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Are A1c tests ever wrong?

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#1
lewisjl

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I have been hypo for years and really have not monitored my BG until the last couple of years. Over the last 6-8 months, I've noticed my fasting numbers creeping up a little...they run from 115-125. I have had a couple of occasions in the last month where I was feeling really funny (not exactly like my hypo symptoms) and I tested 200 & 210, but then other times I test at 80.

I was in the ER last week for a migraine & my blood tests came back with BG of 130 (4 hrs after eating). I finally fessed up to my doctor about what had been going on and he, of course, ran my first A1c. I REALLY expected it to come back high, but it came back as a shocking 5.7. Because my levels are apparently fluctuating from the 80-200 range, would it be expected that my A1c will be "average" or are these tests sometimes wrong?

Thanks - Janet

#2
jps

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First off, A1c's can be off. Labs can mess up, analyzers can mess up. Odds are rather low but there is always a chance.

As you stated, an A1c is an average. If you are 160 half the time and 70 the other half of the time, your A1c will look very good. But that doesn't mean there isn't something going on.

Remember, stress and illness can increase your blood glucose.

But you say you were in the 200 and 210's, that's not a good sign obviously. You need to keep a close eye on all of this because it appears something is going on. Are you eating high carb meals, then maybe come crashing down?

Care to share with us what you are doing in terms of diet, exercise, meds, lifestyle?

You must feel awful with these fluctuations...
"That which doesn't kill us makes us stronger" - Friedrich Nietzsche

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#3
lewisjl

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I have to be honest and say that I have not eating properly at all. The day I felt really bad & tested 200, I had eaten a fairly decent breakfast - I think it was 2 eggs, 1 toast and 1 bacon. It was around noon when it happened, hours after I had eaten.
Exercise - just a busy mom of 2 preschoolers. I try to walk some, but I have back trouble & every time I try to start walking, I get down in my back.
Meds - none.
Lifestyle - not sure what you mean....I never slow down.
Yes, I am not feeling well.

#4
RobertIA

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I have been hypo for years and really have not monitored my BG until the last couple of years. Over the last 6-8 months, I've noticed my fasting numbers creeping up a little...they run from 115-125. I have had a couple of occasions in the last month where I was feeling really funny (not exactly like my hypo symptoms) and I tested 200 & 210, but then other times I test at 80.

Janet,

I have to ask. You were diagnosed as having hypoglycemia? And how long ago? I ask because of things you should have been told at that time. I have a daughter that was diagnosed at age 22 and was told that as she grew older she could develop diabetes. She was told then that because of the stress on her pancreas then, she could become diabetic sooner rather than later and that she was given a very good education in carbohydrates and the glycemic index and instructed to be tested yearly for diabetes after the age of 30. This is the reason for my questions.

I was in the ER last week for a migraine & my blood tests came back with BG of 130 (4 hrs after eating). I finally fessed up to my doctor about what had been going on and he, of course, ran my first A1c. I REALLY expected it to come back high, but it came back as a shocking 5.7. Because my levels are apparently fluctuating from the 80-200 range, would it be expected that my A1c will be "average" or are these tests sometimes wrong?

Thanks - Janet

Labs can vary in their results and you should be given the results of the test to have the ranges used by the lab. Labs can and do make mistakes, but very seldom. I have seen mistakes more when proper sanitation and sample control is not followed by the lab.

Bob
DX 10/03, T2, Lantus & Novalog
Natural beauty is always the best, in nature and in women
Web site: http://bobsdiabetes.blogspot.com/
Web site: http://diabetestopics.blogspot.com/

#5
lewisjl

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Bob - thanks for your reply. I was diagnosed hypo about 17 years ago (I am 43 now). I followed a diabetic diet for about a year and was told about the possibility of developing diabetes later in life, but there wasn't instruction/info given about my pancreas. I was never told to get tested starting at age 30....oh, you may need to know my grandfather and aunt were diabetic (same side of the family).

I did get a copy of my lab results and the normal range they showed was 4.0-6.0 and mine was 5.7.

Since I am having these discussions, I know I need to follow a diabetic diet, but I really don't know where to begin.

#6
Moonglo

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I have a few more questions for you too:)

First, when you say you're not feeling well, what's wrong? Do you feel like you're getting sick? I've got a sinus problem right now, and it has raised my fbg from 130 to 160. And, according to others here, it is normal for illness to raise bg, even when you don't know you're sick yet; people say high bg is often the first sign they are about to be sick.

Also, has anyone given you a glucose tolerance test lately? I only ask because if having one piece of toast sent you over 200 and you had normal bg levels before you ate, to me that is a big red flag that you may need to look into this further. A1c's can be controlled with proper diet, exercise, and keeping stress in check. Having a normal a1c does not mean that a little metformin might not help you to keep your bg from going high, causing you to crash later, and posssibly be what's triggering those migraines.

I'm not trying to scare you, but it sounds to me like maybe more testing would be beneficial.

Oh, and welcome! :)



Getting back on the wagon... been a long trip through denialville!

Started metformin back on 9/3/10; gained back 5 pounds (but about to change that!)

Stats before my deviation:
Metformin 2000 mg
7/24/09 a1c=9.3
10/23/09 a1c=6.4:o
Diagnosed 7/22/09
Weight loss as of 10/23/09: 25 pounds! :D

#7
lewisjl

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Thanks for the welcome!

You asked what I mean by not feeling well. I don't mean sick with a cold or anything like that. I mean similar to my normal hypo symptoms, but a little different....like normally I would be shaky (hypo), but this time I was jittery. For some, this might be the same, but for me it is "different." Inability to concentrate/focus....stuff like that. The two times that has happened, I took my BG & it was high. Strange, because I'm used to it being low, but I knew that I felt funny.

I have never thought about having a glucose tolerance again. The last one I had was when I was pregnant with my last child - 4 years ago.

#8
RobertIA

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Bob - thanks for your reply. I was diagnosed hypo about 17 years ago (I am 43 now). I followed a diabetic diet for about a year and was told about the possibility of developing diabetes later in life, but there wasn't instruction/info given about my pancreas. I was never told to get tested starting at age 30....oh, you may need to know my grandfather and aunt were diabetic (same side of the family).

Janet, It would appear from what you have said that the doctors did not consider your hypoglycemia severe. My daughters was and she had to test at least 4 times a day to be sure she was eating enough carbs. Her doctor also told her that her condition was severe enough that she needed to go to the emergency room anytime she felt it was necessary when she was below a reading of 45. They were worried that she could go into a coma. They gave her a medical alert necklace to wear. And she has had no children. You have obviously been tested while pregnant with the children.

I did get a copy of my lab results and the normal range they showed was 4.0-6.0 and mine was 5.7.

Since I am having these discussions, I know I need to follow a diabetic diet, but I really don't know where to begin.

There is no diabetic diet as such. Many agree that it is a lifestyle change. Some dietitians suggest the South Beach diet (skip part I) and apply parts II and III. Others suggest a low glycemic menu which spreads out the absorption of glucose thus making the insulin usage more efficient and not creating the high spikes in BG. If this interests you, you may want to purchase or check the local library for the following book: The New Glucose Revolution, New York, Marlowe & Company, 349 pages, Third Edition, by Dr Jenny Brand, et al. This gives an excellent explanation of the glycemic index and glycemic load for healthy eating for people with diabetes and those just wanting to lose weight and be capable of keeping it off.

My daughter uses this book and had taught me a lot about the glycemic index when I was first diagnosed.

Others have wisely suggested the OGTT and have the doctor determine whether you are a person with diabetes. With diabetes in your family, I urge you to have this done. It is possible that if you are in the early stages, that with proper nutrition and exercise, you may (emphasis on may) be able to control your diabetes without meds.

Good luck and keep a positive attitude.

Bob
DX 10/03, T2, Lantus & Novalog
Natural beauty is always the best, in nature and in women
Web site: http://bobsdiabetes.blogspot.com/
Web site: http://diabetestopics.blogspot.com/

#9
lewisjl

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I guess I thought the A1c was a much better test than the glucose tolerance. That is why I was confused when my A1c came back ok. You have convinced me that I need to talk to my doctor about it in more detail. Thank you very much for the other resources....I will look at my library for that book.

#10
Moonglo

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Don't let the doctor tell you that you are fine just because your a1c came back normal. If you find out that you are diabetic now, while your a1c is normal, it will be a lot easier to manage than if you don't get treatment for a few more years. I don't mean to sound pushy, but some of us have had experiences with doctors that don't like to listen to what we tell them, they just look at the numbers on paper instead. With diabetes, this can be a very scary thing... please don't let it happen to you.

Good luck, and keep us posted! :)



Getting back on the wagon... been a long trip through denialville!

Started metformin back on 9/3/10; gained back 5 pounds (but about to change that!)

Stats before my deviation:
Metformin 2000 mg
7/24/09 a1c=9.3
10/23/09 a1c=6.4:o
Diagnosed 7/22/09
Weight loss as of 10/23/09: 25 pounds! :D

#11
RobertIA

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Janet,

Moonglo makes good sense. With diabetes in your family it is wise to discuss everything with the doctor. If he dismisses the fact that you were diagnosed as hypoglycemic, then you will have to wonder what his/her advice/diagnosis is worth. Hopefully you have enough history with this doctor that he will weigh all the information before he issues a diagnosis. You may also wish to request the c-peptide test to the other tests as this is also used for diagnosis.

If you are able, I suggest that you test as much as possible even before the appointment. Test as soon as possible upon waking for fasting BG, at least two hours after your first bite of a meal - all meals, pre-meals - noon and evening, and just before bed. Also keep a log of what you ate to give you guidance for the meter readings as this will add value to the information you give the doctor. This testing will tell you what foods you need to cut back on or eliminate because they caused a spike in your BG readings. Be diligent in your testing and log of foods - please.

Continue to ask questions.

Bob
DX 10/03, T2, Lantus & Novalog
Natural beauty is always the best, in nature and in women
Web site: http://bobsdiabetes.blogspot.com/
Web site: http://diabetestopics.blogspot.com/

#12
lewisjl

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When my doctor and I talked about the A1c test, I was reluctant because of being "branded" diabetic (because of insurance). He convinced me to take the A1c test, telling me that he could better treat me if he knew for sure I was diabetic. So....I agreed to take the test. He also said that I should already be lowering/monitoring my carb intake if I knew I was having problems (which is a true statement that no patient wants to hear). I told him my readings had been all over the map and he IS aware of my hypoglycemia diagnosis.

From what y'all are saying, I need to be more forceful and make ANOTHER appt. with him to discuss this further. Gag...I hate glucose tolerance tests. I'll call him tomorrow.

#13
jps

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They are giving you solid advice. Nobody wants to hear it, but the sooner you pinpoint where you are, the sooner you can modify your lifestyle (diet, exercise, and/or medicine) and get a firm grip over this thing.

If this is caught early on, you have a very good chance of controlling it. Let it go too long and it's an uphill battle.
"That which doesn't kill us makes us stronger" - Friedrich Nietzsche

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