Puzzling Rise in A1C

Triathlon Forum
1

At age 70 I’m racing as strong as ever and have no aches, pains or chronic conditions. Lucky me. But by most recent annual A1C test result was 6.4, at the very high end of pre-diabetes. Previous tests were 6.3, 6.2 and three years ago 5.7. My doctor ordered a C-peptide test to rule out type 1 diabetes and I’m greatly relieved the result is 3.9 (strong insulin production). I eat healthy, train and race frequently and am otherwise fine. My doctor is puzzled and can only point to hereditary factors as the likely cause, but figures there must be something else. But what? Any medical professionals care to speculate?

Thank you,
Hed Case

2

At age 70 I’m racing as strong as ever and have no aches, pains or chronic conditions. Lucky me. But by most recent annual A1C test result was 6.4, at the very high end of pre-diabetes. Previous tests were 6.3, 6.2 and three years ago 5.7. My doctor ordered a C-peptide test to rule out type 1 diabetes and I’m greatly relieved the result is 3.9 (strong insulin production). I eat healthy, train and race frequently and am otherwise fine. My doctor is puzzled and can only point to hereditary factors as the likely cause, but figures there must be something else. But what? Any medical professionals care to speculate?

Thank you,
Hed Case

I am not a medical professional but a diabetic that has seen my case change over the years and studied A LOT on the subject.

There could be several things. For example, insulin resistance would show high insulin levels but bad glucose levels.

The most revealing test for me was the OGTT, oral glucose tolerance test. The lab version is 75g of fast acting glucose, and check glucose at 1h, 2h and maybe even insulin levels

Home version : a meter, fasted, eat a bagel and orange juice for breakfast and check your glucose at 1hr and 2hr.

Despite good faster glucose levels, and good insulin production levels, that test was the test that diagnosed me.

3

Many people think they eat healthy but that is arbitrary…

4

Regardless of the cause of your drifting A1c here are the very best ways to reduce it.
Lose body fat slowly. At 70, this will require slow weight loss. Substantial muscle growth is unlikely unless you used to be much more muscular than you are now.Exercise more (more hours, and maybe more intensity, but more hours is more sustainable for folks over 70 usually)Resistance train, but not at the cost of reducing endurance training.Consume more fiber. Veggies galore. Every meal.Consume fewer high GI carbs outside of training.Consume fewer carbs in general.
If you’ve got a bit of fat you can “see” when you look in the mirror, I’d target that first, with everything else being a secondary “back of the mind” small adjustment.

If you’re quite lean, then keep your weight where it is, and target 2, 3, 4, 5 & 6 or some combo of a few of them.

In all things diet and exercise, keep in mind, small changes can *feel *like very big efforts to stick with consistently over time. So start small and make each change something you can handle for the long haul.

5

Regardless of the cause of your drifting A1c here are the very best ways to reduce it.
Lose body fat slowly. At 70, this will require slow weight loss. Substantial muscle growth is unlikely unless you used to be much more muscular than you are now.Exercise more (more hours, and maybe more intensity, but more hours is more sustainable for folks over 70 usually)Resistance train, but not at the cost of reducing endurance training.Consume more fiber. Veggies galore. Every meal.Consume fewer high GI carbs outside of training.Consume fewer carbs in general.
If you’ve got a bit of fat you can “see” when you look in the mirror, I’d target that first, with everything else being a secondary “back of the mind” small adjustment.

If you’re quite lean, then keep your weight where it is, and target 2, 3, 4, 5 & 6 or some combo of a few of them.

In all things diet and exercise, keep in mind, small changes can *feel *like very big efforts to stick with consistently over time. So start small and make each change something you can handle for the long haul.

Thank you for listing these points. It appears my solution will be to do even more of 2-6. I train consistently for the 70.3 distance but could always do a bit more. And at 6’, 165lbs I’m pretty lean, but definitely have belly fat to lose and will make that a focus. I’ve been 7-8 lbs lighter after using the Lose It app - time to fire it up again.

6

Regardless of the cause of your drifting A1c here are the very best ways to reduce it.
Lose body fat slowly. At 70, this will require slow weight loss. Substantial muscle growth is unlikely unless you used to be much more muscular than you are now.Exercise more (more hours, and maybe more intensity, but more hours is more sustainable for folks over 70 usually)Resistance train, but not at the cost of reducing endurance training.Consume more fiber. Veggies galore. Every meal.Consume fewer high GI carbs outside of training.Consume fewer carbs in general.
If you’ve got a bit of fat you can “see” when you look in the mirror, I’d target that first, with everything else being a secondary “back of the mind” small adjustment.

If you’re quite lean, then keep your weight where it is, and target 2, 3, 4, 5 & 6 or some combo of a few of them.

In all things diet and exercise, keep in mind, small changes can *feel *like very big efforts to stick with consistently over time. So start small and make each change something you can handle for the long haul.

Thank you for listing these points. It appears my solution will be to do even more of 2-6. I train consistently for the 70.3 distance but could always do a bit more. And at 6’, 165lbs I’m pretty lean, but definitely have belly fat to lose and will make that a focus. I’ve been 7-8 lbs lighter after using the Lose It app - time to fire it up again.

Do yourself a favor. Get your doc to prescribe you a Freestyle Libre. Wear it for 2 weeks.

Get to the bottom of the problem first.

7

you would be better posting up your diet here too,if you are already saying you can do better on fiber intake.

8

I second this. I sent a CGM in for my wife and it was truly enlightening. I think this will enable you to fully exploit the points that are made above in regards to optimizing your diet and timing your macronutrients in such a way to power your training while minimizing the risk of diabetes. If you are able to get one, combine this with a food diary and you will be able to understand how food and carbohydrates affect you personally. Over the first week, you goal is to learn what your baseline blood sugar is. On the second week, your goal is to fuel in such a way that you minimize swings over 20-40mg/dL from your baseline. My wife is VERY sensitive to carbs and could have big spikes in her blood sugars followed by crashes. She also complained alot about low energy and constant hunger. She adjusted her intake to minimize the swings and has far fewer lows but also far fewer highs and a much more consistent energy level. Her average blood sugar actually decreased over the two weeks with her sensor because she was eating a more balanced macronutrient profile and fueling in advance of her energy needs instead of reacting to them.

9

Regardless of the cause of your drifting A1c here are the very best ways to reduce it.
Lose body fat slowly. At 70, this will require slow weight loss. Substantial muscle growth is unlikely unless you used to be much more muscular than you are now.Exercise more (more hours, and maybe more intensity, but more hours is more sustainable for folks over 70 usually)Resistance train, but not at the cost of reducing endurance training.Consume more fiber. Veggies galore. Every meal.Consume fewer high GI carbs outside of training.Consume fewer carbs in general.
If you’ve got a bit of fat you can “see” when you look in the mirror, I’d target that first, with everything else being a secondary “back of the mind” small adjustment.

If you’re quite lean, then keep your weight where it is, and target 2, 3, 4, 5 & 6 or some combo of a few of them.

In all things diet and exercise, keep in mind, small changes can *feel *like very big efforts to stick with consistently over time. So start small and make each change something you can handle for the long haul.

HED Case: While the above are reasonable lifestyle measures, this situation is nuanced. I assume your physician is a general practitioner (eg internist / family med). It is possible you could benefit from further lab testing, more specific counseling, and potentially even starting a medication (given that you’re apparently already leading an overall great lifestyle). Has your PCP referred you to an Endocrinologist? I would personally recommend that you discuss it with them. For my patients that have a Hgb A1C in the pre-diabetic range, we refer to Endocrinology for further evaluation and management (I’m a physician and a preventive cardiologist but a pediatric cardiologist. Obligatory disclaimer: this advice is non-professional, limited to the information you sent, and of course doesn’t replace a discussion with your health care team, which I always recommend).

Dr Harrison: while that’s great lifestyle advice, I will politely but directly caution you on giving clinical advice. I’m a physician and a preventive cardiologist (at that, a pediatric cardiologist so I just see up through young adults). Just like I would defer to your great knowledge and experience in sports physiology and performance, you should be cautious giving out something that is consistent with clinical advice when you’re not a clinician and are addressing a post that was directed at health care professionals, which you are not (I might add, I have a great deal of respect for PhDs and it’s not at all a point about the doctor role or title; PhDs had the doctor title and scientists had the white coat first and physicians lifted both). Here, your advice of making further lifestyle changes could actually be harmful in that the best route may actually be to instead pursue subspecialty care given that OP already has a great lifestyle, so that advice could delay further testing and treatment.

10

Regardless of the cause of your drifting A1c here are the very best ways to reduce it.
Lose body fat slowly. At 70, this will require slow weight loss. Substantial muscle growth is unlikely unless you used to be much more muscular than you are now.Exercise more (more hours, and maybe more intensity, but more hours is more sustainable for folks over 70 usually)Resistance train, but not at the cost of reducing endurance training.Consume more fiber. Veggies galore. Every meal.Consume fewer high GI carbs outside of training.Consume fewer carbs in general.
If you’ve got a bit of fat you can “see” when you look in the mirror, I’d target that first, with everything else being a secondary “back of the mind” small adjustment.

If you’re quite lean, then keep your weight where it is, and target 2, 3, 4, 5 & 6 or some combo of a few of them.

In all things diet and exercise, keep in mind, small changes can *feel *like very big efforts to stick with consistently over time. So start small and make each change something you can handle for the long haul.

HED Case: While the above are reasonable lifestyle measures, this situation is nuanced. I assume your physician is a general practitioner (eg internist / family med). It is possible you could benefit from further lab testing, more specific counseling, and potentially even starting a medication (given that you’re apparently already leading an overall great lifestyle). Has your PCP referred you to an Endocrinologist? I would personally recommend that you discuss it with them. For my patients that have a Hgb A1C in the pre-diabetic range, we refer to Endocrinology for further evaluation and management (I’m a physician and a preventive cardiologist but a pediatric cardiologist. Obligatory disclaimer: this advice is non-professional, limited to the information you sent, and of course doesn’t replace a discussion with your health care team, which I always recommend).

Dr Harrison: while that’s great lifestyle advice, I will politely but directly caution you on giving clinical advice. I’m a physician and a preventive cardiologist (at that, a pediatric cardiologist so I just see up through young adults). Just like I would defer to your great knowledge and experience in sports physiology and performance, you should be cautious giving out something that is consistent with clinical advice when you’re not a clinician and are addressing a post that was directed at health care professionals, which you are not (I might add, I have a great deal of respect for PhDs and it’s not at all a point about the doctor role or title; PhDs had the doctor title and scientists had the white coat first and physicians lifted both). Here, your advice of making further lifestyle changes could actually be harmful in that the best route may actually be to instead pursue subspecialty care given that OP already has a great lifestyle, so that advice could delay further testing and treatment.

NOT A DOCTORS Opinion
I am not a Doctor. I am not a cardiologist. In my 40’s, when I was doing a lot of triathlons, eating lots of vegetables, not very much read meat, I was metabolically unhealthy, on 4 of the 5 measures. Over the next couple of years, 5 different doctors, including one cardiologist (at Cedar’s Sinai) said I needed to eat more grains, less salt and less red meat. That didn’t work.

Here is what I did learn. Most doctors, including cardiologists have little if any nutrition training, and what they do have, are studies financed by big food. It is pathological science.

This is what worked for me. I am 60, metabolically health, stronger than I’ve ever been, no meds, AIC of 1.8 (all my others numbers are gold). Every single one. CAC score of 0 for example. How did I turn it completely around.
No sugar, no grains, no vegetable/seed oils
Vegetables, be careful, some have oxalates and lectins that can impact gut bacteria (even some vegetarian doctors concede this)
Eat high satiety foods with a lot of protein, such red meat and eggs. Animal fats are good for you. Processed fats are BAD.
If you get off the carbs, your body will take a few weeks to remember how to burn fat for fuel, and not be reliant on it. I bonked real bad on a 50 mile bike ride about one week in.

I’m sure the doctor will say this will give you heart disease. That is wrong. The doctor will point to this study or that study, but I guarantee that study is flawed. As the scientific method tells us, a single study does not prove a hypothesis right. Only wrong, or not wrong. There are plenty of studies to show that hypothesis to be wrong.

My suggestion. Find a vegan doctor. See what actual science that have to back up their claims.
Find a doctor that is carnivore. See what actual science that have to back up their claims.

If you want to see an example of pure propaganda and bad science, watch “the Gamechanger” video. Then watch a rebuttal of that by ancestral diet doctors on YouTube.

Treat anything any doctor tells you about nutrition with skepticism. Most doctors are wrong more than they are right. They won’t like hearing that, but it’s the truth. You want proof. in the U.S. we spend 20% of GDP on health care, hundreds of billions per year on drugs, and the American people are fatter and sicker than ever. 70% obese or overweight, 88% metabollically unhealthy and >50% on the path to type 2 diabetes.

Our doctors and medical system have FAILED with respect to chronic disease. If you have an acute injury, they do great, but other than that.

Critical thinking: 1. Challenge Assumption, 2. Get diversified opinions, 3. reason through logic
Watch the video lectures on YouTube on the scientific method by Richard Feynman

That is the path to knowledge, and health. Can’t wait to see what some doctor has to say. Probably say I’m full of shit. But I got the test results to prove that I’m not.

Oh, if you’re smart, you should assume I too am full of shit. Do your own research and see what conclusions you came up with. Have to go now, and do my leg workout. My goal is dunk a basketball for the first time in my life at age 60. Getting close. A doctor and a couple of trainers said that wasn’t possible. Wrong again.

11

I am nearly 60 and am getting similar results. I go for annual blood work. My fasting BSL is usually 6.x. When this happens my doc will send me for an oral glucose tolerance test. The oral test shows good results, that I am not pre-diabetic.

I am lean, train >10 hours a week and try to eat a healthy diet.

12

Very well said, and great points. I think I can happily agree with every word. To OP, sounds like you have a very well-considered MD assisting here. Worth a listen!

YRocket:
The following writing may be written in a way that might be perceived as possibly tongue-in-cheek because it may be relatively simple-minded / straightforward thinking, and it is written very literally. It is not sarcastic. I’m just attempting to be purely literal for purpose of clarity. Sometimes dry & literal is also how I write when attempting humor or satire, so just to clarify: this is not intended to be snarky or sarcastic in any way. I’m genuinely asking for your input, if you’ll allow me.

You truly made great points. While I have you here, may I ask a question for improvement of my future approach?

If I were to append something like: “a1c is a medical lab value best interpreted by an MD. I’m not a physician. Work with a physician about your a1c, specifically. Using carefully and intelligently applied medical care, which goes far above and beyond the ‘lifestyle’ stuff I recommend here including . In the absence of further clinical consult, here are the very best non-clinical ways to reduce a1c, in most cases. You should allow your MD’s advice to overrule, and come before, anything I write here.”

If you generally approve of the above messaging (in a non-official and liability-relieving way, of course!), I might just make it part of some stock text I use, for any recommendations I ever give where there can be significant blurring of clinical and non-clinical lines.

I would love to hear your thoughts.

13

I’m a diabetic type 1 (22 years) and an A1C in the mid to high 5s, similar to the other diabetic in this thread we end up spending a lot of time studying this, and I have extensively tested my athletes, family and friends.

Discuss with your doctor the use of metformin, there is no serious downsides to it (apart from some potential stomach discomfort) and it certainly helps. We tend to be against drugs but they are out there to help and metformin is very effective in lowering your overall Blood glucose. While metformin is known as a type 2 drug, I use it and find it extremely useful to increase overall insulin sensitive as well as soften liver glucose dump into the blood stream from intense exercising or other stress situations

Your situation could be a good one to try a continuous glucose monitor, you may be spiking in the high 100s relatively often either from diet or exercise. You can get CGMs on amazon in the US I believe, doesnt have to be supersapiens.

Something else to consider is that at age 70, you can expect to be on the higher range of the normal numbers regardless, hard to expect the same numbers as someone in their 20s, 30s, but indeed mid 6s starts to become dangerous long term in terms of complications. I dont see why mid 5s wouldnt be possible with a few nutrition tweaks and potentially add some metformin in your treatment

14

I forgot one thing.

Get a continuous glucose monitor (CGM). Given your AIC, insurance may cover it. If not, it’s worth spending out of pocket for three months. It will be eye opening.

One thing many have found, is once you are insulin sensitive (fat adapted), rather than insulin resistant, when you do eat the wrong foods, the spikes tend to be not as high, and for much shorter durations.

Unfortunately I don’t have CGM data from my old high carb, 90% plant based food days. Just blood test results. One of these days this will be built into smart watches. Will be a game changer (wink).

I wish you good luck. The good news, you can make significant improvements in metabollic health in just a few weeks.

15

At age 70 I’m racing as strong as ever and have no aches, pains or chronic conditions. Lucky me. But by most recent annual A1C test result was 6.4, at the very high end of pre-diabetes. Previous tests were 6.3, 6.2 and three years ago 5.7. My doctor ordered a C-peptide test to rule out type 1 diabetes and I’m greatly relieved the result is 3.9 (strong insulin production). I eat healthy, train and race frequently and am otherwise fine. My doctor is puzzled and can only point to hereditary factors as the likely cause, but figures there must be something else. But what? Any medical professionals care to speculate?

Thank you,
Hed Case

I would use it as an excuse to get a cgm. Your doctor should prescribe it and your insurance (Medicare?) should cover it. Then you’re no longer guessing what’s pushing a1c up. Plus you can be a super sapian.

Also worth noting there is some accepted inaccuracy in a1c tests, though that’s largely offset by the multiple results.

16

I’m a diabetic type 1 (22 years) and an A1C in the mid to high 5s, similar to the other diabetic in this thread we end up spending a lot of time studying this, and I have extensively tested my athletes, family and friends.

Discuss with your doctor the use of metformin, there is no serious downsides to it (apart from some potential stomach discomfort) and it certainly helps. We tend to be against drugs but they are out there to help and metformin is very effective in lowering your overall Blood glucose. While metformin is known as a type 2 drug, I use it and find it extremely useful to increase overall insulin sensitive as well as soften liver glucose dump into the blood stream from intense exercising or other stress situations

Your situation could be a good one to try a continuous glucose monitor, you may be spiking in the high 100s relatively often either from diet or exercise. You can get CGMs on amazon in the US I believe, doesnt have to be supersapiens.

Something else to consider is that at age 70, you can expect to be on the higher range of the normal numbers regardless, hard to expect the same numbers as someone in their 20s, 30s, but indeed mid 6s starts to become dangerous long term in terms of complications. I dont see why mid 5s wouldnt be possible with a few nutrition tweaks and potentially add some metformin in your treatment

nutrition tweaks first, medication last resort.

17

nutrition tweaks first, medication last resort.

Actually, getting to the root cause is step 1. Otherwise you’re pissing in the wind.