# Rapid decline in HbA1c  - good or bad for T2?



## slipper (Oct 16, 2011)

Hi Johnny, welcome to the forum and good luck with your weight loss.

 May I share your post as this interested me,



Northerner said:


> Good for you Jonny! One word of advice, it's best not to go totally over the top and reduce your HbA1c too quickly as the sudden changes can cause problems particularly in the microvascular area (i.e. things like retinopathy or nephropathy, even neuropathy. So aim to bring things down gradually from where you are now. Often the best areas to look at are any bad hypos or highs and try to smooth out these extremes - aim to get most of your levels around the average, then begin trying to reduce that average until you are nicely in range.  Good luck - keep us informed of how you are getting on! Join in the Weight Loss Group as your weight reduces and add to our group totals!



That bit surprised me Northerner, not heard that before. I take it it also applies to Type 2,s so a dramatic change in diet is not good then.?


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## Northerner (Oct 16, 2011)

I'm not entirely sure Slipper as T2s that are not on insulin are highly unlikley to experience some of the lows that a T1 might. I do know a couple of T1 members here have ended up with neuropathy or retinopathy problems after a rapid improvement in HbA1c after starting on pumps.Declines in blood sugar levels may be more gradual where a person is managing them through diet and exercise or oral medication. Perhaps other T2s could offer their knowledge/experiences?

(copied to a new thread)


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## Newtothis (Oct 16, 2011)

As a type 2 I have been advised by my DN to try and reduce my HbA1c from 7.2 to 7 for Christmas. 

However, my priority at the moment is to try and reduce my cholesterol, which although at 4.8 is within guidelines if I wasn't diabetic but because I am it should ideally be around 4.  I have changed my diet; losing weight and testing to control my sugar levels. 

It think its safe to say that everyone is different and everyone's careplan will be different.


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## slipper (Oct 16, 2011)

Thanks  Northerner, better as a new thread too. I can see that type 2s would not drop as dramatically as someone on insulin; it just made me think as my DN told me my diet was ok (really?????) and it made me think perhaps she was breaking me in gently and reduce my diet more next time.

 I have changed my diet considerably, out of necessity I think, to get levels down to a reasonable figure, and lose weight.

I think your target is a good one Amanda, I was 8.1 I think, but would have to look it up.

Would be interested what others have done in the initial first few months.


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## mcdonagh47 (Oct 16, 2011)

slipper said:


> Hi Johnny, welcome to the forum and good luck with your weight loss.
> 
> May I share your post as this interested me,
> 
> ...



Hi Slipper,

The target set by NICE is 6.5 for HbA1cs for T2s such as yourself and NICE advises  medics  to up the medication succesively with each A1c result until that target is reached.
So what that advice seems to be implying is that you should go for it. Read Jennifer's Smart Advice in the sticky section of the Newbies thread and act accordingly i.e. "Eat to your Meter".
Try to get to 6.5 A1c asap and remember A1cs are normally taken every 3 to 6 months so dropping from 8.1 to 6.5 over that timescale is scarcely "rapid".
Also bear in mind advice from Nurses is usually the standard line, "plenty of carbs and don't bother testing". Poor advice and they are usually flabbergasted when a new T2 succeeds in establishing good control because they are simply not used to seeing it with the kind of advice they offer.
Also the A1c is weighted towards the last two weeks so if you have made recent diet changes your A1c should have improved dramatically anyway without you knowing.
Look what Hazel in the other thread achieved just by dropping bread !


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## slipper (Oct 16, 2011)

Thanks mcdonagh47, sound advice, thanks.

The point you make about the typical advice from DNs is so valid. Thats the problem for newbies, more carbs???????? , its hard to get a newbie head around the fact that such bad advice is being peddled about by them.


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## everydayupsanddowns (Oct 16, 2011)

Slipper - just to go back to your original thought... I've also read that a rapid change in BG levels pits strain on the microvascular system (more anecdotal forum posts than published research). People who successfully 'normalise' BGs with substantial carb management very quickly seem to get blurred vision, increased neuropathic pain etc. These symptoms then seem to reduce as time goes on.


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## Northerner (Oct 16, 2011)

My HbA1c came down from 11.8 at diagnosis to 6.8 two months later. I do have a slight problem with background retinopathy and did suffer from some transient neuropathy in the frst 6 months or so. After 6 months my HbA1c was 5.2%! I wonder if it makes any difference how long you have had high levels before the rapid reduction?


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## slipper (Oct 16, 2011)

Cheers Mike, I am 2 months into my diagnosis and have not had those problems apart from some sensation in my feet, but tested ok.

I have been tested for mild retinopathy, but no treatment needed this year. Interestingly, I have been experimenting with different types and quantities of bread at breakfast time, and can sometimes feel my eyes smarting a little, a while after, , but not really related to any high/low BG readings at the 1 hour point.  Maybe coincidence.


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## HelenM (Oct 17, 2011)

everydayupsanddowns said:


> Slipper - just to go back to your original thought... I've also read that a rapid change in BG levels pits strain on the microvascular system (more anecdotal forum posts than published research). People who successfully 'normalise' BGs with substantial carb management very quickly seem to get blurred vision, increased neuropathic pain etc. These symptoms then seem to reduce as time goes on.




This page  from the Good hope clinic explains about the sudden lowering of  HbA1c and possible rapid progression of retinopathy. It apparently may happen when a T2 goes onto insulin (when control wasn't great before). Keeping blood pressure low seems to be very important


http://medweb.bham.ac.uk/easdec/retinopathyprogression.htm

It also  sometime happens,, as Alan said when people go onto a pump. They won't let you have a pump in France unless you have had a fluroescein  angiogram ( where they use a dye to show the blood vessels)  within 6 months. If anything shows up then they are very careful about lowering levels slowly and checking the eyes more regularly.


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## slipper (Oct 17, 2011)

Thanks for that link HelenM, does explain it very well. It is complex though and whilst BP and cholesterol reduction is only good, BG rapid reduction does need some care and thought.

I expect my reduction from 8.1 to whatever I am next month, would not be overly dramatic, but just in case I'll nip down chippie

People with very low blood pressure, seem to do better, so Northerner, as a marathon runner, surely you would come into that bracket.


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## Northerner (Oct 17, 2011)

slipper said:


> People with very low blood pressure, seem to do better, so Northerner, as a marathon runner, surely you would come into that bracket.



Actually, I have a problem with high blood pressure and am taking pills for it!


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## slipper (Oct 17, 2011)

Oh, sorry. Me too, and cholesterol but cant handle statins.  I'm hoping my diet has improved that.


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## Jill (Oct 17, 2011)

slipper said:


> Oh, sorry. Me too, and cholesterol but cant handle statins.  I'm hoping my diet has improved that.




How do statins affect you Slipper?  My GP wants me to take statins but I'm not happy about it at this stage.  I would like to try to reduce my cholesterol naturally first.  Total cholesterol is 6.1 but my HDL is very high so the ratio is 2.2 which is very good I'm told.  Can't help feeling that the doc just wants to tick the box and claim the extra cash from the NHS.


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## Twinkle (Oct 17, 2011)

Oh don't give me another thing to worry about!!

I didn't have an HbA1c on diagnosis, but had my first one 6 weeks later which was 7.7.  Bearing in mind I'd had 6 weeks of a much better diet/exercise regime, I'm sure my original figure would have been higher.

Second test 3 months later and I'm 5.3.  I've had all the tests - eyes, feet etc - and all is tickety boo.  My BP has always been good and is if anything a touch low, and I'm on simvastatin which has taken my chol down from 6.8 to 4.3.

Now I'm concerned I've done it too quickly!!


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## slipper (Oct 17, 2011)

Jill said:


> How do statins affect you Slipper?  My GP wants me to take statins but I'm not happy about it at this stage.  I would like to try to reduce my cholesterol naturally first.  Total cholesterol is 6.1 but my HDL is very high so the ratio is 2.2 which is very good I'm told.  Can't help feeling that the doc just wants to tick the box and claim the extra cash from the NHS.



I got mine down naturally Jill, but not enough. (This was before diabetes diagnosis) So I tried 2 lots of statins and within a few months had rather severe muscle pain in my thighs, and numbness in my right arm. So I came off them and it all improved, but my cholesterol was  not good, I am hoping it will be much better after my change in diet. Most folks get on with them though.

Twinkle, I wouldn't worry, from what I gather so far in what has been said, , the drop in our BG(on diet and exercise) is relatively less severe in comparison to the drop some on insulin could get.


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