So has anyone else experienced this?

Type 1 and LADA
1

Hey guys it’s been a while since I posted here, I’m still alive lol

But anyway, I went to the endo today and found out my a1c is 4.9%. Both my doctor and I were concerned about this. He believes there’s two reasons this could be happening if it’s just not a normal thing for me .

  1. I could be too low and notice it (aka hypo unawareness) BUT I am just really unsure. I test enough and seem aware when I DO have hypos where I don’t know how they could fly under the radar. I did for a short time have issues with it but not anymore to my knowledge?

  2. Something could be up with my hemoglobin levels and it could throw the machine off. He told me this could be harmless or it could be not harmless, googling leads me to a lot of things which indeed it could be harmless some people naturally have lower hemoglobin levels, but also it could be something like anemia , which with some googling I learned that can indeed be something that throws off an a1c test result…or it could be something worse.

I do have a plan of action…

If it’s 1? We’re gonna put me on a 24 hour cgm, if that shows anything funky I will likely try to get a dexcom. I hate the idea of using a dexcom but I don’t need lows flying under the radar now that I’m going to be a CNA and try to be a nurse one day. I don’t wanna have issues. I still don’t know how this is possible though when most of my blood sugars fall between 80 and 160 (I loosened up my control considerably a while back when my a1c dropped to 5.3%) …but somethin’ aint right and idk if it’s me, my meter, or what the heck? That’s where a CGM would be a good idea.

If it’s 2…treatment will have to be decided based on the diagnosis . If it’s anemia I know a plan for that (TMI alert: I have heavy periods…that’s gonna get reduced or stopped with birth control, pretty sure that’d be the issue though , I eat really well) .

If it’s neither of these then I must be some anomaly? Low A1C without low blood sugar? Am I the chosen one?

Has anyone experienced this though?

2

I’ve experienced both. Am on both dexcom and iron pills. Fixing that time of month wasn’t enough, to the point that my dr was suggesting transfusions. It wasn’t diet, because I was worked with a nutritionist to check on that too. Thankfully, the iron seems to help. Iron combined with vitamin c in 1 pill seems to work well.
During that time, I was always surprised how much lower my a1c was. There’s also an alternative test to the a1c that might be more accurate for you right now. Blanking on the name of it though. (Maybe someone else will remember.)

3

I have a lot of bg meters, two different brands, test strips of different batches, and I occasionally compare them. Wash and dry my hands, use drop from same finger on all the meters.

I found one that reads low by 50 almost every time. It was one of my newer ones. I think this is partly responsible for many “false hypos” I had, where I would really be at 80, use the meter that said 30, eat something, come up to what I thought was 110 but was really 160. Or the meter read 140 (which I would not necessarily correct) when I was really 190 (which I would usually correct with an insulin dose.) As a result of this, I think my A1C ticked up in the last 3 months.

If you had a meter that read high by a bit every time, your A1C could tick lower as a result.

All that said… A1C measurements from different labs can’t be compared easily anyway. Each lab may have a different “reference range”. A given might have changed its equipment or measurement. I think if the lab hadn’t changed anything an A1C moving from 5.3% to 4.9% may be significant. But if the lab had changed anything, then maybe it’s not so easy to compare 5.3% with 4.9% and say the difference means anything.

4

To me, hypoglycemia is not a number, but a set of symptoms. Everyone’s “number” will be different. You’re only hypoglycemia unaware if you’re having he symptoms of hypoglycemia without realizing them… Not just drifting below some magic number occasionally without realizing it.

If I was working hard towards a tight a1c, had tight control, wasn’t having significant hypos, and was overall happy with my control-- I would decline any further investigation. (I have had an a1c of 4.9— my doctor applauded it)

What good does it do to document that on occasion you do, perhaps, drift into the 60s? If you’re tightly controlled without hypoglycemic episodes (emphasis on the word ‘episode’) then you deserve a congratulations. If you are not in tight control, but have an a1c of 4.9, I understand there would be concern.

2 Likes
5

Hypoglycemia unawareness is when you’re regularly dropping to dangerously low numbers (like 40s, 30s, 20s) and have no indication that your blood sugar is so low. I don’t know any doctor who would call occasional mild or moderate lows with no symptoms hypoglycemia unawareness.

2 Likes
6

I think that unfortunately there are some out there who would… But I agree with your definition entirely

7

My last A1c was 4.7 and at that time my 31 day BG average was 141mg/dL. My typical A1c for the past 10 years has been between 5.7 and 6.0…I have no idea why it was so low and my doctor just looked at my pump and CGM data and just blew if off…

8

I wish you well whatever you find, and I think no matter that outcome you will find a CGM to be a source of useful information in managing lows and (almost more importantly, really) the trends that are headed that way.

1 Like
9

Thanks for having one of the more helpful answers here as someone that has experienced something similar (not to like be mean to anyone else here but I don’t want a debate over hypo unawareness when I always understood it as not feeling ANY hypos not just severe ones) .

I hope if this is the case something that worked for you will work for me.

10

For the most part, my meter matches the lab work I’ve seen and basically anything more official and I’ve used control solution on it at least 3 times, changed the batteries, everything. I don’t think it’s my meter. It’s either the A1C test machine , something with my blood count, or I’m just weird I honestly don’t think it’s my meter. It’s matched other meters I’ve used as well.

11

I’m in tight control and my hypos are 60 mg/dL at the lowest usually (rarely do I dip into the upper 50’s like I tend to have a weird 56 or 57 out of nowhere hypo once in a blue moon maybe once every year at most) , but I don’t like this A1C because every medical professional around me DOES NOT like it and that makes me uncomfortable. When hospitalized I ran a low a1c and they were pumping me with sugar over it thinking I was missing lows and I keep running low anyway to make them believe I was also missing lows at home??? They fear I’m going to get used to lows that I’m not feeling and will risk problems if I do ever start having severe lows because a lot of people say that you get used to lows if you have them a lot and don’t feel them, which i thought was hypo unawareness? My doctor’s concerned I’m running 50’s and 60’s at some time and not knowing it and he just wants to rule it out…

12

Ok - what’s the story behind “sensorium139”? Sounds like a chemical element or our IQ. A1c 4.9 is world class if it is accurate. Would be interesting to check your A1C from another lab to see since there is some normal variance in results. Are you on an ultra low carb diet? do you have symptoms if your below 60?

13

Your description is not unlike my own. If my doctor was pushing a cgm I would decline, bc frankly it’s just not that pressing for me to know if I ever drift into the 60 or high 50s for me— I’m never having crashing lows that are difficult to manage— why spend time, money, and frustration to possibly prove that your blood sugar drifts low from time to time… Of course it does. If it’s not affecting ones life or causing problems, why pursue it? That’s my philosophy anyway.

14

It is known that “Any condition that shortens erythrocyte survival or decreases mean erythrocyte age (e.g., recovery from acute blood loss, hemolytic anemia) will falsely lower HbA1c test results regardless of the assay method used.” A case study example of this was an 84 year old man with anemia who had an A1c of 3.8% but was found to have a blood sugar of 313 mg/dl.

I also suspect that anything causing the opposite such as polycythemia vera may cause a false high reading in your HbA1c. I have polycythemia vera and this has been a concern.

We need to be very careful about placing too much faith in a simplistic HbA1c number, particularly if we know that we suffer any sort of blood abnormalities.

1 Like
15

@Sensorium139 although this study was conducted on folk w/o diabetes, I believe the findings are significant in that, if you are anemic, the findings indicated that “Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c.”

I hope this is helpful to you.

Effect of Iron Deficiency Anemia on the Levels of Hemoglobin A1c in Nondiabetic Patients
Coban E.a · Ozdogan M.a · Timuragaoglu A.b
aDepartment of Internal Medicine, and bDivision of Hematology, Akdeniz University, Faculty of Medicine, Antalya, Turkey
email Corresponding Author

Abstract
FullText
PDF
References
S. Karger AG
Go to Top

Abstract
Recommend this FullText PDF
Abstract
The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates positively with glycemic control. Previous studies suggest that iron deficiency anemia (IDA) affects the levels of HbA1c. The aim of this study was to determine the effect of IDA on HbA1c levels in nondiabetic patients. The population studied consisted of 50 patients (30 women, 20 men, mean age 35.7 ± 11.9 years) with IDA and 50 healthy subjects that were matched for age and sex. Patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), hemoglobinopathies, hemolytic anemia, chronic alcohol ingestion and chronic renal failure were excluded from the study. Hematologic investigations, fasting and postprandial glucose and HbA1c levels were measured in all subjects before iron therapy. All patients with IDA were treated with iron 100 mg/day for 3 months. We repeated the laboratory investigation after iron therapy. Before iron treatment, the mean HbA1c (7.4 ± 0.8%) level in patients with IDA was higher than in a healthy group (5.9% ± 0.5) (p < 0.001). In patients with IDA, HbA1c decreased significantly after iron treatment from a mean of 7.4% ± 0.8 to 6.2% ± 0.6 (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c.

© 2004 S. Karger AG, Basel

16

@Sensorium139 I hope these abstracts are helpful to you in terms of evidence-based education. If you would like me to send the article. Just inbox me.
@Sensorium139 I hope this isn’t overkill. I’ve included this articles if they will be of use from an evidence-based perspective.

Best,

Jo
The effect of iron deficiency anaemia on thelevels of haemoglobin subtypes: possibleconsequences for clinical diagnosisI. EL-AGOUZA,A. ABU SHAHLA*,M. SIRDAHZoology Department, Faculty of Science, Cairo University, EgyptBiology Department, Faculty of Science, Al Azhar University, Gaza, PalestineSummary The purpose of the present study was to quantify the effect of iron deficiency anaemia onthe levels of HbA2, HbF, and HbA1C. Complete blood counts (CBC) were performed on 730university students. Serum ferritin, HbA2, HbF, and HbA1C levels were determined for allmicrocytic/hypochromic subjects. It was found that 81 (11.1%) of the students weremicrocytic/hypochromic, of which 47 (58.1%) were found to be iron deficient. Twenty-six(32.1%) were b -thalassemia carriers, 4 (4.9%) were b-thalassemia carriers with iron defi-ciency and 4 (4.9%) remained undiagnosed. All the anaemic students were treated withoral iron and followed for 20 weeks. The mean HbA2 level rose significantly (from1.89% ± 0.45 to 2.19% ± 0.53, P < 0.001) after iron treatment. HbF levels were notsignificantly different after iron treatment (0.94% ± 0.18 before and 0.95% ± 0.17 aftertreatment, P > 0.05). HbA1C fell significantly after iron treatment, from a mean of6.15% ± 0.62 to 5.25% ± 0.45 (P < 0.001). In conclusion, iron deficiency must be cor-rected before making any diagnostic or therapeutic decisions based on HbA2 and HbA1Clevels.

Jour~al of lnturial Medicine 1990: . GRAM-HANSEN, J. EKIKSEN, 1’. MOURITS-ANDEKSEN I,. OLESEN From the llepartrnetit’ lriternnl Medicine H. Sectiori of Herncitologg, Anlliorg Hospitcil. Acrlborg. Ilerirriork Abstract. Gram-Hansen P, Eriksen J, Mouritis-Andersen T, Olesen L (Department of Internal Medicine B. Section of Hematology. Aalborg Hospital, Aalborg. Ilenmark).

Glycosylated haemoglobin (HbA,J in iron and vitamin I31 2 deficiency. lourrial of Internal Medcine 1990: 227: 133-136. Glycosylated haemoglobin (HbA,) was measured in 10 patients with iron deficiency anaemia, 10 patients with vitamin B12 deficiency anaemia and 10 healthy controls. Initially there were no significant differences between the groups but after treatment with iron and vitamin B12 for 3 and 6 weeks, the glycosylated haemoglobin concentration decreased significantly (P < 0.01). It was concluded that glycosylated haemoglobin is a sensitive marker of the changes in the erythrocyte population that are observed when predominantly immature erythrocytes are being produced.

Hope this is helpful.

Jo

17

I haven’t, but I’ve read of a third cause that you might want to mention to your doctor.

Anything that makes the lifetime of your red blood cells shorter than usual, without interfering with your body’s ability to recycle the contents of the dead red blood cells.

18

roodgirl - I think you’re referring to a fructosamine test, or Glycated Serum Protein test. While the HbA1c test is a test of the percentage of red blood cells that have glycosylated, the GSP test is a test of the level of fructosamine in the blood. While haemoglobin of the sub-type A1c “reflects” the level of glucose in the blood for the preceding 90 days or so (red blood cells are constantly being replaced, but last about 90 days), fructosamine - which is based on serum proteins that only last 2 to 3 weeks - is “reflective” of glucose levels in the blood for the preceding 2 to 3 weeks.

It’s important to remember that neither of these tests is actually a test of “average” BG… the “average” BG, or EAG, that docs/labs provide are inferred values based on large population studies… but each individual in a population has their own unique biochemistry, and results may “vary” from the averages used. Just sayin’…

19

Your 4.9 A1c could simply an error on the labs. Just a few months ago the endo told my son his A1c was 5.7, that would have been great but it is totally out of line for him, his A1c is usually around 6.4, so I asked for the A1c to be tested again. Low and behold only 10 minutes after the 5.7 result the new A1c was 6.2. Moral of the story, lab equipment can have errors too.