Update: First HbA1c Result

An update with my first HbA1c result since starting Afrezza and the FreeStyle Libre.

My previous HbA1c results have been around 6.5%, which is inline with the recommendations from the Australian Diabetes Society, who recommend “a general target HbA1c of ≤7.0%” for Type 1 diabetic patients.

My latest test result, which reflects the average glucose level over the previous three months, was likely somewhat affected by the basal mix-up I described previously. The result of 6.0%, although a lifetime best, was therefore a little disappointing – especially with some incredible A1c results being posted online by other users.

If I continue with the same level of control as I have now, my next A1c test is likely to be better – as it will not be impacted by the basal mixup. It’s also worth noting that unlike most users posting great A1c results, I do not have a continuous glucose monitor, and therefore do not benefit from alarms when my glucose is going out of range. The FreeStyle Libre samples blood every minute and provides CGM-like historical data, but requires a manual scan to view this data.

I suspect that using a CGM might change the way I use Afrezza, and would provide a further reduction in my HbA1c due to alarms notifying me earlier than my manual scanning with the Libre.

Although I am a little disappointed, the author of the Crick, Tech, Munch blog gave me some encouraging words that put the result in context: Only 7% of Type 1 diabetics in the UK reach an HbA1c result of 6.0% or better.

The HbA1c test is also limited in that it can potentially reward poor glucose control, by being lowered through periods of hypoglycaemia. A supplementary test —1,5 Anhydroglucitol — is a historical indicator of hyperglycaemia only.

Coupling the HbA1c result with this GlycoMark 1,5AG test gives a far better picture of glycemic control than HbA1c alone. Together, they can show whether an HbA1c result is being artificially lowered by hypoglycaemia and give an accurate indicator of glycemic variability.

I hope to have another HbA1c test in about two months. I have also found Australian laboratories that can perform the GlycoMark 1,5AG test and hope to have that conducted around then too. I am looking forward to seeing these results.

-Matt

HbA1c 6.0%

First HbA1c since Afrezza. Historical results are also shown on document.

5 Comments

  1. Matt, is your Endo surprised by your best ever A1C results and with your use of Afrezza considering it is not yet approved in Australia? And let me say congratulations on being able to have the level of control over your disease. It must help you sleep much better at night knowing you have a great combo of basal and prandial insulin keeping your glucose levels in an almost normal range.

    Reply

    1. It’s all a bit overwhelming for my endo – previously I used test strips, Apidra and Lantus which are very familiar to him. Now I use the Libre, Afrezza and Tresiba – all of which are not available here and I am his only patient using.

      For me, it’s been a huge learning experience the past few months – and I’m using the stuff. It would be even harder for an endo to get his head around three very different treatments, especially when he isn’t diabetic himself. Insulin you dose in 4U increments – after you eat – by inhaling! A CGM that isn’t a CGM. A basal that makes no difference when dosed 12 hours late. It’s a lot to get one’s head around.

      My endo is very interested, but says that doctors are very suspicious of new things and medicine selects for very conservative people. He has referred me to the top endocrinologist at the research hospital here, and thinks he will be very interested in my case. If he is, it sounds like we can design some tests together and they might loan out a CGM for some of these. He also asked if I was willing to go back on regular insulin in some future tests, which I guess would isolate the effects of Tresiba and the Libre.

      Reply

  2. Great work Matt, a fantastic result!

    Reply

  3. Matt, your lab report looks like it was typed up on a sixty year old Smith-Corona typewriter — is that typical for Australian path labs? Also, wasn’t Healthscope’s Australian pathology division sold back in July? I read that they changed the name afterwards. Was that an error in the reporting?

    Reply

    1. Don’t know how other path labs do things, but Healthscope isn’t exactly cutting edge – they don’t offer the GlycoMark test. Next test will be with a different lab so I can have both HbA1c and GlycoMark.
      Btw, they are still called Healthscope – http://www.healthscopepathology.com.au – but the front page says “A name change for the Australian Pathology business will be announced by Crescent Capital Partners in due course”.

      Reply

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