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test strip results and HbA1c results

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drippihippy

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now feeling very confused; I was diagnosed T2 in January of this year, Hba1c 8.8
My recent HbA1c result was 7.2, 3 months before that I had mistakenly thought it was 5.6 however, my local surgery has told me it was the Cholestrol result that was 5.6 and not the HbA1c [which was 7.4]
I test 2/3 times daily with strips and on average I am mostly in the mid 5's 2 hours after meals, sometimes in the 6's and sometimes in the 4's after exercise [cycling twice daily] I have checked that the meters are accurate.
My strip results have been in the above ranges for the last 5/6 months yet my HbA1c is 7.2, I would have expected it to be lower given my daily blood test strip results, I don't eat sugar, junk food, rice, pasta, potatoes, cereal, and only 2 slices of Granary bread a day, maybe I'm expecting too much too soon but surely there is a correlation between strip results and the HbA1c figure?
I can't understand why the HbA1c hasn't come down, given the fact that I test several times a day and try to keep tight blood sugar control - it begs to ask the question what is the point of testing regularly and trying to keep control of my blood sugar if it has no effect?
 
Hi.

Lots of people tend to get confused over this. You are confusing HbA1c (expressed as a percentage) with blood glucose level (expressed in mmol/l). HbA1c is glycosolated haemoglobin - basically how much gliucose has attached itself to your red blood cells over their lifetime ( a red blood cell lasts for about 3 months before being broken down by your body) - hence an HbA1c gives an AVERAGE of your blood sugars over the previous 3 months and is used by doctors as a way of assessing your overall control for that 3 months.

A blood test that you do yourself gives you an INSTANTANEOUS reading of what your blood sugar actually is at that point in time and is expressed in mmol/l.

To try and give you a clearer picture the corrolation between the two (if my memory serves correctly) is that an HbA1c of 6% is approximately equivalent to an average blood sugar reading of 7.5mmol/l. 7% is 9.5mmol/l, 8% is 11.5mmol/l and so on.

There is some debate about the usefullness of testing home blood sugars in type 2 diabetes. It is very unlikely that your blood sugar levels will fluctuate significantly and in any case there's not mich you can do about it in the short term yourself (unlike insulin dependant diabetics, where knowing a blood sugar level at a specific moment in time is crucial to management). There is a strong argument that in type 2 diabetes you really only need to do a home blood sugar test if you feel unwell and leave the rest to regular HbA1c assessments and your doctor. I certainly think testing 2 or 3 times a day in type 2 is not really necessary - and will save your fingertips!

With the following proviso - it may depend to a degree on what medication you take. If you are on metformin then the above holds true as you will never get a true hypoglycaemia (metformin will not lower your blood sugar below normal). If you are on something like gliclazide or similar (there are lots of them - called sulfonylureas) then it may be useful to know your blood sugars are not going too low, especially when exercising, when you are first starting out on treatment. Once you are fairly stable and recognise the symptoms of hypoglycaemi, testing once again becomes a bit redundant.

Also I would just query with your doctor his/her plans regarding your cholesterol. It is generally accepted NICE guidance for type 2 diabetics, particularly over the age of 40, to be on a statin of some description if they can tolerate them - almost regardless of their cholesterol and certainly if their total cholesterol is over 4mmol/l.
 
i agree type 2 certianly dont need to test that much.why put youself though this when your Drs will check the best test of ll HBA1c
:crazy:
 
drippihippy wrote
what is the point of testing regularly and trying to keep control of my blood sugar if it has no effect?
Click to expand...

You can ignore the responses from the two T1s (no offence guys - it's simply not your territory), as they don't realise the importance to a T2 of testing in order to adjust their diet, and thereby keep their blood sugar levels down.
If that's what you're doing - using your results to tell you what raises your levels too much - then simply keep on.
I wouldn't worry too much - HbA1c can seem to lag behind actual readings, and those readings may not be the best picture of what your average levels are. That would need a 24-hour monitor.
If Pawn Phenomenon pushes your levels up, there's little you can do about it, although some report that something taken before bed (or imbibed :lol: ) seems to help them.

Each of your HbA1cs has been lower than the previous. That's great.
Do you test at one hour ? I was reading how someone was the same at two hours on two different foods, but much higher on one at one hour. Two hour testing wouldn't tell them that.

Keep on

Geoff
 

Completely agree. I don't test much at all now, as I have a safe list of foods I know I can eat, but only through testing did I learn this. Testing is VITAL for T2 and don't let anyone tell you different. Over the course of a few months I tested religiously before every meal two hours after, fasting when I first woke and at bed time. I would often test in between as well, so I could see what was happening to ME!
 
You MUST test to see how foods affect you as a T2. It is the only way you can find out what you can eat. As your knowledge increases then the number of test needed will decrease and you'll only need to test when you try new foods or feel ill.

Ignore anyone that says you shouldn't be testing!!!!

Ann
 
Hi Geof,
yes, I am using the test strips to adjust and monitor my diet, I e-mailed Jenny Ruhl from www.bloodsugar101.com and her reply to my original question was as follows;

The A1c is often inaccurate because it isn't directly measuring blood sugar. It's only measuring how much glucose has become permanently bonded to red blood cells. If your red blood cells are in any way unusual or if you are anemic (or have a higher than normal amount of red blood cells) the A1c result no longer maps to your average blood sugar over the past few months
Your meter tests give you the actual data about your blood sugar over this period, and the research ties blood sugars to complications in individuals while it only links A1c to risks in groups. So the short answer is when the two don't match, trust the meter.
I have a friend who was receiving A1cs in the high 6% range despite never seeing any highs on her meter. A friend loaned her a continuous glucose monitor (CGMS) which she wore for several months. She assumed she must be missing high readings, but found that the CGMS never showed anything but completely normal blood sugars. The next year she got her A1c tested at a different hospital and it came out a full 1% lower. (Though still higher than predicted from her meter test and the CGMS). She concluded that there was some issue at the lab.
So don't panic, and keep trusting your meter. Doctors used to look at blood sugar logs but they have become lazy and far too dependent on a test many of them don't entirely understand. I have heard stories of people with anemias getting A1cs in the 4%s whose post meal blood sugars were in the 17 mmol/L range whose doctors told them to raise their blood sugar based on the faulty A1c.
 
pump994 said:
:thumbdown:
Click to expand...

Why is it fine for you to monitor your BG's to make sure you are safe but that its not ok for a T2 to do likewise?

I agree the two conditions are different but if you want to keep off the medication escalator as a T2 you need to learn quickly what foods are safe and what foods are not. Remember a newly diagnosed T2 cannot inject extra insulin to cover mistakes so testing is a very effective way to get feedback on how sensitive you are to various foods. Once you've learnt how to do this then I agree testing very regularly is not necessary but in the first critical months after diagnosis it is essential in my and the majority of members opinion. Testing allowed me to reduce my HBA1c from 11.3% to 4.9% in six months without having to resort to any major diabetic medication. Would you have denied me that ?

I wouldn't dream of telling you how to manage your T1 diabetes on a T1 thread on this forum so please give us the same respect.
 

Bit if a misconception creeping in here. I am T2 and the reason I use a meter is to find out whether my sugar is too high. It was high blood sugar that got me into this situation and I have to find out what to do in order to keep it low-ish. I don't think anyone who is a diet/metformin controlled diabetic ever said that they were using the meter to prevent hypoglycaemia. The meter is the only way I have of checking the effect of the food I eat.
 

Precisely. It frustrates the hell out of me when people don't recognise that wanting to gain good day to day control of T2 is no different to a T1 wanting to gain good day to day control. Perhaps those who advocate this T2's shouldn't test viewpoint would like to consider how they would have felt if they were denied testing at their own diagnosis and told "just guess how much insulin you need to inject". It effectively amounts to the same thing.

The whole control thing is a package of measures that ideally includes testing as well as making necessary diet and other lifestyle changes regardless of if you are T1 or T2.
 
I keep a fairly close watch on my BG. I test at different times of the day and usually at least once per day.
I have to buy my own strips, but it matters to me that I keep my diet right. I do sometimes get caught out, but less often nowadays. I slipped up with a portion of fresh peas recently. My BG shot up out of my target range [I try to keep below 6 at all times]
I'd like to get the HbA1c down into the 4s, but can manage the 5s.
Hana
 
Two issues here folks. Before we get onto the age old "to test or not to test" debate, a comment to the OP, drippihippi.

I understand your frustration about the Hba1c not moving in the right direction, especially as you seem to be doing all the right things. The thing to bear in mind is that you may be one of those who does need a helping hand with a little medication and there is nothing wrong with that.
I was very anti-meds at first and in fact managed to lower my a1c a bit, it was actually reading the posts here about the overall benefits of Metformin (especially to the heart) that turned my thinking around. It was especially useful hearing it from those who had cut their carbs considerably who had no problems with taking it-made me feel like I hadn't "failed" but was using all help available to me.

Re the self monitoring and the views expressed, I am sure they are well meant. However it is a sad confirmation that in the diabetic community as well as the NHS generally, it is assumed that there is no benefit to be gained from type 2's monitoring our levels. "Why put ourselves through this" and "there is nothing immediate you can do about it anyway" are two statements that we hear on a regular basis and they have no connection with the real world.

We put ourselves through this because our health is vital to us as it is to type 1's. Those on diet or Metformin may not get hypos (lets not get into the no we can't/yes we can on that one) but if our levels are too high, isn't it vital that we find out why? Or should we be prepared to go for months on end with skyhigh levels damaging our bodies because we don't test and don't know how different foods affect us?
Of course we can do something about it immediately, we can make the connection with what we have eaten and avoid it like the bloody plague! Type 2's have the complications just like anyone else, we can get retinopathy, neuropathy, kidney problems, serious infections, amputations...and that is precisely WHY we put ourselves through this. Given the choice of monitoring my own levels and health or losing a limb down the road it is pretty obvious what we go for.

Returning to the original post, drippihippi obviosuly has some sort of problem going on that needs to be looked at in more detail. He or she has been testing and keeping tight control during the day so something is causing spikes somewhere otherwise the Hba1c would be lower. Can you imagine if he/she hadn't been self monitoring? You can bet your boots that the assumption would have been that drippi had been running higher levels, there would no doubt be the usual advice about dietary changes and possibly meds and nothing further would be done. At least drippi has something to give them so they can investigate further or keep a closer eye to find the best treatment.

drippi, don't get demorialised, you have done the very best you can do. Personally I would suggest that if you are feeling down about the self testing, just keep it to 2 hours post meals for the time being. Perhaps make a note of what you have eaten and your bg's for a few days and post it on here?
We have some very knowledgeable folks who may be able to spot problem areas and give some advice or it may just be that you are one of the people that needs a helping hand. Don't feel bad about it if this is the case.

Good luck and let us know how you are doing.

:thumbup:
 

All I am going to say is; bl**dy good post Angie. :thumbup: :clap:
 
Hi guys,

I don't want to pull rank here but I have had diabetes for 34 years - yes type 1 - but have also been (recently retired on ill health ) a GP for 20 years with a special interest in diabetes (including type 2).

The debate over home blood glucose testing in type 2 is not really a debate, I just didn't want to appear arrogant. It is pretty well accepted by most health care professionals with an interest in diabetes including NICE and my consultant colleagues in endocrinology, that home BG measurement in type 2 diabetes has a very limited role to play and with the occasional exception (there are always exceptions in medicine) is of very little value and hence is not encouraged.

I fully accept that type 2 DMs need to CHO count as much as type 1's but there is no need to test. Whilst there is some merit in what has been said about learning which foods will raise your blood sugars rapidly, all you really need to do is look at the glycaemic index of foods. A food with a low glycaemic index is absorbed slowly and will not spike your blood sugars, whereas the reverse is true for foods with high glycaemic indices. This holds true for everybody - type 1, type 2 and people without diabetes. There are stories of soldiers feigning DM to get out of the army by drinking tea with a lot of sugar in - their blood sugars would spike above the renal threshold and they would present with glycosuria - same for everybody. The key in diabetes (both types - although pumpers may get away with this) is to avoid high GI foods, or take them as part of a meal with lots of low GI foods, hence delaying their absorption. The focus from health care professionals over recent years has been on giving this sort of specific, detailed dietary education rather than on home BG monitoring.

My point is, you don't need a finger prick to tell you this (which in any case would take a lot of trial and error to pinpoint which foods were causing the elevation), you just need to know which foods have fast absorption rates (ie high glycaemic indices) - your GP should have access to a local primary care based type 2 DM specialised education group, usually led by dieticians, that he/she can refer you to for this type of advanced patient education (its obviously not for everybody) - alternatively you can always google it!

As far as HbA1c's are concerned, there are a few but rare conditions that will cause inaccuracies (usually conditions which increase the rate of turnover of red blood cells) but these are rare and often inherited, so you and your doctor would probably be aware of them.
 
Interesting how those who actually have T2 are saying they need to test whereas those with T1 are saying there is no need for people with T2 to do so.

I can only speak from a personal perspective - I am not a health professional. Since I was diagnosed in June, I could not possibly have learned so much about diabetes and how food and exercise effect my blood glucose without a home meter. If I had gone on with the NHS advice to focus on low GI foods I could not have reduced the spikes after my meals. I found with the meter that even low GI foods had that effect and so have either removed them from my diet or reduced them.

Without my meter I really would feel I had little control. I test myself several times a day but can see that in time I will be able to reduce the testing.
 
My diet is sugar free and very low carb and contains only low GI foods, as a result of this I cannot understand why my HbA1c isn't lower, I have daily records of my test strip results for every meal eaten since diagnosis and in the last 4/5 months it has been mostly 5's sometimes 6's with less than 10 results over 7. I simply don't understand why the HbA1c isn't lower when I seem to be getting good results from testing daily [my fasting AM is typically 5.3 - 6.0] :evil:
 
On this forum no one pulls rank anyway, we are a community of equals! :wink:

I fully agree with test_positive, any complaints of testing in T2's is likely to come from T1's. Not all by any means, there are T1's here who fully agree with us 'lowly' T2's testing and support our appeal for testing for ALL diabetics.

Thankfully for me, my GP is a forward thinker. He prescribed me unlimited strips, I presented him with a 4.9 HbA1c. That result would certainly never have been possible with no meter. My GP has now reduced my strips to 50 a month, and while initially I wasn't pleased, I realise I actually don't need to test nearly as much as I did. I have a safe list of foods I know I can eat, so my testing is random, just for me to keep an eye that everything is as it should be.

Testing is VITAL, I know that from personal experience. While we all accept testing is expensive, but testing with CORRECT nutritional information and not the clap trap that is dished out to ALMOST all diabetics, would save the NHS in the long run, with far less complications, but the saving of lives and in particular quality of life there is no price for!
 
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