3 months low carb, flatter BG graphs, but

… my first A1c over 7 (7.2, to be precise). I’m bummed. I thought I’d be in the low 6s, where I used to be quite regularly, maybe even high 5s.

My endo believes that A1c is the best predictor of future complications, and I suspect he might prefer me to be on more of a rollercoaster, if it’s going to mean a better A1c. I don’t think I can do much better than I have been lately in terms of keeping the CGM graph flat(tish). In other words, I don’t think I can achieve lower numbers without risking too much, given the amount of exercise I do.

Don’t know what to try at this point. :o( Haven’t lost any weight either … I think I may have gained. Ugh.

Sorry … this post is more just a whimper-fest than anything!

My A1C went up @ the start of my weight loss attempt. I didn’t have any ratios or rates or anythin but was just winging it. Sice then, I’ve gotten a bit more organized but it’s still a lot of work to yutz around with stuff all the time. I was exercising a lot then too. Maybe there’s a hazard to it too?

Sorry you did not get the results you expected, this disease can be totally baffling at times.

It would seem that with a CGM you would not have been surprised to the extent you were. Although unlikely, labs are not perfect, perhaps there was an error in the lab. I would be curious to see what happened if you punched your average CGM numbers into the A1C calculator here ( its at the bottom of the page) Don’t know how much you are testing but doing but an average of your meter numbers could be more accurate than your CGM average.

Another check might be to get one of the home A1C kits and see what it says. Unfortunately although some say these home tests match up pretty good with a lab test, others say there was significant variation.

I always download my meter numbers onto my computer and figure my average and then punch it into the A1C calculator before I get an A1c test. In doing this I have found that in my case the A1C test is not a perfect 3 month average, it is definitely skewed toward the most recent couple of weeks. This is because all red blood cells do not live exactly 3 months and so those that live less skew the result. I would look at your most recent couple of weeks average and see how it compared to your longer term average. If you have lots of red blood cells that are long lived, the result could be skewed in the other direction.

From following your thread on the Bernstein group I know you exercise intensively, I’m curious what effect your change in diet had on your athletic performance after your body became acclimated to less carbs? Also do your flatter numbers translate into feeling better as opposed to the roller coaster? If you do feel better it might give you reason to continue your experiment to see if you can figure out how to achieve flatter numbers and meet your A1C goals, surely the most desirable result.

Doesn’t it feel sometimes like all these numbers we obsess on are like grades in school? I still go there but I try to remind myself that the body is a bit of a mystery. As long as you know you’ve been doing things right and are really focused on managing your BG – ultimately those numbers will come around. But what’s really important is that you will feel well and reduce the possibility of complications.

I’m sorry to hear this, I know that you have been very hopeful that low carb would work. I do find it really strange that you got such a high HbA1c. That corresponds to an average blood sugar of 160 mg/dl. Is that really what your meter says?

If you are having to keep your average blood sugar at 160 mg/dl in order to not have lows during exercise, perhaps this has nothing to do with low carb. Perhaps this is about getting better blood sugar control with exercise?

Are you “fueling” a lot for exercise? I’ve been experimenting for a while and, while I agree it’s important to have some fuel, I think that you can have good results (sports wise…) with a lot less carbs than the 25G gels or gatorades or whatever? I used to bring high octane gatorade w/ 45G of carbs/ 8 oz for emergencies and water for hydration but tried a low octane version, w/ 12G of powder (and the powder is also quite a bit cheaper than the premade stuff…) in 8 oz and found that 1) it was REALLY refreshing when I was running in the upper 90s a few weeks ago and 2) it seems to have a very neglible impact on my BG and keeps it pretty flat, without crashing or spiking? It seems reasonable that if I run low in a few weeks as we push the mileage out, perhaps I might add in a few more grams or if it gets up when (if?) the temperature goes down, perhaps I could take a couple out? That was a lot of my problem w/ TKD, I’d run low after the first half of class and carb and then it would shoot up at the end, as we pushed the adrenaline envelope?

In every case I felt better about my 4x to 8x a day bg checks being in better control with less extreme numbers… my A1C has ticked up.



In every case where I felt my 4x to 8x a day bg checks were bouncing up and down out of control… my A1C went down.



Part of that may be lab-to-lab variances (which can be quite large.)



I’m not so sure that A1C is appropriate as an overall “diabetic quality of life” measure.



I’m not so sure that low carb is a magic bullet. In my particular case when I low carb I end up needing more units of insulin for the proteins etc. and the peak bg from proteins etc comes many many hours after the meal. It’s possible the peaks are less high, but they’re more extended unless you are bolusing hours after a meal for the proteins.

I think those on metformin (which suppresses gluconeogenesis to a large degree) get the most good from low carb. There are some T1’s here taking metformin.

I still felt better, about myself, when my A1C went up b/c I’d perhaps crazily enrolled in this gonzo martial arts program and decided I was going to lose weight by eating less and just guessed at amounts and reducing doses as I had not done a single iota of research since like 1984, missing out on “carb counting” and other things. At the same time, I was more flexible and could do the “tornado kick” that I’d seen other brown belts doing when I started and thought “there is no way in hell I’m ever going to do that”.

The next step was to get a pump and learn about carb counting and other advances of modern technology and TKD sort of provided the motivation and focus to do ok at that too?

Thanks so much for all the suggestions and encouragement, everyone. Your ideas are helping me to think about what may or may not be going on here. My (former) endo used to insist that frequent lows weren’t having the kind lowering effect on my A1c that I feared they were … but I think I may now have evidence to the contrary. On the whole, I’ve indeed been experiencing fewer lows, so there’s the possibility that, without those lows, this is the average I’m left with.

Re. exercise, I do a combo of temp basals and carbs, with a preference for the former. A fairly common scenario might go like this: I start trending highish (8-10 mmol) in the late morning / early afternoon while at work (extended protein effect that Tim mentions, maybe? … better than a spike to 14, I’ve been thinking), but, knowing that I’ll be cycling home in the mid-afternoon, then doing a workout after that, I hesitate to go after those 8s or 9s or 10s with a correction.

What to do, what to do … ? Wish I didn’t have to wait another 3 months for a re-test. As far as I know, I can’t get the A1c Now in Canada.

Anyway, thanks again!

Heather, A1c Now in Canada ?? … try Bayer 1-800 268-7200 and possibly they can advise …I have used the promo at Safe On Foods /Pharmacy in the past ; the CDA’s Professional Conference and NAGM’s …always found with my results that A1C Now is lower by approx. .4 compared to lab results .
I also like to suggest to contact friend Chris Jarvis …an elite athlete …his suggestion , when I was into marathoning : temp basal as soon as I crossed the finish line , cancel the temp basal … do a bolus to avoid the hi’s after
exercise ( in my case I did .2 u ) …and it worked …

What I do when my BG is up before I’m working out is cut the CB but still take it, maybe a 50-75% CB? Today I worked out ok w/o needing it but the last two weekends I had wierd BG spikes before I worked out and that worked ok to get rid of them.

Heather,

Don’t be discouraged by the higher A1c, remember that it is the accumulation of highs and lows that will cause the long term complications, not the average BG number. If you have reduced your lows, that is likely what increased your A1c. A1c is only a reference to how aggressive you are with your insulin, it tells nothing about how tight your control is. Analasis of CGM data is a much better way to judge how well you are doing. It sounds like you have reduced the frequency and severity of your highs and lows, this is a great thing! Keep up the good work! Let the CGM tell you how well you are doing, not the A1c. A1c is a very primitive method of looking at BG control, right now CGM is still considered new and experimental by the medical community, once CGM is considered as standard treatment, it will replace A1c as the measure of well you are doing with your BG control.

Here's a recent thread about obtaining an A1C Now in Canada. I think she just ordered it from Amazon.

7.2 = 160/8.9 so maybe your A1C is correct, that was a long shot at best anyways.

I am a T2 not on insulin, so I have no personal experience in this, but I do know it is very tricky. I know Bernstein recommends starting normal and taking small amounts of glucose tabs at measured intervals during exercise, using only enough to keep stable. These carbs do not count toward your daily carb total.

I also seem to remember some insulin users suddenly having to account for protein and to a lesser extent fat when they significantly cut their carbs. Have you checked out the TAG Group here at tuD? They have techniques to deal with this.

It actually seems you have made a lot of progress if you are avoiding 14's(253) For reference an A1C of 6.0 = 126/7.0

I place a lot of stock in the idea that spikes over 140 cause the damage. According to this idea someone could have a decent A1C, but with frequent lows masking damaging highs. By this line of thinking someone with a higher A1C could actually be doing a better job of avoiding complications, if they were avoiding highs and lows. Some people think that a combo number which takes into account A1C with standard deviation would be a better measure. The tools we have now are imperfect especially if you are not a big numbers person.

You hit the nail on the peg. The A1c is NOT the gold standard that the medical profession thinks it is. It only responds to highs and lows, and while having a lot of lows will give you a “good” A1c, it is NOT an indication of good control!



That’s also the reason why I’m furious that they have decided to use the A1c as a diagnostic tool, abandoning the OGTT which is what REALLY tells you how a person is processing glucose. They say it’s less of a hassle for the doc and the patients, but a misdiagnosis is MORE of a hassle, and far more dangerous in the long run.



There is also the TOTALLY ignored issue that some of us are low glycators, some in the middle, and some are high glycators, so different people get different A1cs with the same BG averages. Estimated average BG is even worse. Last year, I had a severe depression for months, during which I was taking care of my diabetes, shall we say, less well than usual, and I was running between 400 and 600 for at least 2 months. A week before I went into a coma, my A1c was 10.7 – eAG was 253. Huh? Does not compute!!!



If I were a conscientious diabetic, like AcidRock (my hero!), I should have an A1c in the high 4’s or low 5’s, but I’m not, so I was satisfied with my most recent 6.0, but I KNOW that it indicates an average BG in the 140’s or 150’s, NOT what the charts show.



So I think, in the end, we need to know our own bodies, and what our personal parameters should be – the charts are based on statistics, and WE aren’t statistics, we’re individuals.



Heather, keep working on it – I think the flatness IS a good thing, and more indicative of good control than the A1c ever will be. Talk to other athletes, and maybe you can refine the way you handle your BGs, and maybe bring the line down further as a whole. But I think you’re headed in the RIGHT direction, not the wrong one.

Thank you, Natalie!

Forgive my ignorance, but what is the OGTT?

Oral Glucose Tolerance Test. They test your fasting glucose, then have you drink a 75g solution of glucose OR send you out to eat a carb-heavy breakfast, and then test you every half hour for 2 hours to see what your BG does. Normal people should start under 100 and never go over 140 during the whole 2 hours. If you go over 140 but stay under 200, they diagnose you with pre-diabetes, and if you go over 200, you’re definitely diabetic. This is obviously the best method for catching Type 2’s because they are often asymptomatic, and can have normal fasting BGs and only show abnormalities in the postprandial BGs. But Type 2’s are also more likely to be diagnosed only AFTER they have developed complications, and that is a tragedy. The best time to deal with Type 2 is to attack it BEFORE it actually develops – even delaying it by 10 years can give better quality of life and head off complications.

Of course, this does not apply to Type 1, simply because the onset is usually faster, and more dramatic. There is usually no doubt about classic Type 1. But it COULD help identify LADAs earlier, and I am a proponent of early diagnosis. The OGTT is more expensive than the A1c, but certainly less expensive than complications, and quality of life for ALL diabetics is a biggie in my opinion!