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Can hba1c be too low?
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<blockquote data-quote="NoCrbs4Me" data-source="post: 706390" data-attributes="member: 113206"><p><span style="font-size: 15px">Having just had an HbA1c test myself that was not reflective of my daily self monitoring numbers, I did some investigating. </span></p><p><span style="font-size: 15px">My last result was 42 mmol/mol. According to the converter tool (</span><a href="http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html" target="_blank"><span style="font-size: 15px">http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html</span></a><span style="font-size: 15px">) that's an average of 7 mmol/L. However, I've only had 2 postmeal levels above 7 in the last three months. Based on my meter readings my average should be around 5.5 mmol/L, which should result in an HbA1c of 5.1 mmol/mol. </span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">One thing we all like to do on this forum is post our numbers without consideration of the accuracy of them, with a few acceptions.</span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">So, with respect to how well HbA1c reflects blood glucose levels I found this (<a href="http://labtestsonline.org/understanding/analytes/a1c/tab/faq/" target="_blank">http://labtestsonline.org/understanding/analytes/a1c/tab/faq/</a>):</span></p><p><span style="font-size: 15px"></span></p><p></p><p><span style="font-size: 15px"><strong>"4. Why are my A1c and blood glucose different?</strong></span></p><p><span style="font-size: 15px">Beyond the difference in units used to report them, the A1c represents an average over time while your <a href="http://labtestsonline.org/understanding/analytes/glucose" target="_blank">blood glucose</a>reflects what is happening in your body now. Your blood glucose will capture the changes in your blood sugar that occur on a daily basis, the highs and the lows. Each blood glucose is a snapshot and each is different. The A1c is an indication that "in general" your glucose has been elevated over the last few months or "in general" it has been normal. It is inherently not a <a href="http://labtestsonline.org/glossary/sensitivity" target="_blank">sensitive</a> as a blood glucose. However, if your day-to-day glucose control is stable (good or bad), then both the A1c and blood glucose should reflect this. It is important to remember the time lag associated with the A1c. Good glucose control for the past 2-3 weeks will not significantly affect the A1c result for several more weeks.</span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">In addition to this, it is also important to remember that glycated hemoglobin and blood glucose are two different but related things. For unknown reasons, some peoples' A1c may not accurately reflect their average blood glucose."</span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">I looked for graphs of HbA1c versus average blood glucose and all I found was this (<a href="http://care.diabetesjournals.org/content/25/2/275.long" target="_blank">http://care.diabetesjournals.org/content/25/2/275.long</a>):</span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">[ATTACH=full]9552[/ATTACH] </span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">So the conversion from HbA1c to average blood glucose levels should be taken with a grain of salt...or sugar. </span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">I also found this discussion: "<strong>Why hemoglobin A1c is not a reliable marker": </strong><a href="http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker" target="_blank">http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker</a></span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">And of course the HbA1c only reflects an average number and does not tell you how much time you've spent at elevated levels. </span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">In addition, the accuracy of the HbA1c test is +/- 6%. </span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">One thing I've learned on this forum and researching type 2 diabetes is that we are all different. Almost all of these studies are based on large numbers of people, which means that it's not always applicable to look at our own numbers and predict what it means for us. So just because your HbA1c is a certain number, that doesn't necessarily translate into the average glucose level as someone else with the same HbA1c number.</span></p><p><span style="font-size: 15px"></span></p><p><span style="font-size: 15px">So, to address your original question, I think the lower your blood glucose (fasting, postmeal, and HbA1c) is the better, with a few caveats: 1) you're not going hypo, 2) it's through diet and exercise, but not a crazy diet or a crazy exercise regime, 3) it's not with meds.</span></p></blockquote><p></p>
[QUOTE="NoCrbs4Me, post: 706390, member: 113206"] [SIZE=4]Having just had an HbA1c test myself that was not reflective of my daily self monitoring numbers, I did some investigating. My last result was 42 mmol/mol. According to the converter tool ([/SIZE][URL='http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html'][SIZE=4]http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html[/SIZE][/URL][SIZE=4]) that's an average of 7 mmol/L. However, I've only had 2 postmeal levels above 7 in the last three months. Based on my meter readings my average should be around 5.5 mmol/L, which should result in an HbA1c of 5.1 mmol/mol. One thing we all like to do on this forum is post our numbers without consideration of the accuracy of them, with a few acceptions. So, with respect to how well HbA1c reflects blood glucose levels I found this ([url]http://labtestsonline.org/understanding/analytes/a1c/tab/faq/[/url]): [/SIZE] [SIZE=4][B]"4. Why are my A1c and blood glucose different?[/B] Beyond the difference in units used to report them, the A1c represents an average over time while your [URL='http://labtestsonline.org/understanding/analytes/glucose']blood glucose[/URL]reflects what is happening in your body now. Your blood glucose will capture the changes in your blood sugar that occur on a daily basis, the highs and the lows. Each blood glucose is a snapshot and each is different. The A1c is an indication that "in general" your glucose has been elevated over the last few months or "in general" it has been normal. It is inherently not a [URL='http://labtestsonline.org/glossary/sensitivity']sensitive[/URL] as a blood glucose. However, if your day-to-day glucose control is stable (good or bad), then both the A1c and blood glucose should reflect this. It is important to remember the time lag associated with the A1c. Good glucose control for the past 2-3 weeks will not significantly affect the A1c result for several more weeks. In addition to this, it is also important to remember that glycated hemoglobin and blood glucose are two different but related things. For unknown reasons, some peoples' A1c may not accurately reflect their average blood glucose." I looked for graphs of HbA1c versus average blood glucose and all I found was this ([url]http://care.diabetesjournals.org/content/25/2/275.long[/url]): [ATTACH=full]9552[/ATTACH] So the conversion from HbA1c to average blood glucose levels should be taken with a grain of salt...or sugar. I also found this discussion: "[B]Why hemoglobin A1c is not a reliable marker": [/B][url]http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker[/url] And of course the HbA1c only reflects an average number and does not tell you how much time you've spent at elevated levels. In addition, the accuracy of the HbA1c test is +/- 6%. One thing I've learned on this forum and researching type 2 diabetes is that we are all different. Almost all of these studies are based on large numbers of people, which means that it's not always applicable to look at our own numbers and predict what it means for us. So just because your HbA1c is a certain number, that doesn't necessarily translate into the average glucose level as someone else with the same HbA1c number. So, to address your original question, I think the lower your blood glucose (fasting, postmeal, and HbA1c) is the better, with a few caveats: 1) you're not going hypo, 2) it's through diet and exercise, but not a crazy diet or a crazy exercise regime, 3) it's not with meds.[/SIZE] [SIZE=4][/SIZE] [/QUOTE]
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