nurse again.  Apparently there is a target for my HbA1c
Looks like my target is 48-59mmol/mol.  I got a 47 this time.  It was higher in March.
I was diagnosed in December and have been on metformin more or less all the time since then.
Obviously, since you've just been diagnosed your number will be higher than mine.  I've got no idea what mine was in December.  Once your treatment gets working you'll be able to see how much it's improved.

I think it's the blood glugose (sugar) that attaches to your blood cells (possibly a normal thing).  This can then be measured when they take your blood.  Because your blood cells last several weeks the test covers that period.  Somewhere around 2/3 months.


----------



## Mark T (Aug 21, 2015)

At diagnosis, mine was 85 mmol/mol.  But I was found during a routine test and wasn't showing the usual thirst/pee symptoms.

48 equates to 6.5% in old units and 59 equates to 7.5% in old units.  These are the standard targets applied to diabetics on insulin I believe.

According to NICE, for a Type 2 not on insulin the target is below 48 (6.5%).  Although NICE also states that you should have a personalised and jointly agreed target.


----------



## Ralph-YK (Aug 21, 2015)

I'm type 2 not on insulin.
I'd taken a list from the Diabetes UK website that mentioned targets.  So the nurse circled the numbers & wrote Target on the paper.

Try making a list from what you get on here Rosie and pick what you want to ask about at your GPs.


----------



## DeusXM (Aug 21, 2015)

> 48 equates to 6.5% in old units and 59 equates to 7.5% in old units. These are the standard targets applied to diabetics on insulin I believe.



Not true anymore I believe. For adults with diabetes, the target is <48 unless the patient has severe problems with hypoglycaemia, in which case it's <58. That in itself is a ridiculous position to take as it's basically giving up on reducing hypos by just 'allowing' the patient to have a dangerously high A1C.

PWD should in all circumstances aim for non-diabetic A1Cs _provided_ this is not achieved through constant hypos. Logically your body is designed to work at non-diabetic A1Cs and therefore anything over this puts you at risk of complications, with the risk growing exponentially as you get further away - someone with an A1C of 50 (10 more than non-D) is at relatively low risk, whereas the risk factor substantially increases if you go up another 10 again to 60.


----------



## Cleo (Aug 21, 2015)

I can't believe a health care "professional" said your results were atrocious when you were diagnosed last week and not even on any meds ! 
Have you been given any form of support in terms of understanding dos and donts ? Or will you be given any form of support ?


----------



## Rosiecarmel (Aug 21, 2015)

Cleo said:


> I can't believe a health care "professional" said your results were atrocious when you were diagnosed last week and not even on any meds !
> Have you been given any form of support in terms of understanding dos and donts ? Or will you be given any form of support ?


Thank you all for your advice! This is so confusing and worrying to me so I think even if she had have explained it to me, I probably wouldn't have taken any information in! Plus, I always find it better to hear stuff explained from people that go through it not people that diagnose if that makes sense!

Amigo, I asked the sister if I could have a meter and her response was "well it's high therefore there's no point hurting your finger testing every day because metformin won't decrease it dramatically so don't bother"

Cleo, she was very dismissive of me. Kept telling me I was morbidly obese (I'm 23 and weigh 110kg which yes, puts my BMI in the morbidly obese category but it's not like I don't know what myself!!) and that I'll be on tablets forever basically. She gave me absolutely no information apart from a leaflet for a Living with Diabetes Day and said she wants to see me in three months for another year and to see if I've lost any weight. I mean, yes it is probably linked to my weight but it also runs in my family so I'm assuming genetics also plays a part!


----------



## Mark T (Aug 21, 2015)

DeusXM said:


> Not true anymore I believe. For adults with diabetes, the target is <48 unless the patient has severe problems with hypoglycaemia, in which case it's <58. That in itself is a ridiculous position to take as it's basically giving up on reducing hypos by just 'allowing' the patient to have a dangerously high A1C...


Some nurses obviously need some re-training, my GP nurse pulls out the same old sheet with 6.5% - 7.5% marked on it each time.  Although she doesn't give me a hard time over being lower - which is good for her - because I would give my opinion right back! 



Rosiecarmel said:


> ...Cleo, she was very dismissive of me. Kept telling me I was morbidly obese (I'm 23 and weigh 110kg which yes, puts my BMI in the morbidly obese category but it's not like I don't know what myself!!) and that I'll be on tablets forever basically. She gave me absolutely no information apart from a leaflet for a Living with Diabetes Day and said she wants to see me in three months for another year and to see if I've lost any weight. I mean, yes it is probably linked to my weight but it also runs in my family so I'm assuming genetics also plays a part!


Well that nurse is useless isn't she!

Yes, it can run in families.  My father and my fathers only-brother are diabetic, also diagnosed like me in their mid to late 30's.  My grandfather on my fathers side was diabetic and we suspect so was the great grandfather.

Depending how many generations of relatives you have and what ages they were diagnosed it might be worth seeing if you can get an opinion from a Hospital consultant - because there are specific genetic types of diabetes.

As far as I'm concerned, the jury's out on a direct link of obesity to diabetes.    Too many hugely obese people with no diabetes as far as I'm concerned.  However, diabetes can cause obesity...


----------



## Northerner (Aug 21, 2015)

Rosiecarmel said:


> ...Cleo, she was very dismissive of me. Kept telling me I was morbidly obese (I'm 23 and weigh 110kg which yes, puts my BMI in the morbidly obese category but it's not like I don't know what myself!!) and that I'll be on tablets forever basically. She gave me absolutely no information apart from a leaflet for a Living with Diabetes Day and said she wants to see me in three months for another year and to see if I've lost any weight. I mean, yes it is probably linked to my weight but it also runs in my family so I'm assuming genetics also plays a part!



How very unprofessional of the nurse  Yes, there is certainly a genetic link, otherwise with 60% of the population being overweight then 60% would have Type 2 diabetes. However, it's more like 6-8%. Also, 20% of Type 2 are not overweight at diagnosis (that means about 600,000 in the UK), so although weight is an important risk factor, it's certainly not the only one.

My main worry is that your levels are exceptionally high yet they are doing nothing but giving you metformin and a nasty lecture to try and reduce them. Would it be possible to see another doctor at the practice? If things don't improve you should certainly not wait three months befre going back! I'm shocked to hear such a terrible lack of information and empathy for you.


----------



## KookyCat (Aug 21, 2015)

Rosiecarmel said:


> Amigo, I asked the sister if I could have a meter and her response was "well it's high therefore there's no point hurting your finger testing every day because metformin won't decrease it dramatically so don't bother"



Not to state the obvious but what does she think is going to make it lower then?  Good grief she sounds like someone who shouldn't be allowed near people at all, ever   I would be sorely tempted to march back in there and tell her you're not satisfied with her advice, and ask her to provide actual evidence that her advice will lead to a significant quick reduction in blood glucose.  I'd come with you if I could, that woman wouldn't get out with her ego in tact that's for sure..fuming on your behalf


----------



## Rosiecarmel (Aug 21, 2015)

Oh you've no idea how good it feels to hear other people say she's basically useless! She's a Sister so I expected more help then from for example a practice nurse but even when I found out last week I had diabetes, I said it had never crossed my mind and she looked me up and down and went "really?"... I immediately then just stopped talking. When I said I felt poorly her only response was "I'm not surprised with sugars that high!" Then that's when I got the metformin and the lecture about weight!

Kooky, basically, from what I gathered from her the only thing that will sort my blood sugars it is "by not being obese". She pretty much said that since my thyroid came back absolutely normal, it's all down to me and I need to admit how much I eat and cut down. She said the metformin will slowly bring it down but not lots even though I'm on 2grams which is a high dose. So as far as I understand, the only thing that will help is by dramatically losing weight. I might only be 23 but I have been dieting on and off for ten years. I'm not going to suddenly stop being overweight! She said if I can think of anything she can help me with to come back but how am I supposed to know what will help? Isn't she the expert?!

I'm not sure where to go from here knowing how high my hba1c is now!


----------



## Mark T (Aug 21, 2015)

The Gretchen Becker book recommended in the newbie help thread is well worth a read.

But yes, really _useful _attitude from the nurse!

Yes, loosing weight does help.

Have you tried a few different type of weight help schemes like Weight-watchers, 5+2, low-carb-high-fat, etc?  I saw some research that basically stated that all the different schemes are as effective as each other.  It's just a case of finding one that works for you.

The main thing that causes weight gain is eating more calories then you actually need.  To loose them you would think you could just eat less, but it's sadly not that easy.  High blood glucose levels will be making you feel hungry as your body can't use the energy as effectively - so when they come down it will help you but that probably feels a while off.

Exercise helps as well.  But that doesn't mean you have to instantly hit gym/yoga/etc - unless you fell like it.  The trick here is finding something that you enjoy and will keep doing.

Did the nurse remember to tell you that all carbohydrates will raise your blood glucose levels, not just sugar.  Or did she tell you to eat plenty or bread/pasta/potatoes and avoid fat and sugar?


----------



## Rosiecarmel (Aug 21, 2015)

Yes, I have tried most of them apart from the 5+2? Think ill do some Googling on that!

No she didn't tell me anything about diet! She told me to "admit how much I eat then eat less" that's all the information I was given. I feel constantly hungry yet I'm so exhausted all of the time that I'm sleeping most of the time I'm not on shift so I'm not burning any of it off. So which is best: eating less carbs or more carbs/less sugar? I don't eat that much sugar anyway but God I eat a lot of carbs!!


----------



## Mark T (Aug 21, 2015)

Rosiecarmel said:


> ...So which is best: eating less carbs or more carbs/less sugar? I don't eat that much sugar anyway but God I eat a lot of carbs!!


I'm one of those who believes in moderating carb intake.  Sugar and carb's both break down (eventually) into glucose - so neither are good.

I think when I was loosing weight I was on perhaps a limit of 70-100g of carb per day (I've since lifted this).  However, I got to that figure because I was using my meter to identify what really didn't agree with me (breakfast cereals!) and to moderate portion size.

It will be the high BG that is most likely making you hungry and tired.

I've never been very good at avoiding hunger pangs - perhaps others have useful advice


----------



## Bloden (Aug 21, 2015)

I can't believe the "treatment" your receiving, Rosie, and none of it medical!  Isn't there anyone at your health centre that can give you some kind of sensible advice?! You're hungry and tired because your glucose is high.

I don't know what advice to give you.  Personally, I read about diabetes A LOT because my endo and DSN only covered the basics - I didn't realise this until I started using this forum! You need to get a glucose meter so that you can start working out which carbs you can eat (without raising your glucose too much) and in what amounts. Do you do any type of exercise? I've always found it more effective than just dieting alone, and it makes me feel good. 

Good luck...I can't believe how little help you've received...it's shameful and ridiculous.


----------



## Amigo (Aug 22, 2015)

Rosie THAT nurse is treating you as an undeserving patient and because you're so young obviously feels she can push you around. But despite the unprofessional and callous way she's dealing with you, some of her messages have merit. I was diagnosed with type 2 six months ago. Admittedly my levels weren't as high as yours and I'm much older but I DID need to lose weight and I 
DID need to start cutting carbs. They taste good but they damage hard!

You're hungry because your body is craving the sugar hit it's become accustomed to and the fast hit of refined sugar and carbs is making you hungry fast again. Ask to see a dietician and work out an eating plan with them and if the nurse won't sanction a meter (though I'd push for it), buy one yourself. Testing was the best thing I ever did. I don't diet but eating what could be described as a diet suitable for diabetics has reduced my weight and I feel so much better. You can do this but it needs a different mind set and determination.

Good luck hun...seize your life back from carb damage because at 23, your body has to last a very long time yet!


----------



## Cleo (Aug 22, 2015)

Rosie, is there any way you can be seen by someone else ?
Her approach and general disposition sound appalling and incredibly unprofessional.


----------



## Rosiecarmel (Aug 22, 2015)

I think you're all right. I think I'm going to request to see someone else and hopefully I'll get a bit more advice! I'm also going to do some reading up on carbohydrates and stuff so at least I'll have a little bit more knowledge even if the nurse doesn't help me much!

I'm going to ask again about a meter. She point blank refused buy from what I've read on here, it might be very helpful in understanding what exactly has the biggest effect on my sugars so I can cut down/cut them out! This is a silly question but will I also need a Sharps bin if I end up having to buy one myself? Will I need to take it to a pharmacy to be emptied etc? I don't know how any of this works! 

Hopefully I will be able to see someone much better and at least a little sympathetic to my situation. 

A dietician sounds like a good idea! Is that something I bring up with the doctor and they refer me or do I do it myself? I feel like all this is a mine field and I'm going in blind!

I thought it was just me that thought she was unprofessional so thanks to you all for making me realise I should definitely go back and see someone else!


----------



## Amigo (Aug 22, 2015)

You can ask the doctor to refer you to a dietician Rosie and one of the education courses called DESMOND they run at local hospitals/health centres.

You don't need a sharps bin it's not like the needles used by insulin users. They're little sharp testing needles at the end of plastic and you just need to press them down and bend them back before disposing in an ordinary bin. 

Great idea to read about carbs and you'll be amazed at how certain foods affect you. Read some of the links provided, they really do help. We can all react differently to certain foods. White bread pushes me into the stratosphere! Good luck!


----------



## Ralph-YK (Aug 22, 2015)

I got on DESMOND by asking my Diabetes Nurse.  I'd heard about it years ago.
Dietician - I self refered.  There were some leaflets about this, including some at the side of the room when I did DESMOND.  I filled it in and the people doing DESMOND said they'd pass it on for me.  You could try asking at your doctors.

Try looking in your doctors waiting room.  There may be a couple of leaflets about there.

The address I have for DESOND is the local hospital.  You could try there.  I've got a letter that says Community Diabetes Education Administrator, DESMOND Administrator and Diabetes Centre.


----------



## Amigo (Aug 22, 2015)

I wasn't aware that you could self refer to an NHS Dietician Ralph. I know my local Health Authority won't accept self referrals but maybe others do.


----------



## grovesy (Aug 22, 2015)

I suspect it is like everything else it varies around the country!


----------



## Ralph-YK (Aug 22, 2015)

I've checked a copy of the leaflet.  It has the address for a couple of local hospitals and says to write to them.  It also says Yorkshire Hospital NHS Trust.
I didn't even know they existed before.


----------



## Rosiecarmel (Aug 22, 2015)

No I didn't either, Ralph! Thanks for the advice though  

So I have another question I'm hoping you can answer(!): do the side effects of metformin go away?! I'm on 2 x 500mg tablets but next week that's going up to 4 x 500mg tablets a day. Im praying the, err, side effects don't increase also!! I'm also getting stomach pains which is adding to my "discomfort".


----------



## Ralph-YK (Aug 23, 2015)

Well, I'm not aware of any.  Unless they've started making me feel tired again.  That had gone.


----------



## Mark T (Aug 23, 2015)

For most people, the side effects from metformin go away after about 4 weeks.

Some unlucky people always have problems and there is a slow release version you can get which usually has less side effects.


----------



## grovesy (Aug 23, 2015)

Some people do notice the side effects reduce in time. I personally ended up on the slow release version.


----------



## Pine Marten (Aug 24, 2015)

Coming back to this thread after a while I too am appalled at the treatment you've received, Rosie! 

On the carbs thing, I used to love to scoff potatoes, pasta and bread, cakes & biscuits. Since discovering the effect they were having I cut them down drastically, and now I find that I don't crave them half so much as I've got used to not having so much. Cutting down the carbs really does work so see what foods are best for you by getting a meter. My surgery is pretty good, but still won't prescribe a meter or strips so I bought the Codefree one from Amazon (comes with the lancets and is around £12.99) and the strips, which cost about £7.99 for a box of 50.

The, er, unfortunate side effects from Metformin should clear up eventually....  

I hope you get some better advice & treatment - let us know how you get on. All the best


----------



## Catsmother (Aug 24, 2015)

Hi Rosie!

Although I am a regular 'viewer' of this forum, I don't very often log on or reply to posts. Your dilemma, however, has prompted me to reply as I identify with your story in many ways. 

Let me start by saying that I am much older than you and only diagnosed Type 2 about two years ago. These two years have been a steep learning journey! Firstly, let me say that my diagnosis was totally unexpected - even though my Mum had Type 2 in later life - and it threw me into a whirlwind of self-criticism (which is what I think your nurse was aiming for!). It took me quite a while to realise that looking to put the 'fault' on someone (anyone) was not important.

It is true that I have struggled with my weight all my life, tried all the diets going and had successful weight loss a couple of times, only for all the weight to creep back on over time. The key to this - for me - has been to accept that I am, have always been, always will be hungry! That seems to be the way I'm made. Could that be the same for you?

Until recently, the last time I lost a lot of weight was in the 90s when I did the Rosemary Conley diet which was popular then. It concentrated on low fat and, although it worked at the time, I now realise that my eating patterns changed totally and I replaced a lot of the fats with carbohydrates. I believe this has contributed to the development of diabetes.

When I was diagnosed I had an HbA1c of 109. I was told I should not (must not!) test my blood sugar as it would only make me obsessive. After finding this forum and reading avidly, I realised that I would only be able to influence the progress of my diabetes if I knew what was going on with my blood sugar and how I responded to different foods. 

The doctor I saw soon after diagnosis told me to "eat healthily". I told her I thought I already did that, but here I was with a diagnosis of diabetes. She asked me to tell her what I ate, for example, for breakfast on a normal day. I told her that I would normally have a slice of home-made wholemeal toast with a little butter and a scrape of marmalade, plus a small glass of fruit juice. She said that was excellent. (I thought so too, at the time. Very restrained I thought!) When I finally decided to buy my own meter and tested two hours after such a breakfast the reading was 15.9! Way too high (in my opinion). Using the results from my meter I have been able to change the foods I eat to reduce the readings. I now eat far fewer carbs and - lo and behold - I have lost quite a bit of weight relatively easily and it has now stayed off for over a year, which is almost unknown for me.

Regarding Metformin: I struggled on with the regular Metformin for six weeks with a permanent headache, bad stomach pains and explosive 'events' before I went back to the doctor and asked to be swapped to the slow release version. The symptoms didn't settle down for me. They don't for some people. I have been able to tolerate the SR version, however, and I am now on a lower dose due to a marked improvement in HbA1c from the original 109, to 69 after six months, then down to 40 thanks to the changes in diet. (PS Metformin seems to act as a slight appetite suppressant for me, which is a bonus! When I came off the meds briefly to see whether I could manage without, I could have eaten my own arms most of the time!!! I was almost glad to go back to them)

I'm sorry that this has turned into a rather long post, but I hope there might be some encouragement for you that things can get better - but not all changes will be suggested (or even supported) by the medical professionals. This forum, however, can help you on your way.


----------



## Amigo (Aug 24, 2015)

Excellent post catsmother.  You really should post more often!

Your story could certainly be mine even to the nurse telling me to 'just eat healthily.' I've managed to get my BG's down by 'eating by the meter' and despite some medical advice rather than because of it.

Hope Rosie can too.


----------

