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Super Advisor
strollingbonez
Total Posts: 705
Registered on: ‎12-17-2012

how fast can one lower the a1c numbers?

my first and only a1c was 8.5....now realistically how fast can i lower that number?  i guess i am looking at another one around the end of feb or the beginning of march....i would like to see progress but have no clue how much progess to expect etc...

mollythed
Total Posts: 5,783
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Registered on: ‎10-31-2009

Re: how fast can one lower the a1c numbers?


strollingbonez wrote:

my first and only a1c was 8.5....now realistically how fast can i lower that number?  i guess i am looking at another one around the end of feb or the beginning of march....i would like to see progress but have no clue how much progess to expect etc...


The red blood cells in your body live about 90-120 days.  The stuff that makes them red is a molecule called hemoglobin.  When the red blood cells float around in plasma, they pick up some of the glucose in the plasma, and some of the glucose actually gets incorporated into the hemoglobin molecules and stays there for the life of the red blood cell. When those plain red blood cells pick up the glucose, we say they are glycosylated.

 

For the average person, without diabetes, about 5% of the red blood cells are glycosylated at any one time.  Of course, the older ones die off and keep getting replaced by new ones that are not glycosylated, but as time goes on, they too can pick up glucose.  If the glucose level stays level, the percentage of glycosylated hemoglobin levels off, as old cells die and younger cells become glycosylated.

 

The problem when we have diabetes is that there is too much glucose in our blood.  As a result, a larger percentage of our hemoglobin becomes glycosylated.  When I was first diagnosed, a little more than 11% of my hemoglobin was glycosylated.  That means my A1C was something like 11.2%.

 

What if I had been magically cured of diabetes that day? Would my A1C drop to 5.0, like a person without diabetes?  No.  It would still take months for all those old red blood cells, with glycosylated hemoglobin, to die off and disappear. By about three months, most of the old glycosylated hemoglobin would be gone and my A1C result would be down near 5.0.

 

Unfortunately, we don't have that magic cure.  We have to go to work, slowly reducing the amount of glucose in our blood.  We can tell how much progress we are making by testing with our meters.  As we make progress, less and less of the newly growing red blood cells pick up the extra glucose. Still, the older, glycosylated red blood cells are still hanging around.  If we have an A1C test at that point, it will lag behind, with those old cells contributing to the result.  Our A1C will show improvement, but not all the way down to the normall level.

 

Even with perfect management, it would take around three months for our A1C levels to drop to "normal".  Since we are still learning during those three months, chances are that it will not drop that quick.  As we learn more and know better, we can do better, but the process takes time.

 

Wait, there was a questionthat I have been ignoring! How fast can we lower the A1C?  Well, it's a different answer for everyone.  It depends on how high it was at diagnosis, how much we learn, and how quickly we put it into progress.  Any result we get before three months will reflect our new strategy for managing blood glucose, but also our past history.  If we just stay steady at that point, chances are good that the next A1C will be even lower, because it will be less tainted by that history.  If we start at 11.2 it might be just as easy to get to drop a whole 3.1 % to 8.1% as it would be to go from a starting 6.8%  down less than 1% to 5.9%, even though both results would be very, very praiseworthy.


"Molly" (aka mollythed)
Type 2 diabetes diagnosed in 1995, now managed with Lantus, Humalog and Metformin; diet and exercise.
My husband and three adult sons also have type 2 diabetes.





Super Advisor
strollingbonez
Total Posts: 705
Registered on: ‎12-17-2012

Re: how fast can one lower the a1c numbers?

thanks for explaining all that....

Established Advisor
MariaFan
Total Posts: 3,602
Registered on: ‎12-21-2012

Re: how fast can one lower the a1c numbers?


mollythed wrote:

strollingbonez wrote:

my first and only a1c was 8.5....now realistically how fast can i lower that number?  i guess i am looking at another one around the end of feb or the beginning of march....i would like to see progress but have no clue how much progess to expect etc...


The red blood cells in your body live about 90-120 days.  The stuff that makes them red is a molecule called hemoglobin.  When the red blood cells float around in plasma, they pick up some of the glucose in the plasma, and some of the glucose actually gets incorporated into the hemoglobin molecules and stays there for the life of the red blood cell. When those plain red blood cells pick up the glucose, we say they are glycosylated.

 

For the average person, without diabetes, about 5% of the red blood cells are glycosylated at any one time.  Of course, the older ones die off and keep getting replaced by new ones that are not glycosylated, but as time goes on, they too can pick up glucose.  If the glucose level stays level, the percentage of glycosylated hemoglobin levels off, as old cells die and younger cells become glycosylated.

 

The problem when we have diabetes is that there is too much glucose in our blood.  As a result, a larger percentage of our hemoglobin becomes glycosylated.  When I was first diagnosed, a little more than 11% of my hemoglobin was glycosylated.  That means my A1C was something like 11.2%.

 

What if I had been magically cured of diabetes that day? Would my A1C drop to 5.0, like a person without diabetes?  No.  It would still take months for all those old red blood cells, with glycosylated hemoglobin, to die off and disappear. By about three months, most of the old glycosylated hemoglobin would be gone and my A1C result would be down near 5.0.

 

Unfortunately, we don't have that magic cure.  We have to go to work, slowly reducing the amount of glucose in our blood.  We can tell how much progress we are making by testing with our meters.  As we make progress, less and less of the newly growing red blood cells pick up the extra glucose. Still, the older, glycosylated red blood cells are still hanging around.  If we have an A1C test at that point, it will lag behind, with those old cells contributing to the result.  Our A1C will show improvement, but not all the way down to the normall level.

 

Even with perfect management, it would take around three months for our A1C levels to drop to "normal".  Since we are still learning during those three months, chances are that it will not drop that quick.  As we learn more and know better, we can do better, but the process takes time.

 

Wait, there was a question that I have been ignoring! How fast can we lower the A1C?  Well, it's a different answer for everyone.  It depends on how high it was at diagnosis, how much we learn, and how quickly we put it into progress.  Any result we get before three months will reflect our new strategy for managing blood glucose, but also our past history.  If we just stay steady at that point, chances are good that the next A1C will be even lower, because it will be less tainted by that history.  If we start at 11.2 it might be just as easy to get to drop a whole 3.1 % to 8.1% as it would be to go from a starting 6.8%  down less than 1% to 5.9%, even though both results would be very, very praiseworthy.


Molly,

 

That has to be the very best "All In One Reply" explanation I have every read about how the A1C percentage number works with respect to dilution of the old "sugary" bloodcells versus the new "clean" ones. Thank you very much!!  *thumbs-up emot here*

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MariaFan aka Mark *the biggest fan of Maria Sharapova*
How do you like my newest Maria avatar? Isn't she lovely? :heart: :heart: :heart:

♫ ♫ Dancin' In The Moon Light, and Fighting The Good Fight ♫ ♫
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T2 - Official since 2011. Unofficial probably since 1980.
Hoping to stay in the 5% club.
Advisor
George_M
Total Posts: 2,233
Registered on: ‎11-16-2012

Re: how fast can one lower the a1c numbers?

[ Edited ]

strollingbonez wrote:

my first and only a1c was 8.5....now realistically how fast can i lower that number?  i guess i am looking at another one around the end of feb or the beginning of march....i would like to see progress but have no clue how much progess to expect etc...


Hi, strollingbonez.  To add just a bit to the very complete and excellent answer you received above: I was diagnosed in September with an A1C of 10.1.  I started working on getting my testing numbers down and losing weight by following a low carb diet.  I worked pretty hard at it, but was learning what to eat and not to eat by what it did to my blood glucose levels.  I was also getting lots of advice from well-meaning friends, some of it good, most of it terrible.  I got my fasting blood glucose level down from 235 to around 130-160 first thing in the morning, and peak down to under 200.  Things went on like that for about a month, then fasting came down into the 110-130 range, with peaks below 170.  Again, went on like that for almost another month, then I got my first reading under 100, then another one, now get at least one under 100 almost every day, and peak reading (unless I am running an experiment with foods) under 140.  Walgreen's had a free A1C test a little over 2 months into this, I took it and pulled a 6.0.  At three months, my doctor repeated the A1C and I was 5.6.  During those 3 months I lost 50 pounds, and got better at figuring out what to eat.  I would have loved to have my blood glucose levels drop immediately after diagnosis to what they are today, but that didn't happen.  The reasons why - and I am purely guessing here - are that it took awhile for me to identify and toss out of my menu foods that I thought would be OK but weren't, it took awhile to sort through and test the suggestions of my well-meaning friends, it took awhile for my body to adjust to fewer carbs, and I'm really hoping that weight loss is part of the answer, as I have another 50 pounds to lose and I would like to see a beneficial effect from that.  Don't expect that you can drop blood glucose levels overnight - you will see some benefits overnight, but this is more of a marathon than a sprint.  My 3-month A1C was where I wanted it to be, but it still had in it some of those red blood cells that were alive shortly after diagnosis, when my levels were higher than today, and maybe even a few that were alive for a short while pre-diagnosis.  I am hoping that the next one, in three more months, will be slightly lower.  5.3 sounds like a nice number.

One thing I have learned is that diabetes is a very individualistic disease.  What works for one person won't work, or won't work as well for another person.  For me, frequent testing has been the key.  I test my blood glucose before and 1 hour after every meal to learn what to eat.  I also try to exercise every day for 30 to 45 minutes.  You will see progress in 3 months if you are working on this consistently - how much progress is difficult to predict, but you definitely can move the needle in a positive way.  You have already taken the first steps towards success in dealing with your diabetes.  Congratulations.

George

Diagnosed T2 9/12/12, A1C 10.1
Metformin 500 mg. 1 x daily since 9/17/2012
A1C 12/13/2012 5.6
A1C 3/15/2013 5.4
A1C 11/29/2013 5.5
Weight at diagnosis 9/12/2012 288
Weight 10/01/2013 187
alan_s
Total Posts: 14,710
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Registered on: ‎10-30-2009

Re: how fast can one lower the a1c numbers?

[ Edited ]

strollingbonez wrote:

my first and only a1c was 8.5....now realistically how fast can i lower that number?  i guess i am looking at another one around the end of feb or the beginning of march....i would like to see progress but have no clue how much progess to expect etc...


 

There are two points I would like to add to Molly's excellent explanation.

 

The first is that there is also a reverse action, or decomposition which leads to the most recent period being most important. Here is one of the better explanations I have read:

Subject: What's HbA1c and what's it mean?

Hb = hemoglobin, the compound in the red blood cells that transports oxygen. Hemoglobin occurs in several variants; the one which composes about 90% of the total is known as hemoglobin A. A1c is a specific subtype of hemoglobin A. The 1 is actually a subscript to the A, and the c is a subscript to the 1. "Hemoglobin" is also spelled "haemoglobin", depending on your geographic allegiance.

Glucose binds slowly to hemoglobin A, forming the A1c subtype. The reverse reaction, or decomposition, proceeds relatively slowly, so any buildup persists for roughly 4 weeks. Because of the reverse reaction, the actual HbA1c level is strongly weighted toward the present. Some of the HbA1c is also removed when erythrocytes (red blood cells) are recycled after their normal lifetime of about 90-120 days. These factors combine so that the HbA1c level represents the average bG level of approximately the past 4 weeks, strongly weighted toward the most recent 2 weeks. It is almost entirely insensitive to bG levels more than 4 weeks previous. In non-diabetic persons, the formation, decomposition and destruction of HbA1c reach a steady state with about 3.0% to 6.5% of the hemoglobin being the A1c subtype. Most diabetic individuals have a higher average bG level than non-diabetics, resulting in a higher HbA1c level. The actual HbA1c level can be used as an indicator of the average recent bG level. This in turn indicates the possible level of glycation damage to tissues, and thus of diabetic complications, if continued for years.

The other point is that there is a danger when A1c is reduced excessively rapidly.Scroll down to: Retinopathy progression and sudden lowering of HbA1c , etc

 

A sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime may cause rapid and often uncontrollable retinopathy. This is a very common problem in clinical practice. Good diabetic control is essential in the long term, but unfortunately in the short term may cause a rapid deterioration in retinopathy. A lot of laser may be needed, and usually stabilises the condition.

 

However, using sensible dietary change based on post-meal testing to achieve that reduction is not likely to lead to such a rapid reduction. The only case that I am personally aware of  occurred when a person posting on a.s.d. tried a diet based on broccoli and little else for the first few weeks after diagnosis.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Budapest, Hungary)
Super Advisor
strollingbonez
Total Posts: 705
Registered on: ‎12-17-2012

Re: how fast can one lower the a1c numbers?

thanks alan.....i am trying to be more moderate in eating...i add...i test....i modify ....i just have the desperation all newbies have...i had a 93 test last night and almost cried...i started out at 424 at the beginning of the month...one of my closest friends called last night and invited me to the go to a favorite haunt for pizza and great cookies and all.....i said not now and we will talk....well i have avoided her since i found out....i broke down and told her last night...but last night i decided i will try to go and have a salad and a most piece of pizza after she and i have walked a few miles....lol...i read it is best to 'cheat' right after exercise....

Frequent Advisor
billsreef
Total Posts: 4,079
Registered on: ‎11-02-2009

Re: how fast can one lower the a1c numbers?

It's a bit more costly than pizza, but when I got to pizza place I'll variably get an antipasto salad, veal or chicken cutlet parmegian...minus the hero or pasta...and other lower carb alternatives. Biggest trick is the sauce, some use sugar and some don't. Just got to do some testing to figure how much of your places sauce you can have. The other trick, just eat the topping of a couple slices of pizza :smileywink:

alan_s
Total Posts: 14,710
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Registered on: ‎10-30-2009

Re: how fast can one lower the a1c numbers?


strollingbonez wrote:

thanks alan.....i am trying to be more moderate in eating...i add...i test....i modify ....i just have the desperation all newbies have...i had a 93 test last night and almost cried...i started out at 424 at the beginning of the month...one of my closest friends called last night and invited me to the go to a favorite haunt for pizza and great cookies and all.....i said not now and we will talk....well i have avoided her since i found out....i broke down and told her last night...but last night i decided i will try to go and have a salad and a most piece of pizza after she and i have walked a few miles....lol...i read it is best to 'cheat' right after exercise....


 

A trick I use for pizza, which allows me to eat it in company, is to eat one small wedge completely (you'll have to test to discover how small it has to be) and then eat the toppings off any further wedges, leaving the pie base. It takes a little practice to be able to do that discreetly, but I found no-one really notices or cares.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Budapest, Hungary)
Super Advisor
strollingbonez
Total Posts: 705
Registered on: ‎12-17-2012

Re: how fast can one lower the a1c numbers?

bill....we can get salad, mixed, pizza 12 inch and cookies and desserts....i live in a very rural area and this is a small pizza/bakery with an old fashioned stone oven....there is nothing much on the menu  no antipasta salad....

 

 

o alan.....i love crust....i was the one always eating the edge crust people left....can i have your crust?  was my line.....but i will most likely stick to the salad...the almond cookies are too die for......

 

o i guess that is not a good term now....