Annual review - and a bit of a puzzle

[Northerner]

I had my annual review at the GP surgery yesterday - usual stuff, weight, BP, foot-tickling, do I smoke, how much alcohol do I drink etc. - all fine. Then the nurse got onto my blood tests. My HbA1c was 47 mmol/mol, which is absolutely fine as a number, but it is around 20% higher than my last one (in June), which was 40 mmol/mol. In fact 47 is the highest I've had since I was diagnosed, as I've always been in the 30s, apart from that 40 and a 42 a couple of years ago when I wasn't in a great place with my overall health, so I accepted that.

But I really am puzzled by this as it doesn't seem to correspond to any expectations I've actually been in pretty good shape over the past few months, doing a lot of running, eating well, and I've actually lost about 16 lbs since April, and down to a very healthy weight 🙂 Moreover, I've been using the Libre for the past 4 months and its prediction of my HbA1c is way below 47, and much more in line with my expectations, as shown:



The graph shows clearly how good my control has been, I very much doubt the consultant will see better when I have my 6-monthly review at the hospital in a couple of weeks. I did question whether the results were mine, or if the test might not have been conducted properly, I'm sure these things happen. The other thing on the blood tests was my thyroid test, which also showed higher than I have had previously, although only just above range so nothing to be concerned about and I feel perfectly fine so it's obviously not affecting me (I stopped the medication on the consultant's advice in June). My cholesterol was 5.1, with HDL of 1.7, which I believe (correct me if I've got it wrong!) is a ratio of 3 which is pretty darned good and I'll take that and no statins thank you! 🙂

As I mentioned, I have a review at the hospital in a couple of weeks and will be having all these tests done again - I know, I did query the duplication and expense! - so it will be interesting to see what the HbA1c, in particular, comes out as 🙂

 

[Stitch147]

Will be interesting to see what is said at your review at the hospital. Mine always seem to be lower than I expect them to be. I'm due my blood tests towards the end of January.

 

[Robin]

How weird. Mine are always higher than my libre prediction, but not to that extent. Did you have a full blood count? Anaemia can affect the HbA1c (gives a higher result because there are fewer red corpuscles for glucose to stick to) but that seems unlikely if you’re feeling fit.

 

[everydayupsanddowns]

I’ve had one or two A1cs over the years which have been very surprising and didn’t seem to match my fingersticks. One was just before a Diabetes event where I was attending that had fancy ‘instant A1c’ machines - so I had one of those done and it was much more what I was expecting.

Hope the hospital appointment goes well and I will also be interested to see what the rechecks come up with!

 

[Northerner]

How weird. Mine are always higher than my libre prediction, but not to that extent. Did you have a full blood count? Anaemia can affect the HbA1c (gives a higher result because there are fewer red corpuscles for glucose to stick to) but that seems unlikely if you’re feeling fit.

No, I can't imagine there's a problem there, might just be a duff test, although the thyroid one was a bit confusing too. Cholesterol test was pretty much in line with expectations.

 

[Northerner]

I’ve had one or two A1cs over the years which have been very surprising and didn’t seem to match my fingersticks. One was just before a Diabetes event where I was attending that had fancy ‘instant A1c’ machines - so I had one of those done and it was much more what I was expecting.

Hope the hospital appointment goes well and I will also be interested to see what the rechecks come up with!

I've probably been having fewer 'real' hypos i.e. ones where I get strong symptoms, thanks to the predictive element of the Libre, but I can't see that I was having so many more over the past 11 years that it always meant my HbA1c was low because of them. I do get into the occasional 10s, and I think I had one over 15 in August, but the rest have been in single figures, and I am 96% in range over 90 days, with 2% above and 2% below. I have noticed that my Contour Next always reads about 1 mmol/l higher than the Libre - either blood test or scan - so maybe in working to the Libre over the past 4 months my levels have been higher than in the past. I'll only believe the 47 if it's repeated in a couple of weeks! 😱 🙂

 

[grovesy]

My HBA1C was higher than the Libre was predicting. Though I had not been using for the full 3 month period. Though I have also have high than predicated results with predication Mysugr too.

 

[Pumper_Sue]

How sure are you the Libre is accurate? Another thought springs to mind regarding your thyroid test. Does having a slightly off thyroid, result in a higher A1c than expected?

 

[Northerner]

How sure are you the Libre is accurate? Another thought springs to mind regarding your thyroid test. Does having a slightly off thyroid, result in a higher A1c than expected?

I will ask the question Sue 🙂 Some of the Libre sensors have been a bit suspect, maybe reading 2 mmol/l lower than a fingerprick on the reader, and 3mmol/l lower than the Contour fingerprick, but some have also been right in line with fingerpricks. I think the surprise really is what might have increased the number when I know for a fact I have been very 'good' over the past few months, and in the past that would never have produced a large increase in HbA1c. All may become clearer in a couple of weeks! 🙂

 

[Northerner]

My HBA1C was higher than the Libre was predicting. Though I had not been using for the full 3 month period. Though I have also have high than predicated results with predication Mysugr too.

Yes, I was half expecting the test result to be higher than the prediction, but not 11 mmol/mol higher, does not compute! 😱 As I said earlier, it's still a good number, but a bit worrying if it's going to get worse as I have no idea what I might be doing 'wrong' 🙄

 

[ianf0ster]

Congrats on having such good control. Unless it is a bad Lab result, I have no ideas about the HbA1C.

However just on the subject of Cholesterol, did you have a full Lipid profile? If so was your Triglycerides reading less than 3.4 (twice your HDL)?

That is the ratio that I put most faith in - though my GP Surgery are still in the 'dark ages' and just using LDL.
Of course the best predictor of heart/artery health is the Calcium scan, better even than the sdLDL particle count.

 

[Northerner]

Congrats on having such good control. Unless it is a bad Lab result, I have no ideas about the HbA1C.

However just on the subject of Cholesterol, did you have a full Lipid profile? If so was your Triglycerides reading less than 3.4 (twice your HDL)?

That is the ratio that I put most faith in - though my GP Surgery are still in the 'dark ages' and just using LDL.
Of course the best predictor of heart/artery health is the Calcium scan, better even than the sdLDL particle count.

Hi Ian - no the only numbers I was given were the total chol and HDL 🙄 In 11 years I don't think they've ever given me a number for triglycerides, or even if they've tested for it.

 

[Docb]

Doubt if you are doing anything wrong Northener, more likely that the algorithms used to convert what ever the Libre measures into a predicted HBA1c need tweaking in your case. There is a hell of a lot of jiggery pokery going on between the tiny voltage variations on the libre probe and the fancy graph on your screen. Pound to a penny that the jiggery pokery will have been done to get it roughly right for most of the users most of the time accepting that it might be a bit off for some.

I would see whether you get the same effect next time you have an HBA1c done. If so, it might suggest that your system or technique is producing a low result compared with the lab result. No problem, because most would be happy with what you got, either way.

 

[Northerner]

Doubt if you are doing anything wrong Northener, more likely that the algorithms used to convert what ever the Libre measures into a predicted HBA1c need tweaking in your case. There is a hell of a lot of jiggery pokery going on between the tiny voltage variations on the libre probe and the fancy graph on your screen. Pound to a penny that the jiggery pokery will have been done to get it roughly right for most of the users most of the time accepting that it might be a bit off for some.

I would see whether you get the same effect next time you have an HBA1c done. If so, it might suggest that your system or technique is producing a low result compared with the lab result. No problem, because most would be happy with what you got, either way.

Yes, I'm not unhappy with the result, it's fine 🙂 And I would expect the actual HbA1c to be higher than the prediction from the Libre, that's something that is commonly observed on Libre groups. What is puzzling me is the large divergence from the experience of all my previous HbA1c results, all bar 2 of them in the mid-30s

I did a spot check as I know my current sensor is reading lower than true, and sure enough a scan showed 6.1 mmol/l, an Libre fingerprick showed 8.0 mmol/l and the Contour Next was 9.4. My though was, perhaps if I've been in the 9s but thinking I was in the 6s this would have influenced my behaviour - eating something when I thought I was heading towards 4.0 mmol/l when in fact I didn't need to because I was actually heading towards 7.0 mmol/l. This would mean my levels during my time using the Libre would be perpetually higher than when I was guided by the Contour, leading to an increased HbA1c. However, not all Libre sensors have shown this variation, some have been very much in line with the Contour results, so it's not like I have spent the entire 3 months depending in inaccurate results 🙄

I was actually expecting an HbA1c lower than the 40 I got in June - based on experience over the past 11 years of how active and 'good' I have been prior to the tests - not nearly 20% higher!

Lots to talk about anyway, especially since this will be my first review after the C-peptide test I took in June which resulted in confusion about the actual origin and type of my diabetes 😱

 

[nonethewiser]

Yes, I'm not unhappy with the result, it's fine 🙂 And I would expect the actual HbA1c to be higher than the prediction from the Libre, that's something that is commonly observed on Libre groups. What is puzzling me is the large divergence from the experience of all my previous HbA1c results, all bar 2 of them in the mid-30s

First off 47 is still good result, but can see your frustration comparing it to previous results libre prediction.

Yesterday was out all day and didn't bg test at all, only libre scans, on most days do test just to keep eye on libre accuracy, easy to become complacent with new tech but it can go astray, so frequent bg tests, even just once a day keeps things in check.