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Very disappointed with HBA1C result

Discussion in 'Type 2 Diabetes' started by jim1951, Aug 11, 2020.

  1. jim1951

    jim1951 Type 2 · Well-Known Member

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    Okay so from my data below you will see I was diagnosed type 2 circa 6 years ago, my numbers have bumped along in the 50's but in Jan this year they went up to 73.

    I have just had my latest HBA1C and it is down to 48 and whilst on the face of it that is a very good reduction, I was expecting 38 to 40.

    Over the last 8 months I have tested over 650 times! and kept extensive records and my averages were 38. My nexus machine is showing a 90 day average of 6.2 which equates to 37 which corroborates my own records.

    I had a worry about my DP which has always been a problem and can be 8.x most days. However, that was included in my calculations and Nexus average. I do understand that my 3 or sometimes 4 readings a day are "snapshots" and that had worried me.

    As regards food, I never have breakfast, I have salad for lunch and my main meal would be less than 50g of carbs and taken at circa 7PM.
    My readings would be in the following range with the sometimes rogue reading popping up.
    Early morning would be 8.x taken at 0730
    Lunch reading would be 6.x taken at 1300 with no testing after.
    Evening would be 4.x/5 taken at 1900 and 2 hours later would be 5.x/6.

    So basically I am having one meal a day that includes carbs and appear to tolerating it exceptionally well. But my HBA1C of 48 equates to an overall average of 7.8 and this confuses me a lot because that is not what my machine is telling me!

    Can anybody make sense of what might be happening?
     
  2. Brunneria

    Brunneria Other · Moderator
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    You haven't said if your readings are taken before, or after food?
    That can make a huge difference.
    Also, you have no way of knowing how high, or how long your readings are raised after food, if you just do a single reading around a meal. Ideally you need to text before eating, and then 2 hours after, which will give you a better idea.

    Also, if you have Dawn Phenomenon that pushes your reading up to over 8 on a regular basis, then it is possible you are seeing 8+ for the majority of the hours between 4am and lunchtime. Sad but true. Only more frequent testing will shed any light on that.

    Some of us find that skipping breakfast works like a charm for weight loss and bg control.
    Others of us find that unless we eat breakfast, our bg stays high all morning, giving higher overall readings than if we had a low carb breakfast which makes bg levels steady off or even drop lower.

    IF you want to restrict your usage to 4 strips a day, then I suggest that you switch to testing a single meal 4x, then the next day, test another meal 4x.
    For instance, test just before lunch, then every 30 minutes until your bg returns to the same level it was before lunch. That will give a better idea of your peak, and how long you have raised bg.
    Regarding your fasting level, I would take a test at bedtime, then when you wake up, then every 30-60 mins all morning. Do this on a day you eat breakfast, and then repeat on a day you don't eat breakfast. Then repeat on other days, until you are sure you have spotted any trends.

    You can do all the above on a limited number of strips. You would just test more one day then less the next. But ideally, a libre sensor, or a large number of cheap strips (Tee2 or Codefree, or similar) would mean you got the info much more quickly...

    And don't worry - once you have worked out what is happening, you won't be obliged to test so rigorously forever! This would just be a week or two of intense testing so that you get a feel for what your body is doing with the food you eat. Once you understand that, you can adjust food, and adjust testing frequency, to levels that work for you in the long term.

    Hope that helps!
     
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  3. Andydragon

    Andydragon Type 2 · Well-Known Member

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    Your strips will have a margin of error, that might be impacting a Bit?
     
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  4. jim1951

    jim1951 Type 2 · Well-Known Member

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    Thanks for the advice Brunneria, much appreciated.

    My post was a bit waffly perhaps but did give the info you ask for i.e., no breakfast but a test taken. A test before lunch but not after as only salad (the reason for that test is to see if the DP has come down) and a test before dinner and 2 hours after.

    I will experiment as you suggest.
     
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  5. jim1951

    jim1951 Type 2 · Well-Known Member

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    good thought, the difference I am looking at is 48 to 40 which is 20%. Would that margin of error exist over 650 strips?
     
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  6. Andydragon

    Andydragon Type 2 · Well-Known Member

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    Not sure what the margin is, it's possible but would assume it would balance out

    But I've found finger readings can fluctuate plus the slightest thing such as not washing hands can change level, I have had a reason of 1.4 before which clearly is a problem, 2nd reading was 6.2 or so... Basically a massive delta and initial error

    Also I seem to recall hba1c is 3 months but favours the more recent, is it possible your levels aren't totally flat?
     
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  7. catinahat

    catinahat Type 2 · Well-Known Member

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    You are comparing the results from 2 different types of test. Our monitors are measuring the electrical resistance of a drop of blood. The Hba1c is measuring the amount of glucose that is attached to the red blood cells over their lifetime. They call it a sort of average because the blood cells last around 12 weeks but obviously we are all different. Two people could have exactly the same finger prick average but if one's red blood cells kick the bucket after say 10 weeks and the other person's hang around for maybe 13 weeks their Hba1c's would be very different.
    So what I'm trying to say is that in my opinion ,trust your meter it's giving you real time data and a real mathematical average.
     
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  8. jim1951

    jim1951 Type 2 · Well-Known Member

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    Can you clarify, are you saying a meter average is more reliable than a HBA1C result?
     
  9. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

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    @jim1951 - I hope this doesn't sound harsh, as i certainly don't mean that to be the case, but I'll go on.

    When we do a finger prick test, it is literally a reading a that moment of time. It doesn'ttell us what happened before or after, or how long the test result was valid for. So, if you tested after a meal, your blood glucose could still be rising, or it could stay raised for hours on end. I know for me, what I have eaten and when has a real impact.

    For instance, in terms of the efficiency of blood glucose regulation, my body is at it's worst in the morning despite me definitely being a morning person, in all other regards. On that basis, I can have very different responses to the same eal, eaten at different times of the day, or evening.

    In terms of specific foods; on eggs - whether scrambled, boiled, fried or omelette my blood glucose is fantastic - often being lower after eating than before.

    On a very fatty meal, like delicious belly pork, or lamb chops, the rise I experience in my blood sugars is very low, and takes a while to happen, but it reverts to a good place eventually, and bearing in mind it didn't rise much anyway, that's fine.

    In my experimental times, eating pasta was a real voyage of discovery! My bloods would rise; not stratospherically, but high for me, then stay there, or thereabouts for hours, and hours, and hours on end, followed by a higher than usual fasting blood glucose test.

    So, snapshots are just that.

    Additionally, my finger prick readings, and even my Libre continuous monitor reading predictions never, ever match the lab results. Six and a bit years in, I just accept that now.

    These days I know provided my finger prick tests remain in my known ranges, my A1c will be OK. Of course, it's frustrating, but it is what it is. I have had to work out how to make the information available to me work for me.

    You will note I haven't quoted any specific numbers in this post as my numbers are not relevant to anyone else. My body and your body will work differently, so you'll get to know your body over time.
     
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  10. becca59

    becca59 Type 1 · Well-Known Member

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    I have 4 monitors and wear a Libre. Just for interest I sometimes use all of them. In the space of a few seconds, using the same finger prick, I can get 4 different readings with a range of 2mmol difference. They are a moment in time. The Libre, though not perfect, shows directional arrows and time in range over 90 days. Far more of a help as to how I am really doing. More clinics are looking at time in range as being important rather than HBA1C.
    Think about how far you have come since January and aim to tighten up even more. I am sure you can do it.
     
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  11. jim1951

    jim1951 Type 2 · Well-Known Member

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    No that is not harsh one little bit.

    I am struggling to understand why my HBA1C is different from expected.

    I dont eat breakfast and my lunch is salad with zero carbs.

    So I only have one meal a day and my post 2 hour reading is never above 7 and never more than 1.5 above the pre dinner reading. From this my assumption is that my body is dealing with my BS levels in a good way. So I have to assume that my DP figures are ruining the party and I guess my question is how to cope with that? It is not having a minor difference but making a major difference.
    The crux of the matter is that my pre and post readings are never as high as 7.8 but my HBA1C of 48 is equivalent to a BS figure of 7.8 over an entire 24 hour period for the last 12 weeks!

    How do I bring my HBA1C down when all my intermediate snapshots are very good?
     
  12. bulkbiker

    bulkbiker Type 2 · Oracle

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    Not sure that's possible unless its a meat only salad... all veg and salad stuff has some carbs.. all plant food does. Could this be part of your problem I wonder.
     
  13. jim1951

    jim1951 Type 2 · Well-Known Member

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    okay I guess it is about 7 or 8g of carbs which is not large in the scale of things. It is a snack of lettuce, tomatoes, radish, walnut and olives.
     
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  14. KK123

    KK123 Type 1 · Well-Known Member

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    Hi Jim, I think it's all about the so called averages. My average number is precisely 5.7 and yet I don't think I have ever seen an actual reading of that number, it's normally in the 4s or 6s or higher. I don't know whether you have something else going on but you would have to do a test at least once a minute 24/7 to get any idea of what your levels are like in between testing. I have a Libre now and although it's not 100% accurate, at the start I would be checking my levels every 10 minutes and every ten minutes they were different. My first hb1ac after starting the libre was spot on with the Libre's estimate actually but I think others have different experiences. x
     
  15. bulkbiker

    bulkbiker Type 2 · Oracle

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    Do you have more carbs for dinner too?
    Might be worth keeping a detailed diary for a week weighing everything just to get a firm handle on things?
     
  16. Rose22

    Rose22 Type 1 · Well-Known Member

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    I just wanted to say...an hba1c result of 48 is fantastic! Well done as that takes work to achieve and keep it low. I think it’s a brilliant number!
    As others say the finger test is at that moment. The hba1c is on average how many sugar molecules are attached so a cell...so 48.
    Doctors tend to focus on the hba1c for a guide to control rather than the finger results, unless you are seeing crazy variations or very high numbers.
     
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  17. jim1951

    jim1951 Type 2 · Well-Known Member

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    I dont count in detail the carbs in my evening meal, I just make sure it is low carb which is borne out by post meal readings. It rarely reaches 7, is rarely more than 1.5 increase and sometimes a reduction. I have seen 4.x on occasions after 2 hours.
     
  18. bulkbiker

    bulkbiker Type 2 · Oracle

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    Fine but if you don't know and you are disappointed with your result then....logic suggests a week of close monitoring might be very useful. It is for me.
     
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  19. Resurgam

    Resurgam Type 2 (in remission!) · Expert

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    My BG readings would suggest a Hba1c in the mid 30s, but it is 42.
    I think that all the low calorie low fat high carb diets over the decades have broken something.
    I am almost 70 now and I was told I was overweight in my early 20s - with a 24 inch waist, so my metabolism has been fairly hammered by the print out diet sheets. I get BG readings around 7 when I have eaten. I only eat twice a day and stay under 40 gm of carbs, and I feel great so that seems good enough really.
     
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