Elevated Hemoglobin a1c...Should I do anything?

May 31, 18 6:41

Post #1 of 21 (3222 views)

I had routine labs drawn this month and the a1c came back as 5.8%. It's a little concerning to me. I'm 37, tall, and skinny and have been able to eat what I want as long as I train enough. I do eat fairly healthy but eat my fair share of carbs.

Is a high a1c par for the course on a high carb diet? Or should I do something about it? I don't feel bad.

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 7:02

Post #2 of 21 (3201 views)

This should be a fun topic.

I'm not a Doctor so don't listen to what I say.

Now that that is out of the way......If you are developing insulin resistance, stop doing the thing that is causing it. You already exercise so you should consider diet.

In my opinion, over consumption of carbs is the primary driver. I have type 2 in my family so I generally eat lowish carbs and also practice intermittent fasting to help maintain insulin sensitivity.

Try reading about Sami Inkinen some. He had pretty much the same story as you and fixed it through diet.

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 7:42

Post #3 of 21 (3174 views)

Keep an eye on it. If you start peeing more than you have ever peed in your life and have unquenchable thirst get checked out. Don't overly stress about it. I had elevated A1C at wellness check. No biggie. Next time I went to doctor had A1C of 13 and type 1 diabetes. That was at 34 years old....that said I am healthier and in better shape than ever now

Re: Elevated Hemoglobin a1c...Should I do anything? [nicholasJ] [ In reply to ]

May 31, 18 8:59

Post #4 of 21 (3130 views)

Thanks guys. I'll keep an eye on it. I'm just surprised as I feel pretty healthy. The last month has been stressful for multiple reasons and training really took a hit. I wonder how much that impacted it. I think I'm going to meet with a nutritionist just to be safe.

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 9:13

Post #5 of 21 (3115 views)

Jason AZ wrote:

Is a high a1c par for the course on a high carb diet? Or should I do something about it? I don't feel bad.

Diet of high modified/damaged unsaturated fats too

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 9:21

Post #6 of 21 (3105 views)

I had the same issue come up 3 years ago. Very healthy diet, but lots of carbs, like 60-70% of my calories. In my case the elevated A1c coincided with increasing earlier nutritional meltdowns in IM racing and training. I changed my diet to keep my total carbs under 30%, primarily by increasing my healthy fats. My A1c returned to mid normal range in about 1 year, and my nutritional problems have not reoccurred for the past 18 months. Phil Maffetone is a good resource for information and studies on this, but there is a ton of information out there, and many high level pro athletes across many sports who have made this same change.
PM if you want more details

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 12:27

Post #7 of 21 (3003 views)

This goes beyond triathlon. An elevated a1c implies decreased sensitivity to insulin and a possible pre-diabetic state. You should follow up with your doctor and have a real conversation. Simply lowering carb/sugar intake may be insufficient. Diabetes is a devastating disease that affects multiple organ systems with long term irreversible damage. Find the causes, get control. See your doctor.

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 12:38

Post #8 of 21 (2990 views)

Yeah, this needs discussion with the doc. I currently have normal but high blood sugar, and normal but high a1c. Went in last week for a glucose tolerance test and will be seeing my doc next week. I'm concerned, but I've lost weight and increased exercise, sugar levels still high (but still normal), so also thinking about getting on board with a nutritionist as well to work on that end.

A bit freaked out as it seems that it's likely I'll end up Type 2 at some point

Re: Elevated Hemoglobin a1c...Should I do anything? [AndrewL] [ In reply to ]

May 31, 18 15:47

Post #9 of 21 (2869 views)

AndrewL wrote:

This goes beyond triathlon. An elevated a1c implies decreased sensitivity to insulin and a possible pre-diabetic state. You should follow up with your doctor and have a real conversation. Simply lowering carb/sugar intake may be insufficient. Diabetes is a devastating disease that affects multiple organ systems with long term irreversible damage. Find the causes, get control. See your doctor.

^^^^^^^^^^^^^^^^^
This.

Except an elevated A1c=prediabetes by definition and overt diabetes if it is above 6.5 twice. And diabetes is a risk equivalent for CAD, so once you are a diabetic, you get: aspirin x life, metformin and/or other meds to control the blood sugar, a statin (moderate intensity), probably an ACE (to protect the kidneys), and follow up with a bunch of consultants (cardiac, optho, podiatry) and usually the recommendation for significant life style changes.

As always, talk with your doctor about what your numbers mean and what you can do about them. And everyone should know certain numbers:
their LDL, BP, blood sugar, creat (measure of kidney function), K, BMI.

(I've got to stop responding to these threads....)

http://www.diabetes.org/...at-risk/prediabetes/

https://www.mayoclinic.org/...t/about/pac-20384643

A high A1C means that the blood sugar has been elevated for the last 3 months because the high sugars floating around attach to the RBC's (which last about 3 months in the circulation 'til they are turned over.

I've seen some of my patients lose their diagnosis of NIDDM with really good diet changes and increased exercise regimens, but also have many patients who are thin as a rail with elevated blood sugars and simply need meds to get that sugar into the cells, and other meds to protect them long term...

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 17:30

Post #10 of 21 (2831 views)

"I thought about writing a post suggesting you don't ask for medical advice on the internet where you can't be sure that the people that respond are qualified, they don't know your history, they can't examine you, they can't order tests or review the scans you have, they can't outline your options face to face or offer you any treatment."

I just posted this on a thread about a meniscal tear. It is even more relevant here Jason.

Re: Elevated Hemoglobin a1c...Should I do anything? [Mark57] [ In reply to ]

May 31, 18 18:07

Post #11 of 21 (2794 views)

Mark57 wrote:

"I thought about writing a post suggesting you don't ask for medical advice on the internet where you can't be sure that the people that respond are qualified, they don't know your history, they can't examine you, they can't order tests or review the scans you have, they can't outline your options face to face or offer you any treatment."

I just posted this on a thread about a meniscal tear. It is even more relevant here Jason.

I hear that but feel fairly safe. My wife is a doctor and would slap me if I followed internet medical advice. I bounced this off her too. I'm also not the type to make spontaneous decisions and am the type that values professional advice. I am interested if this is a thing with endurance athletes because the majority take in a lot of carbs. From the posts above, it sounds like some have had elevated a1c and took corrective action. I'm seeing my PCP soon for an annual visit and plan to discuss. The labs were for life insurance and not ordered by a doctor that I could discuss with.

I have a sweet tooth for ice cream and chocolate. I try to eat healthy but justify eating foods like this because it doesn't really make me gain weight at least while I'm training. To some degree, I worry about losing too much weight and feel ok having a blizzard maybe once a week. I eat a lot of fruit and maybe 1-2 sodas a week. I guess I'm just wondering if this is catching up with me.

Thanks everyone for the comments and advice!

Last edited by: Jason AZ: May 31, 18 19:20

Re: Elevated Hemoglobin a1c...Should I do anything? [Mark57] [ In reply to ]

May 31, 18 18:07

Post #12 of 21 (2794 views)

:)~ ur a downer.

Re: Elevated Hemoglobin a1c...Should I do anything? [dtoce] [ In reply to ]

May 31, 18 18:21

Post #13 of 21 (2781 views)

dtoce wrote:

AndrewL wrote:

This goes beyond triathlon. An elevated a1c implies decreased sensitivity to insulin and a possible pre-diabetic state. You should follow up with your doctor and have a real conversation. Simply lowering carb/sugar intake may be insufficient. Diabetes is a devastating disease that affects multiple organ systems with long term irreversible damage. Find the causes, get control. See your doctor.

^^^^^^^^^^^^^^^^^
This.

Except an elevated A1c=prediabetes by definition and overt diabetes if it is above 6.5 twice. And diabetes is a risk equivalent for CAD, so once you are a diabetic, you get: aspirin x life, metformin and/or other meds to control the blood sugar, a statin (moderate intensity), probably an ACE (to protect the kidneys), and follow up with a bunch of consultants (cardiac, optho, podiatry) and usually the recommendation for significant life style changes.

As always, talk with your doctor about what your numbers mean and what you can do about them. And everyone should know certain numbers:
their LDL, BP, blood sugar, creat (measure of kidney function), K, BMI.

(I've got to stop responding to these threads....)

http://www.diabetes.org/...at-risk/prediabetes/

https://www.mayoclinic.org/...t/about/pac-20384643

A high A1C means that the blood sugar has been elevated for the last 3 months because the high sugars floating around attach to the RBC's (which last about 3 months in the circulation 'til they are turned over.

I've seen some of my patients lose their diagnosis of NIDDM with really good diet changes and increased exercise regimens, but also have many patients who are thin as a rail with elevated blood sugars and simply need meds to get that sugar into the cells, and other meds to protect them long term...

Thank for all the detail!

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

May 31, 18 23:17

Post #14 of 21 (2704 views)

Consider buying yourself a blood sugar meter with finger prick and just test your blood glucose once every week to once every month early morning when you are fasted. I think the normal range is around 4-6mmol/l

But don't get obsessed with it testing all the time and testing after you've eaten is a waste of time, and don't worry about small variations. Just keeping an eye on it will put your mind at rest and allow you to spot if diabetes is starting to occur.

You can also get some ketone testing sticks to test your wee, but I'd really only do that if your BG is showing high out of range, by which time you should be phoning the doctors anyway :)

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

Jun 1, 18 0:09

Post #15 of 21 (2686 views)

I second all the advise about creating a good plan with your doctor (and pref with a dietician and maybe a tri coach who is a bit nutrition-savvy). This is not to be taken lightly; The beetus is reversible until it isnt. So it's vital that you create a good plan and follow it up frequently enough.

With that said, this thread needs unqualified nutritional advice! So here comes mine: more beans and greens, man! At least twice daily, big serving of both.

Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

Re: Elevated Hemoglobin a1c...Should I do anything? [dtoce] [ In reply to ]

Jun 1, 18 2:06

Post #16 of 21 (2669 views)

dtoce wrote:

AndrewL wrote:

This goes beyond triathlon. An elevated a1c implies decreased sensitivity to insulin and a possible pre-diabetic state. You should follow up with your doctor and have a real conversation. Simply lowering carb/sugar intake may be insufficient. Diabetes is a devastating disease that affects multiple organ systems with long term irreversible damage. Find the causes, get control. See your doctor.

^^^^^^^^^^^^^^^^^
This.

Except an elevated A1c=prediabetes by definition and overt diabetes if it is above 6.5 twice. And diabetes is a risk equivalent for CAD, so once you are a diabetic, you get: aspirin x life, metformin and/or other meds to control the blood sugar, a statin (moderate intensity), probably an ACE (to protect the kidneys), and follow up with a bunch of consultants (cardiac, optho, podiatry) and usually the recommendation for significant life style changes.

As always, talk with your doctor about what your numbers mean and what you can do about them. And everyone should know certain numbers:
their LDL, BP, blood sugar, creat (measure of kidney function), K, BMI.

(I've got to stop responding to these threads....)

http://www.diabetes.org/...at-risk/prediabetes/

https://www.mayoclinic.org/...t/about/pac-20384643

A high A1C means that the blood sugar has been elevated for the last 3 months because the high sugars floating around attach to the RBC's (which last about 3 months in the circulation 'til they are turned over.

I've seen some of my patients lose their diagnosis of NIDDM with really good diet changes and increased exercise regimens, but also have many patients who are thin as a rail with elevated blood sugars and simply need meds to get that sugar into the cells, and other meds to protect them long term...

Don't stop responding to these threads dtoce!!!
Happy training.

Re: Elevated Hemoglobin a1c...Should I do anything? [Jason AZ] [ In reply to ]

Jun 1, 18 3:12

Post #17 of 21 (2651 views)

I would get a meter and see my fasting levels as well as 2hrs after an oral glucose tolerance test.

Get a meter and test waking first think in the morning. Values should be between 4-6 mmol/l

Eat a bagel and a glass of OJ, mesure 2 hours later. Values should be below 7.8 mmol/.l.
This is similar to an Oral glucose tolerance test where thry make you take 75g of fast acting carbs and measure you two ours later.

Re: Elevated Hemoglobin a1c...Should I do anything? [pbnz] [ In reply to ]

Jun 1, 18 3:28

Post #18 of 21 (2639 views)

pbnz wrote:

dtoce wrote:

AndrewL wrote:

This goes beyond triathlon. An elevated a1c implies decreased sensitivity to insulin and a possible pre-diabetic state. You should follow up with your doctor and have a real conversation. Simply lowering carb/sugar intake may be insufficient. Diabetes is a devastating disease that affects multiple organ systems with long term irreversible damage. Find the causes, get control. See your doctor.

^^^^^^^^^^^^^^^^^
This.

Except an elevated A1c=prediabetes by definition and overt diabetes if it is above 6.5 twice. And diabetes is a risk equivalent for CAD, so once you are a diabetic, you get: aspirin x life, metformin and/or other meds to control the blood sugar, a statin (moderate intensity), probably an ACE (to protect the kidneys), and follow up with a bunch of consultants (cardiac, optho, podiatry) and usually the recommendation for significant life style changes.

As always, talk with your doctor about what your numbers mean and what you can do about them. And everyone should know certain numbers:
their LDL, BP, blood sugar, creat (measure of kidney function), K, BMI.

(I've got to stop responding to these threads....)

http://www.diabetes.org/...at-risk/prediabetes/

https://www.mayoclinic.org/...t/about/pac-20384643

A high A1C means that the blood sugar has been elevated for the last 3 months because the high sugars floating around attach to the RBC's (which last about 3 months in the circulation 'til they are turned over.

I've seen some of my patients lose their diagnosis of NIDDM with really good diet changes and increased exercise regimens, but also have many patients who are thin as a rail with elevated blood sugars and simply need meds to get that sugar into the cells, and other meds to protect them long term...

Don't stop responding to these threads dtoce!!!
Happy training.

Know what I learned from his post? Try really f@#king hard not to let it get out of hand unless you want lifetime of costs and meds.

You already exercise and are in good physical shape. Diet is king. Fix it. Cut out vegetable oils (seed oils) and as much refined crap as you can.

Re: Elevated Hemoglobin a1c...Should I do anything? [svennn] [ In reply to ]

Jun 1, 18 3:52

Post #19 of 21 (2627 views)

svennn wrote:

Know what I learned from his post? Try really f@#king hard not to let it get out of hand unless you want lifetime of costs and meds.

You already exercise and are in good physical shape. Diet is king. Fix it. Cut out vegetable oils (seed oils) and as much refined crap as you can.

Ah, the nature vs nuture question for cardiology. To ignore genetics is just silly. We often talk about high level training here at ST and how genetics sets the upper limit but how close you actually get is much in an individual's hands. To be fair, many of us have significant time or effort constraints and never come remotely close to our true fitness potential. But, I have many patients in the 70's/80's/90's and to listen to them talk about how they lost their siblings to similar diseases is fascinating. How many could live a little longer/better if they had taken care of themselves with more attention throughout their life...I see consults very frequently from patients who have a sibling or friend their age die suddenly from heart disease who was active/fit and appeared to eat right. Genetics are very important, but not everything.

https://blogs.nejm.org/...e-nature/2016/12/14/

Good advice regarding diet, although not very specific. I'll let those with more knowledge comment about the best choices.

I do agree that we should really try to take very, very good care of our bodies, but even doing that is sometimes just not enough.

Re: Elevated Hemoglobin a1c...Should I do anything? [dtoce] [ In reply to ]

Jun 1, 18 4:21

Post #20 of 21 (2599 views)

Agreed.

I don't get specific about diet because everyone is so different, even though I have very strong opinions.

Would you agree that type 2 diabetes is potentially the most costly medical issue facing our nation? I think I read that somewhere..... especially when you factor in all the associated medical issues you mentioned.

Scary.

Re: Elevated Hemoglobin a1c...Should I do anything? [svennn] [ In reply to ]

Jun 1, 18 4:35

Post #21 of 21 (2592 views)

svennn wrote:

Agreed.

I don't get specific about diet because everyone is so different, even though I have very strong opinions.

Would you agree that type 2 diabetes is potentially the most costly medical issue facing our nation? I think I read that somewhere..... especially when you factor in all the associated medical issues you mentioned.

Scary.

Yes potentially. The problem is that chronic diseases overlap a lot. Heart disease (#1 risk of dying), cerebrovascular disease (stroke=#3) and DM all effect one another in so many way so it's hard to tease out how much each would individually cost. (*Cancer is #2 on the list, FTR)
The majority of costs to the healthcare system come close to end of life, IMO. Our nation collectively has done a poorer job taking care of themselves for sure. Obesity is rampant in this country.

https://www.cdc.gov/...e/overview/index.htm

And it is scary-on that I certainly agree.

I always smile when I go to triathlon races and look around at those at the event and the families of the racers. Much better lifestyle choices are made in the triathlon community which is yet another reason that I hope the sport endures.

Last edited by: dtoce: Jun 1, 18 8:31

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