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

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?

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

helensaramay said:

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.

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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)

KK123 said:

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

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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.

Jim Lahey said:

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.

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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 said:

Your link doesn't work outside the US.

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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