The Normal A1C Level

David Mendosa Health Guide February 11, 2009
  • You want to control your diabetes as much as possible. You wouldn't be reading this if you didn't. So you regularly check your A1C level. This is the best measurement of our blood glucose control that we have now. It tells us what percentage of our hemoglobin -- the protein in our red blood cells th...

128 Comments
  • Gretchen Becker
    Health Guide
    Feb. 11, 2009

    "Because we did fasting glucose tests on them, they had no prior history of diabetes, and none of them were obese"

     

    I don't think this is good proof that someone is nondiabetic. Not all people with diabetes are obese. Those with impaired glucose tolerance, having normal fastings but going high after meals, wouldn't be detected by these criteria. They...

    RHMLucky777

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    "Because we did fasting glucose tests on them, they had no prior history of diabetes, and none of them were obese"

     

    I don't think this is good proof that someone is nondiabetic. Not all people with diabetes are obese. Those with impaired glucose tolerance, having normal fastings but going high after meals, wouldn't be detected by these criteria. They should at least have done glucose tolerance tests to pick up those people.

     

    Why don't they study A1cs in healthy 10-year-olds?

    • David Mendosa
      Health Guide
      Feb. 11, 2009

      Dear Gretchen,

       

      I'm sorry that I wasn't clear. The fasting glucose tests that they did on their test subjects were glucose tolerance tests.

       

      Best regards,

       

      David

    • Gretchen Becker
      Health Guide
      Feb. 11, 2009

      Ah. That's different! Then they'd be nondiabetic. It would be interesting if they'd break them down into quartiles or something and relate the A1c to the peak and 2-hour results in the GTT.

    • Anonymous
      RobLL
      Feb. 12, 2009

      GTT figures themselves do not provide a good base for determining diabetes. They are greatly contaminated by the normal including lots of undiagnosed diabetics. Dr Bernstein has observed for years that a normal healthy person typically has BGs of 83, and even after a carby meal is under 100 a few hours later.

       

      RobLL

       

       

  • tshann
    Feb. 08, 2014

    I think the author of this article is trying to find a "truth." I just think it's not a useful truth. Trying to find out what is normal is not so useful in my opinion. In addition, the author is satisified when a researcher tells her averaging A1C's from 39 patients is the end of the search. The patients were non-obese and non diabetic. 

    Normal is an abstraction...

    RHMLucky777

    Read More

    I think the author of this article is trying to find a "truth." I just think it's not a useful truth. Trying to find out what is normal is not so useful in my opinion. In addition, the author is satisified when a researcher tells her averaging A1C's from 39 patients is the end of the search. The patients were non-obese and non diabetic. 

    Normal is an abstraction with little to recommend it as a goal. American's have some of the worst health in the develped world. We've gotten acclimated to setting our goals to mediocre health standards. Instead, we should be looking for OPTIMUM A1C's. 

      For instance, if the researcher had a sampling of very healthy thin, fit people and averaged their A1C's - especially if the number of people was closer to 500 or so, then I'd be more convinced that A1C range is of more utility. 

      But saying "just folks" who are not obese or diabetic is the measure to shoot for - especially such a small sampling. Well, that's not particularly inspiring me towards optimum health. Optimum health is my goal, not mediocricy. 

      In my mind, we still don't have what the optimum A1c aught to be, unless what Bernstein claims is it - or close to it.

      My 5 cents. 

    • David Mendosa
      Health Guide
      Feb. 08, 2014

      Dear Tshann,

       

      You have a good point that optimum can be different from normal. My point is that finding out what normal is, specifically learning that it is probably far less than the 6.0 figure that the American medical establishment is attached to, is where we have to start. We now have a good idea what normal is, and optimum is probably even lower....

      RHMLucky777

      Read More

      Dear Tshann,

       

      You have a good point that optimum can be different from normal. My point is that finding out what normal is, specifically learning that it is probably far less than the 6.0 figure that the American medical establishment is attached to, is where we have to start. We now have a good idea what normal is, and optimum is probably even lower.

       

      Namaste,

       

      David

    • tshann
      Feb. 09, 2014

      I see your point too. "Normal" does have some utility - I was being a bit harsh in my comment. I let my own personal goal of finding optimum blind me to the utility of a decent normal range.

        Still, it'd be nice some day to find some way of determining "fitness" and gathering a large sample of "fit" people (not saying super athletes, just people who are...

      RHMLucky777

      Read More

      I see your point too. "Normal" does have some utility - I was being a bit harsh in my comment. I let my own personal goal of finding optimum blind me to the utility of a decent normal range.

        Still, it'd be nice some day to find some way of determining "fitness" and gathering a large sample of "fit" people (not saying super athletes, just people who are fit and exercise regularly, eat loads of fruits and veggies, sleep 8 to 9 hours and have a good overall lifestyle) and test there average A1C's. 

        I'd love to see those numbers including inclusion criteria. That would be more telling in my mind. The A1C #'s w/o looking @ the people and lifestyle is of less utility in my mind. 

        Another sampling that would be interested are indigenous people who live very close to their ancestors (if they exist anywhere anymore - there were some folks in papua new guinea some time back who fit this criteria) and check out their A1C's.

        Anyway, just an interesting bit of conjecture.

       

               Peace

  • Anonymous
    Diabetic2
    Oct. 31, 2013

    In my eyes, if what you call "normal" (A1C 4.2 to 4.6) is something that non-diabetics can't even obtain, then it cannot be "normal".  If you are doing everything you can to lower your blood sugar levels, then you are doing everything you can, and that is great!

     

    Fellow Type 2 Diabetic

    • David Mendosa
      Health Guide
      Oct. 31, 2013

      Dear Diabetic2,

       

      I agree that it's great to do everything that you can to manage your blood sugar level. But whether or not you have type 1 or type 2 diabetes and you aren't following a very low-carb diet, you re not in fact doing everything that you can do.

       

      Actually, you are incorrect in writing that I maintain that 4.2 to 4.6 is a normal A1C...

      RHMLucky777

      Read More

      Dear Diabetic2,

       

      I agree that it's great to do everything that you can to manage your blood sugar level. But whether or not you have type 1 or type 2 diabetes and you aren't following a very low-carb diet, you re not in fact doing everything that you can do.

       

      Actually, you are incorrect in writing that I maintain that 4.2 to 4.6 is a normal A1C level. That A1C range was an example that I was quoting from someone else. I wrote in the post that a level of 6.0 or below is widely considered normal. Then, in one comment I wrote "I am convinced that it is somewhere between 4.5 and about 5.5." Fortunately, I have been able to keep my own A1C within that range for many years even though I have type 2 diabetes and when I was diagnosed I had an A1C of 14.4. In fact, I think that having a normal A1C level is so important that I make sure to test it on the first day of every month.

       

      Namaste,

       

      David

  • Anonymous
    Lee
    Jan. 28, 2013

    I read an article by DR.Chris Kresser and he says that people who are not Diabetic show higher A1c levels than those who are. Seems like the turnover for cells in people who are Diabetic is much sooner than those who have do not have Diabetes. Cell turnover in people who were Diabetic was upto 81 days and 146 for people who were not Diabetic. I believe that...

    RHMLucky777

    Read More

    I read an article by DR.Chris Kresser and he says that people who are not Diabetic show higher A1c levels than those who are. Seems like the turnover for cells in people who are Diabetic is much sooner than those who have do not have Diabetes. Cell turnover in people who were Diabetic was upto 81 days and 146 for people who were not Diabetic. I believe that explains why my A1C levels have been 5.7-5.9 when I have done everything in the book to prevent this disease. You can look him up and see everything I am talking about

    • Anonymous
      David Cejmer
      Jan. 02, 2014

      Cell turnover has very little to do with the results, a person who's cell lives for 140 days or 80 days is null and void, the idea of A1C is not the total, but rather the average. A diabetic does not have lower readings, unless they are in fact stringently managing their BG. For instance, I imagine Dr Bernstein is maintaining his glucose between 75-83 almost...

      RHMLucky777

      Read More

      Cell turnover has very little to do with the results, a person who's cell lives for 140 days or 80 days is null and void, the idea of A1C is not the total, but rather the average. A diabetic does not have lower readings, unless they are in fact stringently managing their BG. For instance, I imagine Dr Bernstein is maintaining his glucose between 75-83 almost religously, maybe even more closely than this. Eating extreme low cards, and monitoring your glucose, while using an insulin pump as a type 1 removes nearly all variables. A normal person has a pancreas which release insulin at an unknown rate, while it is controlled, it is not being measured by the person, so 70-90 maybe regular for them, with spikes to 99-110 being feasible. A type 2 who is well controlled, would have less than a normal person since they are releasing less of their own insulin, and using some supplementary form of control. For the type 1 it is easiest to monitor, since they have almost none of their own insulin, and if you eat very few carbs, and administer very little insulin to contorl it, the numbers will have very little change. I.E. extremely low, almost in the standard deviation range A1C. While Bernstein has several great ideas, he also perpetuates myths, which have been easily debuncted, and yet he continues to call the nay sayers conspiracy theorists.

       

      I am a nurse, with diabetic experience, and years of nutritional studies.

  • Francesca Thomas
    Sep. 01, 2012

    Dr Bernstein is a quack. If the normal A1C level for non-diabeteics is between 5 and 6% (As I have been told), then aiming to get a normal person down to 4% is non productive and for a diabetic to try and get down to 4%, is downright dangerous!!!

     

    There is NO way to eliminate all sugar from the body. Our bodies and most especially our brains, need sugar...

    RHMLucky777

    Read More

    Dr Bernstein is a quack. If the normal A1C level for non-diabeteics is between 5 and 6% (As I have been told), then aiming to get a normal person down to 4% is non productive and for a diabetic to try and get down to 4%, is downright dangerous!!!

     

    There is NO way to eliminate all sugar from the body. Our bodies and most especially our brains, need sugar and MUST have sugar in order to be at optimal health. 

     

    My son was diagnosed with Type 1 Diabetes, just 3 months ago. At dx his A1C was 13%. Within just 3 months I have been able to get it down to 8.1%.

     

    The doctor and the Diabetic murse were both very impressed. At the next 3 month clinic, I am hoping to have his A1C down to at least 6.5 %.

     

    The second diabetic in the family (who was diagnosed several years ago) was recently tested and his A1C is currently at 6.8% so he has his diabetes well under control.

     

     

  • barb
    Jul. 26, 2012

    my 13 yr old has had type 1 since she was 10. her daily tests which i guess we over test(whatever that means) have been maintainining between 4-7. her A1C yesterday was 5.6.to my understanding this coinsides with her average sugar levels. I don't understand why the diabetic clinic is upset???

  • barb
    Jul. 26, 2012

    my 13 yr old has had type 1 since she was 10. her daily tests which i guess we over test(whatever that means) have been maintainining between 4-7. her A1C yesterday was 5.6.to my understanding this coinsides with her average sugar levels. I don't understand why the diabetic clinic is upset???

  • dwo
    dwo
    Apr. 02, 2012

    Why do all these doctors keep trying to push these levels lower and lower?  By doin this, is pushing a type 1, closer and closer to hypo!  Let us be with the >7.0.  I have been a type 1 for 30 years and have no liver problems, kidney problems, heart problems, vision problems, feet problems, ect.  My goal is >7.0 always has and always...

    RHMLucky777

    Read More

    Why do all these doctors keep trying to push these levels lower and lower?  By doin this, is pushing a type 1, closer and closer to hypo!  Let us be with the >7.0.  I have been a type 1 for 30 years and have no liver problems, kidney problems, heart problems, vision problems, feet problems, ect.  My goal is >7.0 always has and always will.  My average A1c has been around 8.0 and i still have excellent health with this deadly disease, reason being is if i were to go so low i would have such a higher tendency to go hypo, and hypo causes alot more damage than hyper any day of the week.

     

    • dejahthoris
      May. 23, 2012

      This Mendosa guy does not care about type 1's because there are too few of us. He is only concerned about pushing Bernsteins low carb books and stuff to type 2's.  Thats where the money's at.

    • Francesca Thomas
      Sep. 01, 2012

      Is that was this is all abou? Bernsteins sells low carb diet books.


      Type 1 diabetics are suppsoed to be eating carbs - to keep their sugar levels steady.

       

      Type 2's need to combine the amount of carbs they eat with exercise (as much as possible)  in order to keep their A1C at an optimum level.

       

       I was told that for diabetics, the A1C for...

      RHMLucky777

      Read More

      Is that was this is all abou? Bernsteins sells low carb diet books.


      Type 1 diabetics are suppsoed to be eating carbs - to keep their sugar levels steady.

       

      Type 2's need to combine the amount of carbs they eat with exercise (as much as possible)  in order to keep their A1C at an optimum level.

       

       I was told that for diabetics, the A1C for diabetics needs to be around 7%. If that is cautious then so be it - at least we know its safe!!!

       

      Low carb diets indeed. These fad diets should NOT be pushed at or sold to diabetics!!!!

       

       

  • Anonymous
    NCouch
    Feb. 26, 2012

    Okay, I'm having some issues with the ranges of the A1C tests and levels.

    Two things:

    1) I've gone on a carb free diet for three months just to see if anything worked, my A1C results haven't changed a bit.  I am rather active, I exercise, and I have no recurring physical issues.  I don't feel different than when I was eating carbs.  I can't...

    RHMLucky777

    Read More

    Okay, I'm having some issues with the ranges of the A1C tests and levels.

    Two things:

    1) I've gone on a carb free diet for three months just to see if anything worked, my A1C results haven't changed a bit.  I am rather active, I exercise, and I have no recurring physical issues.  I don't feel different than when I was eating carbs.  I can't get below 5, I hardly break 5.3.  My family also has a history of diabetes....

    2) Same thing with a number of my friends.  They too were committed to putting their blood sugar down and those numbers just don't go down for them either.  Most of them hit 5.2, but a few can't get below 5.5.  Nothing wrong with them physically, nothing recurring in their medical history either.  Their families do or do not variably without any consistency.

     

    When on a normal diet, my A1C usually average 5.8.  Which, while on the high side, doesn't cause me to see any changes.  I have a healthy lifestyle, I'm nondiabetic and haven't even been considered pre-diabetic.  I check with my doctors regularly due to history, but nothing changes with or without carbs.

     

    What other factors are involved?

    • David Mendosa
      Health Guide
      Feb. 27, 2012
      I can think of several other factors. Too much protein is one of thr most common ones. Excess protein turns to glucose. Other factors are inflammation, including dental. Also stress in general.
    • Anonymous
      NCouch
      Feb. 27, 2012

      How about levels in kids?

      I know it seems slightly off my original question.  But it's been a slight concern for me.

    • David Mendosa
      Health Guide
      Feb. 27, 2012
      I can't think of any reason why to tolerate higher A1C levels in kids.
    • dejahthoris
      May. 23, 2012
      David Mendosa, Health Guide
      5577
      0
      2/27/12 12:13pm

      I can't think of any reason why to tolerate higher A1C levels in kids.

       

      Here's a reason for you, They will DIE of low blood sugar, you stupid idiot!

    • italiangm
      May. 24, 2012

      About 25% of the population can't lose weight or lower blood glucose on a low carb nutrition plan.

       

      Do a search on APOE4 and look for entries that discuss the genotype APOE4/E4. If you exhibit even a few symptoms of this condition, you might want to get tested to determine your ApoE type.

       

      These folks actually manage better on a moderate carb,...

      RHMLucky777

      Read More

      About 25% of the population can't lose weight or lower blood glucose on a low carb nutrition plan.

       

      Do a search on APOE4 and look for entries that discuss the genotype APOE4/E4. If you exhibit even a few symptoms of this condition, you might want to get tested to determine your ApoE type.

       

      These folks actually manage better on a moderate carb, low fat nutrition plan.

  • Vijaya Jayaraman
    Jul. 10, 2011

    Great work!! hope people around the world realize that they can bring their A1C down and 7 is only normal but not optimal..

     

    I was really happy when I saw my A1C came down from 8 to 7.4 to 6.9 your articles makes me think more deeper into this. I am glad you have done this research and wrote about it. I will continue to focus on get it further down. Thanks...

    RHMLucky777

    Read More

    Great work!! hope people around the world realize that they can bring their A1C down and 7 is only normal but not optimal..

     

    I was really happy when I saw my A1C came down from 8 to 7.4 to 6.9 your articles makes me think more deeper into this. I am glad you have done this research and wrote about it. I will continue to focus on get it further down. Thanks VJ

  • Anonymous
    Flexoplex
    Jun. 22, 2011

    I wanted to thank you for this excellent read!! I definitely enjoyed every little bit of it.I have you bookmarked your site to check out the latest stuff you post.

     

    Flexoplex

  • mench
    Jun. 05, 2011

    These levels are for normal subjects not diabetics. For a diabetic 7.0 is sufficient. As any diabetic will tell you when their blood sugar gets below 90 they have all the symptoms of hypoglycemia. Lets not forget the clinical trial where the subjects that were on tight ie less than 7.0 died. As I recall the trial was stopped.

  • lovingcritters
    Jun. 04, 2011

    Thanking you so much David for this timely info. It was you that got my attention with Dr. Bernstein's book.........It's like my "right-hand" man now. I consult it daily. I've been on his diet for 2years now, and when I say his diet, I mean I'm very disciplined! I'm 74 years old, and exercise every day, unless I can't be home for some reason. I do Aerobetics...

    RHMLucky777

    Read More

    Thanking you so much David for this timely info. It was you that got my attention with Dr. Bernstein's book.........It's like my "right-hand" man now. I consult it daily. I've been on his diet for 2years now, and when I say his diet, I mean I'm very disciplined! I'm 74 years old, and exercise every day, unless I can't be home for some reason. I do Aerobetics from a VCR in my livingroom. I started at A1C 9.5, and within 2 months it was down to 6.5. My Dr. tells me that is great, but as you know Dr. Bern says that it is still very high!

    I've tried everything David. If I thought it would help, I'd stand on my hands and walk everywhere. I can't get my A1c lower than 5.9. I've lost 31 pounds in 2 years, and the more I lose the easier it becomes for me to control my blood. I also have severe neuropathy, and it's such a relief not to have the constant pain my feet and hands. As long as I control my blood and keep it as low as I can, I no longer suffer like I used to.

    I really enjoyed your article, because I feel that we each have our own level. What is normal for me, may not be normal for someone else. My blood tests are marvelous, and since I do the old Vermont

    Folk Lore meds of drinking vinegar at each meal, the Drs. are amazed at my good kidneys too! Keeps my potasium up, and I'm very healthy, with lots of energy.

    Keep up the Good Work David, and Good Health to  you and your many followers

    Connie from Cheyenne, Wyoming

  • Edric Jackson
    Apr. 07, 2011

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    Thanks for sharing this important information.

    FlexoPlex

  • Edric Jackson
    Apr. 07, 2011

    It's a excellent article. It's a really valuable and useful for me.
    Thanks for this great article.


    Instaflex

  • Edric Jackson
    Feb. 17, 2011

    I was looking for crucial information on this subject.Thanks for taking the time to discuss this,They have been a big help for us.Thanks a lot.

    Flexcerin

     

  • WD
    WD
    Feb. 05, 2011

    After I read Bernstein's book some years ago my first attempt to match his numbers got me to 4.3 A1c as measured by my diabetologist. I had been at or below 5.0 for 15 years. As I approach 80 my numbers have become more variable and hypoglycemic risk higher. I am now reducing risk and my wife's worry level. The use of control charts which measure both the average...

    RHMLucky777

    Read More

    After I read Bernstein's book some years ago my first attempt to match his numbers got me to 4.3 A1c as measured by my diabetologist. I had been at or below 5.0 for 15 years. As I approach 80 my numbers have become more variable and hypoglycemic risk higher. I am now reducing risk and my wife's worry level. The use of control charts which measure both the average and variation of my 5 daily blood sugar readings is a more effective method for me than Bernstein. WD

  • Anonymous
    Addie
    Jan. 05, 2011

    I was diagnosed two and a half years ago with an A1c of 11.3% and a random blood sugar reading of 346 mg/dL. My HDL was low, LDL was borderline, and triglycerides were borderline. My doctor put me on Metformin and then later a small dose of Glyburide once a day. My A1c fell to 5.1% within a few months of my diagnosis. My doctor finally took me off Glyburide...

    RHMLucky777

    Read More

    I was diagnosed two and a half years ago with an A1c of 11.3% and a random blood sugar reading of 346 mg/dL. My HDL was low, LDL was borderline, and triglycerides were borderline. My doctor put me on Metformin and then later a small dose of Glyburide once a day. My A1c fell to 5.1% within a few months of my diagnosis. My doctor finally took me off Glyburide and increased my Metformin dosage and I'm maintaining numbers between 68-100 all day.

     

    I eat very low carb to do this. The weight loss also really helped. I couldn't achieve normal numbers two years ago on just Metformin. I've only seen one number over 100 since getting off Glyburide and that was 100 on the dot.

     

    My lipid panel also improved. My doctor asked me how I got my triglycerides down to 70 and my LDL down to 81 and I told him, "Blood sugar control, low carbing, and eating a lot of saturated fat." He seemed mystified.

     

    He also disapproved of my last A1c - 4.9%. I've kept my A1c below 5.1% for two years. He said, "Uh, that's a non-diabetic A1c." I responded, "I'm still diabetic. I just have good control." He wants my A1c to go up and I told him that wasn't going to happen. If he forces me to reduce my medication and my A1c goes over 5.5%, I'm getting a new doctor, even if it costs me an arm and a leg. He's looking out for his bottom line and he's scared to drive down my A1c after those most recent studies about low A1cs. Of course, if I die at 50 from heart disease, nobody will blame him. My doctors then will just say, "Oh, well, she was a diabetic. That's what happens to diabetics." It doesn't have to happen to diabetics. Control your blood sugar, control your insulin levels, keep your HDL and triglycerides, try to lose weight, and stay active. Don't let your doctor tell you that your below-6% A1c is 'too low.' He won't get complications from your high A1c, but you will. Sometimes you just have to be your own health care advocate.

    • David Mendosa
      Health Guide
      Jan. 05, 2011

      Dear Addie,


      I completely agree with you. Doctors really don't understand us and we have to be our own advocate.


      Stick to your guns. Tight blood glucose control can save you from complications and even save your life. 


      Your doctor was talking about the misleading early interpretations of the ACCORD study that seemed to show that tight control was dangerous...

      RHMLucky777

      Read More

      Dear Addie,


      I completely agree with you. Doctors really don't understand us and we have to be our own advocate.


      Stick to your guns. Tight blood glucose control can save you from complications and even save your life. 


      Your doctor was talking about the misleading early interpretations of the ACCORD study that seemed to show that tight control was dangerous in spite of all the evidence to the contrary from so many other studies. Now, however, we have a much better understanding of what went wrong with ACCORD. Please read this article, from Diabetes in Control at "Reanalysis of an ACCORD study refutes link between intensive therapy:"

       

      http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=9287&catid=53&Itemid=8

  • California Pilot
    Jan. 03, 2011

    Sounds weird, huh?  Was diagnosed in May 2010 with an A1c of 11.0, blood sugar of 480 at the time, my cholesterol was messed up - the LDL very high, HDL very low but my total was only 219.  My BP was 140/90 treated with drugs, my BMI was 32.4, my waist was closing in on 40" and my liver enzymes were crummy even though I rarely drank.    By...

    RHMLucky777

    Read More

    Sounds weird, huh?  Was diagnosed in May 2010 with an A1c of 11.0, blood sugar of 480 at the time, my cholesterol was messed up - the LDL very high, HDL very low but my total was only 219.  My BP was 140/90 treated with drugs, my BMI was 32.4, my waist was closing in on 40" and my liver enzymes were crummy even though I rarely drank.    By creatine was elevated and not in the normal range.  My blood work clearly indicated metabolic syndrome. 

     

    Well, I was put first on Metformin and 20mg a day of Glipizide and decided to lose some weight.  I could barely walk the dog up some of the hills around our house and could not run 1/2 mile.   

     

    Fast forward to Christmas 2010.  My weight is down to 165lbs, with a BMI of 25.5.  LDL is way down, HDL is way up, total cholesterol is under 150.  A1c is 5.6.  BP is usually 120/75 or so, I am running 3 miles a day, walking the dog before I go running for at least a mile, my waist is about 31" now, I need to buy all new clothes and they are hard to find because many places no longer stock sizes under 32" with 34" being a common smallest size stocked.  

     

    ALL of my blood work is deeply within normal ranges now and there is no metabolic syndrome any longer.  BUN/Creatinine and liver enzymes are all normal, my blood sugars are usually in the 90's when tested am and pm - and I am no longer on anything except Metformin.  If I take even 1/8th of a glipizide pill [as I tried to do when my sugars were a little elevated after drinking a couple of IPA's] I usually have a minor hypo event - I simply cannot take them any longer - to think in May I was on 10mg am and pm.  

     

    So - seven months after being diagnosed with Type II I am no longer on the pathway to an early heart attack, stroke or other diabetic complication.  

    I am the endo's poster child - 

     

    And it was interesting to learn that a normal A1c is between 4.7 and 5.7- and explains the letter I received from Anthem telling me that if I score under a 5.8 three times in a row over a 12 month period I will no longer be entitled to reimbursed Endo visits because it is no longer medically necessary . . . .  

  • dave
    Dec. 28, 2010

    I was first diagnosed  Dec 7 2010 with type 2. A1c test was at 14. Out of curiosity I bought an A1c home test on Dec 27 and tested myself. I know it is to early to test but I needed to know where I was at after a short time. After 21 days my A1c dropped to 12. Now to my question, is 2 points about a normal drop after a short time or should I work harder?...

    RHMLucky777

    Read More

    I was first diagnosed  Dec 7 2010 with type 2. A1c test was at 14. Out of curiosity I bought an A1c home test on Dec 27 and tested myself. I know it is to early to test but I needed to know where I was at after a short time. After 21 days my A1c dropped to 12. Now to my question, is 2 points about a normal drop after a short time or should I work harder?

    • David Mendosa
      Health Guide
      Dec. 29, 2010

      Dear Dave,

       

      Complicated question!

       

      First, a drop of 2 percentage points in such a short time is excellent. That's because the A1C measures the average of our blood glucose levels over a 2 to 3 month period. Now, 2 to 3 months is a pretty broad range, but that's what all the experts say. My guess is that the range varies by individual and/or their...

      RHMLucky777

      Read More

      Dear Dave,

       

      Complicated question!

       

      First, a drop of 2 percentage points in such a short time is excellent. That's because the A1C measures the average of our blood glucose levels over a 2 to 3 month period. Now, 2 to 3 months is a pretty broad range, but that's what all the experts say. My guess is that the range varies by individual and/or their diet.

       

      Second, your level is still awfully high, as I am sure that you know. This would be a great time to reduce -- and if possible eliminate -- all grains, starches (like from potatoes), and sucrose and high fructose corn syrup from your diet. If you do that you will see a remarkable change in your A1C level.

       

      Best regards,

       

      David

    • dave
      Dec. 29, 2010

      Thank you for the response. I realize that I am at a high but, I am trying very hard to get it under control.When first diagnosed my bs was at 340 now they are averaging at about 150. I know that 150 is still high but I seem to have cut it in half. I have cut out alot of sugar items and switched to brown (rice,etc)

      and portions.Also I dusted off my mountain...

      RHMLucky777

      Read More

      Thank you for the response. I realize that I am at a high but, I am trying very hard to get it under control.When first diagnosed my bs was at 340 now they are averaging at about 150. I know that 150 is still high but I seem to have cut it in half. I have cut out alot of sugar items and switched to brown (rice,etc)

      and portions.Also I dusted off my mountain bike and I am hitting the trail. I DON'T LIKE WHAT IS HAPPENING BUT IT IS WHAT IT IS AND I HAVE TO DEAL WITH IT. Once again thank you.

  • Judi
    Nov. 10, 2010

    I am new to this A1c stuff....just recently had my blood work done and altho the glucose levels were okay, the A1c was 6.4 and my doctor tells me I'm borderline and need to lower it.  Okay.....how?  I've read the comments posted here and no one really answers that question.  One woman did mention the Adkins diet.  I'm not obese but is that...

    RHMLucky777

    Read More

    I am new to this A1c stuff....just recently had my blood work done and altho the glucose levels were okay, the A1c was 6.4 and my doctor tells me I'm borderline and need to lower it.  Okay.....how?  I've read the comments posted here and no one really answers that question.  One woman did mention the Adkins diet.  I'm not obese but is that the only way to lower that number? I eat a lot of greens and have cut way back on sweets (altho I am guilty of an occasional chocolate) and am trying to stay away from anything made from white flour. Any suggestions? 

    • David Mendosa
      Health Guide
      Nov. 10, 2010

      Dear Judi,

       

      For people like you who are not overweight -- by that I mean a Body Mass Index of 24.9 or below (http://www.nhlbisupport.com/bmi/ ) -- you need to do three or four things to bring your A1C down to normal and therefore get your diabetes under control:

       

      1. Be more active.

       

      2. Eat better. This can mean either eating a low-glycemic...

      RHMLucky777

      Read More

      Dear Judi,

       

      For people like you who are not overweight -- by that I mean a Body Mass Index of 24.9 or below (http://www.nhlbisupport.com/bmi/ ) -- you need to do three or four things to bring your A1C down to normal and therefore get your diabetes under control:

       

      1. Be more active.

       

      2. Eat better. This can mean either eating a low-glycemic diet (see www.mendosa.com/gi.htm ) or better, eating a very low-carb diet (like Dr. Richard K. Bernstein writes about in "Dr. Bernstein's Diabetes Solution."

       

      3. Reducing the stress on your body. This includes reducing inflammation, like dental problems, and eating inflammatory foods, like grains and dairy. This can also include activities like meditation that will help you relax.

       

      4. For most people, the fourth step is to take diabetes medication as your doctor prescribes.

       

      For more detail, please see www.mendosa.com/advice.htm

       

      Best regards,

       

      David

  • Donna Campbell
    Nov. 05, 2010

    my son is 38 yrs old, was in a accident in march,2010 he has blood sugar level of 500 to 600 the dr he has cant get it under control & has never admitted him into the hospital to montor him. he is over weight, he drinks gallons of water a day has blurred vision & his feet hurt him. he on L & R insulin & the dr still dosnt know how much to give...

    RHMLucky777

    Read More

    my son is 38 yrs old, was in a accident in march,2010 he has blood sugar level of 500 to 600 the dr he has cant get it under control & has never admitted him into the hospital to montor him. he is over weight, he drinks gallons of water a day has blurred vision & his feet hurt him. he on L & R insulin & the dr still dosnt know how much to give him. his numbers have never gotten below 400 

    • David Mendosa
      Health Guide
      Nov. 05, 2010

      Dear Donna,

       

      How sad. Your son needs to take control of his life. The first step would be to find a more responsive medical team.

       

      David

  • Edric Jackson
    Nov. 02, 2010

    Its Pleasure to read your blog.The above articles is very impressive, and I really enjoyed reading your blog and points that you expressed. I love to come back on a regular basis,post more on the subject.
    Thanks for sharing...keep writing!!!

     

    Menoquil Menopause

     

  • Edric Jackson
    Oct. 11, 2010

    Awesome article, I am a big fan of this website, keep on posting that great content, and I'll be a regular visitor for a long time...looking for the next one....keep it up!!!

    Omega Xl Reviews

     

  • Edric Jackson
    Oct. 11, 2010

    Thank you for another fantastic blog. Where else could I get this kind of information written in such an incite full way? I have a project that I am just now working on, and i am sure this will help me a lot..and I have been looking for such information since from few days....Thanks!!!!!

  • parker
    Oct. 04, 2010

    Lifecell Anti Wrinkle : -
    Superb article ,I really appreciated with it,This is nice to read and valuable for future,I really bookmark it ,for further read.Thanks for sharing.I like it.

  • Anonymous
    anne davies
    Oct. 02, 2010

    My three monthly a1c level is 6.4 brought down from 10 years ago when it was 14.5 I am on prolonged release tablets 2x750 milligrams a day taken with my main meal in the evening what is a mystery to me is I hear a lot of talk about hypos with people on insulin but I am on tablets and if  my readings go down to less than 5 in the day which would be normal...

    RHMLucky777

    Read More

    My three monthly a1c level is 6.4 brought down from 10 years ago when it was 14.5 I am on prolonged release tablets 2x750 milligrams a day taken with my main meal in the evening what is a mystery to me is I hear a lot of talk about hypos with people on insulin but I am on tablets and if  my readings go down to less than 5 in the day which would be normal or slightly high for some people I start to feel shaky and feel like fainting and cant think straight I have met other people the same but nothing seems to be written about it

  • Michael Barker
    Sep. 30, 2010

     

    This is actually simple and I can't believe no one brought it up. All blood gets glycated given time. Time is the issue. The A1c assumes that the average life of a blood cell is 90 days. My A1c is 4.7 but I'm a ketosis prone type 2 diabetic and they are known to be more subject to anemias. (G6PD, sickle cell). The lifetime of my blood cells are typically...

    RHMLucky777

    Read More

     

    This is actually simple and I can't believe no one brought it up. All blood gets glycated given time. Time is the issue. The A1c assumes that the average life of a blood cell is 90 days. My A1c is 4.7 but I'm a ketosis prone type 2 diabetic and they are known to be more subject to anemias. (G6PD, sickle cell). The lifetime of my blood cells are typically going to be shorter than 90 days thus less glycation.

     

    Now, given the vagaries of the standard American diet, it is quite likely that a certain amount of anemia or something close exist in your average healthy American. This would also tend to make the average A1c lower.

     

    If you take the other tact then a healthy person, who is doing all the correct things might extend the life of their blood cells to greater than the 90 days. They would thus show more glycation and a higher A1c.

     

    This is the problem with the A1c as a diagnostic tool. My type of diabetic has a much higher rate of G6PD deficiency. This deficiency tends to lower A1c. The problem with ketosis prone diabetes is that abrupt onset starts at fairly low A1c's. (6.6%) If you lower the A1c reading only a few tenths of a percent than it doesn't show this danger level has been reached and that intensive intervention should be in the offing. http://ketosisprone.blogspot.com/

     

     

  • beedubya
    Jun. 09, 2010

    I haven't read all the coments, but I am 69 Y.O. and was diagnosed in May 1969.  For less than a year I took Diabenase and then started on insulin in March 1970.  The point is that you can live with a slightly elevated A1C and maintain a healthy,  normal life style.  I am retired, but work at a golf course, play ALOT of golf and volunteer...

    RHMLucky777

    Read More

    I haven't read all the coments, but I am 69 Y.O. and was diagnosed in May 1969.  For less than a year I took Diabenase and then started on insulin in March 1970.  The point is that you can live with a slightly elevated A1C and maintain a healthy,  normal life style.  I am retired, but work at a golf course, play ALOT of golf and volunteer at the local senior center.  After over 40 years as an insulin dependent diabetic, my A1C hovers between 6.5 and 7.0. I have no physical conditions that limit me in any way, other than my diet, of course.

  • Diabetes observer
    May. 29, 2010

    Who is David Mendoza? It is important folks who write on such matters as diabetes identify themselves either as doctors, patients or simply non-medical writers.

     

    I am not a doctor, neither am I a diabetic, but a curious observer as one day all of us will succomb to diabetes, even as organs functionally deteriorate.

  • Anonymous
    Anonymous
    May. 24, 2010

    I was diagnosed with type 2 diabetes in October 2009 - my blood suger (fasting) was 356 but my A1c was 5.7.  Since then I have had my A1c tested twice - in January it was 4.4 and in May it was 4.2.  My blood sugars have come down and I have been exercising and watching my diet and taking metformin.  I must be doing something right to get the...

    RHMLucky777

    Read More

    I was diagnosed with type 2 diabetes in October 2009 - my blood suger (fasting) was 356 but my A1c was 5.7.  Since then I have had my A1c tested twice - in January it was 4.4 and in May it was 4.2.  My blood sugars have come down and I have been exercising and watching my diet and taking metformin.  I must be doing something right to get the numbers to come down so quickly. 

  • Anonymous
    Jim
    Apr. 01, 2010

    Thanks for the very helpful information. My "diagnosis" A1c was 10.2. After starting insulin, my recent A1c was 5.5. Yes, I do follow Bernstein's recommendations (though I also use a pump and CGMS). My average blood sugars are about 92. They almost never go below 80 nor above 105. My lab results say that the A1c may be overestimated. I suspect it is. In any...

    RHMLucky777

    Read More

    Thanks for the very helpful information. My "diagnosis" A1c was 10.2. After starting insulin, my recent A1c was 5.5. Yes, I do follow Bernstein's recommendations (though I also use a pump and CGMS). My average blood sugars are about 92. They almost never go below 80 nor above 105. My lab results say that the A1c may be overestimated. I suspect it is. In any case, it's no worse than 5.5. I'm happy.

  • Anonymous
    Adrienne Larocq...
    Jan. 31, 2010

    If you or someone you love has diabetes, you owe it to yourself to be educated about nutrition. If you're on facebook, please join the Nutrition and Metabolism Society group at

     

    http://www.facebook.com/people/Adrienne-Larocque/819863569#/group.php?gid=276354325431&ref=mf

     

    You can alsocheck out the Society website at http://www.nmsociety.org/...

    RHMLucky777

    Read More

    If you or someone you love has diabetes, you owe it to yourself to be educated about nutrition. If you're on facebook, please join the Nutrition and Metabolism Society group at

     

    http://www.facebook.com/people/Adrienne-Larocque/819863569#/group.php?gid=276354325431&ref=mf

     

    You can alsocheck out the Society website at http://www.nmsociety.org/

     

    The Society is dedicated to addressing the problems of obesity, diabetes & cardiovascular disease through public awareness and education. We believe specifically that the therapeutic potential of carbohydrate-restricted diets for the treatment of these diseases is under-investigated and under-utilized, and seek to support research in this area. Our mission is to improve current nutritional guidelines and to see that sound scientific information is provided for the public.

  • Anonymous
    Anonymous
    Dec. 17, 2009

    I have been diagnoses just recently with type 2 diabetes my A1C was 13.5 in 3 months time i brought it down to 8.8 how good or bad is this. I am a truck driver and I am dealing with a dr. about my medical card.

    • David Mendosa
      Health Guide
      Dec. 17, 2009

      Unfortunately the level that you have now will lead to the complications of diabetes unless you bring it down to the normal range.

       

      David

  • Anonymous
    shelby4573
    Dec. 03, 2009

    i just read your article and just to lwet you know, an a1c normal range isn't 4-6 it's 5-7. also, you spelt diabeties wrong... i would think you should know how to spell your own disease. i have had diabeties for 17 years, and its a real battle. at one point; as a young teenager. i gave up. i didnt do anything at all... not one test, no insluin, no carb-counting;...

    RHMLucky777

    Read More

    i just read your article and just to lwet you know, an a1c normal range isn't 4-6 it's 5-7. also, you spelt diabeties wrong... i would think you should know how to spell your own disease. i have had diabeties for 17 years, and its a real battle. at one point; as a young teenager. i gave up. i didnt do anything at all... not one test, no insluin, no carb-counting; nothing. and my a1c was >14, and i almost lost my vision. ever since i have really cracked down on it and have had a steady a1c of 6.4-6.7. keep trying and arranging basal rates to correct your a1c. good luck.

  • Anonymous
    Proud to be abn...
    Dec. 03, 2009

    This article is *very* dangerous for anyone, not only diabetics. Nobody knows what the normal range is for A1c. The debate continues and the charts change. Do you trust the same doctors that told diabetics that eating 180g of carbs a day was healthy? Do you think taking some pills will keep you from having complications of diabetes? Masking symptoms of bad...

    RHMLucky777

    Read More

    This article is *very* dangerous for anyone, not only diabetics. Nobody knows what the normal range is for A1c. The debate continues and the charts change. Do you trust the same doctors that told diabetics that eating 180g of carbs a day was healthy? Do you think taking some pills will keep you from having complications of diabetes? Masking symptoms of bad eating by shooting up insulin or taking some pills will not solve the problem.

     

    I remember when I was first diagnosed with an A1c of 10. I worked hard and the next one was 5.4. It sounded great except I felt like complete crap. I had become a runner and even passed out twice after a run. I chipped one of my teeth in the process. I was a model diabetic. I exercised, ate healthy and kept my bg under control. The sad truth is that I was not healthy at all. I kept my bg too low. I ended up bouncing around from 180 to 30 on a daily basis. I couldn't understand why.

     

    Now I'm on an all natural low carb diet. No wheat, corn, potatoes, rice, etc. I make all my food by hand so I know what goes in it. My A1c is now 6.2. I've lost all symptoms of diabetes, including Acanthosis Nigricans and yeast infections, which I still had with an A1c of 5.4. My bg range stays within 110-130 (from pre to post). I don't bounce any higher or lower. I found for me, after a lot of testing, that I cannot go below 110. If I do, I start having hypoglycemia symptoms and panic attacks, which I used to get, but don't anymore.

     

    So don't let anyone tell you what "normal" is. Being "normal" almost killed me. You need to find the right level for your own body. Do a lot of testing and find what works best for you.

    • Anonymous
      Proud to be abn...
      Dec. 03, 2009

      I realized with my last post that there is another side to consider. The person I live with had many of the same symptoms of diabetes. He was always thirsty, felt sick after eating, would shake and tremble especially at night, had asthma, would sometimes take months to heal from a cold or a rash, was allergic to just about everything, lacked concentration (especially...

      RHMLucky777

      Read More

      I realized with my last post that there is another side to consider. The person I live with had many of the same symptoms of diabetes. He was always thirsty, felt sick after eating, would shake and tremble especially at night, had asthma, would sometimes take months to heal from a cold or a rash, was allergic to just about everything, lacked concentration (especially as a child), etc.

       

      He went to several different doctors over the years, starting in childhood. Each one thought he was diabetic, but when they tested him, he was well within the "normal" range. His bg level stayed under 120, even after a meal. He seemed fine. Over time, his memory became worse and he couldn't concentrate at all. His asthma and allergies were causing him severe problems and he had to have surgery to help. I began to check his bg and noticed after a meal it was 140. Unfortunately, it was still nothing that a doctor was concerned about.

       

      Finally, he started the same diet as me and immediately he felt better. All symptoms were alleviated. He threw away his inhaler and like me, hasn't been sick or has taken any medications since. Through much testing, we found his range to be between 80-95. If he goes below 80, he gets many hypoglycemia symptoms, including shaking and trembling.

       

      This shows how dangerous these guidelines and charts can be. His "normal" and my "normal" are on opposite ends of the spectrum. His "normal" kept him from being properly diagnosed and so he was getting progressively worse, while my "normal" was not good enough and doctors wanted me to be dangerously lower. It has led me to believe the best thing to do is to live by the meter. Test, test, test... Until all your symptoms are alleviated and you no longer need medicine.

  • sbukosky
    Sep. 08, 2009

    Yippee! 5.3 today at the doc's. Been on Byetta for four months after a couple years on Levimer and pills. I was about to give up on the expensive Byetta, but did loose 11 lbs in those months and now don't think I'll give it up.

  • Anonymous
    Mariela Lauria
    Aug. 18, 2009

    I quite feel identify with this article. I exercise everyday ( also during weekends), I eat properly ( I believe, may less than what I need), I´m thin. But my A1C is always above 8. The best I could have, has been 7. What can be my problem. I inject insulin, and my average, to make me feel fine, and no frequent hypog. needs to be 145. I do a lot of exercise,...

    RHMLucky777

    Read More

    I quite feel identify with this article. I exercise everyday ( also during weekends), I eat properly ( I believe, may less than what I need), I´m thin. But my A1C is always above 8. The best I could have, has been 7. What can be my problem. I inject insulin, and my average, to make me feel fine, and no frequent hypog. needs to be 145. I do a lot of exercise, so in order to keep on going, and avoid hypos, I need that level.

    What would you suggest??

    Thanks a lot for your help.

    Mariela, from Argentina.

    • David Mendosa
      Health Guide
      Aug. 18, 2009

      The best recommendation that I can make for you is a VERY low-carb diet. That's what worked for me.

       

      Best regards,

       

      David

  • kilaph2447
    Aug. 16, 2009

    Just what is (?!?) a "normal" A1c really is has been all 'round the park in my reading to date. Also: It's been hard to find a chart of BOTH BG levels AND their equivalent A1c reading, which would be helpful. When I do see a chart, it often is in conflict w/ a prior chart I have seen and committed to memory/practice, so I am confused. Right now, I am assuming...

    RHMLucky777

    Read More

    Just what is (?!?) a "normal" A1c really is has been all 'round the park in my reading to date. Also: It's been hard to find a chart of BOTH BG levels AND their equivalent A1c reading, which would be helpful. When I do see a chart, it often is in conflict w/ a prior chart I have seen and committed to memory/practice, so I am confused. Right now, I am assuming that a BG of '99' is an A1c of '5.0' and that each 1.0% rise in A1c is about '30 pts' on the BG scale (ie, A1c of 6.0 = approx 129 BG "read") Anyone got an 8/2009 chart that is accepted by AACE and ADA, etc? THANX!

  • Anonymous
    Agima
    Jul. 25, 2009

    An old saying, but so true...

     

    First I would like to say that it's alarming how some so called "experts", are posturing as knowledgeable, yet my impression is that about diabetes, multiple sclerosis, lupus et al. almost nothing is known about why they develop.

     

    I was diagnosed with type I in january, almost killed by the first docs I had, because...

    RHMLucky777

    Read More

    An old saying, but so true...

     

    First I would like to say that it's alarming how some so called "experts", are posturing as knowledgeable, yet my impression is that about diabetes, multiple sclerosis, lupus et al. almost nothing is known about why they develop.

     

    I was diagnosed with type I in january, almost killed by the first docs I had, because of overdosing insulin... My A1c at diagnosis was higher than 14%, my BGL was over 30. After 3 days my insulin career ended, I ended it after reading on the internet several testimonials about low carb diets. It sounded logical to me, I have problems whith carbohydrate homeostasis, carbs are not essential, so I don't eat carby stuff. My GAD65 ab count was at diagnosis > 2500, the referencence frame for the test is given as < 9.5... Holy Caroly!!! But then does antibodies against Glutamic Acid indicate diabetes? Or is it that the body is defending itself against the flooding by exogenous glutamate? They put that everywhere nowadays.

     

    Glutamate, as it is with gluten (an opiate like heroine), is known to cause havoc on the nervous system. I'm quite convinced that the main culprit of my high glucose levels, is my brain/nervous system. The sensors don't work well, everything is out of sync, so to say.

     

    Two months after diagnosis, I had an A1c of 7.2%, two months later 5.6% (meter showed 5.8 BGL average), now my meter, shows 5.6, but my A1c is surely lower, since, according to the meter, my BGL ranges from 2.5 to 7 for the last months, I guess that it, the BGL are something more like in between 3 to 6.5.

     

    My uncle had an A1c of 4.1, but he has serious health problems...

     

    My naïve approach is: if it is to small in nature and to eat it you have to cook it first, then it's a no-no. No one in his right mind would spend hours to get a handful of wild rice to eat it raw, we would rather go for tasty nuts, berries, roots, veggies and fatty meat, fish... Meat cooked, the rest raw, that's what I eat, usually 2 times per day. Lots of meat and raw veggies, with lots of canola oil.

     

    I don't eat the morning, to me it's illogical to eat breakfast, our ancestors had no fridge, first they had to look for food, after waking up. I also don't eat everyday and skip meals, but when I eat, usually humunguous amounts.

     

    To me it's also about deficiencies in minerals like zinc (zinc is central for inslin production, without enough zinc...), chromium, vanadium, selenium, magnesium, clacium, etc...

     

    I also don't think that the only culprit for developing type I diabetes is insulin deficiency, there are likely some other factors, like lipid metabolism problems. It looks like insulin is only one of the molecules that can transport glucose through a cell membrane, it may be not even the most important one.

     

    We should also monitor closely our blood pressure, to me, uncontrolled glycation of cells is accelerated if there's a lot of pressure to push glucose through a cell membrane without a transporter, just a very simple physical matter.

     

    What works for me, doesn't has to work for everyone, the short version is, no gluten, no glutamate, no soy, no beans,  no potatoes, no cereals, no grains, (to my knowledge the before mentioned foods/substances are chronically toxic) raw veggies, fatty meat, fish, nuts, vegetal oils, little dairy, supplementation of essential minerals (intermittently), lots of sun, vitamin D3, green tea, little bit of alcohol (like wine, rum or vodka) , positive attitude, question western medicine and medicine in general, go into biochemistry, keep it simple, keep the faith, there's no mistery in this whole thing.

     

    Thanks for your time :)

    • David Mendosa
      Health Guide
      Jul. 25, 2009

      Dear Agina,

       

      What you eat is a sound prescription for living well and long. With it you will be healthier than you ever were and healthier than almost anyone. Keep it up!

       

      Best regards,

       

      David

  • Anonymous
    Anonymous
    May. 22, 2009

    While I found your article very informative, just a small note from a former journalist.  Please do an actual read through of your article before you send it, not just a spell-check.  Spell-check is great for misspelled words, but if the erroneous word is in fact a word itself (such as "they" instead of "then" in your article), spell-check won't catch...

    RHMLucky777

    Read More

    While I found your article very informative, just a small note from a former journalist.  Please do an actual read through of your article before you send it, not just a spell-check.  Spell-check is great for misspelled words, but if the erroneous word is in fact a word itself (such as "they" instead of "then" in your article), spell-check won't catch it. There were several disconcerting such instances in your work where I had to re-read the sentence to figure out what you meant.  Great information, though, and I am encouraged by your research as I am a fairly newly diagnosed diabetic and trying to make sense of it all.  Good job.

    • David Mendosa
      Health Guide
      May. 23, 2009

      Thank you for your comment, your appreciation of my article, and for pointing out that typo. I just fixed it. Of course, I do read through my articles before they go online -- at least three times in fact. One of those times, which I find absolutely essential to correct typos, is to print it out on that old-fashioned stuff we call paper. Still, as you must...

      RHMLucky777

      Read More

      Thank you for your comment, your appreciation of my article, and for pointing out that typo. I just fixed it. Of course, I do read through my articles before they go online -- at least three times in fact. One of those times, which I find absolutely essential to correct typos, is to print it out on that old-fashioned stuff we call paper. Still, as you must know as a former journalist, and I know well as a journalist who saw his first article in print in 1949, no matter how hard we try we can't see every typo. That's why I have recruited three friends and regular correspondents here to add additional sets of eyes. None of us saw that typo. Can I enlist you in that effort too, please?

       

      Best regards,

       

      David

  • Anonymous
    Dave Wright
    Mar. 14, 2009

    I have had type 2 for eight years.

    My doctor tells me that I don't test positive for diabetes.

    I tell her all I need to do is have a sugar pop like Coke in her office.

    She declines my offer.

     

    I have an A1C of 5.3, and a fasting sugar of 5.8.  Consistently, four times a year.

     

    I had to have quad bypass two years ago.  The hospital put me...

    RHMLucky777

    Read More

    I have had type 2 for eight years.

    My doctor tells me that I don't test positive for diabetes.

    I tell her all I need to do is have a sugar pop like Coke in her office.

    She declines my offer.

     

    I have an A1C of 5.3, and a fasting sugar of 5.8.  Consistently, four times a year.

     

    I had to have quad bypass two years ago.  The hospital put me on insulin, and fed me fast sugar foods (high glycemic index).  My sugars were wildly out of control.

     

    I quit eating the hospital food, and started walking down three flights of stairs to the food court and started eating fruit, and salads.  I also spent hours walking the halls.  The nurses had to hunt me down to give me my meds.  I brought my sugars under control despite medical advise.

     

    The information about low glycemic index foods that I find as a result of your newletter are invaluable to me.

     

    Thank-you

    • David Mendosa
      Health Guide
      Mar. 14, 2009

      Dear Dave,

       

      Your experience is an excellent story showing how much diabetes is a disease that we have to control ourselves. We can't rely on our doctors and nurses. As you indicate, we can't even trust them. Good for you!

       

      Best regards,

       

      David

       

    • Anonymous
      Kim
      Apr. 11, 2010

      I  am 47 yr s old  in  2006 I was  diagnosed as a type2 diabetic I  take  a  pillforn   for help in  controling it along  with diet. and  still it is  at 6.7

       

       

      My question is  due to the  fact am  afaid  to take  a shot am not on insulin.

       

      What is the ...

      RHMLucky777

      Read More

      I  am 47 yr s old  in  2006 I was  diagnosed as a type2 diabetic I  take  a  pillforn   for help in  controling it along  with diet. and  still it is  at 6.7

       

       

      My question is  due to the  fact am  afaid  to take  a shot am not on insulin.

       

      What is the  best pill form  in hwlping to  control  your diabeties

       

       

      Kim  in Kansas City

    • David Mendosa
      Health Guide
      Apr. 12, 2010

      Dear Kim,

       

      Your doctor will have to make the final decision as to which pill can help you control your diabetes best. But the one most prefer is metformin, because it works very well to help you control your blood glucose level without causing you to gain weight, as most other diabetes medications do. If you have a lot of weight to lose, you now have...

      RHMLucky777

      Read More

      Dear Kim,

       

      Your doctor will have to make the final decision as to which pill can help you control your diabetes best. But the one most prefer is metformin, because it works very well to help you control your blood glucose level without causing you to gain weight, as most other diabetes medications do. If you have a lot of weight to lose, you now have a choice of Byetta or Victoza.

       

      Best regards,

       

      David

  • Anonymous
    lemarq
    Mar. 01, 2009

    My endocrinologist is most concerned that my A1C is 6.1 and by his standard that is to low..  I patiently explain to him that  I eat low carbs I am taking low amounts of insulin and am unlikely to go into a coma.  He doesn't get it. The last two visits he has expressed his concern about my A1c being low and I explain to him that I consider it...

    RHMLucky777

    Read More

    My endocrinologist is most concerned that my A1C is 6.1 and by his standard that is to low..  I patiently explain to him that  I eat low carbs I am taking low amounts of insulin and am unlikely to go into a coma.  He doesn't get it. The last two visits he has expressed his concern about my A1c being low and I explain to him that I consider it high & am working to get it lower.  This endo is a young guy probably not even 40 but his attitudes are right out of the 50s. I have told him to read Dr Bernstein but I doubt that he will.

     

    In case anyone is  wondering why I don't change doctors let me tell you that I live on a small island in BC, Canada and our medical system pays for my trip twice a year to Vancouver and those trips just happen to be at Easter and Thanksgiving  which allows me to enjoy those holidays with my family without paying for three expensive ferry trips.  The joys of socialized medicine.

     

    By the way I don't take my endo seriously and if I had to pay for my trip to the endo I wouldn't go.  He is the one that totally misdiagnosed me as a type 2.  I finally got my local MD to prescribe a C-Peptide  test which showed that I was not producing any insulin.  From my endo's point of view I am doing great but he is comparing me to his other 2500 or so patients who are typically overweight and not physically active..  With that kind of work load it is easy to see how easy it is to get misdiagnosed.  A  visit lasts maybe 20  to 30 minutes  tops. With people like Dr Bernstein and numerous diabetes forms and newsletters like David Mendosa  and a sympathetic  local MD I don't need to see a specialist.

  • Anonymous
    JulieF
    Mar. 01, 2009

    I just don't understand the A1C, I thought I did.  I have been diabetic for 10 years and have been taking 850 mg of glucophage/metformin twice a day since 2000.  In January 2009, I had a fasting blood sugar test, the reading after two hours (and eating) was 129.  The doctor changed my meds to 500 mg twice a day.  He said the test results...

    RHMLucky777

    Read More

    I just don't understand the A1C, I thought I did.  I have been diabetic for 10 years and have been taking 850 mg of glucophage/metformin twice a day since 2000.  In January 2009, I had a fasting blood sugar test, the reading after two hours (and eating) was 129.  The doctor changed my meds to 500 mg twice a day.  He said the test results were great.

     

    My A1C reading was once 3.9 but over the years I have kept records, the highest was 4.4 but usually the results are 4.1 or 4.2.  At a recent visit to a cardiologist,  I was told that my latest reading of 4.1 meant that I was barely diabetic.  So, what am I, other than confused?

  • steverx
    Mar. 01, 2009

    If you look into other studies, not just diabetes you will find that an excellent A1c result is below 5%.

     

    Is it normal to have a 30% increase in cardiovascular death?  I think not!

     

    In a study, the Epic-Norfolk study they took a couple of thousand people and checked their A1c results, irregardless of wheither they had diabetes or not.

    What...

    RHMLucky777

    Read More

    If you look into other studies, not just diabetes you will find that an excellent A1c result is below 5%.

     

    Is it normal to have a 30% increase in cardiovascular death?  I think not!

     

    In a study, the Epic-Norfolk study they took a couple of thousand people and checked their A1c results, irregardless of wheither they had diabetes or not.

    What they discovered is that when they comparied the A1cs of those at 6% to those that had an A1c of 5%, they found that those with an A1c of 6% compared to those with an A1c of 5%, had a 28% increase in cardiovascular DEATH for women and 26% increase in cardiovascular DEATH for men.

    Which makes sense, the higher the A1c means that you have more glucose attached to the red blood cell and makes your cells sticker and increases your risk for strokes and heart attacks.

     

    Just a note, this June the ADA will be announcing that they will be using the A1c test to diagnosis diabetes.  They haven't come out with the final details, but it looks like the consenses is that anyone with an A1c of 6.5% will be diagnosed with diabetes.

    It will be interesting to see if they also come out with a number for Prediabetes? 

    Maybe 5.5% to 6.5% will be prediabetes.

     

    So if you have an A1c of 6% and your risk for death is almost 30% higher, how can we possibly call that NORMAL????

     

    We need to let people and medical professionals that if a patients A1c is 5.9% that we need to continue to be aggresive in treatment.  Most doctors will stop treating a patient at 6% and wait until it goes up, which it always will.  As we get older the A1c continues to go up.

     

    Let's stop telling patents with diabetes that 6% is normal!

     

    Steve Freed, R.Ph., Diabetes Educator

    Publisher

    www.diabetesincontrol.com

    • Anonymous
      Doris Dickson
      Mar. 01, 2009

      Hi Steve,

       

      Gee ... two of my favorite diabetes peers in one day!  Cool.  (I write articles, blogs and book reviews for diabetes1.) 

       

      Now, about the ADA.  I heard/read the "gods" might be planning to transition to using A1C for diagnosis.  I think it should be part of the diagnosis but not all of it.  Are they planning...

      RHMLucky777

      Read More

      Hi Steve,

       

      Gee ... two of my favorite diabetes peers in one day!  Cool.  (I write articles, blogs and book reviews for diabetes1.) 

       

      Now, about the ADA.  I heard/read the "gods" might be planning to transition to using A1C for diagnosis.  I think it should be part of the diagnosis but not all of it.  Are they planning to skip using other diagnostic measures/techniques?

       

      And certainly, 6.5 is far too freaking high - equal to about 154 right?  You have to wonder what the heck drives these people!  I remember how horrible I felt on a regular basis at 6.5ish (before I read Dr. Bernstein's book).  Lordie.

       

      I found evidence from a Joslin report written in the 70's that clearly shows they KNOW what normal is.  They clearly KNOW when damage to beta cells starts and at what level damage to beta cells can be halted (for type 2's I mean).  They KNOW that at a fasting glucose of 100 there is a 40% loss of phase 1 insulin and that the loss drops very quickly after that.

       

      So why wait til people can't reverse the damage or until they have heart disease, etc. to diagnose?  How is switching to using A1Cs for diagnosis going to help especially if the acceptable range is still so high?

       

      I was going to ask if any of you are going to be at the ADA's Diabetes Expo in Boston on March 14th but ... I'm guessing you won't be there.  I'll be at the Diabetes1 booth but if I don't watch my disdain for the sponsor, I guarantee I'll get tossed out.  It's tough trying to use my voice when they constantly censor it!  Any chance we can get other Expo's started?

       

      Doris J. Dickson

       

       

       

       

    • steverx
      Mar. 01, 2009

      From my conversations with ADA, it looks like 6.5% will be the diagnosis without anyother testing, unless you have a condition that effects A1c like anemia.

       

      If they should also come out with a number for prediabetes like 5.5 to 6.5%, it will let millions of people know they are at greater risk.

       

      It is certainly better then using a fasting BG. ...

      RHMLucky777

      Read More

      From my conversations with ADA, it looks like 6.5% will be the diagnosis without anyother testing, unless you have a condition that effects A1c like anemia.

       

      If they should also come out with a number for prediabetes like 5.5 to 6.5%, it will let millions of people know they are at greater risk.

       

      It is certainly better then using a fasting BG.  It will be easier to have screenings at schools, public events, even dentists offices.

       

      Will not be in Boston, but will be at ADA's main event in June in New Orleans.

       

      It is just about impossible to go against the will of ADA, which AMA and every doctor follows.

       

      But, we need to continue to be proactive and one day it will have an impact.

       

      Until medical professionals understand that hypo's are not necessary when being agressive, we will continue to see doctors treating to 6 or 7% A1c's

       

      Your Friend in Diabetes Care

      Steve Freed

    • David Mendosa
      Health Guide
      Mar. 02, 2009

      Dear Steve,

       

      A level of 6.0 percent may be normal, but I certainly agree that it's not optimal. That's why I have personally striven to bring my level down in my most recent test to 4.8 percent. So essentially I do agree with you.

       

      I disagree when you write that as we get older our levels go up. Diabetes does not have to be a progressive disease...

      RHMLucky777

      Read More

      Dear Steve,

       

      A level of 6.0 percent may be normal, but I certainly agree that it's not optimal. That's why I have personally striven to bring my level down in my most recent test to 4.8 percent. So essentially I do agree with you.

       

      I disagree when you write that as we get older our levels go up. Diabetes does not have to be a progressive disease in that way. Often our levels DO go up, but they don't have to!

       

      Best regards,

       

      David

    • steverx
      Mar. 02, 2009

      David

      Instead of staying as we get older our A1c's go up, I should have said for most people, as we get older we get fatter and less active, causing our A1c's to go up.

       

      Thanks

      Steve Freed, R.Ph., CDE

      publisher

      www.diabetesincontrol.com

    • steverx
      Mar. 02, 2009

      David

      Instead of staying as we get older our A1c's go up, I should have said for most people, as we get older we get fatter and less active, causing our A1c's to go up.

       

      Thanks

      Steve Freed, R.Ph., CDE

      publisher

      www.diabetesincontrol.com

    • Anonymous
      Keeton
      May. 10, 2011

      I don't know if I'm following this feed with the correct understanding.  I am a type 1 diabetic who was diagnosed at 22. I am now 25 and I keep my a1c at the mid to low 5 range. For someone who injects insulin 4 times a day to keep their sugar in check, having an average blood sugar of 90 would mean that the numbers would most likely never peak above...

      RHMLucky777

      Read More

      I don't know if I'm following this feed with the correct understanding.  I am a type 1 diabetic who was diagnosed at 22. I am now 25 and I keep my a1c at the mid to low 5 range. For someone who injects insulin 4 times a day to keep their sugar in check, having an average blood sugar of 90 would mean that the numbers would most likely never peak above 125-140 and be as low as <65.  I am 5'7" and have finally had control to bring my body weight up to 155 lbs. I am athletic and lifeguarded before and after my diagnosis. My doctor warned me when my a1c was in the low 5 range because a person can get to used to the feeling of having lower blood sugars and not realize when they are dangerously low before it is too late.  However, if I am following this thread properly and it is feasible to have a lower a1c, I would be willing to go for it.  I know the only way to avoid the long term side effects (blindness, amputations, etc.) is to live healthy now so I want to know what is the best goal for someone with type 1 diabetes.

       

      Thanks for the article,

                                      Michael Keeton

    • David Mendosa
      Health Guide
      May. 11, 2011

      Dear Michael,

       

      When you use insulin, you have to be careful not to go too low, and that's why the ADA sets the goal at such a high A1C level, 7.0. But Dr. Richard K. Bernstein, who has type 1 himself, has many type 1 patients who keep their level below 5.0. I highly recommend that you read his book, "Dr. Bernstein's Diabetes Solution."

  • Anonymous
    Doris Dickson
    Mar. 01, 2009

    Hi David,

     

    I am also very fond of Dr. Bernstein and the information he has provided diabetics that just plain was not readily available without him.  I am also enormously grateful to him for his work on glucose monitors since they ADA wasn't interested. 

     

    I am a juvenile onset diabetic of more than 32 years.  Prior to reading...

    RHMLucky777

    Read More

    Hi David,

     

    I am also very fond of Dr. Bernstein and the information he has provided diabetics that just plain was not readily available without him.  I am also enormously grateful to him for his work on glucose monitors since they ADA wasn't interested. 

     

    I am a juvenile onset diabetic of more than 32 years.  Prior to reading Dr. Bernstein's book and other material, I maintained the recommended target of <7 and 110-140.  I have no major complications but plenty of "features" I can do without.  Several have abated or reversed themselves since I started targeting an average blood sugar of 85 and having consistent A1Cs of 5.1

     

    Though I haven't yet broken the 5.0 barrier I still strive to do so.  I eat far fewer carbs than recommended though not as few as Dr. Bernstein.  However, when I have cut back that far, my deviances have been far fewer - including lows.  I attribute that to less insulin, less russian roulette.

     

    I do have a board buddy with several more years of experience than I.  He eats more protein and fewer carbs than even I do.  He also hung for years in the 5.2/5.3 range until a few years ago when he started taking a statin.  He has since been in Dr. Bernstein's range. 

     

    I attribute my deviations to several things 1) Female hormones; avoid them if possible 2) Cortisol - I don't sleep well and have varying amounts of dawn phenomenon 3) Stress - THAT I have a master's degree in and it is usually accompanied by adrenalin bursts which result in short periods of insulin resistance 4) medications that also cause periods of insulin resistance (minimally, thyroid and birth control medications) 5) Incorrectly "guessing" digestion of food which tends to result in moderate lows (40-60) and the eventual digestion of the food and extra insulin to "fix"/"cover."

     

    When I look at all the challenges I put my body through, I suppose I'm very fortunate for attaining 5.1s so consistently.  However, I will continue to work to get < the magic 5.0.  I know how much better I feel at 5.1 than I did in the mid 6's. I can only imagine how good 4.2-4.6 could feel.

     

    Doris J. Dickson

  • Anonymous
    Steve
    Mar. 01, 2009

    I had a 150 fasting glucose level 4 yrs ago.  My latest ac1 was 5.2. 

    considering I am 5ft. 11in 175lbs with a body fat of 17% at 56 yrs. old

    I would consider that 5.2 reading in the "normal" range.

     

    I never felt better in my life.

     

    Another great ariticle!

     

    Thanks

  • Anonymous
    Dr Helen Hilts
    Mar. 01, 2009

    From HbA1c of 5.0 to 6.0 your risk of heart attack increases 28%.  Heart disease is the #1 killer in the US and even more so (85%) of diabetics.  Dying of heart disese is "normal", but it isn't what I want for me or my patients.  Your risk of nerve damage, retinopathy, stroke, impotence and every other complication also goes up 20-40%...

    RHMLucky777

    Read More

    From HbA1c of 5.0 to 6.0 your risk of heart attack increases 28%.  Heart disease is the #1 killer in the US and even more so (85%) of diabetics.  Dying of heart disese is "normal", but it isn't what I want for me or my patients.  Your risk of nerve damage, retinopathy, stroke, impotence and every other complication also goes up 20-40% for every 1 point increase in your HbA1c. 

     

    The men in the ACCORD study were eating a High Carb diet which 1) raised their insulin levels, 2) caused yoyoing blood sugars, 3) required large amounts of medicine.  People with insulin resistance make or require up to 4 times as much insulin to deal with carbs.

     

    High insulin levels  cause heart disease in 9 ways:  increasing inflammation, free radicals, and oxidant levels in the body; by raising blood pressure, triglycerides, total and LDL cholesterol, and lowering our good cholesterol (HDL); and by increasing our clotting in the bloodstream.

     

    Yoyoing blood sugars are very bad for you, too, whatever your HbA1c.

     

    I am a diabetic doctor.   My HbA1c is now 4.6.  It's not that hard, you just really cannot eat carbs except the slow ones in veggies.  My splurges are occasional small portions of maltitol sweetened chocolates.  If I eat other carbs I walk or exercise immediately and check my sugar to know the truth. 

    Check 1 (one) hour after you splurge when your sugar is highest, and it's much easier not to splurge next time. 

    • David Mendosa
      Health Guide
      Mar. 01, 2009

      Dear Dr. Hilts,

       

      Thanks for your comments. I especially like the one in your final sentence!

       

      Best regards,

       

      David

    • itfitz
      Mar. 01, 2009

      Dr. Hilts (and David):

       

      I had an engaging dinner conversation just last night with a colleague who is an orthopaedic surgeon.  My friend claimed (as do you) that insulin is the cause of these nine things.  I, however, in my medical education, and even more so after developing diabetes (LADA at age 39), understood that it was the hyperglycemia...

      RHMLucky777

      Read More

      Dr. Hilts (and David):

       

      I had an engaging dinner conversation just last night with a colleague who is an orthopaedic surgeon.  My friend claimed (as do you) that insulin is the cause of these nine things.  I, however, in my medical education, and even more so after developing diabetes (LADA at age 39), understood that it was the hyperglycemia that was causative.  I learned that the formation of advanced-glycation endproducts (AGEs) due to hyperglycemia was the etiology of many of the diabetic complications.  When I returned home, I jumped online and did a PubMed search on insulin and inflammation (and reviewed my notes from my board review).

       

      My PubMed query provided many sources, every single one which supported my belief that insulin itself DECREASES inflammation.  My board review notes said that AGEs weren't the only pathologic agent caused by hyperglycemia.  A hyperglycemic state will also activate Protein Kinase C (which increases the activity of many growth factors like TGFβ, VEGF, etc.); it will increase hexosamine flux; and it pushes the breakdown of glucose towards the polyol pathway, increasing sorbitol production and accumulation.

       

      Help me with this -- I can't find ANY evidence that what you said is scientifically correct.

      Dr. Fitz

    • Anonymous
      DrHelen
      Mar. 02, 2009

      Hi Dr Fitz,

      Hyperglycemia does indeed damage the body in a multitude of ways.  But it isn't the only culprit in  diabetes.  Hyperinsulinemia causes many of the problems years before the sugar goes high in T2DM, and problems for T1DM later, if they follow the standard "eat the carbs you want and cover them with insulin" diet.  Insulin resistance,...

      RHMLucky777

      Read More

      Hi Dr Fitz,

      Hyperglycemia does indeed damage the body in a multitude of ways.  But it isn't the only culprit in  diabetes.  Hyperinsulinemia causes many of the problems years before the sugar goes high in T2DM, and problems for T1DM later, if they follow the standard "eat the carbs you want and cover them with insulin" diet.  Insulin resistance, which has many factors, and our standard US high carbohydrate diet both contribute to years of hyperinsulinemia.

       

      It is very difficult to separate out hyperinsulinemia and insulin resistance in research or life, partly because each causes the other, and except in genetic oddities they always go together.  So people who are producing or injecting larger than physiological amounts of insulin are causing insulin resistance in themselves. 

      High blood sugar also causes insulin resistance, meaning it takes more insulin to lower the sugar from 300 to 200, than it does to lower from 200 to 100.  Keep in mind that insulin resistance usually means hyperinsulinemia in life, when you review the literature.

       

      I have seen the studies (at industry paid symposia) on how IV insulin actually decreases intravascular inflammation and causes vasodilatation.  However,  insulin resistance and diffuse hyperinsulinemia cause endothelial dysfunction and basement membrane changes, besides the list of effects I mentioned.

       

      Especially as a person with LADA, I hope you have read Richard K Bernstein's book. Dr Bernstein's Diabetes Solution.  He and many others agree that as diabetics we have a right to NORMAL blood sugar and insulin levels and that it is possible to achieve that.

      He quotes many clinical studies.  See pages 249, 446, 454 regarding hyperinsulinemia to start.  I have not read the originals of all of the studies he mentions.  

       

      I would love to find one or two great reviews on hyperinsulinemia.  But I wanted to get a response to you quickly.

       

      Try www.nmsociety.org the professional site for the Nutrition and Metabolism Society, a group of physicians and researchers who know that a low-carb diet allows the most normal physiology for diabetics.   They also have a more layperson friendly site with good links.  www.nutritionandmetabolism.com

       

      Here are a few articles I have gathered;

       

      Postprandial Endothelial dysfunction:  role of glucose, lipids and insulin [Review] [35 refs], Nitenberg et al, Diabetes and Metabolism, 32 Spec No2:2528-33, 2006 Sep

       

      Molecular mechanisms of insulin resistance that impact cardiovascular biology.

      Wang CC, Goalstone ML, Draznin B.

      Diabetes. 2004 Nov;53(11):2735-40. Review

      This discusses many mechanism whereby hyperinsulinemia has a very different, atherogenic effect compared to physiologic insulin levels.

       

      Hyperglycemia stimulates coagulation, whereas hyperinsulinemia impairs fibrinolysis in healthy humans.  Diabetes. 55(6):1807-12, 2006 Jun

       

      Effects of Hyperglycemia and hyperinsulinemia on the tissue factor pathway of blood coagulation [Review] [31 refs]  Durrent Diabetes Reports. 7(3):223-7,2007 Jun

      (also talks about proatherogenic and proinflammatory effects.)

       

      Here's to good health and long, fun lives for all of us.

      Helen

  • David Mendosa
    Health Guide
    Feb. 13, 2009

    Dr. Richard K. Bernstein, with whom I agree with on almost everything else, says that a normal A1C level is from 4.2 to 4.6, as I wrote in this post.

     

    He read it and emailed me his rebuttal. To further our understanding of this complicated and crucial issue I am pleased to post it here:

     

    Hi David

     

    If you had contacted me with a draft of your...

    RHMLucky777

    Read More

    Dr. Richard K. Bernstein, with whom I agree with on almost everything else, says that a normal A1C level is from 4.2 to 4.6, as I wrote in this post.

     

    He read it and emailed me his rebuttal. To further our understanding of this complicated and crucial issue I am pleased to post it here:

     

    Hi David

     

    If you had contacted me with a draft of your A1c article I would have shown you the flaw.

    See DIABETES CARE :

    Vol 25 pp 275-278 feb 2002 for an accurate formula converting A1C to avg BG. It's also

    In my book and gives an avg BG of 136 for an A1c of 6%.

    An A1c of 4.7 would give an average BG of 90mg/dl

    It seems to me that BGs of the US population are running too high and arePATHOLOGIC

    Not NORMAL. Average does not mean Normal. Just look at body weight,metabolic syndrome Etc

     

    I'd be glad to discuss with you the problems associated with the new conversion formulas

    From A1c to average BG performed by David Nathan’s ADA group

    Dick

     

    PS – Note that A1cs in my book are based on avg BGs of young adults in the 1980s

           When people were healthier. I pointed out that we are all entitled to those BGs and they are attainable if you don’t have gastrparesis and  untreated CHO craving.

     

    RICHARD K BERNSTEIN, MD, FACE, FACN, FCCWS

    • Anonymous
      Barry in Indy
      Feb. 13, 2009

      Check out Jenny's post on A1C conversion formulas, which she started back in 2006:

       

      http://diabetesupdate.blogspot.com/2006/12/formulas-equating-hba1c-to-average.html

       

      She updated this post over the years with different formulas.  

       

      The formula that Dr Bernstein uses is based on a linear regression analysis done on DCCT patients...

      RHMLucky777

      Read More

      Check out Jenny's post on A1C conversion formulas, which she started back in 2006:

       

      http://diabetesupdate.blogspot.com/2006/12/formulas-equating-hba1c-to-average.html

       

      She updated this post over the years with different formulas.  

       

      The formula that Dr Bernstein uses is based on a linear regression analysis done on DCCT patients (Type I diabetics). 

       

      Here are my questions:

       

      Has the DCCT formula been validated?

      How precise is the DCCT formula? (range)

      How reliable is the DCCT formula? (errors)

      Does the formula work for Type II diabetics?

      Does the formula work for when BG is near normal with low variability?

      Are blood testing labs calibrated A1C to a uniform standard?

       

      PS:  Dr. Bernstein deserves a Nobel Prize IMHO.  Smile

       

    • David Mendosa
      Health Guide
      Feb. 13, 2009

      Dear Barry,

       

      You have several technical questions! I hope that Dr. Bernstein will address them.

       

      Best regards,

       

      David

  • Anonymous
    Barry in Indy
    Feb. 12, 2009

    In my long journey with Type II, I've learned that A1C is of very limited value to anyone striving to achieve normal.  For "tight control" I believe there is no such thing as a normal A1C.  The reason is that its an average over a long period (2-3 months). 

     

    Many people are being deceived by their A1C because it tells you nothing about...

    RHMLucky777

    Read More

    In my long journey with Type II, I've learned that A1C is of very limited value to anyone striving to achieve normal.  For "tight control" I believe there is no such thing as a normal A1C.  The reason is that its an average over a long period (2-3 months). 

     

    Many people are being deceived by their A1C because it tells you nothing about BG variance.  The top and bottom BG values are not known for the period being tested.

     

    Endo's know that most Diabetics are not reliable users of their BG meters, so they love the simple A1C, especially since it fits the quarterly rhythm that they use to see patients.  In addition, I suspect most don't like to clutter their files with unstandardized print-outs from BG meter software (at least mine doesn't).

     

    So what I've done is come up with a new testing method to determine if I'm "normal".  For one day every week (or sometimes every other week), I continously monitor my BG.  I use a regular BG meter and simply test every non-sleeping hour for the entire day.

     

    With this test method, my definition of Normal is all BG readings within the range of 75-100.   When this is the case, my A1C readings are consistently in the 5's.  I've only ever had one A1C below 5.

     

    IMHO, A1C is not the best way to discern "normal" and never will be.  BG excursions are critical to tame and A1C tells us nothing about them.

     

    I personally think BG excursions are even harmful to non-diabetics.  Occasionally, I will challenge my non-diabetic friends to a post-prandial contest.  They eat their normal so-called "healthy" low fat/high carb meal and I eat my so-called "unhealthy" high fat/low carb meal.  I usually win.  Their 1 hour post-prandial BG reading is often 120 or higher.  Mine is typically 100 or less.

     

    Thanks for you incredible dedication to this blog!

     

     

    • NoBox
      Feb. 13, 2009

      Excellent points Barry.

       

      I too believe that large variations between low and high BG levels are potentially more damaging than a higher average BG level with small variations. Lower is not always better in the big picture. For example, healthy blood pressure by current standards is less than 120/80. Ok, so 0/0 must be perfect blood pressure? I doubt it....

      RHMLucky777

      Read More

      Excellent points Barry.

       

      I too believe that large variations between low and high BG levels are potentially more damaging than a higher average BG level with small variations. Lower is not always better in the big picture. For example, healthy blood pressure by current standards is less than 120/80. Ok, so 0/0 must be perfect blood pressure? I doubt it.

       

      Let's also keep in mind that a certain level of blood pressure is required to create the necessary pressure differential across membranes. Without it we can suffer from, among other things, chronic mild hypoxia when on BP medications that drive the BP below the pressure required to create the necessary pressure differential and drive the blood through the kidneys

    • David Mendosa
      Health Guide
      Feb. 13, 2009

      Dear Barry,

       

      Thank you for your comprehensive comment. You make an excellent point. The technical name for this concept is "glycemic variability" and I have written about it several times here. However, as you can see from my articles (as well as your experience) it isn't easy to do -- yet. The A1C test remains the gold standard of testing.

       

      Best...

      RHMLucky777

      Read More

      Dear Barry,

       

      Thank you for your comprehensive comment. You make an excellent point. The technical name for this concept is "glycemic variability" and I have written about it several times here. However, as you can see from my articles (as well as your experience) it isn't easy to do -- yet. The A1C test remains the gold standard of testing.

       

      Best regards,

       

      David

    • Anonymous
      Barry in Indy
      Feb. 13, 2009

      I agree that A1c is widely used in the current standard of care.  I personally hate the label "gold standard" though.  It implies that nothing better exists.  In the case of achieving "normal BG" per the Bernstein protocol I believe the gold standard is the Personal Glucose Monitor.  Without one, I'm absolutely certain that very few of us...

      RHMLucky777

      Read More

      I agree that A1c is widely used in the current standard of care.  I personally hate the label "gold standard" though.  It implies that nothing better exists.  In the case of achieving "normal BG" per the Bernstein protocol I believe the gold standard is the Personal Glucose Monitor.  Without one, I'm absolutely certain that very few of us could tailor our treatment to achieve normal BG.  If I were forced to choose between A1c testing or my personal glucose meter, I would very quickly say good-bye to A1c.

       

      When it comes to blood tests for diabetics, I cast the following votes:

       

      - gold to the portable BG meter

      - silver to advanced lipid testing (berkeley heart lab, nmr, vap)

      - bronze to A1c (takes up the slack for poor compliance by patients to utilize BG meter)

       

      How would others award the medals?

    • Anonymous
      Caleb Murdock
      Mar. 18, 2009
      Barry, I disagree with you that the A1c isn't a useful test. If you have an A1c of, say, 5, then you know that your top BG levels can't be TOO high, since in order to balance out those high levels, your BG would then have to drop to dangerously low levels (and that's probably not happening). Now, if your A1c is 7 or 8, then there is more room for dangerously...
      RHMLucky777
      Read More
      Barry, I disagree with you that the A1c isn't a useful test. If you have an A1c of, say, 5, then you know that your top BG levels can't be TOO high, since in order to balance out those high levels, your BG would then have to drop to dangerously low levels (and that's probably not happening). Now, if your A1c is 7 or 8, then there is more room for dangerously wide swings. I think we should assume that all people with diabetes have high swings when their diet isn't tightly controlled. Let me get theoretical, now, and a little ridiculous: Would it be better to have a steady BS level of 160, or to have wide swings between 120 and 200? Even if you are having wide swings between 120 and 200, that's still better than having wide swings between 120 and 300! So the A1c test does tell us something of use.
    • Anonymous
      Barry in Indy
      Mar. 19, 2009

      I agree that A1C is a useful test, which is why I gave it a bronze medal.  I just think it should not be the "gold" standard.  If I had to choose between A1C testing and a portable glucose meter, I would choose the latter.  Regarding wide swings in BG, I don't have the references handy, but I do recall that some research has shown that BG variance...

      RHMLucky777

      Read More

      I agree that A1C is a useful test, which is why I gave it a bronze medal.  I just think it should not be the "gold" standard.  If I had to choose between A1C testing and a portable glucose meter, I would choose the latter.  Regarding wide swings in BG, I don't have the references handy, but I do recall that some research has shown that BG variance is a critical indicator of poor outcomes with diabetics.  Low and stable is the key which is tough to discern with A1C.

    • tshann
      Feb. 08, 2014

      Yep, an illusion. The A1c is an artifical target IF you are using drugs to massage the numbers. You are still at risk if your lifestyle is poor. Sorry, conventional doc's are WAY wrong on this one. If you don't change lifestyle, drugs are a false comfort - you will still develop cardiovascular issues, cancer, etc. 

  • Aggie
    Feb. 12, 2009

    Nor is it beneficial to aim for some artificial "normal" value for all people. It actually does more harm than good to take a raft of pills to achieve any kind of target number. You may lower the numbers, but that does not result in meaningful reduction in complications or risk of death in the long term.

     

    Older people in particular are given way...

    RHMLucky777

    Read More

    Nor is it beneficial to aim for some artificial "normal" value for all people. It actually does more harm than good to take a raft of pills to achieve any kind of target number. You may lower the numbers, but that does not result in meaningful reduction in complications or risk of death in the long term.

     

    Older people in particular are given way too many drugs. Everyone's blood sugar values rise with age. Let's face it, nothing works as it used to, but aggressively treating a moderately high BG value in someone in his seventies is likely to cause more harm than good and do nothing to prolong his life. It probably will decrease his quality of life. We are over-medicalized in this country.

     

    At Risk: The True and False Promises of Medical Screening

    http://abcnews.go.com/Health/CancerPreventionAndTreatment/story?id=5886642&page=1

     

     

    The Prevention Agenda: Missing the Forest for the Trees

    http://abcnews.go.com/Health/WellnessNews/Story?id=6753330&page=1

    • Anonymous
      Doris Dickson
      Mar. 01, 2009

      I'm afraid I have to disagree that is not beneficial to aim for a "normal" A1C value for all people.  The way people go about it, and their lack of knowledge, is another issue.

       

      I'm proof that lowering an A1C from ADA recommendations of mid 6's to closer to non-diabetic (5.1) is meaningful and there are many of us.  Among other things, I feel...

      RHMLucky777

      Read More

      I'm afraid I have to disagree that is not beneficial to aim for a "normal" A1C value for all people.  The way people go about it, and their lack of knowledge, is another issue.

       

      I'm proof that lowering an A1C from ADA recommendations of mid 6's to closer to non-diabetic (5.1) is meaningful and there are many of us.  Among other things, I feel tons better.

       

      The fact that "everyone's" blood sugar rises with age doesn't make it right or healthy.  Consider the causes of this group of "everyone" having A1C creep - weight, sedentary lifestyle, loss of muscle tone, using pills because they are easier, non-diabetics meds that cause insulin resistance, etc.

       

      It's also NOT healthy for these levels to rise.  As the other doctor mentioned, cardiovascular disease is known to creep as A1C creeps to 6.0.  So ... don't let A1C creep to 6.0 and I'll put money on it that cardiovascular disease decreases.

       

      How will eating less crap, getting exercise and normalizing blood sugar decrease an elderly person's quality of life?  By not appeasing their overly nourished tongue?  They'll have a lot less dimentia and will have a better quality end of life, not worse. 

       

      I will agree with one thing -- being healthier shouldn't rely on pills.  It should start with better food, less food, more movement, etc - especially, if we're talking about type 2 diabetes.  Wish juvenile onset diabetes had been so easy to avoid.  Though the insulin shots 12-15 times a day aren't so bad to be honest.  I'd much rather use insulin than pills.

       

      Doris J. Dickson

    • David Mendosa
      Health Guide
      Mar. 01, 2009

      Dear Doris,

       

      Very well said! I absolutely agree with everything that you wrote. Wonderful advice!

       

      Best regards,

       

      David

  • kfleming55
    Feb. 12, 2009

    not to long ago I remember reading about a study that was stopped because those who were getting lower A1c levels were having heart attacks. The conclusion was that levels below 7 but above 6 were optimum. kfleming

    • David Mendosa
      Health Guide
      Feb. 12, 2009

      I am all too much aware of that study. But it wasn't the low A1C levels that were causing the heart attacks. It was all the medications that their subject were subjected to that was the driver.

       

      Best regards,

       

      David

    • David Mendosa
      Health Guide
      Feb. 13, 2009

      The Accord study was the one that you are referring to. Dr. Eades speculates that it was the high doses of insulin, a cardiac risk factor, that caused the heart attacks. Here's his article: http://www.proteinpower.com/drmike/cardiovascular-disease/ruminations-on-the-halted-accord-study/

       

      Best regards,

       

      David

  • Anonymous
    steverx
    Feb. 12, 2009

    The name of the A1c test will soon be known as the eAG or Mean Average Blood Glucose.  The labs will soon be reporting the A1c as the eAG.  Because 90% of people with type 2 diabetes do not know what an A1c test is.

    Maybe we should call it the "Quality of Life Test".  Then people will be more concerned with the result.

    I tell my patients that...

    RHMLucky777

    Read More

    The name of the A1c test will soon be known as the eAG or Mean Average Blood Glucose.  The labs will soon be reporting the A1c as the eAG.  Because 90% of people with type 2 diabetes do not know what an A1c test is.

    Maybe we should call it the "Quality of Life Test".  Then people will be more concerned with the result.

    I tell my patients that the result of the A1c not only tells you how you are doing but it also tells you how smart your doctor is when it comes to treating your diabetes.

    Because with all the medications and knowledge we have, there is no reason why anyone should have an A1c result over 5%. 

    The average A1c in the U.S. is over 9%, if you include everyone with diabetes and that is an eAG of over215mg/dL.

     

    I also have my patients do their own A1c tests at home every 30 days because 50% of the result comes from the last 30 days.  No reason to wait 90 or 180 days to find out how you are doing. 

     

    The A1c test is a great motivation tool

     

    If people want to do their own A1c test at home, they can look at the A1cnow test at www.a1ctest.com

     

     

    • Mary
      May. 11, 2010

      I hope you are NOT reccomending these A1c levels for type 1's

    • Anonymous
      KW
      Aug. 31, 2013

      Dr. Bernstein is Type 1 and keeps his A1C's under 5.0 and recommends that to his Type 1 patients as well. It can be done with the proper diet- i.e. NOT the diet that the ADA recommends, but a very low-carb diet (30 carbs per day) of meats, fish, fowl, vegetables, nuts, etc. It's hard at first, but it can be done, and pretty soon you're just used to living that...

      RHMLucky777

      Read More

      Dr. Bernstein is Type 1 and keeps his A1C's under 5.0 and recommends that to his Type 1 patients as well. It can be done with the proper diet- i.e. NOT the diet that the ADA recommends, but a very low-carb diet (30 carbs per day) of meats, fish, fowl, vegetables, nuts, etc. It's hard at first, but it can be done, and pretty soon you're just used to living that way and you don't even crave bread and other starches and sugars anymore :) 

    • Anonymous
      KW
      Aug. 31, 2013

      Dr. Bernstein is Type 1 and keeps his A1C's under 5.0 and recommends that to his Type 1 patients as well. It can be done with the proper diet- i.e. NOT the diet that the ADA recommends, but a very low-carb diet (30 carbs per day) of meats, fish, fowl, vegetables, nuts, etc. It's hard at first, but it can be done, and pretty soon you're just used to living that...

      RHMLucky777

      Read More

      Dr. Bernstein is Type 1 and keeps his A1C's under 5.0 and recommends that to his Type 1 patients as well. It can be done with the proper diet- i.e. NOT the diet that the ADA recommends, but a very low-carb diet (30 carbs per day) of meats, fish, fowl, vegetables, nuts, etc. It's hard at first, but it can be done, and pretty soon you're just used to living that way and you don't even crave bread and other starches and sugars anymore :) 

  • Anonymous
    steverx
    Feb. 12, 2009

    Your article still is a little confusing.  That a range of 4.5-6% is normal really doesn't help me set a goal.  Should you shoot for 5.5 or 4.9 or 5.8%?

     

    What I recommend for my patients is an A1c of below 5%.  I get that from the results of the Epic-Norfolk Study, which shows that those people with a 6%(normal??) compared to those with...

    RHMLucky777

    Read More

    Your article still is a little confusing.  That a range of 4.5-6% is normal really doesn't help me set a goal.  Should you shoot for 5.5 or 4.9 or 5.8%?

     

    What I recommend for my patients is an A1c of below 5%.  I get that from the results of the Epic-Norfolk Study, which shows that those people with a 6%(normal??) compared to those with a 5%, had a 28% increase in cardiovascular death.

    So shouldn't we shoot for an A1c of 5% or below?  The study only looked at A1c's and not whether they had diabetes.

     

    This all goes to add to our knowledge that most people with diabetes or prediabetes die from cardiovascular disease which most likely is caused by elevated sugars.

     

    Also when the ADA and AACE come out with the new protocols this May or June, for using the A1c for the diagnosis of diabetes, we might get a better understanding of what is NORMAL.

     

    Steve Freed, R.Ph., CDE

    Publisher

    www.diabetesincontrol.com

     

     

     

    • David Mendosa
      Health Guide
      Feb. 12, 2009

      Dear Steve,

       

      To a certain extent it's not my article but the situation that is confusing! I purposefully refrained from recommending a specific goal. I wanted only to clarify what a normal level is. Still, we have to go beyond normal to optimal.

       

      Certainly we need to reduce our A1C levels to 6.0 or below. That's now clearly established as the normal...

      RHMLucky777

      Read More

      Dear Steve,

       

      To a certain extent it's not my article but the situation that is confusing! I purposefully refrained from recommending a specific goal. I wanted only to clarify what a normal level is. Still, we have to go beyond normal to optimal.

       

      Certainly we need to reduce our A1C levels to 6.0 or below. That's now clearly established as the normal range, in spite of what our good friend maintains.

       

      But normal is not good enough. It's not optimal. And optimal is as low as possible. How low that is depends on the individual. For each of us, I am convinced that it is somewhere between 4.5 and about 5.5.

       

      Does that help to clear up the confusion -- as much as the situation itself and our current knowledge of it permits?

       

      Best regards,

       

      David

    • Anonymous
      paula
      Jun. 26, 2011

      I just went to the doctor (5/27/11)and had my A1c levels checked and was told I was prediabetic. My A1c level is 5.8%. My choloesterol level is 170 total. Hdl + 65mg/d/ and Ldl is 77 mg/dl and triglycerides is  142mg/dl. My glucose is 93mg/dL. I was just diagnosed with fibroid tumors and I was told I needed to loose weight. I"m 5'1 and weight 150lbs. Are...

      RHMLucky777

      Read More

      I just went to the doctor (5/27/11)and had my A1c levels checked and was told I was prediabetic. My A1c level is 5.8%. My choloesterol level is 170 total. Hdl + 65mg/d/ and Ldl is 77 mg/dl and triglycerides is  142mg/dl. My glucose is 93mg/dL. I was just diagnosed with fibroid tumors and I was told I needed to loose weight. I"m 5'1 and weight 150lbs. Are my numbers that bad?

    • David Mendosa
      Health Guide
      Jun. 26, 2011

      Dear Paula,

       

      Your triglycerides would be lower on a low-carb diet. And, according to http://www.nhlbisupport.com/bmi/ , your weight means you have a BMI of 28.3, which is indeed overweight. You need to bring it down below 25.0, which I know that you can do on a very low-carb diet. You can do it!

       

      David

    • Anonymous
      andreacanadian
      Feb. 14, 2010

      I had an A1C in Canada of 5.9 while on toronto ge insulin and metformin 500mg 3 x daily, i would like to stop taking the insulin because I am confident that 5.9 a1c could be adequately maintained with metformin alone

       

      so my question is in terms or your study and article are these universal or just U.S standards because I know measurement is different...

      RHMLucky777

      Read More

      I had an A1C in Canada of 5.9 while on toronto ge insulin and metformin 500mg 3 x daily, i would like to stop taking the insulin because I am confident that 5.9 a1c could be adequately maintained with metformin alone

       

      so my question is in terms or your study and article are these universal or just U.S standards because I know measurement is different between canada and the us.

       

       

      thanks for your input :D

    • David Mendosa
      Health Guide
      Feb. 14, 2010

      Good question. As far as I know a Canadian A1C of 5.9 is the same as one in the U.S. I'm pretty sure that the numbers would be a lot different otherwise!

       

      Best regards,

       

      David

  • Anonymous
    Jon
    Feb. 12, 2009

    My blood glucose level is between 70 and 85 at almost all times. And fasting levels are around 70-75. Yet, my A1c remains at 5.4 or so. I think the mapping betwen glucose levels and A1C has vast levels of variation. And for the same reason, I think that a "normal" of 4.2 to 4.6 is impossible for many people to attain, even those without any trace of diabetes....

    RHMLucky777

    Read More

    My blood glucose level is between 70 and 85 at almost all times. And fasting levels are around 70-75. Yet, my A1c remains at 5.4 or so. I think the mapping betwen glucose levels and A1C has vast levels of variation. And for the same reason, I think that a "normal" of 4.2 to 4.6 is impossible for many people to attain, even those without any trace of diabetes.

    • David Mendosa
      Health Guide
      Feb. 12, 2009

      Dear Jon,

       

      Thanks for adding your experience to this discussion.

       

      Best regards,

       

      David

    • kilaph2447
      Dec. 17, 2009

      Yes - I agree. I just clocked another 5.1, BUT my meter said I had averaged a BG of '118' for the previous 90 days. By my reckoning, I was expecting an HgbA1c of about 5.8. And the same disparity occurred in a prior 5.1 'A1c' reading from about 6 mos ago (w/ almost exactly the same BG number of '118'). 'Variability' indeed.

    • Anonymous
      Retired Physicist
      Jan. 14, 2010

      Your meter is providing you with the AVERAGE of ALL your readings.  Your BG at other times is at different levels --e.g., 100. 150,80, etc.  These are reflected in the A1c reading.  Hence the difference.  Hope this helps to understand the difference.

       

    • Anonymous
      paula
      Jun. 26, 2011

      I agree that reaching that level is very difficult. My A1c is 5.8% and the doctor told me I needed to loose 20lbs becasue I was prediabetic.

  • Anonymous
    Latoya
    Feb. 11, 2009

    It is important to test your blood sugar ever so often, there are <a href="http://diabetes.boomja.com/Diabetic-A1c-Test-Kits-39.html">Diabetic A1c Test Kits</a> available to aid us better in our diabetes management.

  • Gracie
    Feb. 11, 2009

    David,

    Finally SOMETHING about me is normal! I went from a not so perfect 10 to a 5.3 for over a year & a half, last one was 5.1 !

    HUgs,

    G

     

    • David Mendosa
      Health Guide
      Feb. 11, 2009

      Dear Gracie,

       

      Good for you. That's amazing improvement in such a short time. I have always said that we are all normal in some ways. And abnormal in others!

       

      Best regards,

       

      David

    • Gracie
      Feb. 11, 2009

      David,

      I'm mostly abnormal! But hey, it's fun! I keep a very tight rein on my carb consumption, and the BGL likes that!

      Hugs,

      G

    • Anonymous
      fariba
      Jan. 06, 2010

      Hi!  How did you do that? I got mine to go down from 8 to 6.3... can't get it lower.

    • Anonymous
      Gracie
      Jan. 06, 2010

      I am on Atkins, staying at 20 net carbs or less. I also exercise daily (walk a mile daily plus am on a gazelle edge for 3.5 miles a night).

      Hugs,

      G

    • Jerrymat
      Feb. 26, 2012

      I don't know how to keep carbs below 30 g per day - and I find that to be very hard work.  How can you get down to 20?

    • Vijaya Jayaraman
      Jul. 10, 2011

      How did you do that?

  • frankenduf
    Feb. 11, 2009

    I have a friend, Abby Normal- her A1C is >7

  • reese
    Feb. 11, 2009

    Thank you for your research, it was excellent.  I am a newly diagnosed type 2, it sheds alot of light on the A1c test, you have given me a comfort level which I needed.  I will share this with my physician.