HbA1c not recorded

Status
Not open for further replies.
P

pieman69pies

New Member
Relationship to Diabetes
Type 1
Hi, first time poster here.
I was diagnosed with type 1 back in 2002, and have had regular reviews and blood tests ever since.

However, the last 2 tests (6 months apart) for HbA1c were not recorded because the system says that haemoglobin variant is of an unknown clinical significance.

Firstly, what? And secondly, has anyone else had this happen?
 
No, never. I wasn't aware that there were variants to haemoglobin either.

What did the doctor tell you when you asked him?
 
pieman69pies said:
Hi, first time poster here.
I was diagnosed with type 1 back in 2002, and have had regular reviews and blood tests ever since.

However, the last 2 tests (6 months apart) for HbA1c were not recorded because the system says that haemoglobin variant is of an unknown clinical significance.

Firstly, what? And secondly, has anyone else had this happen?
Click to expand...
The HbA1c measures how much glucose sticks to the red blood cells. I think that if haemoglobin levels in the blood are outside the normal range (either lower because of anaemia, or higher because there is too much iron in the blood) the HbA1c becomes unreliable, because it is based on there being an average amount of haemoglobin in the blood for the glucose to stick to.
 
I feel that this consultant should maybe be taking steps to find out as to why after 20years it has now become a redundant method to test that way on me. He is going to put me on this freestyle libre thingy, as apparently that can measure it?
 
pieman69pies said:
I feel that this consultant should maybe be taking steps to find out as to why after 20years it has now become a redundant method to test that way on me. He is going to put me on this freestyle libre thingy, as apparently that can measure it?
Click to expand...
There is another test that can be done if the HbA1C is compromised because of any haemoglobinopathies, fructoseamine test I believe.
 
pieman69pies said:
Not a lot. Looking at putting me on the freestyle libre, as that can apparently measure it.
Click to expand...
The LIbre provides a HbA1C "estimate". Personally, I find the estimate overly generous (it was high by 10 last time).
However, more attention is starting to be paid to time in range which Libre definitely does measure and I think is more important: HbA1C is an average over the last 3 months and provides no indication of whether you achieve a lowish value by spending most of your time below 7 (for example) or because you had lots of hypos.

If you are going to have a Libre, it is a fantastic piece of kit but only if you understand its limitations. Take a look through some of the Libre threads (use the Search at the top of the page) where the limitations are repeated many times. Don't be too put off by the vocal minority who seem to have problems with it. If Libre was as bad as they suggest, it would not be used by as many people.
 
helli said:
The LIbre provides a HbA1C "estimate". Personally, I find the estimate overly generous (it was high by 10 last time).
However, more attention is starting to be paid to time in range which Libre definitely does measure and I think is more important: HbA1C is an average over the last 3 months and provides no indication of whether you achieve a lowish value by spending most of your time below 7 (for example) or because you had lots of hypos.

If you are going to have a Libre, it is a fantastic piece of kit but only if you understand its limitations. Take a look through some of the Libre threads (use the Search at the top of the page) where the limitations are repeated many times. Don't be too put off by the vocal minority who seem to have problems with it. If Libre was as bad as they suggest, it would not be used by as many people.
Click to expand...
I agree, Libre is the best thing that's happened to me diabetes-wise. But as you say the Hba1c estimate on Libre is over-generous, mine was exactly 10 points out as well (on the high side). But the Time in Target, and the alarms for high and low blood sugar, are great, especially during the night.
 
helli said:
If you are going to have a Libre, it is a fantastic piece of kit but only if you understand its limitations. Take a look through some of the Libre threads (use the Search at the top of the page) where the limitations are repeated many times. Don't be too put off by the vocal minority who seem to have problems with it. If Libre was as bad as they suggest, it would not be used by as many people.
Click to expand...
I agree Libre is a pretty good bit of kit - EVEN THOUGH I am one of those vocal people observing that I constantly have reliability issues with it. Hard fact: my failure rate continues at over 50%, not from falling off, it just stops working. I persevere because no Libre is so much worse than unreliable Libre.

BUT it is fair to manage your expectations and tell you it is not reliable for everyone. Accept that, if it happens, work through the inconvenience and the reward will exceed the hassle. Because Abbott have replaced every failure and because I have reluctantly carried short gaps or worked with a sensor reading many points adrift (I just monitor the trend), I have accumulated a reserve of 4 sensors, so now when 2 fail in the same 24-48 hrs (at least 3 times in 18 months) I can now better absorb the impact and just replace them without the consequential stress. My "day out" pack now always includes a spare Libre - because it takes a full 24 hrs to bed in and I'd rather get restarted as quickly as possible.

I am also a strong supporter @hellis ' lists of the limitations. Interstitial fluid is not actual BG. But used within those limitations Libre is invaluable.
 
Yep - trends trends and trends. Had a little adjustment to some basal rates again the other night, after doing a download and seeing that Oh yes, BG is increasing from X to Y o'clock this month .....
 
Hi @pieman69pies. To come back to original question! I have been a bit boring and tried to look up exactly what HbA1c is and how it is measured - comes of having been an experimental scientist who used to measure things for a living. What you find, like many things, it is that it is nowhere near a straightforward as some would have you believe.

First off there seem to be lots of haemoglobin variants. HbA (haemoglobin variant A) is the most common in humans so the idea of a "haemoglobin variant without clinical significance" is not unreasonable, although it would need an expert to figure out why it turned up in your test reports.

Second is that there seem to be number of different methods for measuring HbA1c and I am sure each will have their own foibles.

The fact that two tests have come back as invalid suggests to me, and it really is an educated guess, that something has changed at the laboratory where the tests are done. Kit might have changed, protocols might have changed or even the laboratory might have changed. The consultant probably has a good idea about what has happened because you will not be the only one with the same report, but maybe is not going to share it with you because there is little he can do about it.

Offering the Libre could well be a pragmatic way out for him. Its primary use is to provide a lot more information about how your blood glucose varies during the day and as such is far better than intermittent HbA1c tests when it comes to getting your insulin regime adjusted when needed.

Hope that helps a little. Let us know how it goes.
 
Status
Not open for further replies.
Back
Top