Doctor unhappy i am in 5 club

can this be?!!? went to the doc for the a1c result and it was 5.5! i think that is wonderful and was expecting a well deserved pat on the back and a "good job". and she said this was dangerous and what was i doing eating low carb, giving me the standard low fat diet, 200 carbs a day handout. i am just so perplexed by the fact that we werent on the same page about these results! lower is better! she pointed out that the good range for diabetics is between 6.5 and 7.
mind you, i have had some lows from the honeymoon jumping all over the place but there have also been some highs. i actually expected an a1c in the 6s after a couple of weeks of postprandial highs. the best thing would be to have no highs/lows but i think this is an impoossibility.
i just really expected a "wow, youre fabulous" moment. im too big on getting the gold stars, i guess! :(
are your doctors haapy with an a1c in the mid 5s?

My doctor actually complemented me for my 5.7 but I think this is unusual. Doctor's are hyper conservative when it comes to lows and they have been brainwashed to the belief that anybody who achieves that low an A1C did it at the cost of lots of lows (averaged by lots of highs). Your doctor is just plain wrong, and if you have any doubt consider his dietary advice!

Having said that, I have had two A1C's in the last year both of which were 5.7. The first one was the result of hard work and good control. The second one reflected a period during which I had some problems and had lots of highs and lots of lows. My doctor doesn't know any better (and yours would criticize both!) but I was a lot prouder of the first one. Occasional lows are a normal part of Type 1 as are occasional highs. But only you know if your 5.5 was achieved at the expense of too many. But your doctor makes that assumption out of ignorance.

Congrats on your great A1C!

Hate to do this, but when A1Cs are that low, it means that you are having a LOT of low glucose readings. I got the same thing from my doctors for a couple of years.

My last was 5.5 up from 5.1. WAY too low to be healthy and happy.

I have to say that since I actually listened to them and have eased up slightly on my readings, I feel a lot better. I rarely have a reading over 150, but also do not have readings at 40 or 20. I can actually feel when I am low more accurately.

Life is better. Pressure is less. I have even removed my CGM for the last three weeks and am LOVING the freedom.

That is a general statement that I disagree with, Spock. Though many doctors believe that to be the case, and sometimes it is, there are many people on here that have achieved A1C's in the 5's through hard work, frequent testing, low carb and just having agreeable diabetes ("the luck of the draw"). My own first 5.7 was achieved with a minimum of lows and just a lot of stable numbers. Your own description of a 5.5 with "rarely a reading of 150 and also do not have readings at 40 or 20" is a great example.

My endo prints out 2 weeks from my 1 touch ultalink and looks at the highs and lows and their time of day. The A1c is the last thing he even mentions to me. He does want me to keep it below 7.4 though. He says complications start occurring at that level or above.
He would prefer I keep the bg within a more narrow range but I have never done that. Will power?
I tend to agree with Spock though, and your doc, on the dangers of a 'normal' A1c. And for me, anything below 6 would require a huge amount of time, effort, and attention. I think the lowest I have been is 6.4. On the other hand, I have not been above 7.4 more than once or twice max in several years.
How many hypos have you needed help with during the last 4 months? If none, then I don't know how to explain the 5.5. Could the lab be wrong?

Why would the lab have to be wrong if someone got a 5.5? Though it isn't possible or even desirable for everyone, many people maintain an A1C in the 5's without excessive lows. "How many hypos have you needed help with during the last 4 months?" I've never had a hypo I needed help with (which is good since I live alone!) and I got a 5.7 with a minimal amount of moderate hypos. (On my last page of numbers which is about 3 1/2 weeks worth I had 7 lows, the lowest was 51 - that's about 2 per week.)

This is a curious post. I am T2 not T1 and after 30 years buggered up; finally got mess back to 6.4 from 13.3. My eyes, kidney's weight healed and off of the actos.

While it may be desireable to get ones a1c/average bg like a normal person and if you can - great.

But data I have researched and from my Doctor is as follows:

a) less peopele die in hospital and heal faster when BG is averaging 140 up. Trying to maintain the 110 numbers can be death defying.

b) Doctor's goals is to keep people alive and reduce risk. AFter all he is the ones safety officer. Once proven diabetic - risk for lows goes up along with liver malfunction. I can see why Doctor would be concerned about anybody as proven diabetic attempting to run as normal person. He does not want them dead on his watch should they cycle too low and liver is not adding glucose when BG goes sub - 70.

none!! none!! i am honeymooning and i give lots of credit to that, though i have worked hard to figure out my ratios and keep myself in check! as i said honeymoon has been really up and down this past month, more or less and thats why ive had highs and lows. ive changed ratios every week for the past four weeks, sometimes with just days in between changes.
the lows i have been having always have to do with exercise and i think its because im learning how to be a "real" diabetic, out of the honeymoon at times with less counter regulatory powers..
thanks for the congrats zoe! gold stars, gold stars!

thats not a bad average for hypos! next goal: less hypos.

First off, congrats.

I've never hit the lowest was a 6.2.

I think that for people that do not have diabetes a "6.0 or less" is considered healthy. To me, that means that I would like to have a 6.0 or that I can avoid complications that come with elevated glucose levels.

I think that ZOE is right when she says that your doctor is making assumptions. With that being said, I'll hang out over here with my 7.0 a1c and worry about highs, and you should hang out with your 5.5 and worry about correcting your lows.

First of all congrats on a wonderful HbA. It may not be the ideal 5%, like that of the one Zoe had without all the highs and lows, but it is still far preferable to a hba of 7% and a diet of 200g carbs. My GP told me it was dangerous to have a hbA like that of a normal person, but I have long since stopped listening to the view of some doctors. My aim is to lower mine eventually to 5%, sooner rather than later. I have found in my case it takes an enormous amount of work, but I have mild kidney damage, so I'm hoping to reverse it. Again congrats on a great hbA and I hope you can iron out any highs and lows you have in the future. It is possible.

First, I think that's great. If you're able to achieve an A1c that low without having tons of hypos, you're doing something right as far as I'm concerned! If you're not having constant, debilitating lows, it sounds like you're doing fine, so give yourself a pat on the back!

Everyone's diabetes is different. What works for one person may not work for another person. If this works for you, stick with it and perhaps find a new doctor.

The A1C is just one measure, not the ultimate measure, that should be looked at. You should also be looking at your range - for example, are you constantly bouncing from 30 to 300? If so, that's bad. But if your range is generally within 70-140, you're doing good and staying away from the numbers that will cause you long-term damage.

The concern endos have (I think) is that severe, repeated lows can be dangerous. If you are constantly going low, you'll eventually lose your ability to feel those lows (developing hypo-unawareness). That's BAD. BUT, if you're rarely dipping below 65 or so, you don't need to be too concerned.

My doctor also expresses concern over my "low" A1c and I can't fault her. She is concerned about hypos. And hypos are a valid concern. Most who achieve an A1c < 6% not only work hard to achieve blood sugar targets (like < 140 mg/dl 2 hours after meals), but they work very hard to reduce blood sugar swings. And if you don't control your blood sugar swings you will encounter more and harsher lows as you attempt to tighten your blood sugar control.

Perhaps next time, you can show your doctor how much you have reduced your variability. I measure my standard deviation and record how many times I've been below 70 mg/dl and how many times I've been below 50 mg/dl. When I tell my doctor these numbers, all questions about whether my A1c is too low stop.

Actually, Josephine, PW had me beat by .2 - not that anyone's counting! And she described "some highs and some lows" which I, like all of us have, but (at least in my "good 5.7") not to excess.

"I have long since stopped listening to the view of some doctors"

Sounds like a sign of intelligence to me!

More like a desperate attempt to survive Zoe rather than any great intelligence. I love reading your straight to the point posts and admire your hbA. It is serious hard work.

Five percent a1c can be dangerous although there are some who wouldn't agree. My dr agrees with what your dr said although he doesn't get bent out of shape as yours did. But I have had 5%'s and I must agree it is dangerous because of the frequent lows. I try to keep mine in the 6% range if I can.

oooh, i see my endinosaur, i mean, endocrinologist in a couple of weeks and im gonna bring her that. well, ill work it out and see how good it is. i think its all right though. good advice, ta!

Congratulations on the great A1C! I think aiming for a low A1C is just a different risk. You are minimizing the risk of long term complications, but you are increasing your risk of short term lows. If you are not experiencing many BGs in the 50s or 60s and have not had any hypos that you need assistance then I think you are doing great.

I would like to further add that a new line of thought (certainly not proven) is that if you can maintain near normal BGs after diagnosis, then you can may be able to prolong your honeymoon. And it you may have more functioning beta cells after your honeymoon ends. These are all good things that may help with control and avoid complications.

On a personal note, I blew a 5.6 at my last endo meeting. My endo and I agreed that with current insulins and technologies I could not get my A1C lower without substantially increasing my risks for lows. Or I feel that 5.6 is as low as I can reasonable go.

I'm incredibly interested in this discussion! BRIAN, regarding your response, would you elaborate on how many times you've been below 70 and how many times you've been below 50. What IS "acceptable" (number of lows) to your doctor?

I am type 1 for 3 years this November. I have just changed endo's (see new doc next week) because I believe I have been receiving terrible care since diagnosis (you name it, I've experienced it). My former endo always demanded I run myself around 175-200, I refused and tried for between 90-140. I would average about 2 below 70's a week, and 1 below 50 per week. However, I also had a terrible time with almost at least once daily highs (180-250) DESPITE carb counting, eating "right," and trying everything to avoid the highs (the lows) and the roller-coaster.

My doctor insisted I should only be going below 50 no more than two times a year and below 70 no more than once a month. I felt terrible when I tried and could acheive the 175-200 range he wanted me at, and I couldn't get him to help me figure out the highs and the roller-coastering between 90-250 because he just blamed them on me for trying to stay between 90-140. Ideally, If I could just run around the 120/125 range without the *&$@! roller-coaster I'd be happy!

My former doc also wanted me on pump, but I never felt "ready." I am informed that my new doc is a big fan of the pump, I do have a Ping, but to be honest with everyone, I'd much rather stay on MDI than have to deal with pump. I think I could acheive decent numbers on MDI because I am not an in-between meal snacker, but ugh, there are sooo many different opinions on almost every aspect of this STUPID D that a person could really go crazy!

Sorry I got off point...What my Tu D friends do you people think is acceptable number of lows below 70 and lows below 50? (I will agree that after a low I feel brain fog for hours or days, and yes the more lows I have the more hypo unaware I become). (P.S, my current A1C is 7.9)

Thanks for a great discussion pancreaswanted and all who are contributing here.

You got that right! I also have an advantage in that I wasn't diagnosed until the month before retirement. Though I still work part time I still have significantly more free time to spend managing my D than your average person with a full time job and a family!