Advice needed on HbA1c result and huge disparity with plasma result DEXCOM and finger prick average.

[Thebearcametoo]

My kid’s hba1c is often around 33 when he’s somewhere around target for a t1d but by no means always in range. Readings of 12/13 are very common when he’s got good control. He’s recently had less good control with long periods in the 20s and still had an hba1c of 48.

 

[everydayupsanddowns]

A while ago I read about ‘low glycators’ and ‘high glycators’ somewhere or other (!)

If that is still a concept that is still accepted, it be @Jan1956 that you just naturally make less glycated haemoglobin than most people - so at the same glucose level you produce a lower A1c?

Another factor that is known to affect HbA1c results is anaemia - you don’t have that do you?

 

[helli]

A while ago I read about ‘low glycators’ and ‘high glycators’ somewhere or other (!)

If that is still a concept that is still accepted, it be @Jan1956 that you just naturally make less glycated haemoglobin than most people - so at the same glucose level you produce a lower A1c?

For “low glycators”, is the HbA1C or TIR a better indicator of diabetes complications risk?

That may be a rhetorical question. At least, my expectations is we have not been measuring TIR for long enough to have the data to know.

 

[everydayupsanddowns]

There’s some more information about high and low glucators here

https://www.sciencedirect.com/science/article/pii/S1056872722001295

It sounds like it’s better to have it your way round (a lower A1c than your averages might predict). A high HGI seems associated with some health risks.

 

[everydayupsanddowns]

For “low glycators”, is the HbA1C or TIR a better indicator of diabetes complications risk?

That may be a rhetorical question. At least, my expectations is we have not been measuring TIR for long enough to have the data to know.

Yes that was my first thought about the post suggesting abandoning GMI because of differences with HbA1c.

Personally, I don’t think it should be assumed that HbA1c is always ‘right’, especially as studies already show that complication risk can vary significantly between 2 individuals at the same HbA1c, depending on whether their BG is gently undulating, or huge rises and crashes (which GMI may well capture!)

Maybe try the link I posted above and see if there are clues to answer your question there?

 

[Lucyr]

It sounds like it’s better to have it your way round (a lower A1c than your averages might predict).

Only downside might be making it harder to apply for a pump (not applicable to Jan but perhaps for other people), as the criteria is still based on hba1c so no provision for being someone who has low time in range but happens to have a lower a1c than you’d expect from their bgs.

 

[JimmyBlue]

Hi @Jan1956 , I am currently using a Libre2 CGM and a Clearsens dual to do BG and Ketone tests twice a day. I also have a Sinocare BG monitor. I cannot get a consistent reading between the three of them with Clearsens being higher than the CGM and the Sinorcare being below. However, I know that the CGM is a delayed measure (around 15 minutes delay, as the measure is of glucose in the skin not the actual blood glucose itself and as others have said the BG readings are simply point in time. I did see something on the Internet that suggested you needed to do roughly 9 finger prick tests per day to get a view of what your average is. So I presume that is before and after your three meals, when you get up and when you go to bed and perhaps one at night when you have to go the loo.

 

[Jan1956]

A while ago I read about ‘low glycators’ and ‘high glycators’ somewhere or other (!)

If that is still a concept that is still accepted, it be @Jan1956 that you just naturally make less glycated haemoglobin than most people - so at the same glucose level you produce a lower A1c?

Another factor that is known to affect HbA1c results is anaemia - you don’t have that do you?

@everydayupsanddowns sorry that this is a late reply. I missed the thread but thank you for replying .
My iron count borders on anaemia so I'm unsure if this would affect it ? However GP has accepted the result and does not feel I need a supplement.
I met with my GP this week but she seems as confused about the result as I am. She can clearly see that looking at my continually high blood sugar readings (often in excess of 10 mmol/l ) that there is a huge disparity between Hba1c and both my Dexcom and finger prick results. These are just not budging.
She has agreed to do another Chloresterol test to check my current levels and then change my chloresterol meds to one that is less likely to affect blood sugar so we can see if the Atorvastatin is affecting the BS readings.
She suggested putting me on 1 tablet of slow release metformin to see if this helped but she and I feel concerned that this might drop some of the readings too low into hypo.
I even wondered whether I should just pay for a private consultation to see an endocrinologist for advice?.

 

[Lucyr]

She suggested putting me on 1 tablet of slow release metformin to see if this helped but she and I feel concerned that this might drop some of the readings too low into hypo.

Metformin doesn’t cause dangerous hypos so no need to worry about that. It just helps your body use the insulin it already produces more effectively

 

[Tdm]

@littlevoice359
Thank you for reply. So, to clarify , are you saying that when I’ve converted a 7.5 mmol/l BS average into a HBA1C conversion chart to reach a level of 57 this is wrong?
My thoughts are that to be getting a HBA1C result of 33 I should be hitting finger prick averages of 5.0 to 7.0 mmol/l. However, my readings haven’t budged at all. They are never ever, as low as this. They’re in their 10’s after meals and my morning fasting readings are always 8.5 mmol/l plus? This is why I can’t believe the HBA1C can be correct?

Yes, an a1c of 33 would mean being in the low 5s a lot if the time, not being in the 7s.
Dies this a1c tally with previous a1cs?

 

[Tdm]

Anemia can means a1c is unreliable.
With average blood glucose 7.5 your a1c should be significantly higher than 33. My average glucose is 6 on dexcom and my a1c is (as i remember) 39