High A1C doesn't match my meter readings
I just got my most recent A1C results, and I was very confused to see that it was 6.1. My last one was 5.6 and even that seemed way too high judging by my meter readings. I test a lot, sometimes 12 times a day, and I also eat a lot of the same things so I know how my BG reacts to my diet. My fasting BG has been a little higher recently, but only about 90, and I rarely go over 120 at an hour. By 2 hours I am back under 100. According to my meter, my average is about 100 at the moment. I read somewhere that the A1C corresponds to your average after meal number because that is when glycosylation takes place. This would make some sense because my highest number after eating is around 125. I know Jenny posted about this on her blog. Anyone else have a similar experience? I am also wondering about the fructose test. Has anybody had this? I do eat a mostly vegetarian diet but not a whole lot of fruit.
Replies to This Discussion
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Permalink Reply by gretchen on
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It's not just health care people. You can spend 5 hours trying to solve a complex problem with your computer system, finally give up and call tech support, sit on the phone for 30 minutes, and then have the person ask, "Is it plugged in?"
The problem is that many people do forget to plug the computer in and do use the wrong strips or don't wash their hands before testing and do say they've been following their diets when they're not.
Those of us who don't fit the standard profile just have to learn to let these things wash over us.
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Permalink Reply by VetHost on -
Take this for what it's worth.
For years, I've had pretty good A1C readings and pretty lousy meter readings. Then I was tested for spherocytosis. Yep. Got it. And lo and behold! A1C is useless for me because I have it. Good to know because now I realize my meter tests are golden. I'm now on NPH and Regular in the morning and before dinner. It's working better than ever.
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Permalink Reply by Denise Bevard on -
I am so glad you said this--- RBCs of people without spleens do live longer, your A1c will be higher than expected..they never told me this when they had to take my spleen out--you'd think they'd a told a diabetic this--well--guess not given everything else they don't tell us--but they should! My BG took a .6 jump after my surgery, i am having a deveil of a time getting it back down to 6--and it is higher than my meter (and CGMS) average
Do you happen to know offhand if it throws anything else off (yes I know I can google--but no sense doing a lot of search if someone lese has already done it)
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Permalink Reply by Denise Bevard on
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I asked the doc about this last visit--he agreed that no spleen can cause A1c jump--but not the aftermeal spikes--but the symlin seems to be gettin those now--hopefully it will continue to
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Permalink Reply by s6954118 on -
http://www.diabeteshealth.com/read/2005/03/01/4250.html
Read this article. It indicates that your A1C will more reflect you last 30 days that the 90/120 total average.
Russell
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Permalink Reply by Libby on
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Gretchen,
I think your idea about the age of the red blood cells must be the rreason. The fact is that I have never gone over 140 ever, so it is not an issue of the last 30 days. The research shows that the better your BG control, the longer your cells live, so that paradoxically you have a higher A1C. I have been testing more frequently and know for a fact that 45 minutes after eating my BG is about 135, one hour it's at 120 and at 2 hours it's at 95-105. Fasting and over night is very constant at 90. That is not typically an A1C of 6.1. My A1C seems to correspond with the one hour number rather than the true average. it makes some sense that if my cells are living longer than 120 days, they have more chances to pick up glucose and they pick it up at around 120. However, your comment about looking at my own trends is a good one, and my A1C IS higher than it was 6 months ago, in spite of a better diet, so I am guessing that's to do with my higher fasting rate. I will give it a couple of weeks to see if it settles back to around 80 and if not, I will talk to my endo about a low level of basal insulin. Thanks for all your help.
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Here's a reference that includes graphs of mean BG and A1c for different people. The mean relationship is linear, but there's a tremendous amount of scatter. From graph A in Figure 2, it looks as if a person with an average BG of 5 mmol/L (90 mg/dL) could have an A1c from 4 to 13! And the average would be about 6.5. This is very different from the formulas they use to calculate average BG from A1c.
Your point about the worse control destroying RBCs is also a good one that those with higher A1cs should remember.
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Wow, Gretchen,
That's a complicated article. It worries me a little though that it seems to suggest that a higher A1C does correlate with greater risk for complications regardless of the cause: higher MBG or higher glycation. I am thinking that it would make sense to try basal insulin as a way of getting my A1C to come down lower. It is frustrating though to think that I can achieve near normal BG and yet still have a pretty high A1C with its concommitant risk factors. The RBC longevity theory doesn't fully explain it since non-diabetics have longer lasting RBCs and they have A1Cs in the 4.6-4.8 range.
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Permalink Reply by Jenny on -
Libby,
SOME non-diabetics have A1cs in the 4.6-4.8% range. Many, however, are in the mid-5% range, like my partner who has never tested over 115 and still gets 5.4% A1cs.
If you do try a basal, stay away from NPH. Two weeks on it and I seem to have developed antibodies to R which made it stop working properly. Coincidence? I don't think so, even if I can't come up with a mechanism to explain it. I had been doing so well on R for so long before that. My guess is it has something to do with a reaction to the protamine.
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