Hba1c readings v finger prick readings

[Skinnygirl]

In my last thread I said that I had porridge and banana for brekkie, several people commented on this carb based meal, how it rocketed their BG. I checked my readings at home: fasting glucose was 4.6 and and hour after it was 7.4 - this doesn’t sound so bad does it? On the basis of this I think that’s normal but my hba1c is 45 - so, Q if my BG goes up after food but comes down again (normal insulin response?) why is my hba1c reading high?

 

[Martin.A]

In my last thread I said that I had porridge and banana for brekkie, several people commented on this carb based meal, how it rocketed their BG. I checked my readings at home: fasting glucose was 4.6 and and hour after it was 7.4 - this doesn’t sound so bad does it? On the basis of this I think that’s normal but my hba1c is 45 - so, Q if my BG goes up after food but comes down again (normal insulin response?) why is my hba1c reading high?

There's no direct correlation between HbA1c and finger prick tests. HbA1c is a measure over 10-12 weeks so you would need to average 10-12 weeks worth of finger prick tests to make any kind of meaningful comparison. Even then it would only give you a rough idea of where your HbA1c might be. That fact that you had those numbers for your breakfast while others would see their BG rocket simply shows how true it is that we are all different in the way our bodies respond to carbs.

I haven't eaten a banana since the day I was diagnosed.

 

[Deb_l]

When I was first taking readings, I aimed to eat foods that didn't increase my BG more than 2 so your 4.6 to 7.4 (an increase of 3) would have been too high for me and I would have excluded that food from my diet. My levels at the time however were much higher than yours so I was VERY careful.

Yes, it's a small increase but if all your meals are similar, this is why your HbA1c is higher than normal.

I also haven't eaten a banana since diagnosis because they are like rocket fuel for me. Same with porridge

 

[rebrascora]

Is there any reason why you are testing an hour after eating instead of 2 hours which is the normal regime for assessing how your body coped with the food you ate? After just an hour you may not have reached the peak of glucose release from those foods.

 

[Skinnygirl]

That’sa good question, Barbara, I will test at 2 hrs.

 

[Skinnygirl]

Does anyone think my hba1c could be high because of stress (even if it’s not appearing v high in the finger prick test)? I have had it all in the last 6 months with various close family members: death, dementia (care home) cancer diagnosis, (my own) other health issues; I’m just waiting to see who’s gonna get divorced and made redundant so I’ve got the set

 

[Leadinglights]

Does anyone think my hba1c could be high because of stress (even if it’s not appearing v high in the finger prick test)? I have had it all in the last 6 months with various close family members: death, dementia (care home) cancer diagnosis, (my own) other health issues; I’m just waiting to see who’s gonna get divorced and made redundant so I’ve got the set

Stress and illness can cause elevated blood glucose so it is very possible it will impact on your HbA1C but for some people it will be partly because they change their lifestyle under those circumstances, less exercise, less healthy food which will increase blood glucose.

 

[Proud to be erratic]

Does anyone think my hba1c could be high because of stress (even if it’s not appearing v high in the finger prick test)? I have had it all in the last 6 months with various close family members: death, dementia (care home) cancer diagnosis, (my own) other health issues; I’m just waiting to see who’s gonna get divorced and made redundant so I’ve got the set

Alas, short answer is very much yes. Stress in all of its forms more normally results in our BG rising. That includes medical stress from an incoming illness that the body fights before you are even aware the illness is coming and stress from a frightening film or TV programme. Even sometimes stress from a great comedy programme.

The general explanation is that in protecting you in the round your body activates various hormones such as adrenalin, cortisol, endorphins and glucagon. Each hormone comes from different parts of the body and each have different purpose (with some overlaps) but bring about a release of glucose from the body's main glucose store (the liver). To prepare you for trouble ahead! Hence BG rising. There was a study which seemed to conclude that certain types of emotional stress (eg home problems or work pressures) would gradually become "normal" to many people and the stress triggers would reduce and stop.

While I'm here you asked in your first post and hence the title of this thread about HbA1c vs FP readings. You might find this 1st thread in the Newbies part of the Forum useful.

https://forum.diabetes.org.uk/boards/threads/blood-glucose-numbers-what-do-they-mean.110434/

 

[Ranger]

Is there any reason why you are testing an hour after eating instead of 2 hours which is the normal regime for assessing how your body coped with the food you ate? After just an hour you may not have reached the peak of glucose release from those foods.

I have not been doing my "waking up" simply because within an hour I would have had my breakfast. I tend to get up and within the hour do a test just before I eat. Does this sound a reasonable compromise?
If that's wrong then I will change but it just seems I would be taking 2 prick tests within the first 30-60 minutes.

 

[Martin.A]

The idea of the test on waking is that it shows how your body manages your BG in the absence of food or exercise, since you've been asleep all night. Once you're up and about your liver will start pumping out glucose to fuel your body until you eat. This also causes what's known as Dawn Phenomenon and Foot on the Floor Syndrome and is why some test before they even get out of bed, and most as soon as possible after getting up, in my case usually within 5 minutes.

The pre- and post-meal tests are done for a different reason. I would expect a pre-breakfast test a while after getting up to give a higher BG reading than a test on waking, no matter how far apart they are.

 

[helli]

Once you're up and about your liver will start pumping out glucose to fuel your body until you eat. This also causes what's know as Dawn Phenomenon and Foot on the Floor Syndrome and is why some test before they even get out of bed, and most as soon as possible after getting up

Dawn Phenomenon and Foot on The Floor occur at different times and are different things although the cause is the same (liver dumping glucose to give us energy).
Many of us find our BG does not wait until we get out of bed to start rising - it starts in the early hours of the morning (e.g. around 4am) to give us the energy we need to get out of bed. This is Dawn Phenomenon.
Others, like you, find the rise starts once they get up when your liver decides in needs the energy "now". This is Foot on The Floor.
I think of Dawn Phenomenon as preactve and Foot on the Floor as reactive

A couple of other observations (from a T1)
- some people find that their liver will continue to pump out glucose until it gets the message that we are not starving ourselves. In other words, our BG will continue to rise until we eat something. So, we may find it is useful to eat as soon as possible after getting up rather than waiting an hour or not even having breakfast at all.
- I find my Dawn Phenomenon is far less if I do intensive (enough to raise my heart rate for 20 minutes or more) the day before. Another reason why exercise can help diabetes management (if we are able to).

 

[Ranger]

Cheers Martin, I do literally get up, go downstairs and check so within 5-10 minutes maximum. I am then just at rest until I eat breakfast about 30-45 minutes later, then check 2 hours after, hopefully that's OK.

 

[silentsquirrel]

If you are using the 2 hours post first bite of breakfast to judge how well you cope with that type/portion size of breakfast the rise may be greater than the breakfast itself causes - being "at rest" does not mean your BG level stays the same during that 30-45 minutes, see explanations of "foot on the floor" above. It may (or may not!) rise considerably in that time.

 

[Leadinglights]

Cheers Martin, I do literally get up, go downstairs and check so within 5-10 minutes maximum. I am then just at rest until I eat breakfast about 30-45 minutes later, then check 2 hours after, hopefully that's OK.

You could adopt a strategy that you could just do the before and after breakfast tests until you have established what breakfast options are giving you good results and you would then not really need to test them again and then start to do a waking reading which would then tell you your progress day to day, week to week etc.

 

[Lucyr]

Cheers Martin, I do literally get up, go downstairs and check so within 5-10 minutes maximum. I am then just at rest until I eat breakfast about 30-45 minutes later, then check 2 hours after, hopefully that's OK.

What are you aiming to learn from these tests? How are you using the information?

If the information you want is “does my body cope with this breakfast” then you need to test directly before breakfast and 2 hrs afterwards.

If the information you want is to know how your body is coping with managing bgs without food then you need to test when you wake up.

If the information you want is none of those things, or you already have those pieces of information and you’re happy with the results, then you don’t need to test when you wake up or before or after breakfast, you need to test some other time.

So start with, what information do you want and how will you use the results of the blood tests?

 

[rebrascora]

My Levels can rise by as much as 6 whole mmols in that 45-60 mins after I get up if I don't inject a couple of units of insulin to deal with it, so as mentioned by others above that can skew the results you get for your breakfast testing if you don't test immediately before eating. If you don't want to do that extra test in the morning, the immediately pre and post meal readings will be more helpful in establishing an appropriate breakfast for you, than the waking test, otherwise you may end up ruling out some breakfast options that could be fine because the Foot on the Floor (FOTF) makes it looks like you responded to it with a bigger rise in BG than you actually did.

 

[Martin.A]

Dawn Phenomenon and Foot on The Floor occur at different times and are different things although the cause is the same (liver dumping glucose to give us energy).
Many of us find our BG does not wait until we get out of bed to start rising - it starts in the early hours of the morning (e.g. around 4am) to give us the energy we need to get out of bed. This is Dawn Phenomenon.

OK, but my understanding of DP was based on what I'd previously read on the Diabetes UK site (the other one), ie The dawn effect therefore describes abnormally high early morning increases in blood glucose. Usually, abnormally high blood glucose levels occur between 8 and 10 hours after going to sleep for people with diabetes.

 

[helli]

OK, but my understanding of DP was based on what I'd previously read on the Diabetes UK site (the other one), ie The dawn effect therefore describes abnormally high early morning increases in blood glucose. Usually, abnormally high blood glucose levels occur between 8 and 10 hours after going to sleep for people with diabetes.

That is indeed an interesting definition. Given few people sleep as long as 8 to 10 hours, it definitely suggests a rise after waking but then the diabetes.co.uk page you reference also says "The dawn effect therefore describes abnormally high early morning increases in blood glucose" which seems to contradict itself unless we go to sleep at 6pm.
I think my definition was something I have understood from my reading about it and not necessarily one source.
Thank you for sharing this definition.

 

[Martin.A]

That is indeed an interesting definition. Given few people sleep as long as 8 to 10 hours, it definitely suggests a rise after waking but then the diabetes.co.uk page you reference also says "The dawn effect therefore describes abnormally high early morning increases in blood glucose" which seems to contradict itself unless we go to sleep at 6pm.
I think my definition was something I have understood from my reading about it and not necessarily one source.
Thank you for sharing this definition.

8 to 10 hours sleep? I wish.........

 

[Ranger]

What are you aiming to learn from these tests? How are you using the information?

If the information you want is “does my body cope with this breakfast” then you need to test directly before breakfast and 2 hrs afterwards.

If the information you want is to know how your body is coping with managing bgs without food then you need to test when you wake up.

If the information you want is none of those things, or you already have those pieces of information and you’re happy with the results, then you don’t need to test when you wake up or before or after breakfast, you need to test some other time.

So start with, what information do you want and how will you use the results of the blood tests?

I don't know is the honest answer! I've recently (days) been diagnosed and have to keep records of levels before, 2 hours after, meals. What they are going to do with the results when/if I finally see anyone I don't know.
Put simply, I guess I am monitoring my BG levels and trying to keep my levels down by watching what I eat and trying to sort out what is best for me.
Sorry if that sounds flippant but apart from keeping/monitoring my levels I don't know. If I'm honest it is all getting too much for me, foot on the floor? Carbs = sugar, and trying to Google anything is a waste of effort like how many carbs in a cup of tea? Google it and look at several sites, they go from really low to really high it is all frustrating the the hell out of me. Literally as you can see from the amount of my posts, my life at present is spent asking questions and Googling stuff, my last 3-5 days just seem endless.