Can Hba1c go too low?

By jigsaw Latest Reply 2015-06-26 14:53:00 -0500
Started 2013-01-25 10:30:03 -0600

Allow me a preface to this discussion with the fact that there is no exact or most correct answer known in the field of medicine. There are many opinions howevever, even amongst professionals on this subject.

So, what do you believe is the ideal a1c for you? How low is ideal?

My team of diabetis specialists believe that an a1c of 6.5, but no lower than 6.0 for a type II will drastically cut the chances of related complications, and maybe even eliminate them.
Dr. Bernstein beleives the lowest a1c approaching 4.2 to 4.5 is good!

After almost 19 years of living with diabetes, I still contemplate the question of ideal a1c. Obviously, a non diabetic that eats healthy foods will more than likely have a different a1c, than a diabetic that eats the same foods. Should we factor this in, when figuring the ideal and lowest a1c to achieve the best health?
What is your opinion and conclusion if any?

Here is an interesting link on this subject!

58 replies

naregupt 2015-06-25 09:28:25 -0500 Report

I am a diabetic patient for over a decade. With regular mediaction my HbA1C remained in the range of 6.2 - 7.1. In december I had ITP problem and was put on heavy doses of steroids. Accordingly my sugar management also continued. Steroids were stopped in March. After that my fasting glucose level is in the range of 120 - 130.

Couple of days back I got my HbA1C tested. It was very low at 3.5. Got it retested thrice but it is almost same.

What could be the reason for such a low HbA1C when fasting glucose is in the range of 120 - 130.

Grateful for your advice please.

jigsaw 2015-06-25 17:38:01 -0500 Report

Have you checked your bg ( blood glucose in the wee hours of the night ? Sometimes it is possible to have lows while we are asleep. This would be one potential explanation for such a low A1c. This is assuming the lab results are accurate also. Since A1c is based on a 3 to 4 month average of ones bg, it would appear that you may be experiencing lows, and maybe not aware of it. Just food for thought.

naregupt 2015-06-26 12:40:01 -0500 Report

Thanks for your quick response. I will check sugar level in vee hrs and advise outcome. Howeverone input: I had ITP problemin Dec last and since end January this yr am taking Depsone100 mg every day. Due

jigsaw 2015-06-26 14:53:00 -0500 Report

Generally speaking, it's usually a good idea to alter ones diet, diabetic meds, and or exercise routine, to stabilize blood glucose. The advise of a well informed physician and or dietician where appropriate, is always a good idea. I'm not aware if Dapsone affects blood glucose, but I would certainly approach my doctor on the subject.

CJ55 2013-01-31 00:02:01 -0600 Report

I am a T2 and I have been on Humalog and Lantus and several different meds.. My sugars still go up and down. Now I am on victoza & U-500 Insulin and doing much better. My A1C last month was 5.4. I was very pleased with that.

jigsaw 2013-01-31 08:50:47 -0600 Report

Very nice, and definitely something to be pleased about!
Since I have recently started with Lantus and Humalog, I would definitely like to compare experience with you.

GabbyPA 2013-01-29 09:51:34 -0600 Report

My doctor will switch me from quarterly visits to biannual visits once I drop below an H1c of 7 and mine is currently 6.7. He is happy with that, but I would like to see it lower because for me, I know it can be better.

I feel that the more "normal" range we can achieve the better. However, that is without dropping the bottom out a few times a week. I have never had that problem, so I know my numbers are "safe" at this time. But if you are dropping low just to attain a lower H1c, then that is dangerous and should be addressed.

I guess it's kind of like the skinny syndrome. If you are thin and healthy and are that way without messing up your body with stupid habits such as purging or starving yourself, then go for it. Like anything in life, we have to have balance.

MoeGig 2013-01-27 09:35:06 -0600 Report

For me as a 46yr T1 diabetic, anything under 6 is too low. I use to aim for the 5's, but in doing so would too often over correct with the huma/novalog creating a very low BG requiring a 911 call to wake me up. I believe huma/novalog injections are like handling dynamite. If you guess wrong (trying to keep your sugar low), then it can be very dangerous. EMT's have told me that they have made a number of calls where the patient doesn't recover from a very low sugar. A1c in the 6's is fine. If you're T2, then maybe it doesn't matter as much since most T2's don't typically have the extreme lows..(not on huma/novalog).

jigsaw 2013-01-27 10:00:38 -0600 Report

I've been on Humalog for a couple of weeks, and so far it's working out well for me. I'm a type II and 6.0 has worked well for me during the past 20 years. I'm aiming for another 20 with equally good health.

MoeGig 2013-01-27 10:36:57 -0600 Report

Maybe it's not, but it seems unusual to me for a T2 diabetic to be on humalog. Usually they're on Lantus, a steady baseline insulin. I'm on both Lantus for the base line and humalog to cover the extra carbs. My only advice would be to be very careful if you take some before bed. If you guess wrong earlier in the day then you'll notice the low…at night you don't. But it sounds like you're doing great. Congrats.

jigsaw 2013-01-27 11:25:04 -0600 Report

Your advice concerning lows is well taken. Actually, I have been on Lantus also for about a year give or take. I take one shot of it at bedtime. I had to stop taking Metformin because it caused severe constipation, even with the extended release version. Metformin also caused severe heartburn, and an inability to clear my throat. It did a great job of helping me with my bg though. Now that I'm off Met, all these neg symptoms have cleared up.To make a long story short, I have used numerous oral meds over the years. Now that I'm on mealtime and a baseline insulin, I can smile once again! I'm sure this is due to the fact that my digestive funtions have become efficiently effective unlike with Met. Having an endless supply of bg strips, I check my bg quite frequently, and I am very pleased with the results. By the way, I have not experienced any weight gain.

Nick1962 2013-01-26 18:15:25 -0600 Report

While I’m sure there is a dangerously low A1c, like others (and your link) have mentioned, it would be patient/condition dependant. If you were a 125lb, wheelchair bound 70-year old woman, 5.5 it would probably indicate some form of nutritional deficiencies. However, if you were a 38 year old muscle head contractor like a friend of mine, I wouldn’t think twice at a 5.5.

Bernstein isn’t the only one who advocates a low A1c. Many doctors now believe that certain people in certain age groups (like me) who have a predisposition to certain conditions like heart problems should be under 6. I have no problem keeping it under 6, but I have learned that trying to hold onto my low of 4.9 was a challenge, butalthough I did lose a considerable amount of weight which I needed to do. My blood tests all confirm that I’m in pretty good shape holding around 5.2-5.4.

I think it is important however to not make the mistake of equating a low A1c directly with low carb eating. There are many nutritional and medical things that make up the A1c average, and you can still eat low carb and maintain a reasonably high A1c. I for example avoid corn and carrots due to the sugar content. For years, carrots were my go to snack, as was popcorn. Pretty standard diet fare right? In the amounts I was consuming, switching to celery and peanuts dropped my daily average BG’s by 10 points, and thus my A1c.

I also think that how you get to that low is important as well. If it’s a slow change over time, I think that would be good. Quickly however shows some form of drastic measures taken which may not be healthy. If we go back and examine the Paleo diet on which many survived, sugar and carbohydrate consumption varied by region, and usually came in the form of whole foods. Things like a high A1c 100 years ago would have probably been reserved for the wealthy (who could afford food and over-consumption, and were reasonably sedentary). We need to consider history as well. That magic 7 number we use today is what we consider healthy now. Had we known about A1c 100 years ago, that number may have easily been 5 based on how they ate then. I’m not going to start eating badly again to UP my A1c to 6.5 just because the medical community speculates that a low A1c MIGHT have a negative effect. To me, given my current health, that seems contradictory.

jigsaw 2013-01-28 18:06:47 -0600 Report

What am I missing? I fail to see the correlation that you were making, by using carrots and popcorn vs celery and peanuts as an example. Were you referring to quantity as a potential culprit, or being unaware that to much popcorn and carrots can increase a1c?

Nick1962 2013-01-28 18:41:28 -0600 Report

It's kind of multi-part. Some foods simply have higher sugar content and that goes into your A1c as well. You can still eat low carb and have a higher A1c depending on your choices and amounts. Just like you can eat low carb and have high cholesterol depending on your protein choices. You have to look at the whole picture with foods (fats, sugar, carbs, protein, fiber, vitamins, minerals).
To satisfy myself, I ate way more popcorn than i do peanuts, and carrots have 4g more sugar than celery. Since those are what make up "staples" in my diet, just those little tweaks made a difference.

jigsaw 2013-01-28 18:55:38 -0600 Report

Ok, I see what you are trying to say. I personally, don't separate sugar from carbs since sugar is 100% carb! That's why I wasn't sure where you were coming from with your example. I would certainly expect peanuts and celery to have less of an increase on one's a1c, then carrots and popcorn. Of course if you eat enough peanuts relative to a small amount of popcorn, that could change the results. Looking at the overall picture as you mentioned is not to be overlooked!

Nick1962 2013-01-29 09:15:25 -0600 Report

Well, see that’s where you and I differ. I separate the two because they are not equal and serve different functions metabolically (and why they’re listed separately on food labels). While it’s true carbs end up as sugars and therefore energy, they have to be converted by your body to do so. It’s that conversion process that acts as a sort of “time release” so based on the type or makeup of the carb consumed, you can “meter” that energy for short or long term use. Carbs provide nutrients for the bacteria in your intestinal tract for digestion, and help your body absorb calcium. Carbs convert to glucose and glycogen which is stored by your cells until needed in your cells, blood, muscles, and liver, the excess (if you eat too many carbs) is converted to fat. (you already know this, I'm only putting it here as a public service for those who don't)

Sugar, on the other hand goes into the bloodstream, gets used and it’s gone. It’s not stored. If you take in sugar, you can fairly effectively power your body energy wise, but you don’t have the necessary nutrients for your body systems like muscles that carbs provide. Plus once you stop taking in the sugar, you’d crash, and without the stored glucose and glycogen from carb consumption, you’d pass out. Liver dump, as you know, is a release of the stored glucose from carb conversion.

So here is where we agree on extreme low carb diets. Lowering carb levels to reduce fat is a good thing, but lowering them to levels that do not provide the necessary stored energy is dangerous. As you burn energy, your body consumes the stored sugars, once those are gone, its starts in on the fat, after that, it goes after the muscles and tissues.

So, pulling this all back to your original question - can A1c be too low – yes, but it depends on what makes it up. You can maintain a 5.0 eating a steady diet of celery and chocolate chips (a straight sugar diet), but you’d probably have some pretty nasty hypo episodes at night, and of course once your fat reserves and muscle had been used up, you’d die. You could also maintain a 5.0 with a steady, controlled diet of pasta and tomato sauce, and provided you knew your burn rate, could probably do it for a long time because that A1c is made up of carbs that not only feed the whole body, but provide the necessary energy when its needed. My A1c now is not made up of the same things it was 3 years ago. I don’t need to attack those fat reserves as much anymore, so those carbs I had been over consuming (and storing as fat) can now come back into my diet a little more.

jigsaw 2013-01-29 17:38:30 -0600 Report

Sounds like your referring to complex carbs vs simple carbs (aka sugar in some cases) when referring to the conversion process or breakdown into glucose.
If I'm not mistaken, both simple carbs and complex carbs are converted to glucose. As you mentioned, complex carbs take longer to convert as opposed to simple carbs that are converted to glucose very quickly. Regardless of the source, glucose can be stored in the liver as well as converted to fat such as triglycerides when consumed in excess.

A good link for those that might be interested!

Nick1962 2013-01-29 17:59:01 -0600 Report

Yes, yes I am, and no you are not mistaken.
I differentiate "carb" sugar from other sugar (like in soft drinks, candy etc.) because some sugars (like fructose) need to be transported directly to the liver in order to be metabolized or processed by your body (that’s the killer on trigs and your lipid profile), while others can also be used directly by your muscles and brain without involving the liver.
The sucrose found in table sugar and maple sugar is about half glucose. Dextrose is 100 percent glucose. So going out on a limb, I’d say there are good sugars and bad sugars. Since liver function is important to diabetics, I think knowing what sugars tax it, and controlling those is important.

jigsaw 2013-01-29 20:23:50 -0600 Report

Nah, millions of $ would probably flow into the station like crazy! With all that cash, and the low interest rates being offered, I wouldn't know where to invest it. Best to bypass this great opportunity.

locarb 2013-01-25 20:20:10 -0600 Report

I am T2 and have been diagnosed for about 2 1/2 years. For the last 2 1/4 years I have never been above 5.4. I eat "low carb" and take no medications for this condition; nevertheless, I do have neuropathy. I have to take quite a few meds for that. I make no efforts to go below where my A1c remains (low "fives") and at this point find it relatively easy to eat only "healthy" food.

There are countless complications associated with higher A1C's. I think many here, although amazingly experienced and knowledgeable, at times go beyond their own experience and I am reluctant to do that. I try to remain in the low "fives" but wouldn't be particularly be concerned if I went to 6.0

As you all know, this condition is difficult. I suspect that we all have to be flexible with our expectations and align our our choices and habits every day.

jigsaw 2013-01-25 20:42:28 -0600 Report

Is your neuropathy related to your diabetes? As far as I know, diabetic neuropathy is related to and caused by high blood glucose. Your a1c is that of a non diabetic. This would indicate that for the most part your blood glucose is within excellent range most of the time. Is it possible that you were diabetic for sometime before you were diagnosed? How else would you explain your neuropathy? Just curious?
I do believe that it is important to monitor carb intake. I utilized a low carb diet for many years. However, it is quite possible for many to bring their a1c down to very low levels, simply by cutting out many carbs. Since carbs are a critical part of ones diet, and health, doing low carbs incorrectly and without professional advice, can have some long term serious consequences. I have posted a few links in the past on this subject.

locarb 2013-01-25 23:14:45 -0600 Report

Great questions. Unfortunately, the answer is "I don't know." I have, at least I believe to be, a very good neurologist. After all the tests were done, he told me that some people get neuropathy before a diagnosis of diabetes. Of course there are other causes for it, but you're right. The obvious correlation is high blood sugars; which I've never had (to my knowledge).

I am so cautious with my "diet." The good thing is that I've lost the temptation for food that I used to have. At times we all want something "good", but it can also be healthy. I do reach for Power Crunch Protein Bars. They're great.

I recently tried cinnamon also. I know that some people say it helps. The medical community, by and large, doesn't agree. I do have to tell you though, there was an almost immediate reduction in BG. In fact, since taking cinnamon, I have been in the high 80's. We're all biochemically unique, so I don't advocate taking things in particular. But it is important for us all to keep open to different things. Diabetes morphs through the years and what works today may not tomorrow (and vice versa).

I try my best to encourage everyone here that you can really positively affect your health. When I was first diagnosed, I was very scared. I don't believe there's enough support or information in the medical community for the newly diagnosed. I like to see people involved and making differences in their whole life. All in all, I am probably healthier post diagnosis than I was before (omitting the health condition). I practice yoga twice a week and go to the gym twice a week. I didn't do that before.

You're right. I have "non-diabetic" numbers. I know that if I were to resume ignoring my diet and activity level, I'd have trouble. We live with this every single day. Fortunately, I've had success overcoming the obstacles. I hope everyone else here does too.

jayabee52 2013-01-25 23:28:46 -0600 Report

regarding your cinnamon intake, how much did you need to take before you noticed a drop in your BG? Also was this common grocery store (cinnamon cassia) or "sweet" cinnamon (cinnamonium zeylonicium [or ceylon cinnamon]) ?

locarb 2013-01-27 01:53:11 -0600 Report

It was within days. Just amazing. I was originally using "grocery store" name brand cinnamon. I later purchased capsules. You're correct, there are different types of cinnamon, different grades, etc. It's actually interesting to learn that it has been used for thousands of years.

I am normally reluctant to try alternative treatments or remedies. As you well know, you have to keep yourself open and receptive to things. It worked very quickly and it still is.

I honestly have no idea how well it will work for others (if at all). It's an inexpensive and harmless measure and I was amazed how well it worked.

jayabee52 2013-01-28 00:58:33 -0600 Report

thanks for that Locarb, but what I was asking was what was your DOSE when you noticed the lowering of your BG levels.

locarb 2013-01-28 22:41:26 -0600 Report

Ohhhhhh!!!!! Sorry! 2000mg. I'm still taking it and still amazed. I'm just passing it along because sometimes the slightest suggestion makes others think. It wasn't that long ago that I was first diagnosed and scared to death. Now my numbers are routinely in the non-diabetic range.

I'm just trying to encourage anyone here that learning a few things, changing a few things, exercising (there, I said it!) and a healthy habit or two can help you in many ways.

jayabee52 2013-01-28 23:33:14 -0600 Report

Thank you I have both kinds of cinnamon in my kitchen. I think I am gonna have to make a more careful study to see if it works for me.

Lizardfan 2013-01-25 17:50:17 -0600 Report

My goal is 6.0 or below, currently mine is 5.6. I don't want to go any lower than 5.5, just my personal goals.

jigsaw 2013-01-25 18:12:11 -0600 Report

Sounds like your doing an excellent job of managing your diabetes! I hope you'll share some of your success with us.

Lizardfan 2013-01-26 19:22:22 -0600 Report

Just the basics Jigsaw! I *eat* according to my numbers, take my medication, exercise when able and have fun! My Joslin team makes a tremendous difference in my health, and my hubby and family give me so much support. I have had diabetes for 12 years, so really lots of tried and true factors go into it.

old biker
old biker 2013-01-25 16:06:15 -0600 Report

Interesting topic jigsaw…At age 67 I find myself with a A1c of 6.1 I have been a T2 for 12 years and currently on insulin and metformin..Four months ago I started to cut down my smoking until I eventually stopped..Now here is where the Law of Unintended consequences comes in. I quit smoking because I have PAD in both legs brought on by 50 years of smoking. By quitting and the help of some medication for PAD I was able to increase my exercise level..Which led to a drop in my BS numbers..I fully expect my A1c to be below 6 when i go have it checked in 10 days.
So I have been giving this some thought..Do I keep on doing what I am doing and see how low I can get my A1c or do I cut back on my insulin and keep my A1c around where it is now

jigsaw 2013-01-25 17:44:57 -0600 Report

Having had the same question, I'll tell you what I would do, and what I have actually done. Much of what I do is based on the advice of my dietician, as well as my endo + my actual experience.
If you know that you have a nutritionally balanced and healthy food plan, then cut back on the insulin gradually, and with your doctors approval. I have maintained an a1c of 6.0 to 6.2 for almost 19 years, with the blessing of quite a few doctors. I have read about some interesting tests that claim the mortality rate for diabetics actually increased when much lower a1c numbers were achieved. My current endo feels it is best for a diabetic to NOT go below 6.0.
Personally, I really do not know the best answer for you or anyone else! I do know that 6.0 to 6.2 has worked for me so far, and many others as well. I don't expect to accomplish the same a1c of a non diabetic, where both of us eat the same healthy diet. After all, I have diabetes and so I have to take adduitional measures to keep my a1c where its been. To get my a1c much lower, I would have to take some extreme measures with my food consumption, medication, or exercise. It probably would not be a very healthy choice, and besides, I believe I have found the right balance for me.

old biker
old biker 2013-01-25 18:40:29 -0600 Report

Yeah..I have been thinking more along that line with cutting back on insulin..I'm happy with my Diabetes management plan I'm happy with keeping my BS numbers under 140. I take 36 units of Lantus once nightly..I would like to see if I could reduce that..This next round of blood work will decide for me

IronOre 2013-01-25 12:12:09 -0600 Report

After 38 years of being a T1 I have always been around 7.0 (now 6.8), and I have absolutely no diabetic complications.
As far as I am concerned Dr Berstein is crazy . . . by the way, what kind of doctor is he ???
I think there are too many people who unnecessarily keep there numbers low and eventually get into trouble because of it.

jigsaw 2013-01-25 17:50:44 -0600 Report

I don't agree with many things that Dr. Bernstein says, but I do believe he has some valid and helpful points. Otherwise I agree with your last statement.

jayabee52 2013-01-25 12:31:03 -0600 Report

Here is information on Richard K. Bernstein, M.D., you may find a bio on him in Wikipedia here ~

You may think him crazy, Iron, but his book on diabetes has helped a lot of people. And if you eat low carb, you have been infected with his crazy ideas too, (like it or not).

IronOre 2013-01-26 12:12:54 -0600 Report

Wikipedia is NOT a reliable source.
Anybody can write anything in there.

jayabee52 2013-01-26 13:03:05 -0600 Report

I expected you'd say that Iron. But you don't seem to want to do the work of proving the Wikipedia wrong. That was the best place to find that info in all the same place without taking you on a tour of the internet to hunt down all the relevant info. A tour you have admitted previously you do not like to take.

IronOre 2013-01-27 09:44:10 -0600 Report

Unlike you, I have actually a life outside of DC . . . when I get a chance I will try to get more info on this doctor.

jigsaw 2013-01-25 13:57:23 -0600 Report

Jayabee, are you saying that Dr. Bernstein discovered the low carb diet?

jayabee52 2013-01-25 14:03:53 -0600 Report

I don't KNOW that he discovered the low carb meal plan, but he went a long way toward popularizing it. Especially in light of the American Diabetes Association recommending a low fat high carb meal plan in those days.

jigsaw 2013-01-25 18:18:05 -0600 Report

I do believe that he has offered some good advice over the years, especially since he was an influence in the dangers of high carb diet.

Irish1951 2013-01-25 11:46:30 -0600 Report

As with most things "diabetic" , I think this is a different number for each of us. No two PWD is the same so the number to shoot for is an individual number. I try to get my numbers as close to normal (nob-diabetic) as possible. That just seems logical to me.

jigsaw 2013-01-25 13:08:19 -0600 Report

I agree with you! There are simply countless variables that seem to apply to most if not all of us. If there was one answer for all, I believe the medical profession would have figured it out by now.
Pioneers like Dr. Atkins, and Dr. Bernstein have some helpful ideas, but I do not believe they have the solution for all with diabetes.

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