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CollegeLady1
Total Posts: 227
Registered on: ‎02-19-2012

A1C confusion

My question is:  is it possible to have a high A1C but normal numbers on a daily basis?

 

I have a high A1C number - usually an 8 or 9 but my daily numbers are consistently under 90 in the morning (fasting), 150-160 an hour after eating, and between 90 and 110 two hours after eating.  From what I've read, this means I have fairly good control.  But the A1C says my sugars are too high.  My doctor states that the daily numbers have zero importance because they are only a "snapshot" of the sugars at that moment while the A1C states what has been going on for the last 90 days.  I thought and have been told the A1C is an average of the last 90 days.  According to him, the only number that matters is the A1C.  I disagree with that thinking since I'm testing four to seven times per day.  Now he wants me on insulin and I refuse because I know once I go on insulin, I'll never be off it.  My dr says if I don't go on insulin, I'll be dead in less than 5 years.  My uncle, also a PWD2 for nearly 50 years and insulin dependent only in the past 10 years, stated prescribing insulin makes it easier for the dr but not for me.  My uncle also said that the A1C and the daily numbers are what determines if someone needs insulin. 

 

I use three meters and check them against each other monthly.  The difference between the lowest and highest is 4-5 points, including when tested against the doctor's meter. 

 

So now I'm confused about all these numbers... and I'm ready to quit testing my blood and dealing with all the other stuff that goes along with being diabetic.  Like I told my doctor, if the A1C is the only number that matters, why am I testing at home so often?

 

 

Amy, Poster Child for Better Living thru Chemicals :smileytongue:

~ The Difficult is the work of the moment; The Impossible just takes a little longer.

San Diego, California
PWD2 diagnosed 2/2003
7/2013 A1C 6.9
Metformin 850mg 3x/day; Glyburide 5mg 2a/1p/day; Actos 30mg 1x/day for T2
Nortriptyline 50mg, Depacote 500mg for migraine
Paroxetine 20mg 1x daily for depression
Simvastatin 10mg 1x daily for cholesterol
Albuterol for asthma daily with exercise and additional as needed
Imitrex 25mg with Naproxen 275mg for migraine
Plus OTC supplements as required
alan_s
Total Posts: 14,425
Topics: 203
High Fives: 1,376
Solutions: 155
Registered on: ‎10-30-2009

Re: A1C confusion

[ Edited ]


CollegeLady1 wrote:

My question is:  is it possible to have a high A1C but normal numbers on a daily basis?


G'day and welcome to the forum.

 

Yes, it is. See: A1C: Does One Size Fit All?


I have a high A1C number - usually an 8 or 9 but my daily numbers are consistently under 90 in the morning (fasting), 150-160 an hour after eating, and between 90 and 110 two hours after eating.  From what I've read, this means I have fairly good control.  But the A1C says my sugars are too high.

 


Here is where we differ. Despite what you have read, I do not accept 150-160 at one hour as "normal numbers". And although my A1c is higher than my meter average would indicate, I would not consider anything over 7% as acceptable - for me.

 

I am not a doctor, just a diabetic. But I am also a ten-year diagnosed diabetic without complications. Read both of these to see what I consider acceptable numbers: Blood Glucose Targets and Test, Test, Test


My doctor states that the daily numbers have zero importance because they are only a "snapshot" of the sugars at that moment while the A1C states what has been going on for the last 90 days.  I thought and have been told the A1C is an average of the last 90 days.  According to him, the only number that matters is the A1C.  I disagree with that thinking since I'm testing four to seven times per day.  Now he wants me on insulin and I refuse because I know once I go on insulin, I'll never be off it.  My dr says if I don't go on insulin, I'll be dead in less than 5 years.  My uncle, also a PWD2 for nearly 50 years and insulin dependent only in the past 10 years, stated prescribing insulin makes it easier for the dr but not for me.  My uncle also said that the A1C and the daily numbers are what determines if someone needs insulin. 

 

I use three meters and check them against each other monthly.  The difference between the lowest and highest is 4-5 points, including when tested against the doctor's meter. 

 

So now I'm confused about all these numbers... and I'm ready to quit testing my blood and dealing with all the other stuff that goes along with being diabetic.  Like I told my doctor, if the A1C is the only number that matters, why am I testing at home so often?


As you can see from those links I do not agree with your doctor's "snapshot" opinion. However, I do agree that you need to act to improve your levels. I think you can probably do that with dietary modification rather than insulin: Test, Review, Adjust

 

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Rhodes, Greece)
Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: A1C confusion

There can be error in the A1C reading. One study I read suggested it could be as much as + or - 1%. So if you have a group of people and they all have the same average BG, some may test as high as 7 while others could test as low as 5, when the average A1C is 6. So in your case you may be able to subtract as much as 1 point from the numbers which would bring you down to 7 or 8. But, that is still too high in my opinion.

 

The most likely cause is that you must be missing some times when BG is a fair bit higher than you think, or it is staying higher longer than you think. It is a time weighted average of BG.

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.
alan_s
Total Posts: 14,425
Topics: 203
High Fives: 1,376
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Registered on: ‎10-30-2009

Re: A1C confusion


ronaka wrote:

 

It is a time weighted average of BG.


A1c is not an average of anything. It is an indicator related to past blood glucose levels, but it is not an average.

Cheers, Alan, Type 2, d&e metformin 2000mg, Australia.
Everything in Moderation - Except Laughter.
There is nothing I could eat I like more than my eyes.
Type 2 Diabetes - A Personal Journey (latest: It Must Be OK - It's Sugar-Free! Wrong!)
Born Under a Wandering Star (Latest: Rhodes, Greece)
Super Advisor
powerwalker2
Total Posts: 5,403
Registered on: ‎11-02-2009

Re: A1C confusion

[ Edited ]

College Lady ~ The A1c is actually a test showing how much glucose has "glycosylated", or "stuck" to the red blood cells over the last 90 or so days -- not an average, so it's hard to predict, exactly.  You may be able to have more of an effect on it with daily testing, but also with what you *do* in your way of eating and exercising to produce those numbers.  So what if your doctor is only interested in the A1c?!  Your daily numbers are for *you* to see how well what you're doing and eating is working, and what you need to do or eat to get better bg control.  So I would recommend continuing daily testing, but also looking at your overall bg managment plan.  You may need to aim for lower numbers, and may need to decrease carbs and increase exercise to get them.  Changes for the better are needed.  What is your food plan?  How much are you exercising?  One other note: many people have managed to come off insulin, as well as various meds.  So, if you can't improve your A1c, then why not ask doc for meds, if you don't want insulin?

 

http://www.merriam-webster.com/medical/hemoglobin+a1c

Nancy ~ T2 since '98 ~ 16 yrs ~ D&E 11yrs ~ treadmill, elliptical, bike 15-20 minutes 3x/day (including evening), dumbbells/resistance training, small portions heart-healthy high-fiber/low-fat fuel/carb-counting, 500mg Glucophage XR x4, 2.5mg Glucotrol XL x6, 6000IU Vit. D/day ~ RHR 53 ~ A1cs mainly between 5.9-6.9 av. 6.5
Frequent Responder
savgigi
Total Posts: 528
Registered on: ‎10-31-2009

Re: A1C confusion

Nancy has it exactly right. At any moment in time there are glucose molecules attached to red blood cells trying to get into the cells so the glucose can be taken other areas in the body for energy. Insulin is the "key" that unlocks the red blood cells so the glucose can get in. When our glucose/insulin process is broken, the glucose cannot get into the red cells and the glucose level builds up in the blood stream. The A1c has a rough correlation to what your average BG is over the last 3 months - but it is only a rough correlation, NOT an actual average.

 

When your A1c is high, it means your glucose level is staying high. The A1c gives your doctor a good picture of how your BG has been running the previous 3 months. But that does not help you on a daily basis to manage your BG. That is why we test after meals. Testing at your peak after a meal tells you how that particular meal affects your glucose so you can decide if it is a safe meal or if you need to adjust the amount of carbs so your BG will be lower next time.

 

Have your read Alan's Test, Review, Adjust plan? Following his plan is the best way you can reduce your BG and subsequently reduce your A1c. I agree with Alan that 150-160 post meal is too high, at least for me. My goal is to be at or below 120 at my peak after a meal. I hit that about 80% of the time and I rarely go to 150.

Jeanie

I want to dance at my grandchildren's weddings. I want to live well and die peacefully in my sleep at the age of 110

T2; Dx 2/2009
Initial A1c 5.7; Current A1c 5.6
Metformin 500mg twice a day
Advisor
CollegeLady1
Total Posts: 227
Registered on: ‎02-19-2012

Re: A1C confusion

Thanks for all the links and information.  I do appreciate it.  As for the insulin - guess I was misinformed since even my doctor has told me that once on it, never ever ever off it.  I also have never heard of anyone ever getting off insulin.  Other meds, yes but never insulin.  Calling the A1C an average is what my doctor calls it.  Thanks also for giving me better numbers to work with.  I had only been given the "under 110 first in the am/under 180 at 1 hr after eating/under 140 at two hours after eating".  I like the numbers y'all have better.

 

I do exercise six times per week - cardio and weights - with Saturdays being the exception.  I usually work on Saturdays and there is a lot of walking and stairs involved so I'm guessing I'm getting my exercise in!  My nutritionist and trainer, both are familiar with the campus I work at, agree with that assessment although we all agree it is a light workout.

 

I am working at getting all my numbers down.  My last report was 8.3, previous was 8.8 and the one before that was well over 9 so it is going down fairly steadily since I really started to work on it a year ago (no insurance, no job, no diabetes help for over three years).  I'm going to try to get a referral to an endocrinologist.  I'm already taking plenty of meds plus changed my diet and increased my exercise.  Beyond that, I don't know what else I can do except go day by day.  Perhaps the endo will have a better attitude and look at the larger picture: the A1C numbers have been going down, the numbers are low in the meters and the goal is not to make me hypoglycemic (which I often am in the mornings) but to have a steady decrease of the A1C while keeping my daily numbers livable to allow the body to adjust accordingly.

 

Thanks again for all the advice and links.  I really appreciate it!!!

 

Amy

Amy, Poster Child for Better Living thru Chemicals :smileytongue:

~ The Difficult is the work of the moment; The Impossible just takes a little longer.

San Diego, California
PWD2 diagnosed 2/2003
7/2013 A1C 6.9
Metformin 850mg 3x/day; Glyburide 5mg 2a/1p/day; Actos 30mg 1x/day for T2
Nortriptyline 50mg, Depacote 500mg for migraine
Paroxetine 20mg 1x daily for depression
Simvastatin 10mg 1x daily for cholesterol
Albuterol for asthma daily with exercise and additional as needed
Imitrex 25mg with Naproxen 275mg for migraine
Plus OTC supplements as required
Frequent Responder
Wulfman
Total Posts: 57
Registered on: ‎11-03-2009

Re: A1C confusion

[ Edited ]

 

Amy,

 

According to every source I've ever been able to find, the A1C is defined as an "AVERAGE".

There are some people on this forum who seem to try to redefine medical terms.  (this one in particular)

The following are some links from various reputable sources (including some of the excerpts) for your review.

I suggest cross-checking multiple sources when it pertains to your health.  In other words, try to make up your own mind and don't take for granted what people on forums tell you (even doctors can get it wrong at times).  All we can do is share our experiences or perhaps those of others.  We're definitely NOT doctors.  And, we're all different.

 

Yes, I've experienced some of the same things you're asking about.  In 2004, I had an A1C test result of 7.2 (from the very first one I'd ever had taken), but after getting my own meter and strips, I was seeing numbers around 90 - 125.  I still don't know when the numbers were going high, but that's all in the past now.

 

Den

 

 

http://www.mayoclinic.com/health/a1c-test/MY00142

Definition
By Mayo Clinic staff

The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you're managing your diabetes. The A1C test goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c.

The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control. And if you have previously diagnosed diabetes, the higher the A1C level, the higher your risk of diabetes complications.


http://labtestsonline.org/understanding/analytes/a1c/tab/test

The A1c test and eAG result give a picture of the average amount of glucose in the blood over the last few months.


http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/

The A1C test measures your average blood glucose control for the past 2 to 3 months.
It is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the blood.
Check your A1C twice year at a minimum, or more frequently when necessary.
It does not replace daily self-testing of blood glucose.


http://diabetes.webmd.com/guide/glycated-hemoglobin-test-hba1c

Hemoglobin A1c provides an average of your blood sugar control over a six to 12 week period......


http://www.medicinenet.com/hemoglobin_a1c_test/article.htm

There is a correlation between A1c levels and average blood sugar levels as follows:

While there are no guidelines to use A1c as a screening tool, it gives a physician a good idea that someone is diabetic if the value is elevated. Right now, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.


http://www.a1ctest.com/

A1c Tests Show AVERAGE BLOOD SUGAR For The Past 2-3 Months


http://ndep.nih.gov/media/KnowNumbers_Eng.pdf

The A1C is a lab test that measures your average blood glucose level over the last 2 to 3 months. It shows whether your blood glucose stayed close to your target range most of the time, or was too high or too low.


http://www.diabetes.com/blood-sugar-control-matters/a1c.html

The A1C test shows your average blood sugar level over the past two or three months.


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Super Advisor
carlking2
Total Posts: 2,719
Registered on: ‎04-08-2011

Re: A1C confusion

Amy,

It is not really necessary to understand the A1c test but since there is some robust discussion of exactly WHAT it is and how it RELATES to your estimated average blood sugar..It is ONLY a mathematical estimate of your average blood sugar.  This is the exact equation that is used to derive the estimate:

 

eAG(mg/dl)= (28.7*HbA1c)-46.7, r2=0.84

 

Wow.That taught us a lot:smileyhappy:  The ADAG study is where this formula for estimating the average glucose comes from.  It is interesting to note that this has changed over the years when a linear relationship between HbA1c and AG was first defined in the Diabetes Control and Complications Trial (DCCT) and the subsequent ADAG study.

 

Here is a flyer that ADA prepared to inform your doctor about the relationship:

 

http://professional.diabetes.org/content/PDF/vnzqcAverage%20Glucose%20flyer.pdf

 

For those who really want to know more....visit this website

 

http://www.ngsp.org/A1ceAG.asp

 

 

 

Thanks Rick

Diagnosed T2 4/4/2011
04/04/2011, A1c 11.2
06/27/2011, A1c 5.6
10/07/2011, A1c 5.7
1/14/2012, A1c 5.4
4/17/2012, A1c 5.4
7/27/2012, A1c 5.3
01/30/2013, A1c 5.2
08/26/2013, A1c 5.3
01/26/2014, A1c 5.5
07/25/2014, A1c 5.4

Lipids TC 203, LDL 110, VLDL 20, Triglycerides 100, HDL 73
Managed by diet and exercise along....former insulin and Metformin user
Advisor
ronaka
Total Posts: 950
Registered on: ‎12-24-2011

Re: A1C confusion

Amy,

 

On the insulin, I currently take it, but could easily go off it. I asked to be put on it, for the additional control it gives me. Yes, I do think the doctor is right. While the A1C is the % of glucose on the blood cells, it more or less reflects the time weighted average BG over the past 2-3 months. But, as I pointed out earlier, it is not an absolute and there can be some error.

 

For targets I like to be down to about 90 two hours after meals. That may be one of your areas for opportunity if you are frequently above 100 at that time.

 

What medications are you taking now for the diabetes? Possibly there is some opportunity for different meds before you try insulin.

Ron

Not a doctor, only another T2 diabetic with, unfortunately 11 year experience. Be cautious about accepting advice, including mine, on medical conditions from the internet. It can be a good place to get ideas, but validate them with your doctor and other medical professionals first.