A1c lower than overall finger pokes and CGM?

[Pumper_Sue]

Can anyone enlighten me as to why my A1c has come in at 43 when CGM and fingers pokes say at least 6.5/6.6? Blood tests have come back abnormal for kidney and liver function plus low thyroid and high folic acid.
Ta very much.

 

[gll]

I've given up trying to work out why my a1c never seems to match anything. Can't even really blame variables between fingerpricks when you have the cgm on too. (I know, I am totally helping here).

Mainly hit reply to throw a hug your way because boo for not fantastic results on your bloods {{{hugs}}}

 

[Docb]

They are measuring different things and although both things are related to blood glucose levels, relating one to the other is very, very difficult. In my world it is best not even to try unless you do many finger pricks and are very good at maths. Even then it is more a bit of fun than real science.

I would treat both measurements as different and play to their strengths.

The HbA1c tells you how things are going in the long term and by any stretch of the imagination an HbA1c of 42 has got to be good and says to me (a 'umble T2) that you have got a real handle on your T1 from a blood glucose point of view.

The finger pricks give you short term information about what foodstuffs spike us T2's and how your insulin regime is holding up for you T1's. Put the two together and you get a good picture of your diabetes. Trying to predict one knowing the other just gives you headaches!

PS.. hope the "abnormal" other bloods are not significantly abnormal and you get good advice from your GP about how to get things back in range.

 

[everydayupsanddowns]

How do the predictions usually work for you Sue?

Generally the predictions are a bit optimistic for me, and suggest a lower result than I actually get from a blood test - so the opposite variation to the one you’ve seen.

The predictions are based on a ‘best fit’ of historic pairs of results from a sample set of other people (because there isn’t a way to mathematically convert between the two). So I’ve always seen them as a vague indication.

But yes, it would be a surprise if the prediction suddenly switched from lower than reality to higher than reality!

 

[Pumper_Sue]

@everydayupsanddowns normally there's about .1 difference between the two so am surprised at such a low reading for my A1c compared to CGM and finger poke. Last 3 A1c's have been a lot lower than I usually have as since pumping 15 yrs or more have come in at 6.4 - 6.7.
I have pump clinic next week so will ask consultant when I see him.

 

[everydayupsanddowns]

Any chance you have anaemia? That can affect HbA1c results?

 

[Pumper_Sue]

Any chance you have anaemia? That can affect HbA1c results?

I suspect I have pernicious anaemia, trying to convince the surgery to do something about it is a different matter though.

 

[Leadinglights]

My understanding of the HbA1C is the algorithm it uses is weighted to the more recent weeks which the predictor from other sources may not do.
Any haemoglobinopathies can affect the HbA1C either higher or lower than actually what it is. Another test can be used in that case.
I would suspect if people had several tests done on the same day there would be some variation in the result.

 

[Deleted member 21371]

I suspect I have pernicious anaemia, trying to convince the surgery to do something about it is a different matter though.

The unusual hba1c would suggest that could be correct, and you have a lower red blood cell count, or the red blood cells are replacing at a faster rate than "normal" but any abnormal blood test could also be affecting your hba1c, so it's something to discuss with the surgery.

 

[Pumper_Sue]

The unusual hba1c would suggest that could be correct, and you have a lower red blood cell count, or the red blood cells are replacing at a faster rate than "normal" but any abnormal blood test could also be affecting your hba1c, so it's something to discuss with the surgery.

I have follow up bloods on Wednesday morning so it will be interesting to see what it shows then, and what action is taken. I will raise the matter with consultant as well next week if no joy from GP.

 

[trophywench]

@Leadinglights - well that's always been true, the last 4 weeks account for something like 65% of the result. The 4 wks previous 20% and the original 4 the 15% remainder.

@Pumper_Sue your HbA1c has always astounded me being so 'in line' with your BG test/CGM results that you could predict them.

Pretty obvious you do have summat else going on, my prob being I don't know enough to guess - but anaemia of course is always a candidate. I thought pernicious anaemia became obvious to everybody (whether medically qualified or not) by the results of blood tests? or do you mean your GP won't authorise you a blood test? Or would you need a lumbar puncture and is that contra indicated because of your other health probs?

I'd defo want to have that conversation with my D consultant too.

(Like you needed anything else ....)

 

[Deleted member 21371]

I have follow up bloods on Wednesday morning so it will be interesting to see what it shows then, and what action is taken. I will raise the matter with consultant as well next week if no joy from GP.

Did you have a full blood count?
Is the red cell count normal?

 

[Pumper_Sue]

Did you have a full blood count?
Is the red cell count normal?

Yes and no not normal. There wasn't a lot that was normal which probably accounts as to why I feel decidedly yuck.

 

[Pumper_Sue]

@Leadinglights - well that's always been true, the last 4 weeks account for something like 65% of the result. The 4 wks previous 20% and the original 4 the 15% remainder.

@Pumper_Sue your HbA1c has always astounded me being so 'in line' with your BG test/CGM results that you could predict them.

Pretty obvious you do have summat else going on, my prob being I don't know enough to guess - but anaemia of course is always a candidate. I thought pernicious anaemia became obvious to everybody (whether medically qualified or not) by the results of blood tests? or do you mean your GP won't authorise you a blood test? Or would you need a lumbar puncture and is that contra indicated because of your other health probs?

I'd defo want to have that conversation with my D consultant too.

(Like you needed anything else ....)

GP says I do not have pernicious anaemia even though results point to it. My mother has it my mums cousin has it as did my mums brother, he died due to it not being diagnosed. I have the antibodies for it as well.

All results including liver and kidney were out and inflammatory marker (CRP) are quite high as well. GP wants the bloods done again on Wednesday to see what they show. Not sure of the point as she hasn't a clue what they mean anyway

 

[Deleted member 21371]

Yes and no not normal. There wasn't a lot that was normal which probably accounts as to why I feel decidedly yuck.

Based on that, your hba1c result is unreliable.
It's usually either low red blood cell count, (can actually make hba1c artificially high, or low) or short red blood cell life, which will make hba1c artificially low.
But there may equally be something else in there, from another test, so you definitely need to find someone that knows what that are talking about.

 

[Bloden]

((((Hugs)))). I hope they get to the bottom of what’s making you feel so unwell asap @Pumper_Sue.

 

[trophywench]

?? Needs a haematolgy consultant to look at the blood test results and pronounce the correct diagnosis??

Is it reasonable to request the Diabetologist to consult 'a learned colleague' for proper advice for you?

 

[trophywench]

We were impressed recently by one of the random docs Pete saw who said he honestly didn't know whether one of Pete's blood test results which was higher than bog standard, required any medical treatment and if so, what - so he'd refer it straight to haematology (cos he said they have a fast rack route to do that where they reply in 48 hrs) so he'd do that and ring him with the answer. He rang him within the next couple of hours, very fast reply, no, no prob, shouldn't cause any prob let alone any symptoms, and there's absolutely nowt anyone can do to get a different result anyway! 🙂

 

[Pumper_Sue]

?? Needs a haematolgy consultant to look at the blood test results and pronounce the correct diagnosis??

Is it reasonable to request the Diabetologist to consult 'a learned colleague' for proper advice for you?

I think the consultant is very much on the ball. Well that was the impression I had when he did my endocrine review over the phone. I have the pleasure of a f2f with him next week for a pump review, so will go armed with a lot of questions.