Blood Work

I just had my A1C done and was looking over the blood work. My fasting BG was 139 then off to the side it gives normal range of 65 - 99. I have always been told that if your under 140 it is good but the lab work says I'm high.

For the A1C I am at 6.9 and off to the side it says normal is 5.7 or less. And again I have always been told I need to keep it below 7.0 and that is good.

I am wondering if the lab is right in there range or the doctors I see? Now I know why I stay confused all the time.

I wouldn't get too discouraged. My endo also praises me for staying in the 6.5-7 range. I've noticed on this site that some people freak out if they aren't <6 and I don't know how they do it. I think ideally you should shoot for <6 but sometimes it's just impossible no matter how hard you try. 6.9 is still REALLY good and you should be proud of it. A lot of people have a hard time getting under 7. Keep up the good work!

I think the Fasting numbers the blood test company is using are for everyone - including non-diabetics. My last fasting BG was 118 and my paperwork says that was high. It is high for a person without diabetes - but for me, it is fine.

Let me preface this by saying I work in a laboratory and turn out results. I'm also T1 for 17 years now.

The normal ranges are different (but similar) for every laboratory. They are basically the natural spread of numbers seen in 'healthy' individuals. We all know that ideally, our numbers would be the same as the healthy population, but that isn't usually how the cookie crumbles. An A1C under 7 is fabulous for a PWD!! Congrats! I would listen to your doc for ranges to follow since the big D changes things for us. An A1C of under 5.7 is very hard to achieve for most of us and often causes too many lows to be sustainable.


Fasting should be under 100. That's the goal because that's normal. Under 140 is the goal 2 hours or less after meals for PWD.

Afraid that doctors don't have high standards for diabetics, to our detriment. A 6.9 A1c translates to an average BG of 152. Of course, that means that you've been higher & lower. You know how that is from testing.

Since BG over 140 is where damage occurs, being over 140 frequently isn't healthy.

5.7 A1c isn't normal either, regarding a range. A normal A1c would be in the 4's.

Honestly, if my doctor said A1c under 7 was good, I'd find another doctor. I hate that "good enough for a PWD attitude." Set your own goals. Lower BG is doable without having bad lows.

Any BG above "normal" is causing damage to your body. Currtent thinking says over 140 is dangerous. This does not mean anything under 140 is good. A healthy person will have an A1c of 4.5 to 5.4 or so. An A1c of 5.4 equates to an average BG of about 110 for the past 90 days. The real goal is to keep your BG as close to normal as possible in order to avoid complications. Achieving that level of control is difficult and takes a lot of work and commitment.

In no way am I discounting your efforts or control. Quite the opposite. My concern is the standard medical response that anything under 140 / 7.0 is great. It is not. It's great compared to the 436 and 12.3 I started at, but it is NOT protecting us from complications. It is only kicking the can down the road. And not all that far. It infuriates me that we are told this is good. Are we incapable of rising to the task? How can we be expected to have great control when we are not given complete or accurate information by the very people we look to for help? Yes, tight control means a danger of lows. It is NOT a gaurentee of lows, but an A1c over 6 is a gaurentee of complications. As a T1 I know that I probably will have an A1c above the ideal, but why should I aim for anything less? Nothing about D makes this impossible. It's like Jack Nicholson is our Dr screaming "You can't handle the truth"!

Hi Uniboy. I understand your dilemma.

The trouble with A1C is that it is an average - and if you spend half your time in the mid-200's and the other half in the 20's (God forbid!!) you'll have a fabulous A!C, right? But you won't feel or be healthy.
I think the medical establishment is gradually realizing that the lows, especially deep ones, are also damaging to our bodies - At my last visit my doc mentioned that I should avoid lows because research is finding they do cognitive brain damage (I think I could have told him that, but not when I'm low - ha!). I also wonder if retinopathy is related to too many lows, though that is totally my own private theory.

So perhaps we need to aim for the lowest A1C we can manage without too many deep lows?

That's the best I can figure it, anyway. None of this is easy. All we can do is keep trying.


As someone who is going through a longish rough stretch with control due to female hormones, it's given me the perspective that perhaps the doctors realize how frustrating and disheartening it can be when some patients *can't* (and yes I mean *cannot* despite eating almost carb free, logging, cgm-ing, and monitoring constantly) stabilize bg levels where they need to be.

I'm doing my very best with every ounce of effort I have to give and can't get where I need to be. All I can do until the menopause is done with me apparently is chase a moving target.

Right now, for me, the truth is that control *is* near impossible.

Uniboy, work as hard as you can and celebrate your successes. Your numbers are still really good.

That sounds rough, smileandnod and I hope your support system understands. I think doctors are braced for the many people with Diabetes that are not doing their best to manage their D, and when they see us coming it's like they expected elephants and got unicorns. (I was going to say zebras but I decided to make a judgement call!)

I'm lucky I was diagnosed after menopause (as well as after many of life's travails.) Hang in there until the ride slows down and treat yourself well.

Over the last three months my diet has been terrible and as a result I have a high A1C. Trying to curb my diet is the hardest part of being diabetic. There have been nights I have gone to bed in the 300's and have woke up just as high. In the last few weeks I have stopped this kind of behavior. I keep trying to do better. I'm shooting for a 6.5 A1C next time.

Hi Uniboy. For the general (non-D) public, the cut-off for a "normal" fasting BG is 99. Anything between 100 and 125 is considered to be "metabolic syndrome" or "impaired fasting glucose" territory. Anything 126 and above puts you into "diabetes" territory.

A fasting reading of 139, just confirms what you already know: you have diabetes.

That marker of "high" in the lab report is for everyone who gets blood work done there. It's not customized for each patient.

Ditto for the HbA1C.

You have to decide where you want your numbers to be. But the lab has to report out what is "normal" for the general public.

This is what Dr. Bernstein calls "the power of small numbers". If you stay pretty tight and low-carb, then you only have to make small corrections. Smaller corrections = fewer wild swings in blood glucose.

Because medical professionals either don't know how to guide patients to having good control, or don't have the time or inclination, they assume that serious lows are inevitable. A cop out. I'm weary of hearing this party line. Feels like they've thrown up their hands in defeat regarding education. Why we've got to educate ourselves.

Forgive me here but around 15 years ago when I started haveing some lows that hit the record book my Endo said that when that happened and depending on how long they were taking place I was warned about the barin being depribed of insulin during thats and he toldme to really watch out when they happened. Now given this was a few years back and it's probably changed since then but just wanted to say it. I hopethings are much better now.

Any BG above "normal" is causing damage to your body. Currtent thinking says over 140 is dangerous. This does not mean anything under 140 is good.

This is a great point Randy.

However, I'll even go further and say that if you read the research cited to make the claim that 140 mg/dl is the threshold for damage, the research itself makes no such claim. They aren't even designed to find the exact threshold where damage begins.

What they do, generally, is seperate subjects into cohorts based on an oral glucose tolerance test. Using ADA guidelines, they determine who is normal and who shows Impaired Glucose Tolerance (IGT). The ADA guidelines say that anybody with a glucose tolerance between 140 and 200 mg/dl is considered impaired for glucose tolerance. What they show clearly is that a higher percentage of people with IGT versus normal glucose tolerance have any number of common diabetic complications regardless of whether or not they have actually been diagnosed as diabetics.

Current thinking, then, interprets these results to mean that damage begins at 140 mg/dl, which I think is a bit of a loose interpretation. Not necessarily wrong, but certainly not one that the resarch fully supports. Nobody is going to be surprised to find out that if they look at all of us diabetics, who all would be a lot worse than 140 mg/dl on a glucose tolerance test, that there a greater incidence of diabetic complications compared to a group that scores normal.

I don't think 140 is, necessarily, a number to get wrapped up in, either way.

We all want to be normal. Why not shoot for normality, whatever that number actually is? For us diabetics though, it's a game of averages. If I roll into a lab with a BG of 139, I know that's not what it would be if I did not have diabetes. But I do have diabetes, so the only thing I can do is work to make sure that my BG is going to be lower than that a lot more often than not.

I agree with a lot of other people that "pretty good for a person with PWD" ≠ "normal". Aiming at normal -- genuinely, truly normal -- is the best thing you can do for yourself, but no, it isn't possible for everyone with D.

I'm pregnant with T1, and both my endo and my high-risk OB-GYN want me aiming at NORMAL: less than 100 fasting, and less than 120 1 hour after eating.

Adjusting your basal so your fasting numbers are good -- MUCH easier with a pump -- is really important. Waking up at 85 means that you've bought yourself hours and hours of normal numbers, with no dietary changes!!!

Numbers are numbers, and yes, they will vary based on the lab and the lab equipment used.

Speaking from vet med... in chronic disease states, there might be a particular lab value or set of values that we are looking at when we run repeat bloodwork every so many months. We are looking at trends. We are looking at whether or not that number is good for that animal with that disease state.

We have no hidden agenda of hiding the truth from our patients. In fact, we might say something like, "Well, the XYZ lab value is still elevated above the range of most normal animals, but this is actually a very good number for a patient with this disease. Here's what we might do if you want to try to make it better, but realistically..."

Given that I was just diagnosed with 'the big D' a few weeks ago, I realize I haven't had near the personal experiences that almost all of you have had with this disease..

But I think it's important to remember that your doctors are probably not trying to hurt you, and that they realize some of these numbers may be the best that someone may be able to get with the big D. And if you have concerns that they are hiding things from you or that you aren't getting the whole story, just ask. Really. Don't be afraid to ask if it's possible to have an A1C of 5.whatever... and ask how many non diabetics actually have a 5.whatever A1C.

Also, just as an aside.. there is currently research going on with A1C and figuring out whether it's actually as valid as everyone thinks it is in people... In animals, we measure fructosamine.. and there is some suggestion that measuring fructosamine in people may provide a superior snapshot as compared to A1C (one of my docs told me this, but I haven't looked for any of the papers on it. Just food for thought.)

There's a reason why they call it 'practicing medicine'... 'cause it ain't ever gonna be perfect, there's too many variables! And things change ALL the time.

Thanks FHS. I know this is all subject to our individual D challenges. I believe that everyone here is trying their best to manage their D successfully. To a greater or lesser degree our results will vary. Both person to person and day to day. Unfortunately, due to my own bad choices, I had severe retinopathy and PN at diagnoses. I tackled D like my hair was on fire. I didn't know if these things could be reversed, but I was not going to loose my eyesight or anything else if I could help it. Fortunately I have been able to reach and maintain a great A1c and have very consistent BG's. None of which I could have done following the professional dribble. I have seen and felt what the future holds for that kind of management and I want no part of it. If I had accepted the "7.0 is where you want to be" party line I would NOT be able to drive today. My job would be gone and my life would be miserible.

Worms are pretty high in protein and low in carbs, I've never heard him recommend them. ;0)

Kestrel; Every morning I wake up between 135 and 175 and then do a correction. I told my endo about this and asked if I should change my basal and she said no; she was worried about me going to low.