Results: Attack of the Inaccurate.... LAB?!


#1

Well, I perhaps owe the Ascensia Contour meter an apology. It was actually closer to the lab (remember all tests, including via lab were done through fingerstick, nothing through venous draw) than the Accu-Chek. I mean, technically either of them would be accurate enough, but the Ascensia was closest. So why are my a1c’s freaking crazy? Aha. Well, that’s easy to see now.

Since moving here I’ve had my quarterly blood draw done at my primary care doc’s office (where they also test thyroid and stuff) and the a1c always comes back at least 1/2 percent higher than it should be. I then get depressed and angry and have to take that result to my diabetes doc, who tells me that since last time it was 7.2 and now it’s 7.4 (that was in June), I should maybe attend classes on how to manage my blood sugar better. AGH! (Meanwhile, my meter is telling me that my 90+ day averages should correspond to much better numbers.)

Flash forward to my persistent bitching that got my diabetes doc to retest my a1c and do that weird meter-to-lab all day testing thing.

So, my last a1c was 7.0% at my primary care and… only a couple weeks later… 6.5% at my diabetes doc!!!

This brought up an interesting discussion with him. He said there is a “big problem” here in Germany with lab assays being far, far, far from standardized. His lab uses a normal range that goes up to 6.1% (higher than is typical in American…I’ve already discovered that your a1c will nearly always be lower in America, btw… more about that in the next blog entry) and my primary care doc’s lab might be using one that says 6.5% is normal! WTF?! He now believes me that I really AM doing a good job (my latest a1c indicates an average of 135, which would have given me around a 6.3% at my old lab in America) and he is going to call my primary care to find out what ranges her lab is using. If her lab is using a weird assay that is giving higher numbers, that would hose her. You see, she must report all the numbers to the insurance company/gov’t for the disease management program and 7.0 is 7.0 to them, no matter what lab you’re using. If her lab’s “normal” range is the same as his lab’s, though, then someone must be f-ing up and not calibrating equipment or something and she needs to know that.

So I’m NOT crazy. And best of all…the doctors actually KNOW that I’m not crazy! Talk about a sigh of relief. He actually told me that 6.5% is what he considers perfect for a type 1 and that going any lower usually results in too many hypos, so he’d be happy if I just stayed where I am. He would never expect or want anything lower. (I often had a1c’s below 6.5% in America, but, again, the tests are not even the same between the two countries. Yet.)

So, GUESS WHOSE LAB I’LL BE GETTING TESTED AT FROM NOW ON! Sure as all hell not my primary care doc’s!!!

So, since moving to Germany, my corrected a1c’s:

AUGUST 2006
Crazy primary care lab: 7.1%
Good German lab: 6.6%
American lab: 6.3-6.5%

NOV 2006
Crazy primary care lab: 6.9%
Good German lab: 6.5%
American lab: 6.2-6.4%

FEB 2007
Crazy primary care lab: 7.2%
Good German lab: 6.7%
American lab: 6.4-6.6%

JUN 2007
Crazy primary care lab: 7.4%
Good German lab: 6.8%
American lab: 6.5-6.7%

AUG 2007
Crazy primary care lab: 7.0%
Good German lab 6.5%
American lab 6.2-6.4%




#2

I remember when I was 15, my doctor’s office changed labs. We all got a small talk on how our a1c numbers would be different because the new lab used a different scale.

It just goes to show that pretty much nothing diabetes related is accurate.