Type 2 Medical and Accucheck HbA1c results

[Tombo1206]

I have been using Accucheck on a daily (5x) basis to monitor my HbA1c. I know the figures are estimated but have been decreasing and for more than a week have been showing 35/36. Two hospital blood tests (which I know are snapshots) during the past three weeks have shown 53/52. I think the difference is significant and I wonder if such a difference is to be expected. I shall be grateful for any comments or observations.
Many thanks.

 

[sgm14]

Your AccuCheck knows what your blood sugar levels are for just those five times you did a finger prick and has no idea of how your blood sugars are doing for the rest of the day. It is effectively guessing without 90-99% of the the data it needs. If your blood sugars levels are relatively steady then the estimate may be accurate, but if they are not, then the estimate could be totally incorrect.

It is unlikely the hospital test is a snapshot,(unless they just used a finger prick test) and if the hospital drew blood using a needle, then they would be doing a proper HbA1c test which is not a snapshot, but shows an accurate result for the last 90 days.

To give you an example, when I was doing finger prick readings, I was in normally in range before I went to bed and when I got up in the morning. When I got my freestyle libre, I could see that there was one particular meal that was causing my blood sugar levels to starting rising four hours after eating. This meal was something I tended to eat when I was having a late dinner and hence the four hour rise started after I had gone to bed and hence after the last finger prick. The consequence was that my sugar levels where high for most of the night without me realising that. If that had of been a regular meal it would have meant that my HbA1c was much higher than the finger pricks indicated.

 

[Ronancastled]

Sounds like you could learn a lot from a CGM 2 week trial.
They have been a huge eye opener for many of us.

 

[Deleted member 543160]

I've eaten an LCHF diet for over 8 years and currently use our https://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html (or sometimes the Accu-Chek version) to convert my Contour Next meter's fasting, pre and post meal 90 day averages to my predicted HbA1c. These predictions are always about 2 points lower than my actual HbA1c results but are quite consistent in the actual trends and patterns I see. However, the information that you'll have for just your few tests won't tell you what'd been going on for the past three months.

I've also done similar comparisons when I was using a Libre sensor, and its own HbA1c predictions were very much lower than my actual HbA1cs although again trends & patterns were consistent. But I agree with @Ronancastled that wearing a CGM for a while can provide some very useful information.

 

[Member496333]

HbA1c is overrated, in my opinion. Little use having a perfect A1c if it’s comprised of a hundred hypos and a hundred hypers. And that’s quite aside from it being susceptible to inaccuracies and variances from person to person. Of far more value, cost permitting, is a CGM or even, soreness permitting, dozens of daily finger prick measurements until you understand your own patterns inside out. Time in target is where any professional diabetic is focussing their attention.

I’ll probably be accused of going off topic, but what I’m saying is that I wouldn’t obsess over HbA1c vis-à-vis home test accuracy. It’s not the gold standard of anything. It’s only a (very imperfect) diagnostic tool used by a medical profession that, let’s be honest, often only has a very rudimentary understanding of diabetes anyway.

 

[Tombo1206]

Your AccuCheck knows what your blood sugar levels are for just those five times you did a finger prick and has no idea of how your blood sugars are doing for the rest of the day. It is effectively guessing without 90-99% of the the data it needs. If your blood sugars levels are relatively steady then the estimate may be accurate, but if they are not, then the estimate could be totally incorrect.

It is unlikely the hospital test is a snapshot,(unless they just used a finger prick test) and if the hospital drew blood using a needle, then they would be doing a proper HbA1c test which is not a snapshot, but shows an accurate result for the last 90 days.

To give you an example, when I was doing finger prick readings, I was in normally in range before I went to bed and when I got up in the morning. When I got my freestyle libre, I could see that there was one particular meal that was causing my blood sugar levels to starting rising four hours after eating. This meal was something I tended to eat when I was having a late dinner and hence the four hour rise started after I had gone to bed and hence after the last finger prick. The consequence was that my sugar levels where high for most of the night without me realising that. If that had of been a regular meal it would have meant that my HbA1c was much higher than the finger pricks indicated.

Thank you for your detailed reply, appreciated.

 

[Tombo1206]

HbA1c is overrated, in my opinion. Little use having a perfect A1c if it’s comprised of a hundred hypos and a hundred hypers. And that’s quite aside from it being susceptible to inaccuracies and variances from person to person. Of far more value, cost permitting, is a CGM or even, soreness permitting, dozens of daily finger prick measurements until you understand your own patterns inside out. Time in target is where any professional diabetic is focussing their attention.

I’ll probably be accused of going off topic, but what I’m saying is that I wouldn’t obsess over HbA1c vis-à-vis home test accuracy. It’s not the gold standard of anything. It’s only a (very imperfect) diagnostic tool used by a medical profession that, let’s be honest, often only has a very rudimentary understanding of diabetes anyway.

Thank you for your pragmatic and reasoned response, appreciated.

 

[VashtiB]

Hello @Tombo1206 and welcome.

You've had some advice already but I was interested in how long you have been doing the tests 5 times a day?
The HbA1C gives the reading for about 3 months- if you have only been reducing it for a few weeks it might take a while for the HbA1C to catch up. However, I find the daily testing is the thing that keeps me kn track. There is nothing like seeing a good result and feeling like you are doing the right thing. Conversely a higher reading is sometimes the kick in the rear I ned or warning me I'm coming down with something.

So great work with the results coming down!!

I am looking at trialing a CGM to work out my bloods even better. I am really interested in those days where my fasting test is higher than it is usually. So that may be something for you to consider.

Good luck