A1C Result and Mornings High

So that means if your red blood cells last longer than three months, your A1c will be skewed high. There are a lot a variables to compromise this "standard" for BG control.

In a nut shell!

Since I work in Hematology it is usually a shortened lifespan that gets noticed, I'm not aware of any "disorders" that cause extended RBC lifespans. Especially since an extended RBC survival situation would not be recognized as a "disorder" requiring evaluation and treatment.

I think there is a major disconnect here. An A1c of 5.2 is equivalent to an EAG (estimated average glucose) of 102 mg/dL. Your average fasting glucose is 194 mg/dL. To get to an EAG of 102, you'd have to be living in the dangerously low range the whole day. So either there's a technical error in the A1c, or your red blood cells have a very short life cycle, so that the A1c doesn't have time to increase very much. If it were me, i'd be much more concerned about trying to get the fasting BG down closer to 100 than simply trusting that A1c measurement. The BG measurements are far more reliable than the A1c. But if you really want to get better control, i'd highly recommend a CGM.

This community contains a wide, impressive range of knowledge!

Yikes! I don't want a low A1c that badly. Hope it turned out well.

FHS, great advice back to OP. Would you mind explaining what basal is supposed to do? I know what it does in terms of the liver..but what is it supposed to do in terms of BG's; if we go to bed at 130, our basal is correct if_________. If 4+ hours after meal, our BG's should be ____________? This is where I get so confused because I too feel like I'm just injecting insulin all the time. Are those on pumps constantly tweeking and correcting, giving small doses of insulin or does the basl bring you down to some arbitrary number. THANKS!

Terry, most of the time my readings are in upper 200s but next 2 hours where it drops sharply. I mean If I eat 8AM with fasting reading of around 240, 10 AM it would be around 220-300 and then by noon time it will drop down to around 70-120. I think I need to cut my carbs..I am too much depend on whole wheat, thinking I'm getting more fiber in my diet. Couple of days ago I read this article.

http://www.dailymail.co.uk/femail/article-2645445/Its-ultra-fast-diet-devised-heart-expert-slims-midriffs-cutting-wheat-And-today-reveal-trim-tum-AND-transform-skin.html

I'm now planning to adjust my basal rates , starting from midnight till 8 AM and see If that makes a difference.

I agree FHS on your observations. I need to play with my basal rate first.

It makes sense to start with the overnight basal period. When getting set up for this test you have to be in a certain BG window, not too high or too low. I think it took me like three attempts to just get to the starting line.

The whole testing period took me like 10 days to 2 weeks. This requires perseverance, but I think data is valuable. There's nothing like sleeping through the night flatlining between 80 and 100.

Carbs/wheat have an addictive quality to them. I've heard that people eating simple carbs light up the same area of the brain as cocaine. Cutting carbs does produce irritating withdrawal symptoms but they subside quickly. And then those carbs just don't have the same appeal that they did before.

I agree with your concern Wayne. Wondering most of the people mentioned RBC with A1C, is this bad to have short RBC life cycle? Does this lead to any kind of complications later? I mean blood related.

Thanks Sarah!

If you read Terry's link to the basal testing protocol, absent food and unusual activity, your basal insulin should keep your BG steady and within normal range.

In a perfect world, your basal rate would be adjusted so that you would go to bed at 80 and wake up the next morning at 80. You'd skip breakfast, go through your normal routine through morning and find that your BG is still 80. Similarly, you'd do your thing up until lunch, skip lunch, and still, your BG would be 80.

You get the idea.

That doesn't mean you aren't experiencing liver glucose dumps that would spike your BG, or that normal activity level isn't enough to drop your BG. It just means that the basal insulin release rate you program into your pump precisely matches the spikes and dips in BG you normally experience.

From there, you have your baseline such that when you do exercise, or when you do eat, assuming your ratios and corrections are accurate and precise, you would be adding insulin through boluses and decreasing insulin through basal rate changes to match mealtime and exercise requirements as well.

I shoot for 100 with my basal dose, that gives me wiggle room on either side. If I find that my BG is dropping below 80 consistently and predictably, or spiking above 120 consistently and predictably, under basal conditions, I readjust my basal. I have different basal programs for different conditions as well. I have 4 basal rate changes programed throughout the day and night. Others have more or less.

Hope that helps!

Great advise! :) Can you share your basal settings , if you don't mind. I mean I only have two basal settings..One for midnight till morning and then morning to midnight. I usually decrease my temp basal (40 -50%) if I go for workout. That is the only change I make to basal. I was wondering can I change/set my weekends basal rate, as my routine are different than weekdays.
FYI: I'm using Omnipod PDM. Thanks.

I certainly agree that there could be technical errors in an A1c measurement. I also agree that RBC pathology can wreck havoc on A1c readings.

However, I think just plain ol' normal human variation means that, statistically speaking, very few of us are going to fall directly on the line of correlation for Avg BG and A1c reading generated from the average of a sample of humans. That chart we all look at to compare our A1C to average BG, in other words, is just a ballpark estimate for the vast majority of us.

Hopefully, we don't fall too far off that line to make the estimate meaningless for us, but certainly falling off that line doesn't have to mean there's pathology or unusual error involved.

I do agree that an average BG of 190ish with an A1c of 5.2 is a bit wonky, but I'm guessing that's more due to a lack of a complete BG data set to analyze rather than pathology or a bad A1c measurement.

Thanks MegaMinxX for participating in the discussion.

- My fasting readings were pretty much same for the last 4-5 months.
- I have attached hourly statistic in reply earlier in this thread from CGMS.I usually test atleast 4-8 times a day from my Omnipod pdm and using dexcom sensor to monitor it.
- my A1c was done at Lab.
- I think I have RBC and WBC test done . let me check with my doc tomorrow and let you know.

Oh, and to be sure, with a steady basal, that doesn't mean you won't have spikes after a meal. It just means your bolus will cover the meal just enough to bring your BG back down to your target in a reasonable amount of time. I shoot for under 140 at 2 hours like practically everybody else.

Looks like we replied out...

Here are my basal settings on a typical day. I'm on the pod as well.

12a - 2a 0.35
2a - 6p 0.45
6p- 10p 0.50
10p - 12a 0.40

Strange, I know. I have an elevated basal from 2 in the morning right up until dinner. As it turns out, I sit at a desk most of the day. It wrecks havoc on my BG. When I was teaching, the basal from 6a to 3p was turned down almost to my early am level.

My 6p - 10p is definitely off and needs to be readjusted, but that's post exercise time and covers my post exercise high for the most part. It's never going to be exact so I just leave it.

My others aren't very differnt, but I will use them on occasion. I'm just finding that being in the ballpark is good enough.

Hope that helps.

I agree with 2hobbit, it may be more than just being a high or low glycosolator. These some important interferences with blood sugar meters and A1cs can really make the readings totally useless. There are various blood abnormalities that are known to invalidate the A1c. And blood abnormalities such as low (anemia) or high (polycythemia) hematocrit can really mess up meter readings. It might be good to check to see if you have any of these abnormalities and try to switch to a meter that doesn't have problems. Also I ask my doctor to give me a fructosamine test as another check of actually what my blood sugar control is (I have polycythemia).

That's a good question, Walkingonthemoon. I've looked for literature on this but not a lot is known. Even data on the life span of RBCs is sparse-it's not easy to measure. Humans make about 2 million RBCs every second, and they live from 2 to 4 months in different individuals. But I don't know if longer lived or shorter lived RBCs have any effect on health. There was a poster at an ADA meeting a few years ago that i saw, where they showed that A1c was indeed greater in diabetics who had longer lived RBCs.