I’m a little confused by my recent blood test results. I had my Fasting glucose, a1c and fasting insulin tested. Fasting glucose came back at 6.8 mmol/l (prediabetic range), my a1c is 5.3% (good) and my fasting insulin was 42 pmol/L (lower end of normal).
With an elevated fasting glucose level like that and lower insulin, shouldn’t my a1c be higher?
Your A1C, loosely speaking, is based on an average of the past 3 months. It is not an exact average as it is skewed toward your most recent results. Your fasting BG may have shown a little high due to the equipment used or you may have had some lingering carbs in your blood such as bread, pasta, etc, that you consumed within 72 hours of taking your fasting test.
If you want to micro-manage your diabetes, you can really only do that by using a CGM and following your BG trends for everything you eat, and then adjusting your foods and medications accordingly. You are still below where a CGM is required unless you want to get away from being even pre-diabetic. You may be able to borrow or rent a CGM for a few weeks to see your trends and then eat accordingly and re-test A1C every 6 months to determine if you want to take more aggressive action.
Diabetes is all about managing trends, not managing individual numbers taken at any given point in time.
Thank you for your response.
I actually already have a CGM. My glucose is usually between 6 and 7. It obviously rises after I eat. It will go lower than 6 with exercise and then come up again.
I was actually more curious about the lower insulin in relation to the fasting number.
Since you have a CGM, you should concentrate on TIR and STD Deviation. With your current numbers, you should be able to hit a TIR at about 90% or better and a Std Deviation close to 20. Your most stable results will be on a high fat, low carb diet (keto style), a diet many of us swear by while a smaller group vastly prefer a plant based diet. Diabetes is all about trade offs so each individual needs to do what is best for their particular situation and lifestyle.
Just don’t forget that Cholesterol and Atherosclerosis management go hand in hand with controlling BG and not balancing all three will lead to long term issues,
TIR is currently is around 99% (although I will have numbers in the 8-9 range often). STD is around 13. Cholesterol is good.
So I shouldn’t be concerned with the lower insulin in relation to the higher FBG?
Your numbers are better than pretty much everyone on this forum can even dream of. You are doing great. You can always tighten up your high and low CGM range to bring you down a little from 99%. That would graphically accentuate your highs and your lows. You also want to stick with the same lab over time so that you can follow your trends. Some labs, for example, have certified equipment for A1C while many doctor offices have a tabletop non-certified instrument. The A1C can vary by as much as 1% just from getting the results from 2 different labs. The tighter you control, the more you start looking at all these variables which is why trends are so much more important than any single reading. There are just too many variables involved.
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Thank you.
I just got back my c-peptide number which was 693 pmol/l. Normal. So I’m sure everything is good. I’ll keep doing what I’m doing.
Thanks again for your help.