A1C frustration

[marbel]

About 4 months ago I posted about my pre-diabetes diagnosis due to my A1C of 5.9.   Y'all gave me some good advice and things to think about, as usual.  Though my doc did not instruct me to, I bought a blood sugar monitor and tested my blood periodically, on a pretty casual basis - by that I mean, I didn't test before and after every meal, every day.  I did focus on what I thought would be higher-carb/sugar meals.  Like, the night I made pho with rice noodles and almost cried when I the number 2 hours later.

 

OK so anyway, during the 4 months between tests I cleaned up my diet.  My first test was in Sept, and over the summer I had eaten ice cream almost every day, bagels pretty frequently (my daughter works in a cafe that specializes in bagels), and there was candy around the house which I'm sure I mindlessly ate.  After that blood test I was very careful with regard to carbs, had no more ice cream, the occasional quarter-of-a-bagel as a treat, no potatoes, almost no white bread (just the bit of bagel), the occasional piece of dark chocolate for a sweet/dessert, etc. etc. Even over the holidays I was super careful thought I did eat a bit of pie and a couple of cookies over the week we were traveling between Christmas and New Years.   I walked 5 times a week, at least 30 minutes a day if not more, and after most meals.  (In case someone wonders, I have not sweetened my coffee nor had a sweetened soft drink or sweet tea in years.)

 

My blood sugar when I tested was almost always (90% of the time) well within the guidelines I've seen online (<140 2 hours after eating, etc).  The couple of exceptions were high-carb meals like the pho noted above.  

 

So I retested last week and got the results today.  

 

My fasting glucose went from 93 in Sept to 83.    But my A1C stayed the same!  I am devastated!  I worked hard to reduce that number and really thought it would be down.  

 

I have a followup appointment in 2 weeks.  Between now and then, I'm going to do pre-and post-meal testing for every meal and take it in to the doc. 

 

Anyone with experience/more knowledge than I have any advice?   Is my monitor just wrong?   (It's a highly-rated brand/model, as far as I know.)   Do I just need to accept the fact that all carbs are off the table for me, forever?   

 

BTW my fasting glucose has never been over 98.  The only reason the doc did the A1C in the first place is my age (60) and my weight and struggle to lose weight.  I have an apple shape, so metabolic syndrome is a concern.  

 

I'm just pissed off right now.  I know there are far worse problems, and many people struggle more than I do.  But I'm still mad.  

Edited January 11, 2017 by marbel

[scrapbookbuzz]

You needn't dismiss your own issue with "there are people that struggle more than I do." They might but that

doesn't mean that YOURS isn't worth concern. I notice you focused a lot on what you're NOT eating. Have you focused

on what you ARE eating? Fruits tend to have a higher natural sugar content than most vegetables.

I would encourage you to focus on adding more variety of veggies to what you eat. Find pleasant ways to add more fiber.

That should help some, I would think. Keep a food journal of what you ARE eating, not what you aren't. HTH!

 

I'll pray for you getting that A1C down. Sounds like you've been really working on that!

[marbel]

You needn't dismiss your own issue with "there are people that struggle more than I do." They might but that

doesn't mean that YOURS isn't worth concern. I notice you focused a lot on what you're NOT eating. Have you focused

on what you ARE eating? Fruits tend to have a higher natural sugar content than most vegetables.

I would encourage you to focus on adding more variety of veggies to what you eat. Find pleasant ways to add more fiber.

That should help some, I would think. Keep a food journal of what you ARE eating, not what you aren't. HTH!

 

I'll pray for you getting that A1C down. Sounds like you've been really working on that!

 

Thank you, I appreciate your comments (and offer of prayer).  :-) 

 

Oh, fruit.  Almost no fruit.  Lots of veggies.  I have rekindled my love for celery and eat that daily.  Also greens, like kale and collards.  Salad daily.  Homemade dressing so no sugar! Cheese, yogurt, meat, fish.  Homemade muesli with kefir for breakfast.  There are a few dried currants in the muesli I mix up.  Like, a tablespoon in a quart mason jar of whole grains, nuts, seeds.   Once in a blue moon I put a few raspberries on some yogurt.  

 

Yeah, I will log my food too.  I do know what I'm eating, but I guess the doc should see that too.  

 

Ugh. 

[Roadrunner]

Under 6 is suppose to be fine. I think 5.9 isn't an issue as long as it doesn't go higher.

[Supertechmom]

I lowered mine just by cutting all forms of sugar and all high carb veggies.  I eat dark colored fruits and veggies which rules out potatoes and corn. Plus, I am gluten free, no bread/pasta at all, and stopped drinking diet sodas.    I checked my blood levels every morning and 2 hours after every meal and was able to rule out some additional foods that seemed to spike my blood level.   Diet soda and potatoes in particular spike.  Basically, my diet is nothing processed, whole foods only.

 

But the big key is finding out what food your body considers to be sugar and eliminating it.  It took about a month of tracking food and levels to figure out what spikes my levels.

[Lawana]

The A1c is just one test. One measure amongst many. It is not the end all and be all of all diabetes tests. The fact that your fasting bg has come down as much as it has is evidence that you are making progress! Yay you!!

 

You are still learning. I bet if you will continue your efforts, you will be healthier, regardless of what one test result may say.

 

You have not failed. You have succeeded! The A1c is not a report card on your efforts.

 

Another possible tool is a CGMS (Continuous glucose monitoring system). A sensor inserted into you skin measures the interstitial glucose levels and provides a graph of the results. It can be done for a 3-7 day trial and you get the results either in real time or after the fact. I don't know if insurance would cover it for a pre diabetic, but it can be very enlightening.

[Soror]

A 10 pt lowering of your fasting levels is great, kudos to you! 

[rainbowmama]

Lowering your fasting levels is great.

 

Did you have your vitamin D levels checked, too? If you live in colder climates like me, getting enough vitamin D from sunlight alone can challenge even the most outdoorsy person. Low vitamin D can raise sugar levels. 

[SparklyUnicorn]

Thank you, I appreciate your comments (and offer of prayer).  :-) 

 

Oh, fruit.  Almost no fruit.  Lots of veggies.  I have rekindled my love for celery and eat that daily.  Also greens, like kale and collards.  Salad daily.  Homemade dressing so no sugar! Cheese, yogurt, meat, fish.  Homemade muesli with kefir for breakfast.  There are a few dried currants in the muesli I mix up.  Like, a tablespoon in a quart mason jar of whole grains, nuts, seeds.   Once in a blue moon I put a few raspberries on some yogurt.  

 

Yeah, I will log my food too.  I do know what I'm eating, but I guess the doc should see that too.  

 

Ugh. 

 

Which whole grains?  Which yogurt?

[SparklyUnicorn]

The A1c is just one test. One measure amongst many. It is not the end all and be all of all diabetes tests. The fact that your fasting bg has come down as much as it has is evidence that you are making progress! Yay you!!

 

You are still learning. I bet if you will continue your efforts, you will be healthier, regardless of what one test result may say.

 

You have not failed. You have succeeded! The A1c is not a report card on your efforts.

 

Another possible tool is a CGMS (Continuous glucose monitoring system). A sensor inserted into you skin measures the interstitial glucose levels and provides a graph of the results. It can be done for a 3-7 day trial and you get the results either in real time or after the fact. I don't know if insurance would cover it for a pre diabetic, but it can be very enlightening.

 

I agree.  Really this doesn't sound terrible at all.  Sounds pretty good. 

[marbel]

Lowering your fasting levels is great.

 

Did you have your vitamin D levels checked, too? If you live in colder climates like me, getting enough vitamin D from sunlight alone can challenge even the most outdoorsy person. Low vitamin D can raise sugar levels. 

 

Vitamin D is good.  I have that (and other levels) checked twice a year because of kidney stones

 

Which whole grains?  Which yogurt?

 

Oats, and a cereal that contains "Whole Grain Oats, Wheat Rye, Barley, Triticale and Flaxseed."   (copied/pasted from the label)   Yogurt is homemade, made with full-fat milk and with no sugar added.

 

 

Thanks for all the replies and encouragement!  

[kitten18]

It sounds like you're doing well.

 

For lowering A1c, you could watch some videos of Dr. Jason Fung. He has a series of videos and he's been a guest on many podcasts.

 

 

[SeaConquest]

If you are at all considering meds, Victoza has done wonders for me. I was pre-diabetic after my last pregnancy in 2013, and Victoza dropped my numbers to the normal levels when nothing else would,

[MooCow]

For me, if I have any pasta,rice,grain, cereal,oatmeal,etc it'll stay up. Also yogurt. All kinds. Let sigh

[Joules]

It sounds like you are doing everything right.  Remember A1c is a long term number going months back.  You may have changed your diet in September, but it takes time for the body to catch up and function properly.  The change in morning glucose is SO much more important this early in the game.

[Pegasus]

Fasting glucose is just one small piece of the puzzle.  Until you have a good understanding of how different foods affect your blood sugar, you need to be testing a lot more often and keeping a written record of what you ate.  There's no way I could eat even a small amount of bagel or homemade muesli without it causing my blood sugar to soar.  Grains are not your friend once you are insulin resistant.

 

 

 

[marbel]

Just a comment on grains... I eat homemade muesli with homemade kefir almost every day for breakfast.  My post-breakfast tests are always great.  For the past few days I have been testing before and after every meal and everything has been well within range.  Maybe I am eating something that I don't realize/notice and don't test after eating it.    I could be willfully ignoring something but I don't think so, 'cause what advantage would there be in that?     I did test after a birthday dinner of pizza and cake and was unsurprised to see a high reading (150 2 hours after eating).   That was a few days after the blood test and before I had the results, when I still thought the number would be down!  

 

I'm just going to test often between now and my followup appointment, and take those numbers along with a food diary to the doc.

 

Thanks again for all the comments/suggestions!  It's helpful!

 

 

[SparklyUnicorn]

Vitamin D is good.  I have that (and other levels) checked twice a year because of kidney stones

 

 

Oats, and a cereal that contains "Whole Grain Oats, Wheat Rye, Barley, Triticale and Flaxseed."   (copied/pasted from the label)   Yogurt is homemade, made with full-fat milk and with no sugar added.

 

 

Thanks for all the replies and encouragement!  

 

I'd try cutting back on the grains a bit.  Use the oats and flax.  Skip the rest.  Add in more nuts and seeds to sub if need be.  Especially if you are eating that stuff daily.  Carbs are carbs.  Ya know?  Flax is mostly fiber.  I don't count that.  I do throw in a bit of oats in my granola (that I don't really make very often).  It's something different because yeah I get not just wanting blah...flax...no grain.  And you aren't diabetic so you are trying to cut back not necessarily completely cut it out. 

 

But if the A1C does test for months back (I don't know) then probably your next test will be better with the changes. 

[SparklyUnicorn]

Just a comment on grains... I eat homemade muesli with homemade kefir almost every day for breakfast.  My post-breakfast tests are always great.  For the past few days I have been testing before and after every meal and everything has been well within range.  Maybe I am eating something that I don't realize/notice and don't test after eating it.    I could be willfully ignoring something but I don't think so, 'cause what advantage would there be in that?     I did test after a birthday dinner of pizza and cake and was unsurprised to see a high reading (150 2 hours after eating).   That was a few days after the blood test and before I had the results, when I still thought the number would be down!  

 

I'm just going to test often between now and my followup appointment, and take those numbers along with a food diary to the doc.

 

Thanks again for all the comments/suggestions!  It's helpful!

 

Then I wouldn't worry about it.  Different people have different amounts of carbs they can manage. 

 

I don't test, but if I ate muesli for breakfast my blood sugar would drop like crazy.  I have the opposite problem! 

[Pronghorn]

I had an elevated a1c too. I cut carbs dramatically, lost twelve pounds, went back to the doctor for blood tests, and found my a1c had not budged. The doctor said that some people have sticky hemoglobin, which elevates the number. I have not tested my sugar, but I do feel better than before.

[abacus2]

You've done great! That fasting number improvement is impressive. 

 

Another thing to remember is that diabetes is a disease that you can influence with food and exercise, but depending on what is malfunctioning in your body you may or may not be able to achieve ideal numbers with just diet and exercise.

 

As others mentioned, an A1c of 5.9 is not that bad. If you stabilize there, that would be good.

 

 

[LucyStoner]

I'd see where it is in 6-12 months. Thankfully 5.9 is low in the pre-diabetes range, which means less of a risk for developing diabetes. Also remember that while prediabetes often reverses with diet changes, it doesn't always change. Some percentage of those with prediabetes or type 2 have it because of genetics, not diet.

[SparklyUnicorn]

I'd see where it is in 6-12 months. Thankfully 5.9 is low in the pre-diabetes range, which means less of a risk for developing diabetes. Also remember that while prediabetes often reverses with diet changes, it doesn't always change. Some percentage of those with prediabetes or type 2 have it because of genetics, not diet.

 

Interesting.  I didn't know that!

[Soror]

Well, the act of tracking things tends to alter our habits, even without conscious effort. Over the long term you will get a better idea of what is going on with you.

 

Fwiw I have a friend with bg readings in the diabetic range on a "normal" diet. She has found pasta(brown rice) and pats(homemade rolled)send her through the roof but quinoa causes no rise.it is all so individual.

[ktgrok]

It sounds like you are doing everything right.  Remember A1c is a long term number going months back.  You may have changed your diet in September, but it takes time for the body to catch up and function properly.  The change in morning glucose is SO much more important this early in the game.

 

I was going to say this...A1C is over many months...so those indulgences over Christmas may have been enough to raise your level some. Check again in a few months. 

[freesia]

I was going to say this...A1C is over many months...so those indulgences over Christmas may have been enough to raise your level some. Check again in a few months.

Yes, and it's weighted toward the past couple of weeks before the test. I always test right before Thanksgiving, never in January.

 

And add me to the ones who can't have any grains. Also, test one hour after, not two. My two hour numbers are usually fine, it's the one hour ones that show which food is the problem for me.

[marbel]

I was going to say this...A1C is over many months...so those indulgences over Christmas may have been enough to raise your level some. Check again in a few months. 

 

Yes.  But that's what's so confusing.  In the months prior to the first test, my diet was terrible - lots of white rice, white bread, sweets every day.   Even with the small Christmas indulgences it was so very much better between the first and second tests.  That's why it's  so hard to believe it didn't go down even .1 point.   I am burning through test strips this weekend, trying to see if there are spikes I wasn't seeing with testing before.  this morning I even ate a whole piece of toast instead of my usual half, but so far so good.  

 

Thanks!  I'll figure it out... or I won't, I guess.  :-)  

[LucyStoner]

Interesting. I didn't know that!

Many people don't which leads to a lot of judgment and guilt.

 

I have a friend who was as fit as a fiddle (very healthy diet, athlete, no excess body fat) and she developed type two. Her doctor explained that while the risk is much higher for those who are sedentary and eat too much sugar, it happens for some people who seem to do "all the right things" and can usually be linked to family history.

[marbel]

Many people don't which leads to a lot of judgment and guilt.

 

I have a friend who was as fit as a fiddle (very healthy diet, athlete, no excess body fat) and she developed type two. Her doctor explained that while the risk is much higher for those who are sedentary and eat too much sugar, it happens for some people who seem to do "all the right things" and can usually be linked to family history.

 

Totally an aside, but I told my husband never to tell his parents about this, or even if I become diabetic, need insulin, etc.  Because, they would be quick to assume it's because I'm overweight/eat badly/etc.  And maybe it would be (I have no family history of it) but... I just wouldn't want to go there with them.

 

Another aside:  I have a relative who is a triathlete, teaches some sort of fitness classes at a gym, runs marathons, etc.  But to look at her... you would see a fat girl.  She will most likely never be slim and athletic looking.  But she is strong and fit and healthy.   Fat is part of her/our genetic makeup.    It's from the Eastern European peasant side of the family, as my dad would say.   We are sturdy people.  

 

Carry on.  :-)

[SparklyUnicorn]

Totally an aside, but I told my husband never to tell his parents about this, or even if I become diabetic, need insulin, etc.  Because, they would be quick to assume it's because I'm overweight/eat badly/etc.  And maybe it would be (I have no family history of it) but... I just wouldn't want to go there with them.

 

Another aside:  I have a relative who is a triathlete, teaches some sort of fitness classes at a gym, runs marathons, etc.  But to look at her... you would see a fat girl.  She will most likely never be slim and athletic looking.  But she is strong and fit and healthy.   Fat is part of her/our genetic makeup.    It's from the Eastern European peasant side of the family, as my dad would say.   We are sturdy people.  

 

Carry on.  :-)

 

Uh yeah I don't blame you.

 

It's not always about weight.  My sister has diabetes and she is quite thin (always has been). 

 

People seem to always equate weight with health and I don't think it's that simple.  I think you can be overweight and healthy and be the perfect weight and be very unhealthy. 

[marbel]

Yes, and it's weighted toward the past couple of weeks before the test. I always test right before Thanksgiving, never in January.

 

And add me to the ones who can't have any grains. Also, test one hour after, not two. My two hour numbers are usually fine, it's the one hour ones that show which food is the problem for me.

 

I am doing that for the next few days.  Actually after breakfast I tested every 15 minutes. 

 

But, I'm wondering about something.  Isn't the reason for testing at 2 hours to see how quickly the number comes back down - isn't that an indicator too?  

 

Sorry if this sounds like I'm arguing - I'm not - or haven't done any reading on my own.  But there is a lot of conflicting information to be had.  

 

Another question:  I know most people are advised to test before eating, I guess so they can plan their meal.  But I wonder if at this point it would make sense to skip that and just test after.  Because my before-meal numbers are always low, in the 80s (occasionally) or (most often) mid-90s.    And, I'm planning my meals around vegetables and protein anyway.  

 

Thanks again, all.

[LucyStoner]

Totally an aside, but I told my husband never to tell his parents about this, or even if I become diabetic, need insulin, etc. Because, they would be quick to assume it's because I'm overweight/eat badly/etc. And maybe it would be (I have no family history of it) but... I just wouldn't want to go there with them.

 

Another aside: I have a relative who is a triathlete, teaches some sort of fitness classes at a gym, runs marathons, etc. But to look at her... you would see a fat girl. She will most likely never be slim and athletic looking. But she is strong and fit and healthy. Fat is part of her/our genetic makeup. It's from the Eastern European peasant side of the family, as my dad would say. We are sturdy people.

 

Carry on. :-)

I'm built like your relative, though my bulk is a lot of muscle and my man sized frame. Perfect for hauling in crops with a baby tied to the hip but definitely not the current idealised female form. Definitely not delicate. 😂 Edited January 14, 2017 by LucyStoner

[ktgrok]

I wouldn't bother to test before. I'd test fasting, and then for a while at 1 hour and 2 hour. 

 

Also, how is your sleep and your stress? Both can effect blood sugar and metabolism. 

[freesia]

The before is to have a baseline and to make sure you start below 120. If you are higher than 120, you shouldn't eat.

 

I don't test before unless I think my blood sugar is still too high from a previous meal.

 

There is a website Blood Sugar 101 which is very helpful.

 

The one hour is for me more indicative of how my body handles those foods. The two hour shows hoe quickly I rebound. Some meals my one hours are okay, but

don't really go down much by two hous and actually keep my blood sugar up at three hours.

[SparklyUnicorn]

OMG...I think testing that often would make me insane.  I find it easier to just eat low carb!

 

But then my issue is low blood sugar.  I know when it is too low.  I feel very lousy.