Above 4.6%, the risk for cardiovascular disease doubles for every 1% rise in HbA1C - Dr Mark Houston, MD, a thought leader in Functional Medicine. While the biochemical parameters remain in the prediabetic range, complications start to occur.
HbA1C and risk of complications: Above 4.... - Diabetes India
HbA1C and risk of complications
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DiabetesDestroyer
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ramana42Volunteer
So,what should be considered ideal A1C for person of 75 yrs age and absolutely no history high BP or related issues .Been diabetic for more than two decades and presently on insulin.No other health issues other than those of old age.
ramana42
what is your a1c ?
"No other health issues other than those of old age." Which issues do you consider old age related?
Firstly,Age related problems:
Loss of short term memory,loss of balance(for example,I cannot stand on one leg even for 19 secs,whereas my grandkids can do so for pretty long),loss of skin tone,cataracts,weak joints,no energy etc etc.The list could go on but I know they are not going to go away.I can only manage these within safe limits.
My A1C was 6.9 very recently.As per WHO guidelines I am in good control range,but I know LCHF proponents will not agree with it.I am now on 14+12 units insulin.Aim is to reduce the dosage,if possible.
ramana42
No wonder you have these problems. The problems you consider due to age is actually partly related to D. By the way, what is your diet? A1c 6.9 is not acceptable.
Start lchf diet. It can be good for you. Don't think that at your age one can't do anything.
Good luck!
I am not weighed down by my age,In fact I have started painting as a hobby,and learning algebra which has been a bugbear all through my life,About LCHF,I have no issue but ,has chosen not to follow it after considering all aspects.
ramana42, 6.9 is associated with complications. It is not that LCHF proponents don't agree with it, it is that the science has proven that this level is associated with complications. It is in response to scientific data that the LCHF proponents arose! Aim higher! Aim to get off insulin completely. It can be done, it is being done.
I am also75 years. Type 2Diabetic for 20 y but under control No Bp/ cholesreal What is idealAIC, Drs said dont takeaic. check sugar periodicallly
Ramasswamy
"Drs said dont takeaic. check sugar periodicallly"
It's the other way around. Random sporadic readings are less important than a1c.
"....under control No Bp/ cholesreal " with or without medicine?
7 to 7.5 HbA1c is ideal for your age.
Thank you very much.That is what exactly what my doctor says.Kindly share your thoughts more elaborately on this issue.
Our body is very wise. We have been abusing it, by exposing it to toxins, and adopting an unhealthy lifestyle along with inadequate nutrition. Once we reverse these, the body can heal itself. That's all it takes.
We have become used to accepting lower health levels with age, but the fact is that we can enjoy optimal health and vitality at every age. HbA1C of 7 and 7.5 is associated with complications.
Accepting lower health particularly for HbA1c is because, we may be otherwise frequently be going for Hypoglycemia.I am 72 and I had severe problem of hypoglycemia upto 45 in sleep ,when trying to maintain HbA1c value to 6.Further because of Diabetic Neuropathy I am not getting indication of Hypo.Earlier I used to get indication when sugar level goes down to 70,but now it is not so.This is very dangerous.
Now I am maintaining HbA1c 7/7.2 and I am not facing Hypo problem.
Thanks.
arunalshi, when the blood sugars are maintained within normal range without pharmaceutical medicines, the risk of hypoglycemia is minimal. HbA1C of 7-7.2 is associated with serious complications. I am posting a link to a blog post explaining link of HbA1C levels and risk of complications. I hope this is allowable. drlilykiswani.com/prediabet...
cureAdministrator
So you mean if person controls his sugar below 4.6 Hba1c he will not have other diabetic complications???
What if some one remains under 4.6 with help of medicines??
4.6 translates to average BS of 85....which means to achieve this we should never spike above 85 any time in 24 hrs...
and what will happen to such person when he is in need of sudden energy like catching train..or some emergency???
The ideal blood sugar levels would be; Fasting 80, 125mg% 45min after a high carb meal, 100mg% after75 min and back to 85 after105min. Controlling levels this tightly with pharmaceutical medications would be risky, plus the medications have serious side effects. Adopting an Integrative / Functional medicine approach. along with the LCHF diet which has been quite widely propagated on this forum, sugar levels are well balanced and emergencies are rare.
DiabetesDestroyer
"Adopting an Integrative / Functional medicine approach. along with the LCHF diet...."
Would you please elaborate?
Integrative Medicine, Functional Medicine, Regenerative Medicine are various appellations for a recent advance in allopathy where we go to the root cause of a disease and help eliminate it. By taking a holistic approach, this addresses all the symptoms a patient might have, for example, migraine, bloating and gas, skin rash, etc. This approach acknowledges the innate wisdom of the body. All we need to do is bring the body back into balance, then it can heal itself.
DiabetesDestroyer
So what did you find is the root cause of t2d?
Remember, not all diabetics are the same. One thing that is good for one person might not be okay for another person.
4.6 is not practicable for a diabetic on medicines,for fear of hypo.If you are at that range without medication,then you can safely consider yourself a non diabetic.If one tries to maintain 4.6 with help of medicines I would consider it not advisable.
ramana42
I don't think one can have a1c 4.6 with medicine. It's always higher with medicine. First low carb diet with or without exercise, drop medicine gradually and then with excellent idm can one land with this a1c. Metformin is exception means you can achieve 4.6 while on it. Also pioglitazone. These drugs have no effect on insulin release.
Please elaborate one thing,insulin and drugs pertains to same category or opposite ?,means insulin and drugs count both as drugs or separately/,if both are drugs then how the insulin is different from drug/in any case/
Pharmaceutical medications are in a different category than insulin, which is usually human insulin. So in that sense, the actual product is quite safe, unless it comes from a GMO source. The issue though, is that insulin is an 'obesogenic' hormone, ie, it promotes the deposition of fat, which is inflammatory. Also, it does nothing to address the root cause of the problem, it only suppresses the sugar levels. Complications can continue to develop. It can be tricky, attaining steady sugar levels and hypoglycemic emergencies are possible.
DiabetesDestroyer
so this means sugar or Hba1c is just one part.... And insulin spike is another part..
And insulin spike leads to many other complications...
further as you had said in your earlier reply that PP after 45 mts to be 125...and FBS 80...in that case is 4.6 Hba1c achievable??
cure, my suggestion is to follow a personalized LCHF eating plan. The blood sugar spikes and the insulin spikes are very low and therefore an average plasma glucose of 86, or HbA1c of 4.6, is possible. In actual practice the PP level does not even go to 125, it could be 100-110.
even then FBS 80 and PPBS 100...may translate to 4.8/4.9....
4.6 looks like a dream...and I think on presentation of such Hba1c...any other liver malfunctions should be ruled out.
cure
"Someone who is not diabetic will have about five percent of their hemoglobin glycated. This means that if your A1C is below 5.7, ". Can anyone tell exactly what is a1c range for nonD people? !< 5 ; upto 5.7 or less or more?
below 5.8 No one knows what should be normal/limit for Hba1c.... but lower is better....but how low we should go....and safe for us..no one is sure.
I think around 5 should be safe and normal...(Personal opinion) 
cure
Lower is better unless you become hypoglycemic.
anup
The study you referred quotes US recommendations. They still say 6.5 to be strict control. A1c 5 is 97bs and 4 is 67. Below which perhaps the symptoms of hypo appear. One can go as low as possible imho. All this u and j and linear etc curves are weird presumptions. Why should one get more complications with low a1c. We are like nonD once we control sugar. What makes us more vulnerable to complications on low a1c? What if a person nonD ? Will he have more complications? All the complications of D is solely because of high sugar.
IMHO Not everyone has the hypo limit of 67, me for instance and for sure, show strong signal of hypo (sweating, palpitation and high bp (around 200) every single time i hit the low 90s, again IMHO not even every normal people can reach 4.6 let alone prediabetics, and for diabetics....forget about it
nyonyo, every person is different and there is no one-size-fits-all approach. On the other hand, you may be having hypoglycemic symptoms in your 90's because you are probably controlled on medication. If you are metabolically stable, you will not have these peaks and valleys.
Incidentally, my HbA1c is 4.6 and it wasn't such a struggle to reach there (from normal). I don't know what it was before I started on a healthy eating plan.
Diabetes Destroyer, That is exactly and definitely my point, "every person is different and there is no one-size-fits-all approach", so what is your "personal" target in reaching 4.6% and why do you recommend it to every diabetic? If what is considered normal is <5.7% why do you insist on 4.6%?, it is like everyone with hypertension is recommended to have BP of <100/70 while the normal and international standard is <120/80 and every obese people is recommended to have BMI of <20 while the international standard for normal 1s 18.5 - 25, and let me remind you again "every person is different and there is no one-size-fits-all approach".
"Above 4.6%, the risk for cardiovascular disease doubles for every 1% rise in HbA1C", does it mean that people with HbA1c of 5.6% (which is very much normal by international standard) have twice cardiovascular disease risk as someone with 4.6%? why don't cardiologists support this argument. Do you "personally" believe that by keeping your HbA1c < 4.6% you will live longer, healthier and free of other disease? Well, it is up to you, but i absolutely don't, why? because "every person is different and there is no one-size-fits-all approach" 
When did I say I insist on 4.6 or even recommend it to anyone, leave alone diabetics? It was just an observation that mine is 4.6. And I didn't fight for it, again, it was just the result after CGM.
Yes, after 4.6 the CVD risk increases. I have posted Dr Mark Houston's article stating this, earlier. He is a highly renowned cardiologist. I am glad you don't follow it if you are very well controlled without it.
Aha... of course you didn't say it literally (i hereby insist on..:)), but you keep telling others in this forum who don't agree with your statement and feel comfortable around 7% that "Above 4.6%, the risk for cardiovascular disease doubles for every 1% rise in HbA1C" and 7%-7.5% is associated with serious complication, for me that means insist, because they and their doctors don't think so
ehm...BTW when did i accuse you of fighting for it
cureAdministrator
still 4.6 is dream....
for me 4.6 is not even a dream that will never come true, but it is a nightmare that has to be avoided, and i mean MUST be avoided, why? because i get hypo every time i hit low 90s, the range i feel BEST is 97-117 to be precise, and 4.6% equals average bs of 85, repeat AVERAGE, while my lowest tolerable bs is 97, IMHO our aim in treating diabetes MUST be what suits us best and what makes us feel best not what is complying with other people's number or other people's recommendation, why? because every person is different and
there is no one-size-fits-all approach
cureAdministrator
of coz its is great for shashikant ji....but again 4.6....just 5 points lower....one has to struggle lot...
But risky.... honestly...I don't agree with such fantastic figures...
It is like striving for zero figure...at risk of health
cure
@Anup
I don't think we need to be that desperate. Anything below 100 average is good. The idea is not to flood tissues with sugar imho. And hypos will not occur if you are not taking medicine.
cure
Possible with keto or near keto diet. Shashi is taking hypocalorie low carb diet. And his profession / job makes him walk more. So he does lots of exercise too.
This is why i strongly believe that patients should not take advice from forums like this but stick with their doctor's plan. How could someone say a 72 year old DM patient use an HbA1c target of 4.6%? When prediabetic range is 5.7 to 6.4%, diabetic range is >6.5% and anything <5.5% is non diabetic range? Actually 8.0% is still acceptable especially in old age with presence of comorbidities and this is why the recommendation is that HbA1c be individualized and your doctor has more info that us here. I observed that the Administrator was trying to caution ⚠ the contributor using A1c of 4.6% , that is good but i think you could even be more robust and clear in admonishing against this because it is very dangerous esp to people with limited info
I am 72 and my H1BC came 8.2.I work 10 hrs a day ,do yoga half an hr get good sleep,control diet only two chapati and some fruits,milk etc.I take controlled food morning ,afternoon and 8pm in night.
Stopped all diabetic medicine two yrs back.also stopped blood pressure medicine. Cant sleep proper if dont take two chapatis,so cant follow.. LCHF formula.Take tea or milk without sugar but add cinnamum some time.
Only worry with my sugar figures otherwise noproblem.
Got B-12 nd D vitamin in limit but iron 11 only.Any advise for me. All blood test come in normal range except sugar figure.
Suresh shah
SURESHSHAH, apart from diet, there are other factors such as hormone balancing and detox involved in the healing process. It is possible that when these are balanced, your sleep will be, too. Because the fact is that your carbohydrate intake is incompatible with good sugar control.
You are right, mbofie, what's right for one need not be right for another. The management of diabetes, or any other condition for that matter, is very individualized. What's on this forum is just broad guidelines.
cureAdministrator
hmmm...again in long term is this sustainable diet program???
May be due to Anemia/ We have to see Total iron binding capacity(Electrolytes),Hemoglobin,Hematocrit (PCV) etc.also,before conclusion HbA1C. Moreover HbAIC mostly give picture of 30-45 days of glucose concentration.
cureAdministrator
professional badminton player.
yes...may be....but we are simple mortal human beings 
and during his peaks.....
which means he must be on normal diet now...
cureAdministrator
Ofcoz bhai...there are many professionals who even sort help of steroids for bodybuilding etc...many Olympic players go for such things...
But this is not normal....they are professionals... we are common ppl...
cureAdministrator
still they find out new methods to cheat tests....
....But now, several recent A1C studies have shown a J-shaped relationships, in which at the lower end some bad things happen, at the center things are better, and at the top end things are terrible. While linear relationships are the rule in observational studies, U-shaped and J-shaped curves aren’t uncommon, and some authors lump both of these shapes as U-shaped......
suramoStar
DiabetesDestroyer
"Above 4.6%, the risk for cardiovascular disease doubles for every 1% rise in HbA1C -...". I have never understood such predictions. Can you please explain how you / dr mark calculated doubling of risk and how? What etiopathogenesis?
suramoStar
Hidden
🐒🐒🐒😝😝😝.
Again weird interpretation. Not by you bro but by doctors / scientists. Perfect example "if can't convince confuse ". 🙏
High a1c means poor bs control. More ros and more inflammation in the body. Tissue damage and whenever and wherever there is tissue damage platelets are the first agents to go there to limit the spread of inflammation. Now they have to stick to the site to limit the spread. You can indirectly connect a1c and platelet stickiness but i have seen triple vessel disease with 7 a1c and none with 9. The reason is that there are multiple factors affecting like genes, diet, level of activity, Yoga, exercise and few more. But it's a weird interpretation.
suramoStar
Hidden
Whole or full-fat milk has a glycemic index rating of 41, according to Harvard Medical School. Skim or fat-free milk is even lower, having a glycemic index score of 32.
8 oz contain 12.3 g carbs. So its gl is roughly 4😁😁
I got my reports -------
1.eGFR 94
2. Iron 58
3. Blood urea 11.3
4.creatinine 0.6
5.H.D.L 67
6.LDL 135
7. triglycerides 115
8.protein 7.1
9.Albumen 3.92
10 T3 81
11.T4 6.8
12.TSH 4.64
13. Random blood glucose 165
14. total cholesterol 227
.15. BMI 24.7
16. BP 130/80
am not taking any modern medicine ,no insuline shots , no special diet , just normal food which all the members of the family take , with one plantain and one guava per day , with herbs sage , terminalia chebuka ,amolaki and turmeric . Daily in the evening 15 mminutes pranayama , 15 minutes yogasanas ------ardhamatsyendrasanaa , sarvangasana , Halasana and mudras . I take food of 1200 calories ,almost equal quantities of dal and rice ------ dal cooked with greens or vegetables , with 3 coffes per day with 5 spoons of sugar , 5dates per day.
swathy, it is not possible or safe to give specific medical advice without a proper understanding of your biology, but what is obvious is that your carb intake is high therefore your triglycerides are high. As well, your TSH is high and needs balancing. Your health status will improve if these are corrected.
in reply to DiabetesDestroyer
The report is from Thyrocare . It is given the normal ranges for TSH is 3.3 --5 .5 . The normal range for triglicerides is given as 25 - 200 . Any way I have shown to three other doctors .I take 100 to 120 gm carbs per day . I don't have any other symptoms associated with diabetes even fatigue or loss of weight or excess weight ,excess of hunger , excess urination , lack of sleep , neuro problem , nothing what so ever. Tests were done in three different labs ,three times with small difference in the normal ranges. But insistence of family made me to go for tests ,otherwise left to me I would not have gone .
swathy, the reference range is like 'recommended daily allowance', just the level required to prevent disease. It is not the level required for optimum health. TSH should be less than 2, ideally in the range of 1. Normal range for triglycerides is, as anup says, 100 or even 75. You don't need to wait until symptoms appear. Because with your reports, unfortunately they can appear. He is right, HbA1c, FBS and FSInsulin levels are very important but missing.
in reply to DiabetesDestroyer
we , have seen that all the readings keep on changing . .A1bc has come from 5.6 to 4.4 , all the ranges keep on changing . my inspiration is DR B.M.Hegde not any other alien .
And how to bring TSH to that levelof 1???
Tg is 115 and not 200 . See the op. The limit is given as up to 200 . When i take mangos during the season , I reduce the other item of carbs .Rb 165 may not fit in to your idea but according to me it is ok . Fbs I never go for . The lab where I go for yearly tests , send the samples to thyrocare in Bombay in case of thyroid . The rest of the tests are done in his lab . He is a family friend .Albc -----, so far I had never bothered to undergo .Apart from the carbs in direct form of the carbs like mixed grains rice and a small portion from greens my calories come from dals , nuts ,seeds and yogurt . Any way it is a rough calculation and not armed with scales and calculations as if in a lab .What matters is I am perfectly healthy with out any modern medicine . Only diet control with yogasanas , pranaama , mudras and herbs I could achieve this . I go only foer an yearly tests for overall check up.
My staple diet is not mangoes . That is taken only during the season , that also the 4 months in summer from mangos of our trees . At that time I take butter milk , oranges , lots of greens , seeds,nuts yogurt and preparations with dal . Let LCHF decide it's fate in another 5 years .
ridiculous and absurd opinions in the name of science .
cure, you might be aware that 80-90% of hypothyroidism cases are autoimmune in origin - Hashimoto's disease. Treatment is that of any autoimmune condition.
What does that means??? Those who are not around 1 TSH are suffering with Hashimoto's??
and what about other 10/20 %???
Should we consider other clinical signs along with lab reports ???
No, no, they reach the level of 1-2 only after treatment. Tests such as Thyroglobulin antibodies and TPO thyroperoxidase antibody will identify those with the antibodies. In addition, some people have Reverse T3 - there is T3 but it is Reverse T3 so it just blocks the cellular receptors. Clinical signs may be similar, so testing is required.
It is said that low carb diet sometimes increases RT3. Which in turn blocks T3 to enter in your cells...
On other hand carbs will increase Hba1c..which we want in range of 4.6...
We want to keep Hba1c around 4.6....and same time TSH around 1....
How to do????
I am able to get HbA1C of 4.9 with TSH 1, which is great. It depends on the patient and their goal. Some are happy at 5.6. But a really cooperative patient can get down to 4.9-5. 4.6, honestly, I haven't achieved.
BTW, cure, are you a doctor? Ot like Gary Taubes and Nina Teicholz, a journalist?
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