I went to the doctors today for a follow up visit for some blood work and my a1c changed from a 5.0 to a 4.4 and my doctor is getting on to me. my doctor did not answer my questions so I will ask them on here. As you well know I have diabetic neuropathy for the last 6 years with the last 1-1/2 years having a 5.0 a1c. I have read a lot about keeping the blood sugar level under 100 at all times in attempt to stop the progression of the diabetic neuropathy getting worse but with no success. please let me know, thank you

Does low blood sugar below 70 cause neuropathy to get worse when not exceeding 100 at all times

can low blood sugar deprive(starv) oxygen not to get into the nerve cells causing the neuropathy to get worse

what should my blood sugar level goals be to where my neuropathy will not get worse if this low blood sugar is the problem

I am a bit confused. Are you a diabetic? With a 4.4 A1C? How often are you below 70? What diabetic meds are you taking? How long have you been diabetic? 6 years? What were your A1C levels prior to the last year and a half? I have never met a diabetic with your A1C levels. Is your control that tight? WOW !!! I am sorry if I am in the dark about your history. Maybe I should look up some older posts you have made and acquaint myself with you. Sorry if I am just confused since I do not know your past.

Hi,

I went and looked up some prior posts you made and now have a better idea. Your neuropathy does not sound like it stems from your diabetes. Also, your control is so tight, I do not think your blood sugar levels are adding to your nerve pains. Why is your doc "getting on to you"? My endo would be throwing a party and taking me off of meds if I had your A1C levels.

Great work on your part. I applaud you for all your efforts to improve your health and your situation. You changed your diet, quit smoking, quit drinking, etc. That is fantastic. Your compliance is a doctor's dream patient.

Hope you can find relief from your pain. Keep up the great work.

The problem with a diabetic having an A1c that low is that it usually means they are having periods of HYPOglycemia, which can be deadly. OP, have you tired benfotiamine?

This is a good question.

The problem here is that in medicine...numbers are not laws...they are guidelines and based only on "studies".

Take the new guidelines for cholesterol... they just threw out 15 years of NUMBERS! This is because for cholesterol, the evidence is mounting that statins do not really benefit many people, (statistics were "massaged" by drug companies creating a need where for most patients where this need did not exist)....so to get in before the big blow up of real facts, the "experts" who were motivated by Big Pharma ties, threw out the numbers!

There are already studies coming out now, that show that A1C does go up some with aging and to treat these people is a possibly a mistake. New studies on A1C are showing that ethnic and racial history, also plays a part.

This A1C calculator does not even go below 5.0!
https://www.accu-chek.com/us/glucose-monitoring
/a1c-calculator.html#
I plugged in 5 to this calculator and it showed average glucose of 96 daily. So your 4.4 would certainly be low. Typically the A1C cut off for treatment of elevated glucose is 7.0 today.

The little energy parts of each cell in your body, called mitochondria use glucose to keep that cell functioning and alive.
In some emergencies they can use fatty acids but glucose is the primary fuel for energy.

Your nerves as well as other cells, will start to suffer if you are hypo and if these times are frequent or long standing, your brain will suffer. There are studies coming out now showing Alzheimer's more likely when HYPOglycemia is present or there are frequent times when the brain is being starved.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551641/

This information by the CDC reflects the trend to elevated A1Cs....offering the comment that "why" has not been elucidated yet. As the baby boomers reach higher ages in great numbers, I think we will see the data shift further. Some researchers think this might be a trend in aging going on which is "normal", and they believe that overtreatment of this with drugs, may actually be harmful and create more health issues. But the answers are still not really available on this aspect of A1C and age.
http://www.cdc.gov/nchs/data/nhanes/A1c_webnotice.pdf

This means that in the near future as more studies are done, we are going to find that overtreatment of patients is going to be discouraged, as that may lead to MORE pathology requiring hospitalization, and health care costs, with declining daily quality of life.

Medicine is very trending and filled with fads. So nothing we discuss here, today, will likely be in place in 5 to 7 yrs IMO. If you go overboard in your attention to numbers, you may lose aspects of your life you hadn't planned on.

Sit down with a sheet of paper and note if you are losing stamina, getting colds and flu more often, needing sleep more, being really hungry between meals, feeling loss of strength, or shaky, sweating alot, or becoming more forgetful. These are signs that something is wrong.

It is possible to starve your peripheral system of fuel to work properly. If you feel cycles of more PN discomfort when hungry, and then when you eat, you feel better for a while, but then it becomes worse again, that would be a sign that you have issues going on with LOWS. Doctors are not trained in LOWs really. This is a new concept. Getting a 4 or 6 hr glucose tolerance test may reveal your lows dramatically. You may also want to get fasting insulin done too to see where you start off at.

I'd also get some liver testing to see if your liver is working right. When you are low, the liver, really works hard to convert amino acids from protein to glucose. It also stores glycogen, made from extra glucose up to a point. When the liver fails, this work becomes undone and less efficient.

Thank you very much

yes i have been taking benfotiamine with no retinopathy in my eye exam 2 months ago. i just started on r-lipoic acid and evening primrose oil as a diabetic peripheral cocktail or dpn cocktail

Dear Mrs D,

I am sorry but I disagree with your statement (quote above). The ADA guidelines of
A1C's below 7.0 means you are considered to be "controlled", NOT that you do not need treatement. It is the "treatment" that gets a person with diabetes down to a range below 7.0

Maybe with an A1C of 4.4, medication should be halted. It does not necessarily indicate that the patient is having "lows", it may indicate that the person is no longer in need of medication and the body is working to control blood sugar levels with diet alone. I have personally seen people on insulin lose enough weight that they no longer needed ANY type of medication to control their blood sugar levels.

I get your point but disagree with the way you stated it. If I were to suddenly have an
A1C of 4.4 without losing any weight or any other changes, it would be a result of many lows. Many many lows. I stay below 7.0 but not without medication. I am always in the 6.0 to 6.9 range. Even in the 6's, damage is still being done to body systems. 6's are NOT normal. 6's need treatment.

If the A1C is a result of lows, yes, I totally agree that hypoglycemia is detrimental and can be fatal.

If the A1C is a result of metabolic changes due to weight loss, better diet, etc., the patient should be taken off of medication and determine if blood sugar levels can be maintained in normal ranges with lifestyle changes alone.

Was your question addressed to me??? I do not understand OP. Does that stand for "other person"?

A1C levels do not tell the whole story. It is an average of blood sugar levels over the past several weeks. It does not indicate what variations are involved in the "average". There is no standard deviation stated with an A1C. Self monitoring is also limited as it depends heavily upon WHEN testing is performed and frequency.

The BEST indicator in MY opinion of what is really going on is from a device used by a few type 1 diabetics that does continual monitoring, every 5 minutes or 15 minutes, etc.

All other "tests" are either an average or at a single point in time. Maybe some day, the cost of continuous monitoring will be low enough that everyone with diabetes can use it for at least one week, periodically, to get a true picture of the fluctuations.

A low A1C is not always an indication that hypoglycemia episodes is the reason. Some type 2 diabetics do regain control by body function alone. This happens mostly in people that have extreme weight loss or for some other reason that changes their metabolism.