Should Geezers run Higher A1c's?

Hi,
I’m a Type 2. was diagnosed 27 years ago with an A1c of 9.0. Once I got over the shock and awe of the diagnosis, I found Bernstein and got my A1c down to 5.5.

In recent years I was doing well on glimepiride until my doctor told me I’d gotten sooo old that pills could give me unexpected lows. So I got shifted to Tresiba.

My A1cs have been running 6.0 to 6.5 lately.

But now my doctor is telling me that I need to increase my A1c to 7.5. I’ve worshiped at the altar of Bernstein too long to want to do that. I actually laughed. She probably thought I was rude.

She didn’t seem to have a convincing explanation why that would be better for me. She just insisted it would be ‘good.’

Later at home, I googled, and found a recommendation that for geezers my age 8.5 might even be good! Ugh. But even that web page didn’t seem to have a convincing reason. It only seemed to suggest that since geezers aren’t likely to live more than 10 more years, it would be okay. I can only think of a really cynical reason why a 10 year limit could be considered good by any stretch of the imagination. But maybe there’s a non-cynical reason I should know.

Can anyone tell me why a 7.5 or an 8.5 would be good for a codger?

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I’d say get a new doctor.

I think it might be ok for doctor to mention it as option, but to not change things if you prefer. Using “need to” suggests a one size fits all attitude which is unacceptable to many.

For those already struggling to get to 6s, and are older, offer it as a choice, depending their current health and mental capacity.

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I think the issue is that you have not defined what you or your doctor consider the age to qualify as a geezer. I am quite young at 72, almost 73, and would run so fast from any doctor that even considered anything over 6.5 acceptable that I would need to be careful not to trip and hurt myself. I run in the 4.8 to 5.2 range which works best for me.

If, however, you are well into your 90’s, then I agree that a slightly higher maybe even up to 7.5 would be OK if you think you will only live another 10 years or so and perhaps have other underlying conditions. It all depends on other factors as well as how much you exercise, how strict you want to be with your diet, and how maniacal you want to be about blood glucose control. Some of us are a bit obsessive, and we have to balance lifestyle/diabetic A1C goals.

Anything over 7.0 will give you complications that will cost you time, money, and a shortened lifespan.

Diabetic control is all about A1C, Cholesterol Control, Atherosclorisis Control. The balance of those 3 elements is what determines both your lifespan as well as your quality of life while you are living. Don’t dwell on one while ignoring the other two.

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Well Edd, I am 70 and my alc is 4.8. I am hoping to live at least 10 more years. The ACCORD study of a few years ago suggested that older people who had A1c’s lower than 6.5 were more susceptible to dying early. Many doctors insisted that their patients had A1c’s of at least 6.5 after that study came out. It turned out that the study was flawed but that fact was not as well know as the study.

If I lived by myself, I would probably want an A1c which was a bit higher than 4.8, but I would still want to be in the non diabetic range.

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Thank you for your post.

4.8! That’s fantastic. My doctor nearly had a heart attack the last time I had a 5.6. I had to promise her I wouldn’t try to go lower.

That’s for the reference to ACCORD. I’ll try to look up what it has to say about (heaven help me) elderly diabetic A1cs.

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You’re quite right about individual condition.

As I understand it, the docs consider ‘elderly’ beginning 65 and they have worse names to call you once you reach 80.

As for me, I’m 75 with some comorbidities that are pretty much under control.

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Edd, look up what Dr. Bernstein had to say about the study.

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There was a study released I will try to find it. It said that hypo death increases sharply at 70 for those using insulin.

So I expect your doctor read that study.
However if you are on a cgm and or if you can still feel your lows, I don’t see the point in going that high.

Even when I was not using any glucose testing at all, I was never above 8.

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They try to run older people higher. I kinda think its an excuse not to provide treatment or decrease their own liability. I’ve heard this myself and I’m not THAT old (under 40).

They will often run old men around 9 without a concern in the world. It leads to miserable experience of old age with constant discomfort due to infections and sometimes amputations as a consequence. I have seen them tell people it is unsafe to run lower even when they are married to very competent retired nurses.

I think this is pretty negligent medical advice because you need to inform people of the risks of any treatment decision. They just say, “Its safe,” and they rarely list all the horrible consequences of following this advice. That’s distinctly unethical.

You sound perfectly competent to me.

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This is a difficult issue to make conclusions for a population with wide ranging abilities and deficits. I think overall, doctors themselves are impaired by the fear of hypoglycemia. Their fears make sense for some patient profiles but I see as over-reactions for many of us.

If the patient has a good cognitive ability, understands their vulnerability to hypos and keeps their glucose variability in a relatively low range, then I think the docs should relax their concerns.

An A1c below 6.5% should not be the measure by which physicians should screen for counseling their elderly patients to back off on their glucose control efforts. They should instead use CGM and monitor glucose variability as indicated by standard deviation (SD). If their patient doesn’t normally use a CGM, then they should put them on one for at least a 14-day period or two to discover what their real-world glycemia is all about. The A1c measure by itself misleads.

If the SD is below 30 mg/dL then they should back off their “hair on fire” recommendations to raise A1c into the stratosphere. An A1c of 7.5% means an average glucose of 169 mg/dL. That means spending a lot of time above that already high level. Incidence of infections, kidney disease, heart disease, eye disease, peripheral neuropathy, and degraded balance all go up at these levels.

What does your doctor think about these hazards? Seems like a poor trade-off for the more capable members of the elderly cohort. You appear to live in the more-capable strata of that group. Why doesn’t your doctor see that?

If you can demonstrate to your doc with a lower glucose variability that their fears of hypos are over-blown, then running an A1c in the 6-6.5% range seems conservative to me.

It seems like we have enough to manage without adding soothing the fears of an overly-nervous doctor to the load. I think you’re doing well!

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Hi Edd. Don’t pay attention to those people who want your A1 higher. There’s a new ACCORD analysis out that admits that some people benefit from lower A1cs. They’ll never admit they were wrong.

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All kinds of studies out there. In my opinion diabetes is an individual managed disease. I will be 69 in a few months. Look at 2 different type 2 one exercises, walks and swims. The others exercise is turning the pages of a book. Does little activity. The risk of falling or damage from a low in the second person would be more a risk I am thinking. I make a plan with my doctor 6.2-6.5 ,I have been at below 6.5 for many years. I would tell my doctor that recommendation is not acceptable to my plan. Nancy50

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I remember my new internist sort of freaking out about my A1c at 5.3 at the time. "That’s too low, don’t go lower, be careful "etc etc. My new internist was also literally a newer graduate and I’m sure taught these things in school. She has now stopped freaking out about it as I guess she has decided I’m okay.

My endo had much more sense and has always said I’m doing great, She doesn’t care that I am at 5.1-5.3. I have said one of these days I might try for under 5 and she doesn’t care.

I will have to tell you that my endo has said almost no one has close to my numbers and we all know how swamped endos are with patients. That tells me that most diabetics don’t aim for low numbers. My DE has said most of her type 1 elderly patients don’t care about watching their numbers in the first place much less keep close track of how they eat and what BG levels they go to etc.

Eye opening and shocking when I first heard that. I remember someone saying on this board that we are distinct because people on this board care more and it’s not the general population. But I always thought it was at least a percentage cared, but I have come to conclude it’s a very small percentage that care. The podiatrist made a comment that he is amputating a toe almost every day, he loved my numbers.

So if you take the majority of diabetics run higher anyways, a majority take only slight interest of their numbers, I have a feeling it makes sense to them to say run higher versus lower. But hopefully doctors will take us as individuals and will realize that some of us do great at lower numbers and that it has benefits.

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The initial result from the ACCORD caused quite a stir and was widely reported and believed. What isn’t widely known and corrected, is they were almost certainly wrong.
ADA articles

PMC

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What meds are you on that can cause a hypo and how often do you hypo?
I’m 70 and on Ozempic with no hypos and an A1c of 5.4%

I can answer at least part of this question. Glimepiride is a Sulfonylurea, it acts by increasing insulin release from the beta cells in the pancreas.

Right. I’ll do that. thanks.

I’m sure my doctor’s concern about hypos is her reason for wanting me to increase my A1c. I’m not on CGM. Would love it of course, but frankly, she was reluctant to prescribe 3 test strips a day. She insisted 1 test a day was more than enough. She has me on Tresiba and she still thought 1 test a day was sufficient. But she conceded to 3 due to my charming smile and abrasive personality.

I haven’t had any lows. She had me on 80 units of Tresiba nightly. I trusted her and shot 80 every night until I had a streak of fasting readings in the mid 60s. Even she advises number under 70 are too low.

I felt no hypo symptoms with those readings in the 60s, but I didn’t want to risk going lower, so I violated my doctor’s orders by reducing my nightly dose for a while.

Once this had my attention, it didn’t take much to realize my bedtime reading sharply influenced my fasting reading the next morning. I keep my BG log in an Excel spreadsheet, so it’s easy to sort to see what bedtime readings and doses result in what fasting readings. I’ve used this to adjust my nighttime dose. I aim for a fasting reading of 95. (She wants my fasting up around 130.) This has kept my fasting readings well above the 60s since. And It’s allowed me to wake with a reasonable reading after succumbing to a massive carbing out on a bad day.

She still wants me to to shoot a straight 80, but conceded I could adjust my dose within a narrow range. I fear she could reduce my Tresiba script, so I haven’t admitted I vary more than we agreed. A few nights ago, I shot 40 on a bedtime reading of 116 and woke with an 88. 40 is a good 30 units less than she recommended. And I’ve shot more after pizza and ice cream (I know, shame on me.) My last 2 A1c’s were 6.0 and 6.5.

I think that too.

and you to me! :wink:

Sorry TL:DR
I haven’t known many diabetics IRL. I met a neighbor with bandages on one leg covering sores that never healed. One day he returned from a doctor visit with the ‘good’ news his doc wanted to install a shunt in his arm so it would be fully healed when he went on dialysis. I tried to tell him he wouldn’t like dialysis. He didn’t test or even know what the numbers meant. I got him a meter, but he never tested himself. Then he moved; I moved; we lost contact. A year later I ran into him at a grocery store. His one remaining leg was wrapped in bandages and from his wheelchair, he was shopping for a chocolate cake.

My cousin was so ashamed of his diagnosis that it only slipped out by accident. His feet were numb. He’d been hospitalized for a deep sore on a foot he couldn’t feel and nearly lost his limb. He’d been hospitalized for numerous infections. My ego jumped on its white charger and went to tell him how to take care of himself. I got a glimpse of his BG log that day. His numbers ran from 500 to 650 even though he was on insulin. He wasn’t interested in help. He actually said something like, ‘I’d rather be dead than miss desert.’ Six months later, three heart attacks one week gave him his wish.

I’ve heard over and over that diabetics always go bad.

I think those of us on Lists and in forums may be the only ones who believe we can make a difference to our own health.

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