Why Do Some Have Different A1C Targets Compared To Others? | DiabetesTeam

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Why Do Some Have Different A1C Targets Compared To Others?
A DiabetesTeam Member asked a question 💭

In the past few years some significant research was conducted to try and determine if a more "personalized approach" with regards to A1C targets would provide greater benefits to some patients.

Depending on our particular situation the "typical guidelines" may not necessarily apply to us.

The General Guideline is to target an A1C of equal to/less than 7.0%

An A1C of >7.0 is associated with a significantly increased risk of both microvascular and cardiovascular complications (Kidney Disease… read more

posted September 9, 2022 (edited)
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A DiabetesTeam Member

@A DiabetesTeam Member short spikes in the 140 to 150 range, if we are talking in the initial two hour period after you eat, would be considered normal whether you are diabetic or not.

Even if that was your 2 hour number that would not be "significantly" detrimental.

While there are no absolutes it is generally accepted (by the leading experts) that if you can keep your blood sugar below 140 (7.8 mmols) 90% of the time you effectively protect against ALL complications.

If we consider that on a daily basis, 90% of 24 hours would be 21 1/2 hours a day. So essentially you could be "peaking" over 140 for about 2 1/2 hours daily (total combined) and still be super well controlled.

Again, we are all different but if you are keeping your spikes, at worst in the 140-150 range I will suggest that, like me, your peaks are probably "short lived" - mine tend to last between 15 and 30 minutes "when they happen" so even with me eating 4 meals a day if each of them "peaked a little higher then range" (for me) I would only be riding those peaks for "at most" 2 hours (about 1.8% of the day) leaving me "fully controlled" somewhat north of 98% of the time.

Certain health conditions (unrelated to diabetes) do present a danger to a mid/low 5.something A1C. Particularly if someone has even the slightest hint of heart disease or disfunction a lower A1C can add extra stress to the heart (The Veteran's admin tried to run a study and ended up killing too many of the participants) - so there certainly is data out there.

However, for the average Type 2, newly diagnosed (with a duration of under 3 years of onset), who has no confounding medical conditions, an A1C in the low to mid 5's is not only "not dangerous" but is beneficial allowing them considerable room to progress before they even need Tier 1 pharmaceutical intervention.

(one other confounding condition to setting an A1C target too low is to protect against hypoglycemia - going too low. Because while "too high" may kill us in 20 years, too low will kill us in our sleep tonight, so there is guidelines for those "susceptible" to low's and I (believe) their target A1C is closer to 7.5, at least by the guidance)

But as always it's tough to make blanket statements (which I hate because they never apply to a specific individual). We all need individual medical advice from an (engaged) Doctor that sees our particular situation and needs as a co-operative between US and Them to establish the best course of treatment.

posted September 9, 2022 (edited)
A DiabetesTeam Member

Hi Nick- I think Graham answered it all well.

Good luck!

posted September 10, 2022
A DiabetesTeam Member

When I got diagnosed years ago they said to keep it 80 to 120 and never explained why. That doctor also looked at me and my mother and said I was fat and needed to loose weight. I need to have a talk with my new doctor about what my target should be. I go see her on Tuesday and I will ask her. Thanks for all the information!

posted September 10, 2022
A DiabetesTeam Member

Alot to do with age and our weight. How much insulin we produce on our own?? I have been told to try and keep mine under 7 percent. Seven or less. The country/state u live in might affect how Drs read the numbers. But you are right I really don't want kidney failure. My godmother died of it. Hope this helps.

posted September 9, 2022
A DiabetesTeam Member

When I began in 2014 when I was 49 My doctor told me to keep under 125 and when I went on insulin the same doctor said to keep under 130. What is interesting & wonderful all at the same time for me is that I actually have an easier time keeping my numbers at range and below on insulin than I did with Metformin.

posted September 9, 2022

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