I've had next to no hyperglycemia but a HbA1c of 10. Huh?

[Belzedar]

I've been correcting insanely high triglycerides levels by concentrating on low-carb (daily average 22g net carbs) and low-cal (daily target 900kcal) for the past six weeks. The strategy worked and halved those levels. And it had the unsurprising dividend of causing the lowest glucose levels and the lowest insulin requirements I've had in the seven years since diagnosis. I've lost 6kgs, my eyesight's sharpened, my memory's sharpened and insulin sensitivity's improved. All good, right? Not only have I had almost no hyperglycemia - 26 incidents and only 10 of them have been over 14. Three-quarters of my readings have been in the target range. (By the way, to clarify that, those readings are for the past three months and not just the six weeks I've been low-carbing).

Yet I've just received the results of a blood test taken two days ago, a text message saying my HbA1c is 10. 10! My own records, which include a formula for calculating estimated Average Glucose, based on four daily glucose level tests, that I've found to be reliable to within 0.01% of the HbA1c reported by blood tests, returns 6.7. How could their be such a wild discrepancy?

My GP's surgery is closed today and I've a quarterly clinical review next Wednesday, an unpleasant event where my doctor is driven to prove everything she knows is right and everything I know is wrong, and I'd like to be able to defend myself from her accusations of reckless disregard even though she's only met me three times and has yet to understand that managing this diabetes so I can resume my life is my only priority. She has yet to show any interest in my records - glucose levels, insulin dosage, food diary, exercise habits, sleep patterns, etc.

So, does anyone have experience of this? A very high HbA1c when there is no supporting evidence for it? Is it just a lab mistake? Or something else?

 

[Marwanoz]

see there would be error in the report and if youre not satisfied with the test report. i would like to suggest you do the test from trusted labs and you will get to know the exact HbA1c. after receiving you can compare with your own calculation and the previos report. i hope this report result will not correct. have a good day buddy

 

[EllieM]

So, does anyone have experience of this? A very high HbA1c when there is no supporting evidence for it? Is it just a lab mistake? Or something else?

It could be a lab mistake, it could be that you're running very high at night, or it could be that you have one of many blood conditions that lead to falsely elevated hba1c results.
https://www.goodrx.com/blog/could-your-hba1c-diabetes-test-be-wrong/

Note that one of the potential causes is high triglycerides...

You could try asking for a fructosamine test.

Bring in a food and blood sugar diary and be prepared to argue your case.

Good luck

 

[DCUKMod]

@Belzedar, depending on when those 4 tests a day were done, you may or may not be seeing any high levels you are experiencing.

My A1cs, although lower than your, are always higher than my finger prick testing would suggest they would be. I have accepted that now, and view my finger prick tests as a snapshot of time, from before I eat, to 2 hours after I start eating, and the A1c as being what it is, the percentage of glycated red blood cells.

You could ask for a retest, of the original sample, which depending upon your lab, they may still have, or have a new sample taken immediately and run the test again.

The immediately is becaue every day that passes introduces additional variables to the result.

 

[Member496333]

It should also be said that some people have abnormalities in their blood cells that skew HbA1c and do not necessarily reflect a true measure of blood glucose history in relation to the general populace. More likely though, as already stated, is that you’re not testing during the periods where your glucose concentration may be highest? Your profile also suggests that you use exogenous insulin, which I would imagine raises an increased possibility of many highs (and lows) which your measuring regimen may not be detecting.

 

[KK123]

Hi there, what were your A1c readings before this one (not your own formula) but your last Drs one?

 

[Deleted Account]

A few thoughts
- the Hb1AC is an average over 3 months and you say you have changed your lifestyle in the last 6 weeks. So the previous 6 week will have an impact on your Hb1AC
- I am not sure how you are taking your BG measurement. If it is via finger pricks, this will only give you the BG at the time of the finger prick and not indicate what was happening between finger pricks ... which may have been higher readings
- If you were taking your BG measurements via a CGM or Libre, these are far from accurate and your reall BG may have been higher than the sensor reported
... or, as others have suggested, there may be some inaccuracy in your Hb1AC.

Whatever the reason, 6 weeks is early days. Keep at your low carb diet and hopefully you should see significant improvements in your next Hb1AC.

 

[kokhongw]

You may also want to consider getting a Freestyle Libre to give a good 14 days view of your glucose fluctuation.

 

[Belzedar]

Thanks, everybody.

For those wondering about when and how I do testing, I follow the same instructions as you all - testing before and/or after meals - and before hitting the bed.

And no, I have no condition that might cause a false HbA1c result. Quarterly tests over the past seven years have been nothing like this one.

I think it’s an Occam’s Razor thing; the lab has made a mistake or, I just realised, the text message had a typo

 

[Belzedar]

A few thoughts
- the Hb1AC is an average over 3 months and you say you have changed your lifestyle in the last 6 weeks. So the previous 6 week will have an impact on your Hb1AC
- I am not sure how you are taking your BG measurement. If it is via finger pricks, this will only give you the BG at the time of the finger prick and not indicate what was happening between finger pricks ... which may have been higher readings
- If you were taking your BG measurements via a CGM or Libre, these are far from accurate and your reall BG may have been higher than the sensor reported
... or, as others have suggested, there may be some inaccuracy in your Hb1AC.

Whatever the reason, 6 weeks is early days. Keep at your low carb diet and hopefully you should see significant improvements in your next Hb1AC.

Just to clarify, I did say the readings I mentioned the past three months not just the six weeks I’ve been low-carbing. Three months is the lifespan of the HbA1c molecule. Previous doctors have agreed a good rule of thumb is to regard 20% of readings being in the hyperglycemic range as being poorly controlled diabetes. With only two days left in my current 90-day cycle, only 7% of my readings have been in the hyperglycemic range and only a third of those higher than just crossing the line. So that’s only 10 readings over the past three months being over 14.5.Oh and, in the interests of full disclosure, only one hypo (caused by overcorrecting a hyper with insulin)

 

[Bluetit1802]

All you can do is ask for another test, and if refused consider purchasing a home A1c test kit.

I have always had this problem. My HbA1c results are several points above where my other data says they should be - and before I gave up frequent testing I was testing 7 or 8 times a day. I also use a Libre part time, and have done a home A1c test on the same day as my official one. My GP is on board with this and now my blood sample is sent first to the normal lab and then forwarded to a different one. The two labs provide significantly different results.

 

[Belzedar]

Hi there, what were your A1c readings before this one (not your own formula) but your last Drs one?

All my tests are done through my GP’s office. The last one - three months ago, for the period including Christmas and all its hazards - was 6.2.

 

[Belzedar]

It should also be said that some people have abnormalities in their blood cells that skew HbA1c and do not necessarily reflect a true measure of blood glucose history in relation to the general populace. More likely though, as already stated, is that you’re not testing during the periods where your glucose concentration may be highest? Your profile also suggests that you use exogenous insulin, which I would imagine raises an increased possibility of many highs (and lows) which your measuring regimen may not be detecting.

Interesting idea. Yes, I was first diagnosed in Wales as a Type 1 who was really bad at taking care of himself and put on insulin. I had to say six times, to four different people, that this was the first I’d heard of being a diabetic and they were breaking the news to me the worst way. Indeed, when I first went to my GP, the week before I was rushed - dying - to A&E, he didn’t waste time examining me and just showed me the door with a script for pain relief for an ulcer (which I didn’t have, then or ever). But a couple of years later, after I was in a place that wasn’t Wales, they ran further tests for antibodies and concluded I wasn’t Type 1 but I was now insulin dependent.

I must say, in my experience, it hasn’t been the rollercoaster you imply. There have not been many highs and lows. There have been highs in the morning, most likely as a result of Dawn Phenomenon and, something people really seem to have difficulty in accepting, practically no lows. In any given three-month period, I have at most four hypos. So that’s four test in 360 reporting a low.

 

[Antje77]

it could be that you have one of many blood conditions that lead to falsely elevated hba1c results.
https://www.goodrx.com/blog/could-your-hba1c-diabetes-test-be-wrong/

Note that one of the potential causes is high triglycerides...

Your link doesn't work outside the US.

 

[Member496333]

Interesting idea. Yes, I was first diagnosed in Wales as a Type 1 who was really bad at taking care of himself and put on insulin. I had to say six times, to four different people, that this was the first I’d heard of being a diabetic and they were breaking the news to me the worst way. Indeed, when I first went to my GP, the week before I was rushed - dying - to A&E, he didn’t waste time examining me and just showed me the door with a script for pain relief for an ulcer (which I didn’t have, then or ever). But a couple of years later, after I was in a place that wasn’t Wales, they ran further tests for antibodies and concluded I wasn’t Type 1 but I was now insulin dependent.

I must say, in my experience, it hasn’t been the rollercoaster you imply. There have not been many highs and lows. There have been highs in the morning, most likely as a result of Dawn Phenomenon and, something people really seem to have difficulty in accepting, practically no lows. In any given three-month period, I have at most four hypos. So that’s four test in 360 reporting a low.

I didn’t mean to imply anything. Merely a possibility.

 

[Belzedar]

Your link doesn't work outside the US.

Oh that! The Americans reacting to EU’s GDPR. I use a US proxy to get round that: us.hideproxy.me

Its purpose is to make the website accept it’s dealing with a user in the US

 

[EllieM]

Your link doesn't work outside the US.

Oh that! The Americans reacting to EU’s GDPR. I use a US proxy to get round that: us.hideproxy.me

That's interesting. I"m in New Zealand and had no ideea it was blocked in the UK.... (I was using duckduckgo as my search engine.) Here' s the important paragraph.

Here are some times the HbA1c will not be helpful:
A1c falsely elevated (HIGH)

Your test may tell you that you have diabetes, but you don’t.

• Untreated anemia from iron deficiency or vitamin B12 and folate deficiency can result in a HbA1c value that is falsely high because your red cell turnover is low. Because you have more “older” red cells instead of making new ones (due to lack of iron, or other vitamins) your HbA1c will be higher than it should be.
• Kidney failure or chronic kidney disease. If you have abnormal kidney function your HbA1c may be falsely high.
• Very high triglycerides (over 1,750) may also cause a falsely elevated HbA1c.
• Splenectomy (spleen surgically removed) will give you a falsely elevated HbA1c, due to decreased red cell turnover. This is because the spleen can’t remove the red cells from the bloodstream—which is the spleen’s normal job.

 

[Antje77]

That's interesting. I"m in New Zealand and had no ideea it was blocked in the UK....

I don't know about the UK, as I'm in the Netherlands, but the page I got redirected to said something like: "Sorry, this website is only available in the US".
Thanks for the copy-paste. Much more convenient than installing something I hardly ever need

 

[HSSS]

For context 10% hb1ac = 85mmol/mol =daily average of 13.3mmol/l
And 6.7% = 49=8.1

Do either of these daily figures look more typical?

Converter used https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

My questions would be what are your target ranges? What is a hyperglycaemic event for you? When do you test, how long after meals? Four times a day may easily miss highs. If none of these yield an explanation, as it apparently doesn’t seem to, then I’d be looking for repeat or alternative tests. Although previous tests have been as expected you’ve made significant changes this time and this is when the unexpected results hit. Coincidence?

 

[EllieM]

My questions would be what are your target ranges? What is a hyperglycaemic event for you? When do you test, how long after meals? Four times a day may easily miss highs. If none of these yield an explanation, as it apparently doesn’t seem to, then I’d be looking for repeat or alternative tests. Although previous tests have been as expected you’ve made significant changes this time and this is when the unexpected results hit. Coincidence?

All good points for @Belzedar to consider. Given the review is next Wednesday, in his position I'd probably do some extra tests, making sure they include some that are 1 or 2 hours after meals, and one in the middle of the night, just so that the doctor can't claim that the hba1c is accurate (unless these tests show it is). I'd also be asking for an additional hba1c and a fructosamine test. The latter gives an average of blood sugar over the last 2-3 weeks and hopefully shouldn't be affected by any weird pathologies going on in the OP's blood.