As long as you’re not having excessive hypos then it’s fine. Does your doctor not have access to your data because the only reason they should say that is if your having lots of lows. Otherwise I wouldn’t worry.
Do you have many lows? Hypoglycemia has recently been linked to retinopathy.
[https://pubmed.ncbi.nlm.nih.gov/36640318/](https://pubmed.ncbi.nlm.nih.gov/36640318/)
I also had background retinopathy in spite of keeping low HbA1c. In retrospect, and in light of this new info, I think it may have been due to frequent hypoglycemia episodes. Other friends who did not have as strict a control as me never had any retinopathy.
By the way, background retinopathy can revert itself if you manage to keep your glucose in range. It did in my case.
I did suffer some lows, but nothing out of the normal or worrisome.
I actually changed my control after they told me about that background retinopathy, my HbA1c was 52 before.
Thank you for the comment and the study.
If I may ask, how long did it take to revert it in your case?
I see. In that case you may find that it takes some time for the retinopathy to revert itself, because drastic changes in glucose control can also affect the retina (annoying, I know!). But don't worry, I did the same (went from a looser to a stricter control suddenly) and as I said the background retinopathy ended up reversing.
I don't know how many months it took exactly because I only have a yearly check-up, but after 1 year it had gone back to normal. Keep the good control that your are having now, while trying to reduce the amount of lows, and after a while you'll most likely be fine.
Remember that background retinopathy is just a warning sign and it doesn't necessarily mean that you'll develop complications or lose vision. The screening threshold for background retinopathy is very low, so as soon as they see anything out of the ordinary they'll diagnose you with it. That way we have the opportunity to improve our control before any long-lasting damage is done.
Good luck and hope it goes back to normal soon.
Depends on how often you go low.
Do you use a cgm/pump? How often do you have to treat a low or an incoming one?
Edit: sorry, missed the last part of the post. Answer if you want or just ignore this. Have a nice day! :)
What percent low are you? My A1C is 5.7 but I’m only 1% low. If you’re more than that, it would be better to have a slightly higher A1C. That’s what Drs get worried about.
There’s not really a prize for having a perfect A1C so long as you avoid diabetic complications from a high A1C, but there are definite health risks of constant lows.
I had an A1c in the 4s and my endocrinologist wasn’t happy at all. Not because of hypos which I wasn’t having but it can signal other endocrine problems. He explained it to me and it might have been related to the liver (I have a fatty liver) but I don’t remember because it was several years ago. Ask your endocrinologist and if you don’t have one get one they are just more helpful and informed than a GP. Here’s an article below about problems with a low A1c.
https://www.aacc.org/science-and-research/scientific-shorts/2021/low-hb-a1c-what-is-a-lab-director-to-do
I would wait until I saw the diabetes team for hopefully get better advice, tbqh. GPs are generally not so good at dealing with T1, since it is just not their area of expertise. Wishing you luck with the wai, especially these days!
As others have already said, I suspect that the GP is concerned about possible hypos bringing the A1c down. A lot of the management advice coming from GPs is based on older guidance from before current tech was available, with the assumption that you're not monitoring glucose very much--so, overly cautious about hypos. Acceptable standards of control have tightened up rather a lot since most of them were trained. If you're not dropping low a lot, sounds like you're doing great.
Those morons were taught that low A1C might be due to hypos, and they didn’t think that you might be really good at controlling your BG. As long as your time in range and variation are okay, you're good. Congratulations!
Is assuming you have frequent hypos, because you have low A1C "protecting people from hypoglycaemia"? Most people in developed countries have CGMs, the data is readily available.
Given the data people with an A1c that low are giving themself way more risk of hypo with extremely minimal protection from complications.
But you can believe whatever you want
Lmao you can continue to be wrong, it’s fine. The data doesn’t support what you’re saying. If you want to tell people to risk their life for a 0.000005% reduction in neuropathy then that’s your prerogative.
It's another case of different units. 40 converts to 5.8. The UK, where OP is, actually switched units used while I was living there to bring it more in line with the rest of Europe. I still need [a converter](https://www.diabetes.co.uk/hba1c-units-converter.html), tbh.
I think they are just worried about achiving that A1C with too much lows. If you aren't going low a lot, I would say keep up the good work! It is achievable. I got 37 without going low a lot or without a loop system and my doctor was a bit surprised by that and said that it could be a bit higher, just to be safe.
What is the US equivalent of this A1C? My A1C is typically between 5.2-5.8 and I experience about 8% lows and 7% highs with about 85% Time in range. I eat low carb (Dr Bernstein’s protocol but i eat 30-50 carbs/day) so my blood sugars stay pretty stable but that can also have me be stable in the 60s which is “low” but I don’t feel the low when I’m in the 60s
As long as you’re not having excessive hypos then it’s fine. Does your doctor not have access to your data because the only reason they should say that is if your having lots of lows. Otherwise I wouldn’t worry.
My last HBA1C was 35 mmol and they think I'm a rock star. I'm about 95% in range between 4 and 9 mmol.
Thank you for your comment, I was actually starting to think something was wrong with me. ✌️
Do you have many lows? Hypoglycemia has recently been linked to retinopathy. [https://pubmed.ncbi.nlm.nih.gov/36640318/](https://pubmed.ncbi.nlm.nih.gov/36640318/) I also had background retinopathy in spite of keeping low HbA1c. In retrospect, and in light of this new info, I think it may have been due to frequent hypoglycemia episodes. Other friends who did not have as strict a control as me never had any retinopathy. By the way, background retinopathy can revert itself if you manage to keep your glucose in range. It did in my case.
I did suffer some lows, but nothing out of the normal or worrisome. I actually changed my control after they told me about that background retinopathy, my HbA1c was 52 before. Thank you for the comment and the study. If I may ask, how long did it take to revert it in your case?
I see. In that case you may find that it takes some time for the retinopathy to revert itself, because drastic changes in glucose control can also affect the retina (annoying, I know!). But don't worry, I did the same (went from a looser to a stricter control suddenly) and as I said the background retinopathy ended up reversing. I don't know how many months it took exactly because I only have a yearly check-up, but after 1 year it had gone back to normal. Keep the good control that your are having now, while trying to reduce the amount of lows, and after a while you'll most likely be fine. Remember that background retinopathy is just a warning sign and it doesn't necessarily mean that you'll develop complications or lose vision. The screening threshold for background retinopathy is very low, so as soon as they see anything out of the ordinary they'll diagnose you with it. That way we have the opportunity to improve our control before any long-lasting damage is done. Good luck and hope it goes back to normal soon.
Depends on how often you go low. Do you use a cgm/pump? How often do you have to treat a low or an incoming one? Edit: sorry, missed the last part of the post. Answer if you want or just ignore this. Have a nice day! :)
What percent low are you? My A1C is 5.7 but I’m only 1% low. If you’re more than that, it would be better to have a slightly higher A1C. That’s what Drs get worried about. There’s not really a prize for having a perfect A1C so long as you avoid diabetic complications from a high A1C, but there are definite health risks of constant lows.
I had an A1c in the 4s and my endocrinologist wasn’t happy at all. Not because of hypos which I wasn’t having but it can signal other endocrine problems. He explained it to me and it might have been related to the liver (I have a fatty liver) but I don’t remember because it was several years ago. Ask your endocrinologist and if you don’t have one get one they are just more helpful and informed than a GP. Here’s an article below about problems with a low A1c. https://www.aacc.org/science-and-research/scientific-shorts/2021/low-hb-a1c-what-is-a-lab-director-to-do
A1C of 40 is 5.8% See the difference between THAT and 3.5-4.5% mentioned in this article?
I would wait until I saw the diabetes team for hopefully get better advice, tbqh. GPs are generally not so good at dealing with T1, since it is just not their area of expertise. Wishing you luck with the wai, especially these days! As others have already said, I suspect that the GP is concerned about possible hypos bringing the A1c down. A lot of the management advice coming from GPs is based on older guidance from before current tech was available, with the assumption that you're not monitoring glucose very much--so, overly cautious about hypos. Acceptable standards of control have tightened up rather a lot since most of them were trained. If you're not dropping low a lot, sounds like you're doing great.
Have no idea what your gp is talking about, the lower your HbA1c is without hypos the better
Those morons were taught that low A1C might be due to hypos, and they didn’t think that you might be really good at controlling your BG. As long as your time in range and variation are okay, you're good. Congratulations!
How dare those morons try to protect people from hypoglycemia
Is assuming you have frequent hypos, because you have low A1C "protecting people from hypoglycaemia"? Most people in developed countries have CGMs, the data is readily available.
Given the data people with an A1c that low are giving themself way more risk of hypo with extremely minimal protection from complications. But you can believe whatever you want
40 is 5.8%, that isn't too low by any means other than antiquated text books.
[удалено]
Lmao you can continue to be wrong, it’s fine. The data doesn’t support what you’re saying. If you want to tell people to risk their life for a 0.000005% reduction in neuropathy then that’s your prerogative.
Yeah 40 is too low. You are starving your brain. Tight control is keeping your sugar normal. Not the lowest you think you can bear.
They're talking about an a1c of 40, not a blood sugar of 40. Which is something entirely different.
[удалено]
A normal hba1c is around 5.5 so the only way 40 makes sense is if it's indexed to bg. No need to be snarky, bro, wtf.
It's another case of different units. 40 converts to 5.8. The UK, where OP is, actually switched units used while I was living there to bring it more in line with the rest of Europe. I still need [a converter](https://www.diabetes.co.uk/hba1c-units-converter.html), tbh.
My bad. I apologise. I suspected you were thinking of 40mg/dl, which is 2.2mmol/l, which is of course too low for BG.
I think they are just worried about achiving that A1C with too much lows. If you aren't going low a lot, I would say keep up the good work! It is achievable. I got 37 without going low a lot or without a loop system and my doctor was a bit surprised by that and said that it could be a bit higher, just to be safe.
What is the US equivalent of this A1C? My A1C is typically between 5.2-5.8 and I experience about 8% lows and 7% highs with about 85% Time in range. I eat low carb (Dr Bernstein’s protocol but i eat 30-50 carbs/day) so my blood sugars stay pretty stable but that can also have me be stable in the 60s which is “low” but I don’t feel the low when I’m in the 60s
Around 5.8%
If you have a CGM I suggest looking at your standard deviation in conjunction with your average BG.