So, I just got my A1c back from my new endo and it was 7.1. My average bg for the past 3 months has been 126 with the majority of those numbers within 70-140. The past month's average has been 120. I test 15 or more times a day and am pretty aware of where my blood sugars are at all day long. Actually, my average has probably been thrown off a bit because I test a LOT if my bg is high. According to a few of the online bg to A1c converters I have found online, my A1c should have been around 6.0.
Also, in October I did a home test and it was 6.7, but even that didn't seem all that accurate because my average was around 120. A fructosamine test in November, which was done after a period of three weeks where my bg was generally a bit higher, matched up with an A1c of about 6.7 according to the calculations my endo did. I wonder what my A1c would have been if she checked that at the same time?
Anyways, my A1c just doesn't make sense, and I've seemed to have this problem for a long time. I've heard others mention that there are different rates of glycation, and I am wondering if I am a high glycator. Does anyone know what exactly would be causing me to be a high glycator and if I am still at higher risk for complications because of my higher A1c despite my generally good control?
Those charts you see online comparing A1c to Avg Bg are aggregate data and do not show the amount of variation around either number.
Here's what the graph really looks like...
Pick a point.
So yeah, possibly a high glycator, possibly just reflects normal variation.
My A1c generally comes in around .5 points higher than would be predicted by my avg BG. I've confirmed the generally accuracy of my BG meterS by comparing to lab numbers, and my avg BG by testing multiple times during the day, night, and comparing to CGM data.
It ain't that my BGs are off.
Personally, if your own data are good then I would rely on that much more to gauge my control than your A1c.
Thanks! Those charts are very interesting. I didn't realize that there was THAT much variability in the A1c result, which makes me feel a little better. Of course, it is still very frustrating when the A1c test is seen as this ultimate test of BG control and it doesn't quite reflect the effort that is being put in!
Yup, lots of discussion here about A1c with many opposing but equally informative opinions on its utility. I think its a good number to track but realize that your number has most of its utility when you can compare it to your other numbers.
Here's another reason for variation.. I work in a lab and do the actual testing for A1c's. Depending on the test method your lab uses, the number will vary. One method runs significantly higher than the other. Could this be causing your consistently increased numbers? Ayup.
a) your meter could be 20 points lower than the real blood glucose. It is rare that meters show a systematic bias but I still think it is possible. Have you tested your meter against lab equipment?
b) what happens at night when you are not testing? Are you sure that your numbers are fine then? Do you need high numbers / additional carbs to compensate for the tendency to go low later at night?
Your A1c is your Glycated hemoglobin at the time your blood is drawn.I have been in a study for about 6 years and they retest my sample using some very expensive equipment and compare it to the standard test ran at my local hospital lab, Quest, and LabCorp. They have retested about two dozen of my A1c's and none of them have been within .2% and most are off by .4% to .5%. My A1c is always lower than my BG average and my SG average?...everything associated with the Bete's has a variable. My BG average is around 116-119 and my A1c has been under 5.5 for over 4 years..it does not add up.
Yeah. A1C is an interesting one. After a couple of years of trying to get to the bottom of progressive numbness in my feet, a neurologist finally ran a 2-hour OGTT on me last year. Although my fasting sugars had generally been in the so-called normal range (and the GP who I have since fired refused to look any further once he saw normal fasting numbers), my A1C came up at 6.6 and the 2-hour test results weren't pretty. So I was given a diagnosis of pre-diabetes and neuropathy.
Huge freakout later, I set about getting the situation under control. Tons of exercise, very moderate carbs, lost (the first) 40 pounds and went back in 4 months later to recheck the bloodwork fully expecting that A1C to have starting coming down significantly.
Nope. At the second check, I had managed to get that number down a whopping 0.2 to 6.4. So I really freaked out. Took the meter that the CDE had set me up with and started testing like a madwoman to understand what the heck was going on. I learned some interesting things, but for the most part, my actual meter readings weren't bad - almost never over 140 at 1 hour and always coming down at 2 hours.
At the next check, my endocrinologist decided to look at fructosamine as well and sure enough, the fructosamine numbers have me at the low end of the normal range, while my A1C seems to be hovering right around 6.0 no matter what I do. Now down around 90 pounds from where I started this 'adventure', my meter says I can eat just about anything (as long as I keep up a pretty heavy workout schedule), but getting that A1C below 6.0 is just not happening - even though I continue to watch the carbs very carefully.
My theory as to why I managed to develop fairly extensive neuropathy, despite glucose numbers that are 'only' pre-diabetic is that I appear to be one of those whose body will take every micro-scrap of free glucose and stick it onto the nearest red blood cell. Then those red blood cells seem to hang around my system a lot longer than the 'average' 90 days. End result is that while I'm not 'formally' diabetic, I have to manage my sugars just as tightly as any T2 in order to keep the neuropathy from progressing any further.
My wife is non diabetic and has an A1c of 6.0%. If you look at the spread in the correlation it is possible to have 6% and have normal blood sugar at all times. My last A1c was 5.7% and I can assure you my BG are not normal. so go figure.
I agree my none diabetic wife also has A1c tests that are 6.0 and I have tested her blood after she has gone through a whole sack full of chocolate chip cookies and her BG will not spike above 90. I can have a A1c of 5.5 and my BG has been in the 140mg/dL to 250mgldL range for 15% of every day...the numbers never add up.
That is really frustrating! Especially since you have such great control! I've been surprised by my A1c in the past compared to average bgs (I know, I know, not perfect correlation) but the discrepancy between yours is definitely incongruous. How did your endo explain the difference? Mine usually gives some account of the different methods used to measure a1c (as Red_T1 says), but that doesn't seem to totally explain your story! Curious as to how the "professional" explained it!
This has always boggled me to no end. I test upwards of 14x/day and keep very close tabs on my averages. I even test in the middle of the night (often twice). Too often my A1C is higher or lower than I would expect it to be based on my averages. Even my endo has questioned the results before. Sometimes, it's lower than I would expect given what I'm seeing on my meters. Sometimes it's higher.
Pamaloo , the topic appears as frustrating for you as is for me ...the A1C results: last one 7.0 .My averages with my Contour Link 6.0 ( x18 ) I started using the One Touch VerioIQ , after I had my last lab test done . A fasting Lab BG showed 6.9 , my Contour finger poke at the Lab 5.3 ...30 percent variance . I have used the Contour's Control Solution ...meter appears working OK .Verio claims 15 percent variance ...averages 6.3 same period , same number of tests as with Contour meter .My MM pump and CGMS's CareLink show a lower average . What does put my mind at ease is living with D over 29 years , no complications, good BP ,chol results , no kidney, no eye problems , other than the usual aging problems ( 71 plus ).Something more recent has been observed :Potassium is elevated ( ???) and have some blood work done .
Neuropathy can be caused by other things than high blood sugar. Have you ever taken Cipro or an antibiotic in the fluoroquinolone class of antibiotics? Are you someone who avoids red meat and may be low on B vitamins? Do you drink a lot of alcohol, as that can drastically affect B vitamins? Other drugs can be responsible for bringing on neuropathy. So check every drug name you have used +neuropathy in google and see what you come up with. I had neuropathy very severely in 2002-3 due to Cipro, but solved it with a lot of supplements and injections of B vitamins. I do drink red wine, but very rarelynow, because when I made my last 2 batches in 2009 and had three glasses each night for 3-4 days a week, I felt a sign it was coming back, so immediately but the wine in a locker a mile away and dropped the frequency of having it so low. It just isn't worth it, but I feel sure I could have wine once a week if I wanted. I even have 2 more batches to bottle, knowing that it will last me up to six years. So I repeat neuropathy is not only caused by blood sugar issues. It can be caused by even 8 days on an antibiotic if you are low on B vitamins. It took me 6 months to reverse it, but I have been fine since 2003, except for the scare after the 6 weeks of more wine in 2009.
In all seriousness if you feel fine why sit and worry about it? I could care less if my A1C was 10 if I felt fine. I've had this devil for nearly 4 decades with many years of extremely high BS and don't have any complications. If people are going to get themselves sick over the numbers their wasting their energy IMO. For me the whole nightmare is I've documented any glucose reading above 95 I feel awful. I am going to investigate whether I have some additional endocrine problems though its pretty consistent to note every sugar I take over 95 I feel horrible. I could be 95 and eat even something like a few peanuts and within 30 seconds I'll feel the spike and become physically irritable almost immediately if I don't take an injection. Between 80 and 95 I am generally fine. Less then 80 I start to feel a little to low but I handle the lows far better then the highs. I'd rather be 50 then 110. FWIW you look like a real cutie. Sorry you have deal with this monster.
You say you test 15 times per day, do you wake up in the middle of the night and test? For several years I would get liver dumps at wierd times of the day which affected my HbA1c's. Now I have finally lowered my HbA1c to the low 5's by lowering the range of my bgs. I don't like to go over 120 ever.
It F*****G blows doesn't it! My best sugar days are going from 80-100 back to 50. Anyone that doesn't feel like total hell from the highs really has it made in the diabetes world IMO. My dad could run 300 and he feels absolutely fine. I really wish someone can explain how that is possible.
I've been a Type 1 for 37 years and I just know that I really don't give my A1C much consideration b/c I'm NOT a number. If I feel ok than that's fine with both me & my dr no matter what the number's game says. I'm sorry that ur so flustrated. Please don't make urself a number it will lead to even more flustration.
