Recent Posts - DAFNE Online

Mar 5, 2012

Jennypenny 34 posts

Topic: General Discussion / Dawn Phenomenon

Hi Gill , i experienced this for a number of years after previously not having this , so i would say yes .My dawn Phenomenon stopped when i went on the pump

Jenny Very Happy

Mar 5, 2012

SA2010 69 posts

Topic: General Discussion / Pain after injecting

Hi - just noticed this thread whilst searching for posts relating to using same needle type/size for both novorapid novopen and lantus solostar pen.

Adding to John H reply, I use 8mm BD Microfine for Lantus Solostar and 6mm Novofine needles for Novorapid Novopen. On advice from my clinic, I was asked to use the BD micro-fine 5mm for both lantus solostar and novopen. I found it very painful and after few days of perseverance I gave up and switched back to the BD Micro-fine 8mm for the lantus solostar and novofine 6mm needles for the novorapid novopen which cleared the problem.

Now 18 months on the clinic is recommending AGAIN that I use the same needles for both pens - suggesting using the novofine 6mm for the lantus solostar as well. I am hesitant as it is not recommended by the manufacturers of the lantus/solostar pens and also I have come across posts on forums mentioning leakage when wrong needles used and 6mm for me might be as painful as the 5mm was. Anyone uses novofine needles with lantus / solostar?

Mar 5, 2012

Garry 328 posts

Topic: Site Development / New Format Website

Wow. Top service.
Wish other IT departments fixed stuff as quickly and it works Laughing

Thanks
Garry

Mar 5, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Dawn Phenomenon

Hey Gill.............

My belief is that everyone experiences the hormonal response that helps them up in the morning, so, glucagon release from the pancreas, cortisol, adrenalin etc, all these hormones will increase insulin resistance and push up blood sugars. Its just some diabetics struggle more to get it under control......

I take 2 doses of Levemir, one at 6:30am and another at 22:30pm, I have to take it later so as I have more Levemir in me at 3 am, prior to the hormone release, and I also need to eat something for breakfast, which tells the pancreas to stop its release of glucagon and subsequently the liver to stop releasing glucose........

You will experience this to some degree, it may just not be noticeable........

Mar 5, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Dawn Phenomenon

I've been Type 1 diabetic taking insulin for approximately 20 yrs.

Just wanted to know if Dawn Phenomenon can strike at any time?

Gill

Mar 5, 2012

Simon 578 posts

Topic: Site Development / New Format Website

Hi Garry,

Thanks for your positive comments re the new site design. There was a minor problem with post editing - thanks for flagging it up with us - which has now been fixed.

Thanks,

Simon

Mar 5, 2012

Garry 328 posts

Topic: Site Development / New Format Website

Bit of a surprise to find a completely new format and an ideal crossover between the traditional website that we are all familiar with and smartphone based view.
Everything works well......and intuitively....not sure how to edit a post though. Thought the link and bouncing ball meant that I would be able to enter text edit directly as before.
Thanks to those who put in the work.
Congratulations Very Happy

Regards
Garry

Mar 5, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Basal Insulin Testing

No, its just 3am is meant to be the time where the least amount of hormones are swimming about and so the best time to take a test of your basal, however if someone was to get up at 4:00am every morning for work, then 3am would not be hormone free, in fact an hour or two before you get up [your body clock expects you to get up] is when the hormonal responses begin...........

For you though, getting up at a normal time of 8am, 3am testing is fine............

From you results, you would assume you would need an extra unit or two overnight, lets see what the next few nights show............!

Mar 5, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Basal Insulin Testing

novorapidboi26 said:
You can carry out a basal test at any time, you are always best to get an overnight test done first, allowing you to get your morning levels right, then you can do a daytime test, either between breakfast and lunch, lunch and dinner, etc........you could even try a carb free breakfast and dinner if you feel up for it............

the problem with Lantus, or a single dose background, is you could find you need more or less Lantus in the daytime than you do overnight, so you could risk waking high, or going low overnight........and you cant really accommodate for it unless you split the dose.....

Thanks so much for your reply, it's really helpful.

I did an overnight test last night & have my alarm clock set for the next couple of nights. Mad

BEDTIME (2314PM) = 4.2
0255AM = 6.7
0806AM = 7.3

Re the 0300am test, does this have to be spot on 0300am?

Mar 5, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Basal Insulin Testing

You can carry out a basal test at any time, you are always best to get an overnight test done first, allowing you to get your morning levels right, then you can do a daytime test, either between breakfast and lunch, lunch and dinner, etc........you could even try a carb free breakfast and dinner if you feel up for it............

the problem with Lantus, or a single dose background, is you could find you need more or less Lantus in the daytime than you do overnight, so you could risk waking high, or going low overnight........and you cant really accommodate for it unless you split the dose..... Wink

Mar 4, 2012

marke 681 posts

Topic: Questions for HCPs / Accessibility for Blind/ VIP diabetics

Hi, no its not true. There is a web version on this site that you could use although sadly its not fully compliant with VIP standards. There is also a PDF version that is not generally available but I'm sure we could get permission to send to you.
With regards to doing the course there is no reason that you cannot do it. Generally there is very little reading needed and any that is could be done for/with you by someone else on the course. One of the best parts of the course it's interacting with other diabetics which you will sadly miss out on.
Sorry but it sounds like NHS political correctness that they are not letting you do the course with others, which is a great shame. They probably aren't allowed to call you blind either just like diabetes UK want to call us people with diabetes and not diabetics. As you rightly say you are not stupid so why not let you integrate with others that understand your diabetes.
Anyway, rant over. If we can do anything to help let us know

Mar 4, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Warrington / Gemini Retail Park

Hi,

Just wondered does anyone live in the Warrington area? I live 2/3 mins drive and about 15 mins walk from the Gemini Retail park.

Mar 4, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Basal Insulin Testing

I take my BI / Basal Lantus at bedtime. Can i do a Daytime test or does it have to be Nightime?

Mar 4, 2012

Faulty Headl... 18 posts

Topic: Questions for HCPs / Accessibility for Blind/ VIP diabetics

I am due to start the DAFNE course tomorrow, WITH MY MUM!!
I was tld that the DAFNE course information isn't availible in any other format other than print. I ws told I couldn't do the course as there was printed material to read, then when I told them I could have it converted into a format that my computer could read I was told there was calculations to do too! Shock horror!! a blind person doing maths?? Well I never!
I mean DUH! I'm blind not stupid!

After a bit of discussion they finally said I could do it but in a one to one course... With my mum!
I'm 29 years old and I was wanting to do this course so I could be a wee bit more independant.

What I wanna know is why a blind or visually impaired diabetic can't do this course in a group setting like any sighted person would? we have the ways and means, technology has come on a bit over the years.

Obviously the printed material was printed from a computer? right? so why couldn't this be sent as a word doc or PDF file to the blind or visually impaired persons computer? easy!

I was told it wasn't availible in these formats, is this true?

Mar 3, 2012

Mairead 10 posts

Topic: Carbohydrate Counting / Low Carb Cookbooks

I finished my DAFNE course in early February and have been trying to make changes at home, diet and exercise and so on. I recently bought a couple of low carb cookbooks which I am finding helpful:

'The low-Carb Cookbook' by Elaine Gardner (2011) Published by Southwater
"Lose wight the smart way with 150 healthy, tasty recipes;

'Recippes for Health: Diabetes (2000) Azmina Govindji and Jill Myers, Published by Thorsons "Low-Fat, Low-Sugar, Carbohydrated counted recipes for the management of diabetes." (bought this one on amazon marketplace as it was pub in 2000); and

'The Vegetarian Low-Carb Diet Cookbook' (2011) by Rose Elliot, Publ Piatkus. "The fast no-hunger weightloss cookbook for vegetarians."

My HbA1c has gone from 10.4 to 8.00 since finishing the course and I have lost 2lbs in weight.

I still have bad days because of other conditions, Rheumatoid Arthritis and Osteoarthritis which can upset diabetic control when they flare up, but am managing better than I had initially thought I would.

I am also hoping to lose more weight, I am 10st 10lbs at 5'4" in height, and want to lose the excess 10 lbs. I am hoping this will help not only improve the diabetes further but also to reduce inflammation factors and help my other conditions. I try to exercise by walking more and gentle exercises because my mobility is not great.

Any advice or other cookbook/diet recommendations from others who have been through the same and have to manage other conditions alongside diabetes? - thanks

Mar 1, 2012

thebatoutofhull 60 posts

Topic: General Discussion / Guestimating Hba1c

Hi, both these estimating systems are only a guide. They just give me an idea where I am. Hypo'thetically you could have 3 months of test results ranging from 5 to 7 and get the same average as someone with test results which are much more wider ranging.

You could in theory have more glucose in your blood, but also have a lot of hypos and get the same average BG as someone with better control.

Feb 29, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Guestimating Hba1c

Also for some reason my DSN said at my last appointment that my average will probably go up??? Confused

Feb 29, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Guestimating Hba1c

I haven't had enough personal experience with it to confidently trust the formula, my average blood sugars just aren't accurate enough........so don't worry too much.....

Feb 29, 2012

mum2westiesGill 502 posts

Topic: General Discussion / Guestimating Hba1c

Hi,

Just done my Hba1c. It was 7.37% doing it using thebatoutofhull's way & about 7.4% doing it novorapidboi26's way. I got the 3 months results (last 90 days) from the "my blood glucose diary" on here. When i get my result on the accu-chek site it does give me a message of "Keep up the good workâ€”you're very close to target!" Myself i'm, really annoyed now Evil or Very Mad

because my last one in December was 6.8% & i had my DSN phoning me to congratulate me.

Feb 29, 2012

thebatoutofhull 60 posts

Topic: General Discussion / Guestimating Hba1c

Maybe i'll use that formulae instead. Thanks.

I never had any problems with my old Dafne team or anyone who was dafne related.

Feb 29, 2012

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Ratios and compensating

Some people have higher insulin resistance and therefore need a higher insulin/carb ratio....................

I have known ratios ad high as 4.5, however if you do find you need these amounts it would be best to confirm your BI dose or doses.............if you are on one dose like Lnatus and needing high ratios a split might also help bring the ratios down...........

Feb 29, 2012

novorapidboi26 1,819 posts

Topic: General Discussion / Guestimating Hba1c

I use the formula:

HbA1c = Average BG + 2.52 / 1.583

its usually within + or - 0.5%

Its strange though, I have never feared a bollocking from my team, they have always shown concern if its really high, but asI am DAFNE trained, they know I am doing my best and that I can identify the areas that need attention...........

Feb 29, 2012

memelr1986 1 post

Topic: Questions for HCPs / Ratios and compensating

hi i have recently finished the dafne course and am getting used to carb counting and ratios was wondering if any one could answer a question for me the guidelines say that a ratio of 1-3:1 ratio for breakfast and 1-2:1 ratio for lunch and dinner i am finding that this ratio does not work for me i need more is it safe to use a higher ratio and how high is ok to go????????

Feb 29, 2012

thebatoutofhull 60 posts

Topic: General Discussion / Guestimating Hba1c

I get my Hba1c test once a year. It used to be more when I had access to a DAFNE team.
I now estimate my own just by using an online estimating calculator to give me an idea whether I am going to get chowed at by my GP. With one test a year I miss out on 9 months worth of Hba1c's. (3 tests)
I can end up talking to my GP about a result from nearly a year before.

http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/e5184/index_en.html

This is what I do to estimate my hba1c.

step 1/
Work out an average BG for your results.( you can add 3 months results up if you like and divide the result by how many results you counted, or look at your 'mean' graph)

paste the above link into your address bar. It brings up the website for'SOCIETY FOR BIOMEDICAL DIABETES RESEARCH'

step 2/ Use their converter to change your average BG in mmol/l to mg/dl.

step 3/ Use the A1c test calculator from the following link. (it does not accept mmol/l readings only mg/dl)

www.accu-chek.com/us/glucose-monitoring/a1c-calculator.html#

It was not far off last time for me when I compared it too my last actual hba1c.

Mar 5, 2012 Jennypenny 34 posts	Topic: General Discussion / Dawn Phenomenon Hi Gill , i experienced this for a number of years after previously not having this , so i would say yes .My dawn Phenomenon stopped when i went on the pump Jenny

Mar 5, 2012 SA2010 69 posts	Topic: General Discussion / Pain after injecting Hi - just noticed this thread whilst searching for posts relating to using same needle type/size for both novorapid novopen and lantus solostar pen. Adding to John H reply, I use 8mm BD Microfine for Lantus Solostar and 6mm Novofine needles for Novorapid Novopen. On advice from my clinic, I was asked to use the BD micro-fine 5mm for both lantus solostar and novopen. I found it very painful and after few days of perseverance I gave up and switched back to the BD Micro-fine 8mm for the lantus solostar and novofine 6mm needles for the novorapid novopen which cleared the problem. Now 18 months on the clinic is recommending AGAIN that I use the same needles for both pens - suggesting using the novofine 6mm for the lantus solostar as well. I am hesitant as it is not recommended by the manufacturers of the lantus/solostar pens and also I have come across posts on forums mentioning leakage when wrong needles used and 6mm for me might be as painful as the 5mm was. Anyone uses novofine needles with lantus / solostar?

Mar 5, 2012 Garry 328 posts	Topic: Site Development / New Format Website Wow. Top service. Wish other IT departments fixed stuff as quickly and it works Thanks Garry

Mar 5, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Dawn Phenomenon Hey Gill............. My belief is that everyone experiences the hormonal response that helps them up in the morning, so, glucagon release from the pancreas, cortisol, adrenalin etc, all these hormones will increase insulin resistance and push up blood sugars. Its just some diabetics struggle more to get it under control...... I take 2 doses of Levemir, one at 6:30am and another at 22:30pm, I have to take it later so as I have more Levemir in me at 3 am, prior to the hormone release, and I also need to eat something for breakfast, which tells the pancreas to stop its release of glucagon and subsequently the liver to stop releasing glucose........ You will experience this to some degree, it may just not be noticeable........

Mar 5, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Dawn Phenomenon I've been Type 1 diabetic taking insulin for approximately 20 yrs. Just wanted to know if Dawn Phenomenon can strike at any time? Gill

Mar 5, 2012 Simon 578 posts	Topic: Site Development / New Format Website Hi Garry, Thanks for your positive comments re the new site design. There was a minor problem with post editing - thanks for flagging it up with us - which has now been fixed. Thanks, Simon

Mar 5, 2012 Garry 328 posts	Topic: Site Development / New Format Website Bit of a surprise to find a completely new format and an ideal crossover between the traditional website that we are all familiar with and smartphone based view. Everything works well......and intuitively....not sure how to edit a post though. Thought the link and bouncing ball meant that I would be able to enter text edit directly as before. Thanks to those who put in the work. Congratulations Regards Garry

Mar 5, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Basal Insulin Testing No, its just 3am is meant to be the time where the least amount of hormones are swimming about and so the best time to take a test of your basal, however if someone was to get up at 4:00am every morning for work, then 3am would not be hormone free, in fact an hour or two before you get up [your body clock expects you to get up] is when the hormonal responses begin........... For you though, getting up at a normal time of 8am, 3am testing is fine............ From you results, you would assume you would need an extra unit or two overnight, lets see what the next few nights show............!

Mar 5, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Basal Insulin Testing novorapidboi26 said: You can carry out a basal test at any time, you are always best to get an overnight test done first, allowing you to get your morning levels right, then you can do a daytime test, either between breakfast and lunch, lunch and dinner, etc........you could even try a carb free breakfast and dinner if you feel up for it............ the problem with Lantus, or a single dose background, is you could find you need more or less Lantus in the daytime than you do overnight, so you could risk waking high, or going low overnight........and you cant really accommodate for it unless you split the dose..... Thanks so much for your reply, it's really helpful. I did an overnight test last night & have my alarm clock set for the next couple of nights. BEDTIME (2314PM) = 4.2 0255AM = 6.7 0806AM = 7.3 Re the 0300am test, does this have to be spot on 0300am?

Mar 5, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Basal Insulin Testing You can carry out a basal test at any time, you are always best to get an overnight test done first, allowing you to get your morning levels right, then you can do a daytime test, either between breakfast and lunch, lunch and dinner, etc........you could even try a carb free breakfast and dinner if you feel up for it............ the problem with Lantus, or a single dose background, is you could find you need more or less Lantus in the daytime than you do overnight, so you could risk waking high, or going low overnight........and you cant really accommodate for it unless you split the dose.....

Mar 4, 2012 marke 681 posts	Topic: Questions for HCPs / Accessibility for Blind/ VIP diabetics Hi, no its not true. There is a web version on this site that you could use although sadly its not fully compliant with VIP standards. There is also a PDF version that is not generally available but I'm sure we could get permission to send to you. With regards to doing the course there is no reason that you cannot do it. Generally there is very little reading needed and any that is could be done for/with you by someone else on the course. One of the best parts of the course it's interacting with other diabetics which you will sadly miss out on. Sorry but it sounds like NHS political correctness that they are not letting you do the course with others, which is a great shame. They probably aren't allowed to call you blind either just like diabetes UK want to call us people with diabetes and not diabetics. As you rightly say you are not stupid so why not let you integrate with others that understand your diabetes. Anyway, rant over. If we can do anything to help let us know

Mar 4, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Warrington / Gemini Retail Park Hi, Just wondered does anyone live in the Warrington area? I live 2/3 mins drive and about 15 mins walk from the Gemini Retail park.

Mar 4, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Basal Insulin Testing I take my BI / Basal Lantus at bedtime. Can i do a Daytime test or does it have to be Nightime?

Mar 4, 2012 Faulty Headl... 18 posts	Topic: Questions for HCPs / Accessibility for Blind/ VIP diabetics I am due to start the DAFNE course tomorrow, WITH MY MUM!! I was tld that the DAFNE course information isn't availible in any other format other than print. I ws told I couldn't do the course as there was printed material to read, then when I told them I could have it converted into a format that my computer could read I was told there was calculations to do too! Shock horror!! a blind person doing maths?? Well I never! I mean DUH! I'm blind not stupid! After a bit of discussion they finally said I could do it but in a one to one course... With my mum! I'm 29 years old and I was wanting to do this course so I could be a wee bit more independant. What I wanna know is why a blind or visually impaired diabetic can't do this course in a group setting like any sighted person would? we have the ways and means, technology has come on a bit over the years. Obviously the printed material was printed from a computer? right? so why couldn't this be sent as a word doc or PDF file to the blind or visually impaired persons computer? easy! I was told it wasn't availible in these formats, is this true?

Mar 3, 2012 Mairead 10 posts	Topic: Carbohydrate Counting / Low Carb Cookbooks I finished my DAFNE course in early February and have been trying to make changes at home, diet and exercise and so on. I recently bought a couple of low carb cookbooks which I am finding helpful: 'The low-Carb Cookbook' by Elaine Gardner (2011) Published by Southwater "Lose wight the smart way with 150 healthy, tasty recipes; 'Recippes for Health: Diabetes (2000) Azmina Govindji and Jill Myers, Published by Thorsons "Low-Fat, Low-Sugar, Carbohydrated counted recipes for the management of diabetes." (bought this one on amazon marketplace as it was pub in 2000); and 'The Vegetarian Low-Carb Diet Cookbook' (2011) by Rose Elliot, Publ Piatkus. "The fast no-hunger weightloss cookbook for vegetarians." My HbA1c has gone from 10.4 to 8.00 since finishing the course and I have lost 2lbs in weight. I still have bad days because of other conditions, Rheumatoid Arthritis and Osteoarthritis which can upset diabetic control when they flare up, but am managing better than I had initially thought I would. I am also hoping to lose more weight, I am 10st 10lbs at 5'4" in height, and want to lose the excess 10 lbs. I am hoping this will help not only improve the diabetes further but also to reduce inflammation factors and help my other conditions. I try to exercise by walking more and gentle exercises because my mobility is not great. Any advice or other cookbook/diet recommendations from others who have been through the same and have to manage other conditions alongside diabetes? - thanks

Mar 1, 2012 thebatoutofhull 60 posts	Topic: General Discussion / Guestimating Hba1c Hi, both these estimating systems are only a guide. They just give me an idea where I am. Hypo'thetically you could have 3 months of test results ranging from 5 to 7 and get the same average as someone with test results which are much more wider ranging. You could in theory have more glucose in your blood, but also have a lot of hypos and get the same average BG as someone with better control.

Feb 29, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Guestimating Hba1c Also for some reason my DSN said at my last appointment that my average will probably go up???

Feb 29, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Guestimating Hba1c I haven't had enough personal experience with it to confidently trust the formula, my average blood sugars just aren't accurate enough........so don't worry too much.....

Feb 29, 2012 mum2westiesGill 502 posts	Topic: General Discussion / Guestimating Hba1c Hi, Just done my Hba1c. It was 7.37% doing it using thebatoutofhull's way & about 7.4% doing it novorapidboi26's way. I got the 3 months results (last 90 days) from the "my blood glucose diary" on here. When i get my result on the accu-chek site it does give me a message of "Keep up the good workâ€”you're very close to target!" Myself i'm, really annoyed now because my last one in December was 6.8% & i had my DSN phoning me to congratulate me.

Feb 29, 2012 thebatoutofhull 60 posts	Topic: General Discussion / Guestimating Hba1c Maybe i'll use that formulae instead. Thanks. I never had any problems with my old Dafne team or anyone who was dafne related.

Feb 29, 2012 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Ratios and compensating Some people have higher insulin resistance and therefore need a higher insulin/carb ratio.................... I have known ratios ad high as 4.5, however if you do find you need these amounts it would be best to confirm your BI dose or doses.............if you are on one dose like Lnatus and needing high ratios a split might also help bring the ratios down...........

Feb 29, 2012 novorapidboi26 1,819 posts	Topic: General Discussion / Guestimating Hba1c I use the formula: HbA1c = Average BG + 2.52 / 1.583 its usually within + or - 0.5% Its strange though, I have never feared a bollocking from my team, they have always shown concern if its really high, but asI am DAFNE trained, they know I am doing my best and that I can identify the areas that need attention...........

Feb 29, 2012 memelr1986 1 post	Topic: Questions for HCPs / Ratios and compensating hi i have recently finished the dafne course and am getting used to carb counting and ratios was wondering if any one could answer a question for me the guidelines say that a ratio of 1-3:1 ratio for breakfast and 1-2:1 ratio for lunch and dinner i am finding that this ratio does not work for me i need more is it safe to use a higher ratio and how high is ok to go????????

Feb 29, 2012 thebatoutofhull 60 posts	Topic: General Discussion / Guestimating Hba1c I get my Hba1c test once a year. It used to be more when I had access to a DAFNE team. I now estimate my own just by using an online estimating calculator to give me an idea whether I am going to get chowed at by my GP. With one test a year I miss out on 9 months worth of Hba1c's. (3 tests) I can end up talking to my GP about a result from nearly a year before. http://www.soc-bdr.org/rds/authors/unit_tables_conversions_and_genetic_dictionaries/e5184/index_en.html This is what I do to estimate my hba1c. step 1/ Work out an average BG for your results.( you can add 3 months results up if you like and divide the result by how many results you counted, or look at your 'mean' graph) paste the above link into your address bar. It brings up the website for'SOCIETY FOR BIOMEDICAL DIABETES RESEARCH' step 2/ Use their converter to change your average BG in mmol/l to mg/dl. step 3/ Use the A1c test calculator from the following link. (it does not accept mmol/l readings only mg/dl) www.accu-chek.com/us/glucose-monitoring/a1c-calculator.html# It was not far off last time for me when I compared it too my last actual hba1c.