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  #1   ^
Old Mon, Apr-03-17, 17:09
jcm13's Avatar
jcm13 jcm13 is offline
Senior Member
Posts: 158
 
Plan: Keto Diet (LCHF)
Stats: 267/220/180 Male 74 inches
BF:
Progress: 54%
Location: Pennsylvania
Thumbs down A1C of 12.4%

An A1C of 12.4% is what my doctor tells me I have from my blood test. He actually did not tell me, but rather had one of his nurses call me and read a card saying I have an A1C of 12.4% and I need to go pick up prescriptions that the doctor sent to the pharmacy.

So, without any instructions, I now have a glucose monitor, some pills to take and I am supposed to be injecting myself with insulin (which I did not buy yet)

The thing is, that everyone I tell that I have a 12.4% A1C says they never heard of such a thing. I immediately started a LCHF diet to help with the problem and I have been monitoring my glucose for the last couple of weeks. It has been between 90 and 130. Nothing like what I would expect from the A1C of 12.4% now that I have started reading about the subject.

Should I demand another test, or accept these results as reasonable? My thought is to go to the doctor and say this does not make sense to me, can you explain what you think is wrong, redo the A1C and explain how you think I should manage the disease.

Does and A1C of 12.4% make sense with those glucose readings on a LCHF diet?
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  #2   ^
Old Mon, Apr-03-17, 19:43
deirdra's Avatar
deirdra deirdra is offline
Senior Member
Posts: 3,686
 
Plan: HF/vLC/GF,CF,SF
Stats: 197/136/150 Female 66 inches
BF:
Progress: 130%
Location: Alberta
Default

The A1C is sort of like an average of your last ~90 days of BG readings. Were you eating tons of sugar for the 3 months before the test? Do you have any previous tests to compare this high reading to?

Are you taking the pills? Or are the 90-130 readings just with LC eating? If you are achieving those low values without medications, it sounds like you should request a new A1C test and may not need pills or insulin. If with pills, these readings suggest you do not need insulin yet (or ever if you stay LC).

A1Cs can be unreliable in people of African, Mediterranean or southeast Asian heritage:
https://www.niddk.nih.gov/health-in...gnosis/a1c-test

Last edited by deirdra : Mon, Apr-03-17 at 19:53.
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  #3   ^
Old Mon, Apr-03-17, 20:56
jcm13's Avatar
jcm13 jcm13 is offline
Senior Member
Posts: 158
 
Plan: Keto Diet (LCHF)
Stats: 267/220/180 Male 74 inches
BF:
Progress: 54%
Location: Pennsylvania
Default

Quote:
Originally Posted by deirdra
The A1C is sort of like an average of your last ~90 days of BG readings. Were you eating tons of sugar for the 3 months before the test? Do you have any previous tests to compare this high reading to?

Are you taking the pills? Or are the 90-130 readings just with LC eating? If you are achieving those low values without medications, it sounds like you should request a new A1C test and may not need pills or insulin. If with pills, these readings suggest you do not need insulin yet (or ever if you stay LC).

A1Cs can be unreliable in people of African, Mediterranean or southeast Asian heritage:
https://www.niddk.nih.gov/health-in...gnosis/a1c-test


Thanks for the reply. The only other test I had was 3 years ago and it showed pre-diabetic, but I have not yet started any pills or insulin. I am not in those unreliable test groups and I was not eating loads of sugar, so I will call the doc in the morning and request a re-test because it just does not make sense.
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  #4   ^
Old Mon, Apr-03-17, 21:13
deirdra's Avatar
deirdra deirdra is offline
Senior Member
Posts: 3,686
 
Plan: HF/vLC/GF,CF,SF
Stats: 197/136/150 Female 66 inches
BF:
Progress: 130%
Location: Alberta
Default

Quote:
Originally Posted by jcm13
Thanks for the reply. The only other test I had was 3 years ago and it showed pre-diabetic, but I have not yet started any pills or insulin. I am not in those unreliable test groups and I was not eating loads of sugar, so I will call the doc in the morning and request a re-test because it just does not make sense.
Good plan! Waiting until you've been eating LCHF for 90 days should give a more meaningful A1Cnumber.

It is scary that a doctor would go from nothing to pills + insulin based on one reading.

Last edited by deirdra : Tue, Apr-04-17 at 07:18.
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  #5   ^
Old Tue, Apr-04-17, 04:36
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,317
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

At the weight you were when this A1C blood test was taken indicates you were eating some type of carbs that could have resulted in that level. Maybe not sugar, maybe whole grain breads and beer? As diedra explained, it indicates an average of BG readings over roughly the previous 3 month period, but the rate of red blood cell turnover can vary.

From your previous posts, it seemed that you had not started LC when the test was taken and BG can respond quickly, so 12.4 is likely accurate. Even if it wasn't, I would suggest that you stick to a VLC diet for about four months, and then request a A1C again. You are not going to get any information from it that should change your course of action now. Believe Ken had a similar situation, he had been eating LC for five weeks before the A1C test was taken. The A1C was still high while the BG was already in normal ranges. Rather than prescribe meds, his doctor had him continue with what he was eating.
Eat a strict LC diet, and use that glucose meter often to test your reaction to foods. By the end of 4 months, you will have a better idea what LC foods work well for you and which to avoid.

Last edited by JEY100 : Tue, Apr-04-17 at 06:44.
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  #6   ^
Old Tue, Apr-04-17, 04:50
jcm13's Avatar
jcm13 jcm13 is offline
Senior Member
Posts: 158
 
Plan: Keto Diet (LCHF)
Stats: 267/220/180 Male 74 inches
BF:
Progress: 54%
Location: Pennsylvania
Default

VLD diet? The only references for this I can find, are very low fat diet. Is this what you mean? I have been taking a LCHF (low carb high fat) because fats have the least effect on blood sugar and carbs the most.
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  #7   ^
Old Tue, Apr-04-17, 04:59
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,317
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

Sorry, corrected VLC or Very Low Carb. Meaning the 20 g total carb plan if the 20 g net carb plan is not giving you the results you want. If net carb is working for you, great, but you can tell best by testing BG before and after meals, not just your weight. I'm a six year committed low carber..gave up those low fat ways forever.

A how-to for the glucose meter to help refine your food list: http://www.wheatbellyblog.com/2016/...ng-blood-sugar/

Last edited by JEY100 : Tue, Apr-04-17 at 06:48.
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  #8   ^
Old Tue, Apr-04-17, 06:55
teaser's Avatar
teaser teaser is online now
Senior Member
Posts: 11,058
 
Plan: ketosis/IF
Stats: 190/158/154 Male 67inches
BF:
Progress: 89%
Location: Ontario
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If your had an A1C of 12.4 so recently, but low carb is giving you a blood glucose with a range between 90 and 130, that's not an anomaly--it's an awesome response to low carb.

The worst thing you could do is not take that 12.4 seriously. If your A1c reverts to pre- or even non-diabetic in three or four months times, that won't mean that you can handle carbs again, it will just mean that you're handling not eating carbs very well.


Quote:
My thought is to go to the doctor and say this does not make sense to me, can you explain what you think is wrong, redo the A1C and explain how you think I should manage the disease.


This might be a good idea, if enough time goes by for your A1C to show the improvement that seems very likely given your blood glucose numbers. But maybe you should be the one to explain how he should manage the disease in his patients. What you are already doing is more effective than what your doctor has contributed so far.
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  #9   ^
Old Tue, Apr-04-17, 09:11
PaCarolSue PaCarolSue is offline
Senior Member
Posts: 272
 
Plan: Whatever Works
Stats: 217/200.5/199 Female 5ft 2 inches
BF:lots/lots/less
Progress: 92%
Location: USA
Default

Although I hesitate to tell anyone not to listen to their doctor, I hate when I hear that a doctor prescribes insulin without first allowing the patient to try lifestyle changes. I consider my doctor to be an advisor, whom I pay to advise me about my health, but the final decision is mine. I dropped my A1c quickly by switching to low carb eating and adding exercise. A 30 min walk after dinner helped tremendously.

My advice would be to tell your doctor you would like to make serious lifestyle changes before starting on insulin. If he is not willing to work with you on this, maybe you need a new doctor.
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  #10   ^
Old Tue, Apr-04-17, 09:31
cotonpal's Avatar
cotonpal cotonpal is online now
Posts: 2,985
 
Plan: very low carb real food
Stats: 245/122/135 Female 62
BF:
Progress: 112%
Location: Vermont
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Quote:
Originally Posted by PaCarolSue
Although I hesitate to tell anyone not to listen to their doctor, I hate when I hear that a doctor prescribes insulin without first allowing the patient to try lifestyle changes. I consider my doctor to be an advisor, whom I pay to advise me about my health, but the final decision is mine. I dropped my A1c quickly by switching to low carb eating and adding exercise. A 30 min walk after dinner helped tremendously.

My advice would be to tell your doctor you would like to make serious lifestyle changes before starting on insulin. If he is not willing to work with you on this, maybe you need a new doctor.


I agree with this 100%. I am eagerly awaiting the release of Dr Davis's (of Wheat Belly fame) new book "Undoctored" about how to manage your own health through life style change without unnecessary and wrong-headed intervention by the medical profession. It will be released on May 9.

Jean
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  #11   ^
Old Wed, Apr-05-17, 05:32
jcm13's Avatar
jcm13 jcm13 is offline
Senior Member
Posts: 158
 
Plan: Keto Diet (LCHF)
Stats: 267/220/180 Male 74 inches
BF:
Progress: 54%
Location: Pennsylvania
Default

It is all sound advice. I will keep my doing what I am doing and monitor carefully. It seems that I am getting the results I need through just diet and we will check the A1c in at the 90 day interval to confirm. I still think the test may have been off, but there is really no way to know that and it is better to be safe than sorry.

I will start looking for a better doctor, but I fear it is the more the norm to prescribe first and ask questions later. I do appreciate any thoughts from those of you that have already been down this path.
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  #12   ^
Old Wed, Apr-05-17, 07:33
PaCarolSue PaCarolSue is offline
Senior Member
Posts: 272
 
Plan: Whatever Works
Stats: 217/200.5/199 Female 5ft 2 inches
BF:lots/lots/less
Progress: 92%
Location: USA
Default

I agree that it is more the norm to just prescribe meds, but is up to the patient to ask about a different solution. I would give this doctor a second chance....go back for another A1c after 90 days, and if it's improved, then tell the doctor what you did, and he should agree that you don't need insulin.

When I improved my A1c with LC and exercise, my cholesterol also improved. My doctor was so amazed he asked me what I did to get that, so your doctor may be impressed, too!

Medicine is OK when necessary, but patients should be more proactive in their care.
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  #13   ^
Old Wed, Apr-05-17, 09:14
jcm13's Avatar
jcm13 jcm13 is offline
Senior Member
Posts: 158
 
Plan: Keto Diet (LCHF)
Stats: 267/220/180 Male 74 inches
BF:
Progress: 54%
Location: Pennsylvania
Default

Carol - I will do like you say, but I was really disappointed that the doctor got my test results and did not call me or schedule a visit, but just had a nurse call me and tell me to pick up my prescriptions.

He is a young doctor and maybe not experienced with diabetes. I think you are right that we must first manage our own care and help the doctor to do a good job.
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  #14   ^
Old Thu, Apr-06-17, 04:37
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,317
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

That is even more disappointing that a young doctor did not prescribe lifestyle changes first! Many med schools focus only on the meds and have little or no time for nutrition or lifestyle as a therapy.

I am blessed to be in an area where doctors do get some nutrition training, Dr Eric Westman teaches it at Duke, and my Duke GP supports his LC clinic program for me. But he's given some fun advice....if you think your doctor would go nuts over a low carb diet, say that you have been doing a "Modified Mediterranean Diet" and exercise Rare is the doctor who would drill down to find out the macros of exactly what you modified. Current dogma is Mediterranean = Good, so if you come back with a lower Hba1c not using the meds, that should be OK.


But if you want to look for another doctor...

Quote:
How to Find a Doctor Supportive of LC/Paleo Diets

There are a number of resources to help you find medical care supportive of a reduced carbohydrate way of eating. Some lists include not only medical doctors, but chiropractors, naturopaths, nutritionists, RDs, etc. Some are for general practitioners, some for Obesity specialists. With any recommendation, check the website/reviews or phone the office directly to learn more about the doctor’s philosophy on diet.

Find a Low Carb Doctor (Jimmy Moore’s site): http://lowcarbdoctors.blogspot.com

Primal Advice: https://re-findhealth.com

Obesity Medicine https://obesitymedicine.org/#
(New name for the ASBP) Click Menu, Clinician resources, Find a Clinician. Members may use other non-surgical plans, not necessarily a LC diet but many are now being trained in it by Eric Westman, past president.

Institute for Functional Medicine: https://www.functionalmedicine.org Click Find a Practitioner. Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. Diet may not be LC.

There are also many Low Carb/Paleo RDs and Diabetes Educators, and most offer consulting via Skype.
http://authoritynutrition.com/11-pa...ans-with-blogs/
https://lowcarbrn.wordpress.com
http://www.lowcarbdietitian.com
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  #15   ^
Old Thu, Apr-06-17, 06:59
PaCarolSue PaCarolSue is offline
Senior Member
Posts: 272
 
Plan: Whatever Works
Stats: 217/200.5/199 Female 5ft 2 inches
BF:lots/lots/less
Progress: 92%
Location: USA
Default

Janet, thank you for all the links!

I never tell my doctors what type of diet I'm following and they never ask. The nurse at the cardiologist told me to "watch my fats." OK.

jcm13, I have had the same PCP for 25 years and I like him, but he never makes the calls, always has someone from the office call, a nurse, or receptionist. Also, they only call if there's a problem. If I want the test results, I have to call to ask for them, or I schedule my own appointment to discuss them.

It's your call. You do want to be comfortable with your doctor.
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