Is HBA1C accurate enough...

[jingyd36]

Sorry to post again, it's been a while but I am not actually diagnosed diabetic.

I had a HBA1C in September was 38. Gp then repeated it December 2015 and was 40. GP told me I was fine. I then had a HBA1C April 2016 and it was 35. I felt relieved it had come down.

I had been diagnosed with an underactive thyroid and slightly raised cortisol last year. I am on 75mg of thyroxine. My TSH was down to 1.7 and Ft4 near 20, Ft3 5. All good but then recent test showed the TSH had increased to 3.5 and FT4 dipped to 17. GP refused to increase my medication as it was still in range despite it showing my thyroid was struggling. I have chronic fatigue and sometimes energy crashes that land me in bed for days, which over the last 18 months has changed my life considerably. I have ended up with anxiety and I rarely go out as a result of the chronic fatigue and anxiety. I have been so isolated due to how tired i am and other than my husband and children i have no other family or support.

My GP did bloods again in November last year and my random glucose was 8.9 This was 30 minutes after a fruit bar, one of the Nakd bars. My HBA1C was 35. GP wasn't concerned. Then in January this year he rung me to discuss my thyroid and then told me he had been thinking and he thought my chronic fatigue and crashes were due to my glucose and he thought I was diabetic. Which was a shock as he wasn'r concerned after the last results.

I had to repeat my HBA1C in March and it was 34. My GP said he was happy with that but again a few weeks ago he rang saying he wants it tested again along with a random glucose. I explained to him I have anxiety and have trouble going out, plus now I've developed a huge needle phobia. It's all so worrying.

My friend was diagnosed with gestational diabetes a few days ago after a glucose of 8.9 after the GTT. I have since been concerned was my random glucose of 8.9, despite it being 30 minutes after eating a sugary fruit bar, enough tot diagnose.

I am tired daily, sometimes weak legged and have energy crashes. My cortisol is raised and I have the thyroid issue. I have a very clean diet. I am 5ft tall and 8 stone 10lbs. I am only 37. No diabetes in the family. My GP has even said I shouldn't be at risk considering how clean I eat and how slim I am but I guess the thyroid and raised cortisol put me at a greater risk. I also take the drug Mirtazapine which I am currently weaning off. I had been on it 4 years almost.

He says my HBA1C is good but i am now worried is that safe enough to assume I am not diabetic? My friend said it was more the fasting test they use to diagnose so I am concerned. I suffer anxiety and even struggle having the GP to my house due to the anxiety and fatigue issues wearing me out. It's all taken it's toll the last 19 months. I probably sound a complete idiot and loonie. lol! I suffered a trauma in 2012, I was attacked by my brother and family cut me off as I refused to forgive him, I since had anxiety and on and off agoraphobia but then when my faitgue and health issues began 19 months ago it all came flooding back hard and I have suffered worse anxiety and as a result of the thyroid it led to depression. No fun. I keep smiling though, I have 3 children that keep me going and they are so understanding that mum has her tired days and has to rest.

Sorry this got long. I hope it's ok I posted.

Julie

 

[NoCrbs4Me]

Yes, it's possible the HbA1c test is unreliable for some people for various reasons. You can ask your doctor to run a fructosamine test instead. Also, it might be a good idea to avoid sugary/carby foods, even supposedly healthy packaged foods, like Naked bars.

 

[fletchweb]

Yes, it's possible the HbA1c test is unreliable for some people for various reasons. .

I was just reading last week how there is a variance between ethnicity and A1Cs - it wasn't a huge variance but some ethnicities have higher A1cs than others totally normal but could lead to mis-diagnosis. It was one of those not all tests are equal kind of stories ....

 

[Bluetit1802]

Hi Julie, and welcome,

I'm so sorry you are having such a rough time.

I'm afraid I know nothing about thyroid issues.

Your random blood glucose test of 8.9 was good half an hour after a fruit bar, and your HbA1c's are all excellent. GPs never diagnose diabetes on the strength of a random test. Fasting tests followed by an HbA1c is the norm, although even fasting tests are flying out of the window nowadays. My surgery never does them.

The HbA1c can be unreliable in certain circumstances, mainly if your haemoglobin red blood cells aren't quite "average". This can happen if you are anaemic, or if you are one of those that happens to have red blood cells with a different life span than average. Red blood cells live on average for about 120 days before being replaced by new ones, and this is the basis for the HbA1c calculation. If you happen to have RBC that die off and get replaced with new ones in a shorter time, your HbA1c can be lower than expected. Similarly, if your RBC live a lot longer than 120 days before being replaced, your HbA1c can be elevated. Without special tests you have no idea how long your RBC live.

http://www.diabetes.co.uk/forum/thr...due-to-red-blood-cell-age-variability.110793/

If you are so concerned about this, all you can do is ask for an oral glucose tolerance test (OGTT). This is a fasting test whereby after a fast you have a finger prick test to discover your fasting blood glucose at that time. You are then given a glucose drink and told to sit down for an hour. After an hour they test you again. You then have to sit for another hour at which point you are tested again. This is to determine your reaction to glucose. Anything over 11mmol/l at the 2 hour mark indicates possible diabetes.

http://www.diabetes.co.uk/oral-glucose-tolerance-test.html

You could also ask for a Fructosamine test, but will be lucky to get one. They are expensive and very few labs in the UK process them, so your blood has to be sent away to one of these labs for testing.

 

[Bluetit1802]

Whilst on the subject of inaccurate HbA1c tests, if anyone has given blood within 12 weeks (men) and 16 weeks (women) of the HbA1c test, the results may not be accurate. Donated blood (the red blood cell bit) takes that long to be completely replaced, so for that period your blood stream is short of red blood cells.

 

[Resurgam]

In my teens and 20s I often felt totally drained of energy in mid afternoon, and recently, whilst reducing my blood glucose I had similar episodes.
I suspect it was when I was between normal and diabetes levels. When I was younger I began eating low carb foods and felt a lot better - though I was pushed into 'normal' eating so many times, and always felt unwell and very miserable.
Although there has always been such a negative attitude towards doing Atkins, following that way of eating has always been the best way for me.
If your blood glucose levels are rising and falling the average could be good, but the times when you are out of the normal range will make you feel unwell.

 

[Deleted Account]

Hb1AC is an average over the last three months.
Someone without diabetes is unlikely to experience much fluctuation in BG as the body self-regulates to maintain a BG of around 5.5mmol/l. I am not sure what this is equivalent to in terms of Hb1AC.
Someone with diabetes manages the fluctuation without their body's help. For example, with type 1, I manage my BG my attempting to match my insulin needs with what I eat, how stressed I am and how much exercise I do. Sometimes I do well and all my BG readings for a day are between 4 and 7 mmol/l. But often I go lower (after exercise, yesterday, I experienced a 2.2mmol/l hypo) and go higher (the thunder storm woke me in the middle of the night with a BG of 10.5mmol/l). The average of a good day and yesterday are likely to be very similar.
So a HbA1C is an excellent tool for providing a single figure indication of BG control but it does not tell the whole story.

 

[Avocado Sevenfold]

Hi @jingyd36 Would you consider asking your GP for a referral to a community psychiatric nurse? A CPN can visit you at home to discuss treatment options for your anxieties. I don't know about thyroid issues, but believe that prolonged anxiety which causes elevated cortisol levels can raise your risk of developing diabetes. You might never become a person with diabetes, but you deserve a better quality of life x

 

[DavidGrahamJones]

Sorry to post again, it's been a while but I am not actually diagnosed diabetic.

I had a HBA1C in September was 38. Gp then repeated it December 2015 and was 40. GP told me I was fine. I then had a HBA1C April 2016 and it was 35. I felt relieved it had come down.

I have chronic fatigue and sometimes energy crashes that land me in bed for days, which over the last 18 months has changed my life considerably. I have ended up with anxiety and I rarely go out as a result of the chronic fatigue and anxiety.

My HBA1C was 35. GP wasn't concerned.

I had to repeat my HBA1C in March and it was 34. My GP said he was happy with that but again a few weeks ago he rang saying he wants it tested again along with a random glucose.

I also take the drug Mirtazapine which I am currently weaning off. I had been on it 4 years almost.

He says my HBA1C is good but i am now worried is that safe enough to assume I am not diabetic? My friend said it was more the fasting test they use to diagnose so I am concerned. I suffer anxiety and even struggle having the GP to my house due to the anxiety and fatigue issues wearing me out. It's all taken it's toll the last 19 months. I probably sound a complete idiot and loonie. lol! I suffered a trauma in 2012, I was attacked by my brother and family cut me off as I refused to forgive him, I since had anxiety and on and off agoraphobia but then when my fatigue and health issues began 19 months ago it all came flooding back hard and I have suffered worse anxiety and as a result of the thyroid it led to depression.

Hi Julie,

there's a lot going on and not nice either, so I've highlighted the BG bits. The HbA1c is considered to be the gold standard test and although there are plenty of things that can affect the results and they have been known to be inaccurate, your results are consistently GOOD. There are other tests to diagnose diabetes but you really should listen to medical advice and try not to worry about what anybody else says, your GP should be very familiar with your medical records, nobody else will.

The anxiety thing is understandable and I had a similar experience because of the diarrhea caused by Metformin, I never wanted to be further than six foot from a bathroom. Friends of my wife and I thought I'd died. I've recently had long discussions with not only my brother but a close friend, both on similar meds for anxiety and/or depression and trying to wean themselves off the drugs and have come to the conclusion that sometimes the best option might be to stay on the meds. I'm not giving advice, I'm just saying that in my friend's case especially, delaying coming off her meds has made a profound difference to her wellbeing for the time being.

The fatigue thing is obviously worrying and something I have only experienced when my BG goes low, below 5, technically not called a hypo, but lower than normal. I see in your profile there's a reference to worryguts and you have identified a problem or maybe the problem. For that I can only suggest things like meditation, self hypnosis, yoga, tai chi, there's lots of thing that can help without further meds.

As for families, where does one start. My sister wouldn't talk to me because I left the country for 4 days when my mother was ill. Despite the fact that I not only asked my 2 brothers, father and her should I go, but could I go, and they ALL said yes, go for it. Her loss, not mine.

BTW, you're not a loonie, trust me, when I was 18 (1970) I did voluntary work at Broadmoor.

Best Regards

 

[JohnEGreen]

BTW, you're not a loonie, trust me, when I was 18 (1970) I did voluntary work at Broadmoor.

And they let you out? WoW.
Sorry couldn't resist it, mind you I used for a while to instruct inmates at Dartmoor Prison on wiring and soldering, that was a bit nerve racking at 19 I must admit.

 

[dogsmummy]

Hi jingyd, I was so relieved to read your post as you could be me! You explained pretty much how I feel, I even take mitazepene! I don't have the agoraphobic feelings you mention but I do feel a lot of the time that I just want to remain at home rather than be bothered to go out, but I do make myself do it to break the circle i.e. If u give in to it it gets worse. I have managed my type 2 for 5 years now by diet but yesterday I had to have metformin as my stats were up, I don't want it as it causes the runs!! I believe my diabetes was brought on by my underactive thyroid for which I take levothyroxine, thyroid causes anxiety aswell, and I have got ptsd caused by being treated for 3 1/2 years for angina, I didn't have angina as it turned out but the damage was done by then, the trauma of two angiograms and numerous ambulance call outs for "funny turns", I believe these episodes were caused by the angina drugs not being compatible with levothyroxine, once it was discovered I did not have angina and the meds discontinued, the "funny turns" stopped, hence this is why I am taking a low dose of mirtazapine. At least I know I am not the only one! As for the hbA1c being accurate I can only accept what I am told, initially I did the glucose drink test but it came back with the readings back to front so I have the hbA1c test every 6 months, I find weight impossible to lose due to the thyroid aswell, but at least I know someone else feels the same as me!!

 

[DavidGrahamJones]

And they let you out? WoW.

Like it. I remember that us volunteers were only helping to keep the patients socialised. They were the short stay patients. I played a lot of chess, cards etc I also remember that it was emphasised that they were patients, it was not to be called a prison.

 

[KenBachelor]

Hi Julie
A friend of mine who was part of the team who created the HBA1c test told me that it was only accurate to about +-10%, so on that basis it doesn't seem that you've got much to worry about.

 

[Bluetit1802]

Hi
A friend of mine who was part of the team who created the HBA1c test told me that it was only accurate to about +-10%, so on that basis it doesn't seem that you've got much to worry about.

I have read +-4% somewhere, but either way, there is an error tolerance.

 

[jingyd36]

Hb1AC is an average over the last three months.
Someone without diabetes is unlikely to experience much fluctuation in BG as the body self-regulates to maintain a BG of around 5.5mmol/l. I am not sure what this is equivalent to in terms of Hb1AC.
Someone with diabetes manages the fluctuation without their body's help. For example, with type 1, I manage my BG my attempting to match my insulin needs with what I eat, how stressed I am and how much exercise I do. Sometimes I do well and all my BG readings for a day are between 4 and 7 mmol/l. But often I go lower (after exercise, yesterday, I experienced a 2.2mmol/l hypo) and go higher (the thunder storm woke me in the middle of the night with a BG of 10.5mmol/l). The average of a good day and yesterday are likely to be very similar.
So a HbA1C is an excellent tool for providing a single figure indication of BG control but it does not tell the whole story.

Thank you for your reply. Very helpful.

 

[jingyd36]

Hi @jingyd36 Would you consider asking your GP for a referral to a community psychiatric nurse? A CPN can visit you at home to discuss treatment options for your anxieties. I don't know about thyroid issues, but believe that prolonged anxiety which causes elevated cortisol levels can raise your risk of developing diabetes. You might never become a person with diabetes, but you deserve a better quality of life x

Hello

No I don't feel i need a CPN to be honest..i have anxiety and agoraphobia but it's purely driven by the fatigue I've experienced making me housebound for so long. It led to anxiety and of course depression, which also are symptoms of an underactive thyroid. Mentally I am pretty sane lol I just have social anxiety and agoraphobia. I get out on my good days easily and feel fine so it is led by the ill health I've experienced for too long.

I had therapy private for 18 months after I was attacked which helped a lot. The nhs were beyond useless and told me I had to wait 18 months for therapy and they refused to cone to my house to assess me initially despite me being attacked and afraid to leave my home. I went to therapy at someone's house and did some via video call and paid private. I'd never want to even try to use the nhs again. All my go did was put me on anti depressants which made things worse as I gained over 2 stone and it's made me feel insecure about how I look and feel about myself.

The raised cortisol I guess is due to the depression. I don't feel high anxiety every day, it's rare I do and I only panic in social situations like a gp visiting me or anything family related. Also if your thyroid is out of range your cortisol raises. So I've a lot going on causing it.

 

[jingyd36]

Hi Julie,

there's a lot going on and not nice either, so I've highlighted the BG bits. The HbA1c is considered to be the gold standard test and although there are plenty of things that can affect the results and they have been known to be inaccurate, your results are consistently GOOD. There are other tests to diagnose diabetes but you really should listen to medical advice and try not to worry about what anybody else says, your GP should be very familiar with your medical records, nobody else will.

The anxiety thing is understandable and I had a similar experience because of the diarrhea caused by Metformin, I never wanted to be further than six foot from a bathroom. Friends of my wife and I thought I'd died. I've recently had long discussions with not only my brother but a close friend, both on similar meds for anxiety and/or depression and trying to wean themselves off the drugs and have come to the conclusion that sometimes the best option might be to stay on the meds. I'm not giving advice, I'm just saying that in my friend's case especially, delaying coming off her meds has made a profound difference to her wellbeing for the time being.

The fatigue thing is obviously worrying and something I have only experienced when my BG goes low, below 5, technically not called a hypo, but lower than normal. I see in your profile there's a reference to worryguts and you have identified a problem or maybe the problem. For that I can only suggest things like meditation, self hypnosis, yoga, tai chi, there's lots of thing that can help without further meds.

As for families, where does one start. My sister wouldn't talk to me because I left the country for 4 days when my mother was ill. Despite the fact that I not only asked my 2 brothers, father and her should I go, but could I go, and they ALL said yes, go for it. Her loss, not mine.

BTW, you're not a loonie, trust me, when I was 18 (1970) I did voluntary work at Broadmoor.

Best Regards

Thank you David

Veey reassuring reply. Thank you for taking the time to reply to my post.

I am pretty sane haha. Yes I have depression since developing an underactive thyroid which is a common symptom.. I also developed anxiety and agoraphobia due to being so unwell with the fatigue and crashes. Being stuck at home isolated it took it's toll I think.

I get out on my good energy dsys and it's not too difficult either so I know the agoraphobia isn't it in its true form, it's health related. I had agoraphobia after I was attacked and that was proper agoraphobia but I overcame it. This is all.due to my health and the lack of confidence I have since feeling so unwell. I don't feel safe going out alone.

My gp visits my house and I even feel an idiot I find that hard. I've developed social anxiety quite bad sinxe being ill in the kast 18 months. It's been hard as I've had no support other than hubby so visitors became rare when I was ill and with that I've become so anxious socialising..doctors making me anxious about my health too have made me even more anxious seeing them lol!

Families are difficult. It is your sisters loss and an awful reason to cut you out. I had to cut our my 2 sisters, brother and my mother because I was being attacked physically and later verbally. I had to walk away. They say they've changed and noe want me back but i refuse. My health and my children's safety comes first. They witnessed too much because of my brothers random violent outbursts that I can't ever risk going back to that. I'm resented now because of my decision but I shrug and think we'll that's their choice, they've not been in my shoes and they weren't attacked so they can't possibly understand. I then straighten my crown and walk on like a boss Haha!!!

Thanks again
Julie

 

[jingyd36]

Hi jingyd, I was so relieved to read your post as you could be me! You explained pretty much how I feel, I even take mitazepene! I don't have the agoraphobic feelings you mention but I do feel a lot of the time that I just want to remain at home rather than be bothered to go out, but I do make myself do it to break the circle i.e. If u give in to it it gets worse. I have managed my type 2 for 5 years now by diet but yesterday I had to have metformin as my stats were up, I don't want it as it causes the runs!! I believe my diabetes was brought on by my underactive thyroid for which I take levothyroxine, thyroid causes anxiety aswell, and I have got ptsd caused by being treated for 3 1/2 years for angina, I didn't have angina as it turned out but the damage was done by then, the trauma of two angiograms and numerous ambulance call outs for "funny turns", I believe these episodes were caused by the angina drugs not being compatible with levothyroxine, once it was discovered I did not have angina and the meds discontinued, the "funny turns" stopped, hence this is why I am taking a low dose of mirtazapine. At least I know I am not the only one! As for the hbA1c being accurate I can only accept what I am told, initially I did the glucose drink test but it came back with the readings back to front so I have the hbA1c test every 6 months, I find weight impossible to lose due to the thyroid aswell, but at least I know someone else feels the same as me!!

Oh no you poor thing. I can't believe they misdiagnosed you like that.

I'm weaning off Mirtazapine now but I've been on it a few years.

It's helped me knowing I'm not alone.

Thank you

 

[DavidGrahamJones]

Thanks again
Julie

I wish you well.

 

[koukSundo1188]

Sorry to post again, it's been a while but I am not actually diagnosed diabetic.

I had a HBA1C in September was 38. Gp then repeated it December 2015 and was 40. GP told me I was fine. I then had a HBA1C April 2016 and it was 35. I felt relieved it had come down.

I had been diagnosed with an underactive thyroid and slightly raised cortisol last year. I am on 75mg of thyroxine. My TSH was down to 1.7 and Ft4 near 20, Ft3 5. All good but then recent test showed the TSH had increased to 3.5 and FT4 dipped to 17. GP refused to increase my medication as it was still in range despite it showing my thyroid was struggling. I have chronic fatigue and sometimes energy crashes that land me in bed for days, which over the last 18 months has changed my life considerably. I have ended up with anxiety and I rarely go out as a result of the chronic fatigue and anxiety. I have been so isolated due to how tired i am and other than my husband and children i have no other family or support.

My GP did bloods again in November last year and my random glucose was 8.9 This was 30 minutes after a fruit bar, one of the Nakd bars. My HBA1C was 35. GP wasn't concerned. Then in January this year he rung me to discuss my thyroid and then told me he had been thinking and he thought my chronic fatigue and crashes were due to my glucose and he thought I was diabetic. Which was a shock as he wasn'r concerned after the last results.

I had to repeat my HBA1C in March and it was 34. My GP said he was happy with that but again a few weeks ago he rang saying he wants it tested again along with a random glucose. I explained to him I have anxiety and have trouble going out, plus now I've developed a huge needle phobia. It's all so worrying.

My friend was diagnosed with gestational diabetes a few days ago after a glucose of 8.9 after the GTT. I have since been concerned was my random glucose of 8.9, despite it being 30 minutes after eating a sugary fruit bar, enough tot diagnose.

I am tired daily, sometimes weak legged and have energy crashes. My cortisol is raised and I have the thyroid issue. I have a very clean diet. I am 5ft tall and 8 stone 10lbs. I am only 37. No diabetes in the family. My GP has even said I shouldn't be at risk considering how clean I eat and how slim I am but I guess the thyroid and raised cortisol put me at a greater risk. I also take the drug Mirtazapine which I am currently weaning off. I had been on it 4 years almost.

He says my HBA1C is good but i am now worried is that safe enough to assume I am not diabetic? My friend said it was more the fasting test they use to diagnose so I am concerned. I suffer anxiety and even struggle having the GP to my house due to the anxiety and fatigue issues wearing me out. It's all taken it's toll the last 19 months. I probably sound a complete idiot and loonie. lol! I suffered a trauma in 2012, I was attacked by my brother and family cut me off as I refused to forgive him, I since had anxiety and on and off agoraphobia but then when my faitgue and health issues began 19 months ago it all came flooding back hard and I have suffered worse anxiety and as a result of the thyroid it led to depression. No fun. I keep smiling though, I have 3 children that keep me going and they are so understanding that mum has her tired days and has to rest.

Sorry this got long. I hope it's ok I posted.

Julie

Hi Julie,

I read the posts and responses under this heading.

My sister and I inherited a fragile nervous system from our mother.

In my late twenties, when i did a home renovation in my parents' backyard, i handled a jackhammer to break up the concrete patio and soon later had anxiety issues with a couple of weeks of intermittent bed rest.

My sis, bro and i grew up on the tennis court

(think RED CLAY COURTS and lots of exercise in fresh nature

My sister became a medicine woman and our mom died in 2012.

My sis and i handled each others personal issues and those related to our deceased mom differently. She used the orthodox methods and i used the alternative methods.

So, later in life when i had another episode of anxiety attacks and couldn't leave my home i could heal myself by remembering the exercise connection and by lying on my back, relaxing my shoulders against the floor, and turning the body so it essentially got twisted like when you wring a towel or putting the legs up steeply against a wall and resting them there in various positions including crossing the ankle over the other knee and gently pulling the bent knee to observe a stretching of the butt muscles.
You can also do variations of that standing up.

Our body has an amazing capacity to heal itself in areas that are outside of fundamental unease, meaning that if something fundamental is of issue then yes, let the doctors tweak direction. Example would be fundamental hormonal imbalances right from puberty or getting a second opinion during menopause.

But if you have been living this far and perhaps lately been going through menopause (slight hormonal misbalance) then the mix of psycho-somatic to reset your systems daily can be adjusted with non-medical means, such as

1.) Increasing Exercise (join a yoga/zumba/Chigong/meditation class or do those at home via YouTube and perhaps try other recommendations that i may have),

2.) Increased Water intake (Think and act >> Drinking and Eating << NOT Eating and Drinking),

3.) Increasing Before_10 pm_sleep

4.) Raising awareness that Me-Time can be shared with your husband when he gives you a back massage just before you fall asleep. It all takes a little training him and soon he learns that it's relaxing for him too,

5.) And perhaps ease up on anger re your bro's mis-directed energy event when you consider that he has been a patient in that respect and that the situational energy at that time was unfortunately misaligned.

Many people learn that medications are meant to be only temporary until their bodies learn from experience that behavioural changes speak louder than medicine induced changes. My sister learned before she became a doc that prozac throws your body off into other unexpected areas that require new techniques to readjust. My mom learned that if you have your medicine cabinets and all drawers in your bathroom full of medications then there is a raised risk of ending up getting the wrong advice and the wrong medications.

Back to your anxiety, my former yoga teacher keeps telling people that her anxiety issues got fixed after doing yoga. I second that and learned that other benefits show up miraculously with continued practice. Until you've given home practiced yoga (supplemented with formal instruction) a thorough try, you can't form an opinion of its usefulness in your case. When you practice yoga do remain in touch with your body at all times to prevent over stretching until your body adapts and allows the extra stretch. Men with ego issues learn that type of advice the hard way
Sure, show me a man with no ego issues. I dare say that ur bro can be fixed daily if he practices yoga at least weekly.

I can only lead you to the water, ...

Sent from my SM-T713 using Diabetes.co.uk Forum mobile app