Need help to understand weird lab results

Okay, I’m new to this diabetes thing. So, I took my first A1c after dx and insulin therapy. It was at 4.2%. However, 3 months earlier it was at 10.9. I will say that at dx I was also dealing with some gnarly infections (no pathogen, just my AI attacking my dermis). The blood test was right before surgery to help the skin lesions that had become inflamed. I should also say, that my normals before dx were about 4.0-4.7.

It took quite awhile to get my sugars under control, at least a month. Hell, I’m still having trouble keeping my fasting sugars under 100, they tend towards 120-130 mg/dL. Now my doc is kinda freaking out. I don’t think there were any hypos during this time. I know I’d go a bit low during the day but not super low.

Has anyone else had this happen? Is this the ‘honeymoon’? I know that my insulin needs seem to change daily. If I’m having hypos, when is it happening? During sleep?

I kind of also need help to see if there is something I could do to keep my fasting sugars low. Right now I take 20 units of Lantus at night and my carb ratio is near 1 unit/20 g carbs (humalog).

Thank you

That is certainly a big jump in a short time, with first month being on higher BG side, and fasting > 100. But A1C is only estimate that correlates to BG, and if your blood cells have shorter than average lifespan, they will give lower A1C.

Do you do frequent before and after BG checks?

Can you get a freestyle Libre to get better visibility to your patterns?

1 Like

I see my doc in a few weeks so I’ll ask about the Libre. There are times that I feel low but I’m only at 90-100. Heck, even today, after working out, I felt low, but alas, my sugars were at 146.

I’m not sure if my other issues will affect my RBC’s. I do notice my insulin needs reduce a bit when I take my Cimzia (it’s an TNF-alpha antagonist that I take for Crohn’s disease and inflammatory arthritis AS). But when I’m flaring, my BS rise.

I was wondering if taking my Lantus at different times might help with morning sugars. I take it now at 9:30 pm.

I’m still new to this whole thing. It seemed quite easy to deal with at first, but now everything is in flux and I feel I don’t really have the tools to deal with all the changes. Your advice is quite helpful. TY

Yes, it can be overwhelming! I was “lucky” and diagnosed 50+ years ago, when only did one injection per day, and tested urine instead of BG. Easy, but of course not very good control. I was able to transition over time gradually as the newer products came out.

There is a Pro version of Libre, where your doctor applies it, and you don’t get to see the readings until you go back to the doctor to download and review. It gets billed by Drs office rather than pharmacy.

Sorry I can’t address any of the other things you mentioned, but someone else here may.

1 Like

Hi @Jenn20 , from personal experience, I can tell you that when your body is used to running at higher BGs, you will feel low even when you are +100. As your daily sugars correct to normal ranges the point where you feel low should change to a lower value also. The transition from a higher daily BG to a lower daily BG for some is not fun (feels like you have the flu), but once achieved you feel “normal” again. For me, the transition generally takes ~ 2 weeks.


Hi Jenn,
I know that when I am feeling real sick from stomach issues and such my blood sugar soars. If you were recently diagnosed with a type 1 then there is that honeymoon phase where your body could still be producing insulin. I’m not sure if that could be why there was a huge drop in A1C. I was diagnosed 25 years ago and I am on a Dexcom CGM. I believe my Endocrinologist had a device for patients to use to help get more info on blood sugar fluctuations. So definitely ask your doctor about that. I also am on an Insulin pump with Novolog insulin. Before that I was on Levemir and Novolog (I think). My fluctuations went from like 400 to 25. I switched to a NP and they told me the long acting only lasted part of the day for Type 1’s. So right away she changed the Levemir to twice a day to give 24 hour coverage. I’m not sure how long Lantus lasts in the body. But you should definitely try checking your blood sugar at different times then you normally do to see if you notice any spikes or lows. I believe at one time my doctor had me set an alarm in the middle of the night to check my blood sugar. (not fun) Well definitely talk to your doctor about any concerns.


Do you understand yet that glucose meters aren’t exactly real time accurate. They’re allowed to vary by 20% from your actual glucose levels. Finger sticks also tend to lag by 20 minutes or so from your “core” value. As in, it shows you what your BG was 20 minutes ago. If you have active insulin still working, you may have actually already dropped lower than what the meter is displaying, and you might be 20% lower than that.

Do you have control solution to test the accuracy of your meter? Some come with it in the starter kit, others you have to purchase it separately. It’s possible that it’s not even in range. But it’s an easy test, you just substitute a drop of test solution instead of your blood.
You can’t just take for granted that all the tools work correctly.

Your meter may not even work for YOU. There seems to be some variances with body chemistry. Free meters are pretty easy to come by, though most companies want a Dr script to do so. I’d try a different brand or two. Contour next seems very popular around here. Personally, I love my freestyle lite, and positively despise every One touch meter Byram Healthcare keeps trying to force on me. I’ve found the one touch meters consistently read too high, and I go hypo evey time I try to bolus from them

It’s also possible your insulin:carb ratio, DIA, and correction values aren’t dialed in yet. They vary a lot by person, and you Endo can only give you a starting point. I don’t use it anymore, but I found the mySugr app really helpful for figuring that out. If your good about recording your insulin, carb, and glucose data, over time it can provide that info for you.

You’ll never stop learning about your diabetes. It’s an every day evolution. Seems like you’re really of to a good start, though. Definitely set an alarm to test during the night. Good luck!


There is always a lot of adjustment, bear with it for a while, it will be worth it. Even though my target is around 120, I usually consider myself to be doing a reasonable job if it stays between 60-200. I will obviously immediately take the appropriate actions when it is out of my target range, and of course do my best to avoid letting it get there at all, but your numbers will never be perfect all the time. For example, you will most likely be a little bit high after eating, the insulin just needs a little time to work, that’s to be expected. If you have been doing a lot of heavy physical activity, you may end up a little low, just make sure you have something to eat (or even have it beforehand, if it makes you a little high the activity may bring it down).
Has your doctor put you on an insulin pump and/or CGM? The insulin pump is great for giving you freedom during the day (especially when your schedule frequently changes or is unknown), and the CGM is great for helping you figure out when you are high, low, how different foods affect your BG (especially at night or at events where it is hard to do a BG), what your carb ratio(s) should be, and many other things.
This is definitely a big change in your life, and there are certain things that are different for everyone, such as symptoms of hypos and hypers. For me, hypo symptoms usually include getting sweaty, blurred vision, and/or an urge to rub my stomach. Hyper symptoms are mostly a frequent need to urinate (I’ll admit, I’ve actually had rare occasions where I didn’t wake up at night and ended up having wet my pants in the morning). Some parts may take a while to learn, especially since they are things you are trying to avoid (how do you learn your hypo & hyper symptoms when you’re trying to avoid them?). But don’t be too hard on yourself, don’t be afraid or ashamed to admit when your numbers are high or low, just keep tweaking everything over time, and before long, taking care of everything will feel as simple as brushing your teeth!

1 Like

This is not generally true for blood sugar checks.

Is is true when comparing a CGMS sensor glucose level, which is not directly measuring Blood.

The BG you get from your finger is going to be similar to what your brain and feet are getting.

Generally it is most helpful to test BG before meal, or 2-3 hours after meal.


BTW, as a general ed question, what is a preferred level for a1c?

I’m on MDI right now. So would changing Lantus dosing times help with elevated morning sugars. Right now I take it before bed (9:30 pm or so). How does splitting doses work? Why does it work? What is the best timing of doses? (sorry, I have a lot of questions, as I’m new)

I’m still wracking my brain to figure out why the results are so low (again, my doc is freaking out because it’s too low). According to the app I use (MySugar), they estimated my a1c at around 5.8% which looks about right) I do know that the week before I went in, my insulin needs dramatically decreased. I went from needing 48 units Lantus, to needing 12. Insulin ratio went down too. I was at 1:10 but then it was more like 1:60. I also worked out quite a bit (8 days or more in a row over 1 hr each).

My own hypothesis of why this result happened, is more than likely due to issues with crohn’s and losing blood via gi system. Yet that is kind of weird too, because I can usually see it when I’m bleeding, but I didn’t during this period. My liver has also been acting up a lot more during this time. (yeah, I also have auto-immune liver disease). I don’t know how the liver would affect this. Again, just grasping at straws.

Thank you all for helping me with this. I’m still trying to understand so much of this. But I’m guessing the diabetes is much like my crohn’s flares…I never know what/why can cause many of my flares, and defies explanation. Still doesn’t stop me from trying to figure it out though :wink:

Oh, I get it now, just looked at an article and I’m on Dapsone and it looks like this can artificially lower a1c. My PC might not know about this either, as it’s not a commonly used med.

That does make sense, but have you been on Dapsone for a while or did you recently start it? The diabetics who can maintain non-diabetic A1C’s usually fall between 4.9 and 5.5 so if your A1C is actually 4.9 you would either have to be having severe and frequent lows or perfect BG’s.

Are you on a CGM or just finger sticks? For the app to really get an accurate A1C estimate you would need to be checking your BG all throughout the day and night, catching all of the highs and lows in addition to the in range BG’s. Basically that’s about 15 tests a day. That is why a CGM is so helpful in really seeing what your control is like even if you only wear one for a few weeks.

With low doses of Lantus splitting the dose doesn’t work as well as if you are on a higher dose. In order to find the best time to take your Lantus you need to find out when it peaks for you (12 hrs., 14, 16?) everyone is different. You would need to coincide the peak in your Lantus with when your dawn phenomenon starts or thereabouts.

Yes, diabetes is like any other autoimmune condition with flares, head scratching, why are my BG’s doing that, etc., but if you can eliminate some of the variables it becomes much easier to live with.

1 Like

4.2% is a very low A1C, even for non-diabetics. I’d double check that. Note that there are conditions that can influence your A1C as well, and artificially raise or lower it.

My doctor switched me to a split dose because the Levemir wasn’t lasting 24 hours. I think it might have been like 20 hours. So the few hours without it in my system my blood sugar would spike up to 400. I remember reading before you will have a peak time where it is working the most. I think that was wher I would drop to my lowest like 20. My doctor just had me do half every 12 hours. I am not sure how long your insulin lasts though. Please make sure to talk to your doctor and try random testing to see if something is fluctuating without you knowing it.