A1C Mystery Will not Come Down

CGM data is more informative than A1c data, once you’ve got a good amount of it. A1c measures a correlate of blood glucose, vs a direct measurement (granted, CGMs measure interstitial fluid, but it’s still actually measuring glucose levels). It’s like if I wanted to estimate a person’s weight, and I had the option to use their clothing size (A1c) or daily scale readings (CGM). If we can get to a point where everyone who is diabetic can be on a CGM, you’ll see A1cs becoming less and less of a thing.

Most people are indeed diagnosed via A1cs, because most people don’t have CGM data.

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Particularly with an exogenous insulin-naive Pt without a Ddx, and given that we cannot really know the Hx here, an exploration of possible medical exotica and zebra diagnoses is a bit much. The most likely scenario here can be fully ellucidated with routine labs like fasting CMP a few times on various dates and some routine add on orders like A1c each time and one C peptide lab. Also you might want a food log and some downloadable home self testing of bG, not glucose tollerance testing IMHO. And, that’s it. We cant diagnose here and NOT without hard copy of labs anyway. So, the most likely explanation is overwhelmingly likely that eAG is in 240’s mg per dL and the treatment is probably insulin. The Ddx comes from a few CMP labs and is not rocket science, as everybody here surely and fully grasps. Now if the claim was that all was done already and there is some ambiguity then repeat it all.

Thank you everyone for your help. I appreciate the different points of view. I’ve been at this for awhile and have had so many tests (including c-peptide). When I do take metformin I tend to feel a big crash but my readings are always in normal ranges 70-100 mg - in fact every test has kept me in the range despite the ongoing symptoms that have become somewhat debilitating. It’s the high A1C and the diabetic like symptoms that are the mystery.

As a new member to this site I’ve taken a lot of space here so will absorb what I’ve learned from some of you and consider next steps. I look forward to supporting others soon as I learn more. Thanks.

Zack, welcome…although truly sorry about why you are here. After breezing through all the comments and advice, am wondering if you have had C-peptide/GADA tests? I was diagnosed T1 at the age of 62, and the C-Peptide revealed it to the endocrinologist I saw. A1C is an average and used as a general marker of our progress or lack thereof. The emphasis on A1C by your providers is a bit appalling to me, and not good medical practice imo. I don’t know how it works in Canada, but those of us who use “healthcare systems” (as opposed to private practitioners) have the means to go up the “line of command” (as it were…) and demand that you be given the care and treatment you deserve. Trying to diagnose yourself has got to be anxiety inducing. My 2 cents (and given current economy, probably worth less…haha).

See a third doctor.

John

HOLD on there!
Canada uses a different number system than the US! You NEED to make sure everyone is on the correct / SAME, BG / A1C number system, FIRST!

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I hope the unit conversion thing didn’t get the Docs. It might have gotten us.

You checked your ketones? Do they still make ketone strips and sell them at the pharmacy? Are you peeing all the time? https://www.walgreens.com/store/c/walgreens-ketone-test-strips-for-urinalysis/ID=prod6000723-product

Do you do finger sticks? You ought to be able to tell if you did a week of readings, maybe 4 per day. You ought to be able to buy a Blood sugar machine in Canada.

Yes, I am doing finger pricks now everyday and I’m on my third day.

I might be able to get keystone strips at our Walmart and will check. I do fine during the day but pee a lot at night… 3-5 times.

I have been reading all the advice from others. I agree with diagnosis of type 1 diabetes until proven otherwise. Are you able to provide any other information about yourself like age and other health issues? Thanks, Jane

Post your data for us. Ketones might be unnecessary. The most useful data will come after eating - thats when you will see it go high. People aren’t always symptomatic. I’ve seen people run 800 and say they felt great. Sometimes people just adjust to high numbers.

Make sure we know what the units are, though.

I will do that. I’m keeping a log and will post these tomorrow. Thanks.

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Lots of good replies and advice here. I would also consider trying to obtain a full comprehensive GI system workup (gastrointestinal system). This would include, at minimum, gastric analysis, full liver function studies, pancreatic scan and pancreatic enzyme levels. All our “duct” work from the gastric to hepatic to pancreatic ought to be evaluated in case there are anatomically related pathologies here. This could be hard to do as MDs are sometimes either unavailable or hindered by the insurance companies in providing diagnostic testing…

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I am posting some data as some have asked as it might be helpful. I do appreciate this support and understand if we reach the point soon to move other things and topics.
I’ve done monitoring for three days. I’ve converted the Canadian units to the US. It’s a bit lengthy. I’ve also posted other test results below as some have asked.

April 9
morning fasting 100 (5.0)
went for walk -lightheaded felt dizzy (common most mornings)
after breakfast one hour 108 (6.0)

April 10
fasting. 108 or close to it (5.9)
smoothie, nuts
walk - -lightheaded felt dizzy (common most mornings) - feeling said for most the day
108 (6.0) after walk and one hour or so after eating

1:30 pm
decaf latte small snack

120sh (6.6)

lightheadedness, fuzzy feeling and generally tired feeling dry mouth not really going away much these last few days

6:00 pm salad for dinner with tempura shrimp
one hour after eating 115 (6.7)

April 11

fasting boring 112 (5.1)
smoothie, decaf coffee two eggs
lightheadeness, fuzzy feeling and generally tired feeling dry mouth

dinner
salad w/ black beans 108 (6.0)

April 12
fasting 80 (4.7sh)
breakfast cheese and some deli meats and fruit/ fake coffee

6:00 pm
115 (5.4)
still feeling heavy legged and lightheaded all day

April 13

fasting 100sh (5.5)
some cereal (no sugar) and fruit
walk and same old feeling
same BG after walk

1:15 pm
lunch soup I piece bread and butter 160 sh (8.5) ! this is the highest reading I’ve ever seen since I started all if this on and off for then last 16 months.

The lethargy has not seemed to pass like it usually does and has set in. Dry mouth, toes throb a little after eating most days especially in evenings

Other tests
A1C reported tests for then last two years and hover around 10.5 - 10.6
(went off sugar and very low carbs since then with no change)
ulta sound on abdomen and internal organ look normal
Fructosamine is 195 and considering in normal range in Canada
C-peptide 488 and within normal range in Canada
iron, B, ferratin all in normal ranges, thyroid tested normal
insulin level 69 (reference range 64-83 g/L)

Thanks. I will speak about these tests with my GP.

The BGs you’ve posted look fine. They don’t speak to the a1c you post. It could be your diet and exercise were different for the months prior to taking those tests.

What is the normal range for c-peptide in Canada? I’m asking to see if where you are in the labs normal range.

I agree your finger sticks looks to be in good range. Most of your tests are fasting or one hour after meals, and those are fortunately certainly not T1 values. Could you do a few more tests, though, say 2 and 3 hours after meal? Sometimes BGs rise slowly. I’m not sure feeling dizzy is related to your BGs since they do look in range at least for the couple of tests you logged. The dizziness is very concerning. And you have normal blood pressure?

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I agree. Data looks good.

Just to give you something to compare it to, so you know what to look for…

People are looking for purple data points, like the 181, 240, and 211.

Here is my data today (with insulin treatment). Pretty decent day.


Yesterday…

2 days ago…

People are really looking for you to break 200 in USA units. (above 10.5 in Canadian units).

So, I’m guessing the American Doc thought your a1c was 10 in American units, not Canadian ones. He saw 10 and thought your BG was running around 13.9 in CA units, or 250 in US units.

It might be a little confusing. Ask if you have any questions.

image

People are looking for data points in the purple range. So, above 10, in CA units.
If you see any of those, be sure and let us know.

Thanks so much mohe001. The graph you shared of your day puts things in perspective for me. I have not dipped below 70 and rarely have I gone above 120. So I can begin to understand why GP’s here and endocrinologists
have not diagnosed diabetes with just the high A1C. A 10.5 is considered very high for Canadian standards where a normal A1C should be in the 4.5-5.0 range and with controlled diabetes in the 7.0 range. In Canada an A1C of 10.0 is the equivalent of 13.9 or
250 US.

What’s perplexing are the symptoms I have are so diabetes like and they happen especially after consuming any carbs or other sugars. And I’ve been tested for all the typical food allergies (even Lyme disease).

Thanks again.

Zack - A1C’s in Canada are exactly the same as those used in the USA. Don’t be confused by others suggesting they’re different.

A1C may also be used for the diagnosis of diabetes in adults (see Screening for Diabetes in Adults chapter, p. S16). In Canada, A1C is reported using the National Glycohemoglobin Standardization Program (NGSP) units (%). In 2007, a consensus statement from the American Diabetes Association, European Association for the Study of Diabetes and the International Diabetes Federation called for A1C reporting worldwide to change to dual reporting of A1C with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) SI units (mmol/mol) and derived NGSP units (%) with the hope of fully converting to exclusive reporting in SI units (8). However, this has not been adopted worldwide, and both Canada and the United States still use the NGSP units (%) (9). Although there are some advantages to reporting in SI units, the most notable disadvantage is the massive education effort that would be required to ensure recognition and adoption of the new units. Canada is currently not performing dual reporting; therefore, throughout this document, A1C is still written in NGSP units (%). For those who wish to convert NGSP units to SI units, the following equation can be used: IFCC = 10.93 (NGSP) − 23.50 (10) (see Appendix 15. Glycated Hemoglobin Conversion Chart for conversion of A1C from NGSP units to IFCC SI units).

Blood sugar scales in the 2 countries are different. Canada uses mmol/L, while the US uses mg/dl

Blood Glucose Conversion. U.S. value = UK / Canadian value times 18 (mmol/L x 18 = mg/dl). U.K./Candian value = U.S. value divided by 18 (mg/dl / 18 = mmol/L). … In a person without diabetes , blood sugar is typically between 80 and 110 mg/dl.

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