Meter Readings / A1c Mismatch

[Alexandra100]

There is a mismatch between my meter readings and my A1c. During the winter I was eating pretty low carb c.20g daily but I had lots of health problems and sometimes had to take meds that can raise bg, so an A1c of 37 (down from a previous 41) seemed reasonable. I was confident that given better health I would improve on that. Over the next months I began taking Metformin and gradually worked up to 2g daily of Glucophage XR (recommended by Dr Bernstein as more effective than the generic Metformin) by the beginning of May. I was also even stricter about carbs. During the whole month of May there were only 2 days when my fasting bg was over 5, and those readings were only 5.2 and 5.3.

At the start of June I was devastated to find that my latest A1c had gone up to 38. Even allowing that A1c tests are not very accurate, that was at least no better than my previous A1c of 37. ( I would have expected at worst 34 = average 5.8). 38 = average 6.4. I am not troubled by the dawn phenomenon and it is very rare for me to see a meter reading at any time as high as 6. I try to avoid going as high as 5.6. So why this discrepancy? I am hoping soon to start testing with a Libre for a while, and maybe this will show something quite unexpected. Is something happening in the middle of the night, or a rise during the day that I am not catching, even though, because I suffer from gastroparesis (delayed stomach emptying) I often test repeatedly after meals, not just at 2 hours?

Any thoughts would be welcome.

 

[Bluetit1802]

I have just posted this on another thread, but will repeat it here.

This is how unreliable HbA1c tests can be, particularly someone with Hb variants and other forms of Red blood cell peculiarities. (and very few of us know if we have these anomalies)

My results in mid June.

My own data with rigorous testing 6 to 8 times a day converted to HbA1c measurements = 33
MySugr estimate = 32.5
Libre HbA1c estimate = 32
A1cNow (Home HbA1c test) = 33
Actual HbA1c = 43.

An HbA1c of 43 is equivalent to an average of 7.1mmol/l

Hand on heart, I have only seen the odd level of 7, maybe 2 or 3 times at an hour after main meal, and then very briefly before it falls. I live most of the day and all of the night in the 4s and 5s. Post meal 5s and 6s.
Queried with GP who believes my data, is concerned, and has contacted the biochemist at the lab my practice uses. The biochemist is arranging for my blood to be sent to another lab at Salford Royal Hospital that uses a different measuring system that can eliminate some of the peculiarities in Hb.

 

[Rachox]

What a shame, you’ve put in all the effort then not got the result you were expecting. Having said that anything in the 30s is brilliant. Bluetit just beat me too it, her post popped up as I type, but I was going to say, is your haemoglobin count normal?

 

[EllieM]

You could ask for a fructosamine test if you're one of those for whom the hba1c is inaccurate? (It gives you an average of blood sugars over the last 2=3 weeks.)

 

[Bluetit1802]

You could ask for a fructosamine test if you're one of those for whom the hba1c is inaccurate? (It gives you an average of blood sugars over the last 2=3 weeks.)

My GP had never heard of a Fructosomine test! Anyway, they seem to be more for people with certain types of anaemia that experience lower than expected HbA1c levels rather than higher ones. Or at least that is what I have understood from readings, but I could be wrong.

EDited to add - also for those that have recently changed medications to see what effect it has had.

 

[Alexandra100]

is your haemoglobin count normal?

It was very slightly above normal.
"Mean cell haemoglobin level 32.4 pg [27.0 - 32.0] Above high reference limit".

My neutrophylls are as often slightly below normal, but I can't find anywhere that this affects A1c.
"Total white blood count 3.96 10*9/L [4.0 - 11.0] Below low reference limit"

 

[Bluetit1802]

It was very slightly above normal.
"Mean cell haemoglobin level 32.4 pg [27.0 - 32.0] Above high reference limit".

My neutrophylls are as often slightly below normal, but I can't find anywhere that this affects A1c.
"Total white blood count 3.96 10*9/L [4.0 - 11.0] Below low reference limit"

It isn't just the Hb total amounts, it is what is inside the Hb that matters. One of the markers is the haemotocrit levels, but there are many other bits inside the red blood cells that matter. This is why none of us know what ours are like, not without specialist testing. A lot of it is genetic. It is all too scientific for my brain. The lab my blood is going to be sent to uses Affinity Chromatograpgy as opposed to the high performance Liquid Chromatography that is used at the normal lab.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769887/