HbA1c 79 - don’t fully understand

[Twisty2229]

Hi, I’ve been a member for just over a week and hoped to get some feedback.

Hi, last week at my request a nurse at my GPs medical clinic took blood to test for diabetes. The GP reviewed the results and gave me the all clear based on 3 test results he reviewed.

I asked about my HbA1c level and was told it was 79. He said while this is a higher number it does not indicate pre-diabetes or T2. I was expecting to be told I have T2 diabetes so this was a surprise.

I’m working on weight loss and a healthier lifestyle but I’m still surprised by the feedback from my GP.

Will the wider range of tests have given GP the confidence in this feedback?

I have been wearing a CGM for a week and my blood glucose average over the last 7 days has been 5.1 mmol and my 3 day average has been 4.9 mmol. I am eating less sugar due to a focus on weight loss

 

[Inka]

Welcome @Twisty2229 It sounds like you misheard your doctor or they mis-spoke. Your Libre results of 5.1 and 4.9 are perfectly normal. I suggest you contact the surgery to verify your actual HbA1C result as it’s clearly not 79.

 

[Twisty2229]

Many thanks Inka, I will do that.

 

[Leadinglights]

Many thanks Inka, I will do that.

Make sure you get the units for the HbA1C result, it should be in mmol/mol 42-47mmol/mol is prediabetic, 48mmol/mol and over is diabetes or if they are still using old units %, 6% = 42mmol/mol , 6.5%= 48mmol/mol.
I wonder if they said 7.9% in which case you would be diabetic but that doesn't quite fit with your Libre readings.
Don't forget if you do need to make changes it is all carbohydrates that convert to glucose not just 'sugar'. Foods can be low sugar but still high carbohydrate.

 

[everydayupsanddowns]

Hope that you get to the bottom of things @Twisty2229

Good to hear that your Libre readings seem to be in a good place.

 

[Twisty2229]

Hi, just an update. I am just back from a 2 week holiday and just received a call from my GP's office, they would like to see me tomorrow to discuss a care plan for diabetes. I am again confused as I have 2 weeks data from my CGM and my average glucose for the 14 day period is 5.2 mmol/L and my GMI value is 5.6%. I have been in target range 100% of the time (highest reading I have seen is perhaps 7 mmol/L).

I started to lose weight about 5 weeks ago and have been watching what I eat as part of weight loss. Could my HbA1C have been high without it meaning diabetes?

 

[rebrascora]

Which CGM have you been using?
It looks like people have assumed it is Libre but doesn't look like a Libre graph. I am just wondering if you have been using something else and perhaps it isn't reliable.

What made you request the diabetes blood test? I assume you suspected diabetes and perhaps had some symptoms and if so, what were they?

If your HbA1c result is correct at 79 mmols/mol then you are definitely well within diabetes diagnosis range but if you have mad significant changes to your diet as a result then perhaps your levels have dramatically improved since then and the CGM is showing that improvement. Your HbA1c will still be raised as it takes 2-3 months for high levels to clear your blood, but at this stage unless you have been double checking with finger pricks, I would be suspicious of your CGM. You didn't buy one of those watches did you?

 

[Twisty2229]

Hi Rebrascora, I am using a Dexcom G7 CGM. I took a Lloyds chemist home blood test as I just turned 50 and wanted a health check. They suggested I get a follow up blood test from my GP. These are the 14 day stats from the Dexcom app.


The GP blood test was on the 28th of March and I started wearing the CGM on the 29th March. I understand the HbA1C reading covers the previous 3 months but wondered if changes would be so dramatic as I started dieting in early March. I was not watching my carb intake during March but I did remove processed food and chocolate and crisps from my diet. I am currently about 85lbs over weight.

 

[rebrascora]

Ok, well Dexcom are very reliable, so I can only assume you have made some serious modifications to your diet since the HbA1c test, which have brought your levels down into range. This is certainly possible as dietary changes can be far more powerful than most diabetes meds.
What was the result at Lloyds chemist that prompted all this? Just wondering if that corroborates the HbA1c result of 79 or if perhaps there has been an error somewhere with the HbA1c result or some misunderstanding.

 

[Leadinglights]

Ok, well Dexcom are very reliable, so I can only assume you have made some serious modifications to your diet since the HbA1c test, which have brought your levels down into range. This is certainly possible as dietary changes can be far more powerful than most diabetes meds.
What was the result at Lloyds chemist that prompted all this? Just wondering if that corroborates the HbA1c result of 79 or if perhaps there has been an error somewhere with the HbA1c result or some misunderstanding.

I wonder if the HbA1C result was actually 7.9% not 79mmol/mol as some surgeries still seem to use old units.

 

[Twisty2229]

The HbA1C result from the Lloyds test was 82.0 mMol/Mol and was from the 26th March. What confused me initially was that when I called my GP on the 5th April they told me the 3 tests they completed showed as okay. I was planning on calling the GP today to clear up my confusion when they called me first.

 

[Leadinglights]

The HbA1C result from the Lloyds test was 82.0 mMol/Mol and was from the 26th March. What confused me initially was that when I called my GP on the 5th April they told me the 3 tests they completed showed as okay. I was planning on calling the GP today to clear up my confusion when they called me first.

Have you actually had an HbA1C test done by your doctors surgery from a blood sample taken from your arm and sent to the lab.
If the Lloyds test was from a finger prick then that would be less accurate and it is conceivable you had something on your finger to distort the result.
However if your readings are genuine then your dietary changes have been effective if a little puzzling given the high HbA1C.

 

[Twisty2229]

Have you actually had an HbA1C test done by your doctors surgery from a blood sample taken from your arm and sent to the lab.
If the Lloyds test was from a finger prick then that would be less accurate and it is conceivable you had something on your finger to distort the result.
However if your readings are genuine then your dietary changes have been effective if a little puzzling given the high HbA1C.

A nurse at my GP's surgery took blood from my arm on the 28th March, after my finger prick test on the 26th. I followed up with my GP office on the 5th April and they said the doctor had reviewed 3 results and they were happy with the findings. I suspect this may have been where the error happened.

It is just that the data from my CGM helped me validate the 'okay' from the call on the 5th so I thought maybe all was okay.

 

[JITR]

I suspect HbA1c results are more dependent on spikes than averages. My diagnosis result of 104 early in December 2022 was certainly largely due to huge spikes over a two week period of over eating in Novmber 2022, but my GP was not interested in talking about that. I'd say you and your GP really need your next HbA1c result before considering any changes to what you are already doing, unless there is something else not disclosed in this thread.

 

[mitchsi]

As you’re wearing a CGM, you could check your response if you ate a chocolate bar or some carb heavy food (as long as it’s safe for you to do so) then your response I would expect, would indicate if your diabetic or not. If your blood glucose level dropped back to near pre food level or within 2 units within 2hours then, someone pls correct me, it would indicate reasonable insulin sensitivity, if you went high (above 10?) and stayed there for a period of time then insulin sensitivity is reduced.
A quick and dirty test you could try anytime until you hear from your doctor.

 

[Twisty2229]

Thanks @JITR and @mitchsi. I cannot think of any other information that I have not shared that is relevant.

@mitchsi - would a 300 ml glass of fresh orange juice work?

Edit: I have just had a 300ml glass of fresh orange juice (30g Carbs). Current mmol/L is 5.2. Will check again in 2 hours.

 

[mitchsi]

@Twisty2229 you should notice something but I’m not type2 so have no experience and there would be differing levels of insulin sensitivity but it will give you an indication. Post the graph pls, it’s a funny (not ha ha) situation you’re in with the figures you’ve posted and the doctors response. I can’t work it out it for the moment, except an error somewhere along the lines.

 

[Twisty2229]

I had the 300ml of fresh orange juice at 6.05pm and my mmol/L was 5.2. 45 mins later my mmol/L was 6.8 (the screen shot below was taken just after I saw the 6.8 and it changed to 6.7. At 2 hours my mmol/L is 5.5.

 

[mitchsi]

The 30g didn’t have a significant effect on your BG and it came down well. Hard to say what it means for you really, obviously you will speak with your doctor for an definitive answer ( I hope they can give it to you) but a higher carb level next would test your pancreas more. Like mentioned, insulin sensitivity would be different for everyone and depending on the severity the response would differ.
Hopefully someone with T2D and a CGM could comment on your response and what to expect for a given carb intake.

 

[Twisty2229]

The 30g didn’t have a significant effect on your BG and it came down well. Hard to say what it means for you really, obviously you will speak with your doctor for an definitive answer ( I hope they can give it to you) but a higher carb level next would test your pancreas more. Like mentioned, insulin sensitivity would be different for everyone and depending on the severity the response would differ.
Hopefully someone with T2D and a CGM could comment on your response and what to expect for a given carb intake.

Thanks mitchsi. I’ll update after my appointment tomorrow.