Type 1 diabetic

I just went to the dr for a checkup and he had previously done a 4 month Ha1c. He said it was 5.1. Which is low for a type 1 diabetic. I was diagnosed with diabetes 6 yrs ago, I am 26 right now. He said all of my blood work was absolutely perfect, cholesterol, liver enzymes,etc. I am currently taking 70/30 twice a day 10 units each time. He suggested that I lower my dosage. My question is that with my Ha1c being so low is that normal for a diabetic? He seems to be in shock. I lost 10 lbs recently too. He said he has never seen bloodwork so perfect for a diabetic. Please let me know what you think. Thanks

[JDRF-Team-dm]

Dear sweet77,
I am a volunteer and not a physician so I can't give you medical advise. I would recommend that you follow your doctors advice. An a1c that is 5.1 is low, but not impossible for someone who has type 1 diabetes. You must be taking very good care of yourself and that is great.
Keep in touch.
dm

[JDRF Team SGG]

I, too, am a type 1 diabetic, and I fully understand your doctor's concern over the low a1c. It is possible for a diabetic to get so used to being slightly hypoglycemic when taking too much insulin that the diabetic loses all warning symptoms of hypoglycemia. There is actually a medical reason that these symptoms disappear, which I have read about with interest but won't go into at this point. If this happens, you FEEL fine, but may be a real risk when driving a car or sleeping. Some folks even have regular hypos while they sleep (I was one of those, but never knew it until I did an experiment by setting an alarm clock for 2 or 3 a.m. to check), and the body goes after its emergency stores of insuln to help out every night. This is not good for you and can even be dangerous over a long period of time, for the loss of warning symptoms can result. So raising the a1c number a little is probably safer. A car accident can be deadly, and you truly need to be fully aware of lows when they happen. By the way, research has shown that avoiding ALL hypos for a period of 2 weeks is supposed to help bring back those warning symptoms. We truly get used to what our bodies consider normal and your doctor may be simply concerned over possible lows.

[JDRF-Team-LRS]

Sweet77,
I'm a long time diabetic & not a physician.  Here's another perspective to consider.

You didn't mention if you're having a lot of hypos or if your bg is steady.  An a1c gives us an average blood sugar over the previous 2-3 months, but don't reveal whether we have a high variation in those numbers.  The variation is wehre the concern may come in.

For example, if we had 5 BG tests of 90 90 90 90 90. Our average BG would, of course, be 90, which is excellent and not at all dangerous.  A pattern like this would result in an a1c of about 5.0  None of the warnings about a "too low" a1c would be relevant.

We can also end up with an average of 90 by accumulating these 5 BGs:
30 30 30 30 330.
This second pattern is dangerous and perhaps deadly.  The 30s could be deadly and the 330 would be horrible, too.  This pattern would also result in an a1c of about 5.0 also -- and all the warnings and concerns about a "too low" a1c would be relevant.

If your patterns are more similar to the first example, you're enjoying a time of superb control -- likely the result of your diligence.  If your patterns are more similar to the second example, it IS extremely important to raise those lows & lower those highs.  Your a1c will likely rise and you'll also be more healthy.

I hope this helps, too.

[dgordon]

http://www.diabetes-normalsugars.com/
You might want to check out this web-site. Lots of people are achieving less than 5 on their Ha1c being very strict with their carb intake. If you haven't read Diabaetes Solution by Richard Bernstein, it is worth the read and some chapters are at his web-site. They have their own forum. I think Dr.s are surprised because most people find it hard to be disciplined enough to achieve those goals. The better your Ha1c, the less likely you will have complications.