Higher hba1c

(Sam) #1

Hi all, i have been doing keto for over 1.5 yrs now, and i did my bloodwork a few weeks ago for a general checkup.

My LDL/HDL is overall pretty good (LDL a little high, but that was to be expected).
CAC score was also good.

What was more puzzling to me was my HOMA IR and HBA1c score.

Before starting keto my HBA1C was hovering around 5%.
My HOMA IR was around 0.95

My latest bloodwork is showing that:
HBA1C is 5.5%
HOMA IR is now 0.65

I have used a CGM on and off as well and my usual daily average is around 105, with no spikes above 115, and usually starting the day around 110 and ending around 95.

Before i started keto my blood sugar was 80… then would spike to 120-140 during meals and come back down to 80 a few hrs after meals.

Is this something i should be worried about? Why would my HBA1C be higher… I have spoken to my doctor who has also said that the physiological insulin resistance is probably at play which is why my blood sugar in a rested state is higher than it used to be, as well as the “dawn” effect as to why it’s higher in the morning.

My only concern is that the HBA1C has risen a fairly significant amount, which he did say to watch, but considering i have been doing keto for such a long time… i would think my fasting blood sugar would be lower than what the CGM/HBA1C is showing.

Has anyone else had this problem before (after doing keto for 1yr +).

(Bob M) #2

It’s not physiological insulin resistance; a better term is glucose sparing. If you start the day at 110 and end at 95, your HbA1c should be lower. This lists the average blood sugar for 5.5 as 111, and that’s all day, every day:

https://www.diabeteschart.org/bgc1.html

The problem with HbA1c is that it relies on how long your red blood cells live. If yours are living longer, your HbA1c will be higher, but that does not mean that your blood sugar is higher. This has a pretty good explanation:

As for HOMA IR, I have found this to be useless. Why? Because my blood sugar is always higher in the morning. That means HOMA IR will be “worse”, unless my insulin is also very low, and mine is around 10 usually.

Here’s an example of my blood sugar over the course of about 16 months:

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Also, if you’re like me and exercise, that causes higher glucose, I think to be able to replace glycogen. (And part of the morning rise you see in my graphs occurs because I exercise in the morning; though days I exercise I still have a similar curve; have the same curve while fasting, though the whole curve will drop down.)

#3

5.0 to 5.5 is only a rise of like 10pts average, its ignoreable. That said even going from 80 to 120-140 isn’t even remotely a spike, that’s normal rise and to be expected.

Do you track what you’re eating? Do you workout?

#4

Take a look at Dr. Boz videos on YouTube. She would say you should check your ketones as well as glucose numbers every morning to see if you are in ketosis. While there are differing theories about why our glucose goes up on keto, I don’t think there have been any studies as of yet.

(Sam) #5

I do exercise . Usually run 5km 4 days week, swim one day, bike one day. + some gym activity a few days a week.

In terms of tracking what i eat. I am not perfect… but i am usually around 30-40 net carbs per day and ketones are usually between 0.5-0.8. If I do a fast, the ketone levels will rise to ~1.5-2.

The higher hba1c was really the only metric that concerned me, but i will test it again in a few months.

My HOMA-IR results were very good (.65) even though my fasting blood sugar was about 105 at the time of the reading (4 hrs after waking up).

The article over at mark’s daily apple was interesting talking about the red blood cell life cycle and how that can affect hba1c readings.

I will continue to use the CGM on and off and i guess as long as my blood sugar is fairly flat with a slight downward trend during the day i shouldn’t be too worried about the hba1c number.

I guess maybe a better question: “How can i decrease the dawn effect or reduce the amount of sugar that my body produces for glucose sparing.” Since this has been this way for over a year… is it normal just to have a fasting blood sugar of 110, and then watch it drop throughout the day down to ~95 ? Are there any studies/routines/practices to reduce this ?

(You've tried everything else; why not try bacon?) #6

Since you are not messing up your metabolism by overeating carbohydrate, what is your reason for thinking that your body is getting things wrong? If you’ve cut out sugar, grains, and starches, and are limiting the rest of the carbohydrate you eat, then I don’t see any particular need to worry.

Although, for what it’s worth, Prof. Ben Bikman speculates in a couple of interviews that the people who report a rise in serum glucose may simply not be eating enough fat. I couldn’t say, myself.

(Bob M) #7

Studies on people on keto > 1 year? No. At least not for this purpose. I just saw a study for exercise, where they put people on a keto diet for…3 days. Yes, 3 days. (I think Virta Health may have hit two years. but it wasn’t to test glucose sparing.)

If you don’t like glucose sparing, you can eat carbs. That’s guaranteed to lessen the morning number.

As Paul said, some theorize that more fat will help too. I have never tested that, as more fat = more weight gain for me and/or less satiety for me. For me, protein = satiety.

(You've tried everything else; why not try bacon?) #8

There’s enough individual variation in this that I doubt Bikman’s speculation applies to everyone.

(Bob M) #9

Well, I think Amber O’Hearn believes the same.

But you’d need to measure a lot of people and give them CGMs, as pin prick measurements have too much error in them. Ideally, you’d like to get the data from the CGMs in a format where you could compare individual days. (You’d have to compare numbers, as if you’ve seen any of the curves I have, the differences from day to day are tough to decipher. I can see when I exercised, as there is a bump, but even it isn’t huge.) And you’d need to devise diets for them.

And factor in exercise, as supposedly some exercise can reduce blood sugar. I never found that, but I only had my CGM for a year and, for instance, wasn’t jogging or walking a dog, as I am now.

It’d be a tough study, even as an n=1.

There are other things you can do, like drink apple cider vinegar at night. I also never studied that, as I thought that the morning blood sugar rise must be there for a reason. The body isn’t stupid.

(Bob M) #10

Like this, for instance:

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I assume Saturday and Tuesday were days I exercised, but the peaks aren’t huge. Monday and Tuesday compared:

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Not a huge blood sugar rise due to exercise on Tuesday, maybe 15 points? But you can see that the average for Tuesday is higher than Monday, which is what I found: exercising can cause higher blood sugar for the day.

Of course, these readings are nothing compared to a high carb meal, where 150-180+ is expected.

(Sam) #11

I am not a doctor, but i would think a higher resting blood sugar, one that is consistently on the low end of “pre diabetic” is a problem? I’m not too worried if it’s elevated slightly (not an average of 80)… but having an HBA1C of 5.5, with the average throughout the day probably ~100-105… seems like it is too high for being on keto for over 1.5 yrs (and never having blood sugar problems before).

(You've tried everything else; why not try bacon?) #12

Well, one keto doctor, Paul Mason from Australia, says he’d rather see his patients’ blood sugar staying within in a narrow range, even if that range would be considered on the high side, than to have it lower but subject to wide fluctuations.

How are you measuring your glucose?

If you have a continuous glucose monitor, you might want to share the data, as Bob has done, and we can compare the graphs.

If it’s just a periodic measure of HbA1C, then, as Prof. Bikman says, the measurement may be subject to some error if your red blood corpuscles, being healthier, are living longer. Using HbA1C as a surrogate for continuous blood sugar readings is based on the assumption that your red blood corpuscles are living for exactly 90 days. If they live longer, you are going to get a higher reading that is benign; if they are living shorter than that, you will get a reading that is falsely low.

(Bob M) #13

The problem is that you blood sugar might not be that high. You have to actually test blood sugar to see what it is.

Now, if it is that high, then I personally would not fret, but come back armed with data.

#14

I’m sorry to welcome you to the club. My blood glucose isn’t as I had expected it to be on keto. Fasting numbers are disappointing, often above 100 mg/dL.

I also exercise, quite a lot, and my bmi is 22.6.

I’m quite upset about it. I’ve been doing many experiments to see what works for me. It seems I’ve managed to stop the raising trend of my fasting blood glucose by increasing carbs and changing my exercise regimen. I think it’s early days to celebrate, though.

Good luck.

(Sam) #15

i just put in a new cgm… will post results in 14 days.

(You've tried everything else; why not try bacon?) #16

For what it’s worth, Prof. Benjamin Bikman speculates that this may happen when people aren’t consuming quite enough fat for the body to make a good quantity of ketones. I wouldn’t take it as Gospel, but it may be something to look at and experiment with.

#18

In a video, Bikman said he has the same problem: high fasting blood glucose and that he didn’t know the cause, but would investigate it. He said he thinks it’s ok to have high FBG on keto.

But people ‘think’ a lot of things. I never paid much attention to what people ‘think’. I wait for the last stage.

I’ll be interested and relieved when it goes beyond the ‘thinking’ and speculating time.

About a year ago, I’ve read a paper where they were suggesting more categories for people, admitting that not all people see BG decrease with physical activity. There was a category for people like me. But then, there was no follow up as in what people like me should do to get better. If there was, I’ve missed the paper.

Therefore, I’m trying on my own, experimenting. My aim is to have fasting BG below 100 mg/dL. It’s already much better, since changing lots of things on my very low carb diet. But I still get days above 100. Rarely above a 110. I’m very happy about that, because at least it seems I was able to stop the trending upwards. Or it wasn’t anything I did and it just stop on its own… I’ll never know.

Postprandial BG was and is already good.

(You've tried everything else; why not try bacon?) #19

“Should do to get better”: Is there necessarily a problem, if you are eating a ketogenic diet? Without an excessive carb intake to mess things up, perhaps the body knows what it is doing?

Paul Mason has stated that he isn’t concerned if a patient’s serum glucose is in a higher range, as long as that range is narrow, without large variations from high to low. It’s the swings that concern him, not the absolute values.

(Joey) #20

Can you share the things you’ve been doing that you’ve found are reducing your glucose peaks? Stricter adherence, perhaps, to dietary carb restriction?

I find it interesting you’ve got a ceiling goal for your serum glucose.

I do wonder what you’ve based this goal upon - i.e., from which population might such a comparison for a “good” max number be derived?

I’m totally with @PaulL on this… if you’re not eating (glucose elevating) carbs, then all of the glucose you’re seeing in your blood has been created by your own body from fat stores, triglycerides,…and has likely been released to wake you up in the morning and keep you going until you eventually eat something once you get hungry.

In other words, in this case, you’ve reached the point where your body is functioning as it should.

Unlike all those carb-stuffing people whose blood test results are creating the unhealthy “norm” population against which the reference ranges on lab tests are produced (+/- 2 standard deviations of an overwhelmingly sickly population), your metabolism is functioning at its best.

And as @ctviggen notes, there’s some evidence that your red blood cells may be living longer, and therefore picking up more glycation during their longer life (therefore higher potential HbA1c). More good stuff to celebrate.

I know you didn’t ask, but FWIW, my blood glucose levels are highly stable yet somewhat elevated above what they used to be. To me, this suggests my insulin levels meander in a narrower (healthier) range than when I ate the SAD foods for decades prior to carb-restriction. (And all my symptoms of systemic inflammation have clearly disappeared for 3+ years since cutting out the dietary carbs. Clinical evidence that my body’s metabolism is working better than ever.)

As result, I’m thankful my body is doing its thing rather than feeling alarmed. The idea of establishing some arbitrary maximum glucose level above which I’d feel “unhealthy” strikes me as an odd concept with no meaningful science to support such worries. :man_shrugging: To each her/his own.

#21

Around 100 isn’t bad at all, if it’s come down, that’s still a win.

My BMI is 33 (very into the obese territory) and I’m at 13% Bodyfat per, BMI is a useless metric, don’t base anything on it.