# Relationship between A1c and number of lows **URL:** \ **Category:** Type 1 & LADA\ **Created:** [June 13, 2017, 4:48pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240 "2017-06-13T16:48:20Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Chris](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/chris/32/382_2.png) [@Chris](https://forum.fudiabetes.org/u/Chris)\ **Post date:** [June 26, 2017, 10:07pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/41 "2017-06-26T22:07:35Z")
Here is a simple one: > **[How High Blood Sugars Damage Blood Vessels](http://www.diabetesincontrol.com/how-high-blood-sugars-damage-blood-vessels/)** > > Researchers have gained fresh insights into how elevated glucose levels damage blood vessels. The mechanism could lead to novel strategies for blocking ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 26, 2017, 10:13pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/42 "2017-06-26T22:13:07Z")
> [@Chris](#): > > You won’t find ones that are studying the effect of glycolated hemoglobin as a primary cause of damage. I am not so sure now. (I am sticking with my story that CGM is significantly better and more useful than A1c). But to the issue/question as to what actually causes damage, I think this article: > **[Glycated hemoglobin and its spinoffs: Cardiovascular disease markers or risk...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549778/)** > > Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated glycated haemoglobin A\[1C\] ... is pretty spot on to the question of: > [@Thomas](#): > > Is it the glycated hemoglobin which causes the damage OR the glucose in the blood which is not attached to the hemoglobin? (Or some combination thereof.) ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [June 26, 2017, 10:16pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/43 "2017-06-26T22:16:55Z")
But it’s also accurate to say that it’s not the glucose that directly damages the blood vessels, per se. Basically, there’s a complicated, multi-step chemical reaction (or several of them) in which free-floating glucose is bound and then chemically transformed into multiple byproducts which we lump together as advanced glycation end products. Some of these AGEs likely directly contribute to damage, some may be correlated with underlying damage processes but not directly respnsible, and some may even be a sign that the body is adaptively responding to high sugar levels in a way that is protective (some Joslin medalists have a few AGEs that seem to be protective), and some may have no significance at all. i found this study, which is talking about skin aging, to still have a good and informative discussion about AGEs in the beginning, although perhaps others might find this too technical. > **[Advanced glycation end products: Key players in skin aging?](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3583887/)** > > Aging is the progressive accumulation of damage to an organism over time leading to disease and death. Aging research has been very intensive in the last years aiming at characterizing the pathophysiology of aging and finding possibilities to fight... ---
**Author:** ![Chris](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/chris/32/382_2.png) [@Chris](https://forum.fudiabetes.org/u/Chris)\ **Post date:** [June 26, 2017, 10:45pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/44 "2017-06-26T22:45:31Z")
I don’t disagree with why you have said in any way. You usually have a better technical answer than I, since my cro-magnon research was on transition metals, and in no way studied how they affected the numerous body processes. Every damage pathway will include some combination of genetic predisposition, acute and chronic changes to normal physiology, multiple chemical reactions resulting in a simple or complex pathway change. I find it interesting that some have been found to be helpful. ---
**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\ **Post date:** [June 26, 2017, 11:42pm UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/45 "2017-06-26T23:42:14Z")
I kinda have to side with @Thomas on this one. A1c can be pretty variable in a narrow range–is 5.5 really that much better than 6.3? CGM gives you information to figure your average bG AND the Standard Deviation. An average of 108 will give you an A1c of about 5.5. But what you don’t know if if that was achieved with an S.D. of 15 or 40. That makes a big difference. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [June 27, 2017, 12:05am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/46 "2017-06-27T00:05:18Z")
> [@docslotnick](#): > > That makes a big difference. I think science hasn’t quite yet determined if it really makes any difference at all in terms of complication risk… it seems to be a widespread assumption amongst users that it does, but not one yet established by science, and maybe not one that ever will be, perhaps even one that will be disproven… But we do know that A1C and complication risk go hand in hand. I think it’s a reasonable goal for everyone to minimize variability to as closely as possible mimic normal glucose profiles, and I think the cgm is a very good tool to use in pursuit of that goal, but I don’t think that goal does anything to reduce the value of a healthy A1C-- which we positively know for certain is hugely significant in the the complication risk > **[Glycemic Variability and Microvascular Outcomes in T1D](https://www.mdedge.com/endocrinology/clinical-edge/summary/diabetes/glycemic-variability-and-microvascular-outcomes-t1d)** > > Glycemic Variability and Microvascular Outcomes in T1D ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 27, 2017, 12:10am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/47 "2017-06-27T00:10:02Z")
> [@docslotnick](#): > > A1c can be pretty variable in a narrow range–is 5.5 really that much better than 6.3? Some of the things CGM doesn’t capture well: 1. Gaps when sensor is down, new insertion time, or time when the sensor and receiver are not communicating. 2. Lags in low time, how the CGM thinks you are low for 30 minutes but you’ve actually corrected it much faster. 3. Never reaching the top height of your BG spike, you reach 200 and have corrected and your on your way down, but your CGM is still at 150. I think these are problems with the CGM as a marker. I don’t think A1C is useful for comparing Eric to Doc, but I **do** think it is useful for comparing the Doc from “January thru March” to the Doc from “April to June”. (As long as you haven’t killed a lot of your RBCs 😂 ) A lot of the problem we have is comparing our own A1C with that of another. That is not a valid comparison. ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 27, 2017, 12:30am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/48 "2017-06-27T00:30:56Z")
> [@Eric](#): > > time when the sensor and receiver are not communicating G5 v1.2 transmitter - No longer an issue. Fixed. 3 hr data backfill from transmitter to the Apple/Android apps. [if you have more than a 3 hr gap - you probably have bigger issues - lol] 🙂 As FYI, we absolutely do not see a 30 minute lag time. Not even close. 10 minutes maybe? ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 27, 2017, 12:37am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/49 "2017-06-27T00:37:11Z")
Must be nice, the lag time doesn’t work that way for me. Also when I turn on my phone app, I get zero backfill. Is that an app version problem maybe? ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [June 27, 2017, 12:43am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/50 "2017-06-27T00:43:29Z")
I don’t know that it would be expected to backfill starting the moment you turn the phone on… but if the app is tracking the data and is interrupted for a period of time, it should backfill for up to 3 hours… I’d say I also see close to a 30m lag on the cgm… at least 20 anyway, and when my blood sugar is actually acting funky it’s unacceptably inaccurate… it basically is only really good and accurate for tracking my bg while it’s perfectly stable and not moving, and even then it frequently registers false lows… ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 27, 2017, 12:49am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/51 "2017-06-27T00:49:51Z")
I’ll mess with the phone backfill some more. I mostly use the receiver. I like it better because…you can buy them on eBay! 🤣 ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 27, 2017, 12:52am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/52 "2017-06-27T00:52:00Z")
> [@Eric](#): > > Is that an app version problem maybe? I tested the backfilll from Apple iPhone on app version 1.7.1. (I think - version not in front of me as I type.) Based on the Dexcom receiver NOT working with the backfill, I would assume that older apps also did NOT support the backfill. I can only say the one (ie Apple v 1.7.1) that I saw which DOES support it. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [June 27, 2017, 12:56am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/53 "2017-06-27T00:56:21Z")
> [@Eric](#): > > you can buy them on eBay! You can also buy tweezers on eBay. I did so today. ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 27, 2017, 12:57am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/54 "2017-06-27T00:57:32Z")
> [@Sam](#): > > when my blood sugar is actually acting funky it’s unacceptably inaccurate My daughter just had a low in the 55 range of so. Don’t recall exactly. We verified with a meter partly because the Dexcom had been complaining for lack of a calibration all day. I forget the difference but it was less than 10 points between the CGM and meter. At least for us the Dexcom is really great and quite accurate. ---
**Author:** ![Sam](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/sam/32/10595_2.png) [@Sam](https://forum.fudiabetes.org/u/Sam)\ **Post date:** [June 27, 2017, 1:00am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/55 "2017-06-27T01:00:45Z")
It will register lows (some of them correctly even) so for people who really struggle with lows I can see the appeal, and I suspect when you’re managing for a child they’re probably the best thing in the world… at this stage of the game for me though I just already know when my blood sugar might be low, what conditions might lead to that being the case, and can avoid those situations long before a cgm could notify me of them… ---
**Author:** ![TiaG](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/tiag/32/594_2.png) [@TiaG](https://forum.fudiabetes.org/u/TiaG)\ **Post date:** [June 27, 2017, 1:37am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/56 "2017-06-27T01:37:29Z")
We find Dexcom is really great and accurate … except when the numbers are weird. It often (very often) overestimates the depth of lows and how long they last. If ever get the mental bandwidth I plan to do a systematic experiment: Finger test before each of our Dexcom treatment thresholds, then record the same reading on Dexcom at the same time. Finger test 15 minutes after treating the low, and record Dex’s reading at that time. Thensee if Dex has any skew. My guess is that it may be lagging by about 10 minutes on the steep drops but that it dramatically overestimates the time it takes for BG to rise. Anecdotally, I would say about 75% of the time when it says our son is low during the night and I actually test, he’s not low. I can’t say at school because they usually don’t test, but a lof the really persistent lows (say he’s hanging out in the 50s or 60s for nearly an hour on Dex) and I ask them to test, he’s usually 89 or 95 or something. The main times when he’s low by finger stick and Dexcom is oblivious to the low, we have usually missed a calibration earlier in the day. But it would be nice to actually have some numbers on this, ---
**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\ **Post date:** [June 27, 2017, 2:23am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/58 "2017-06-27T02:23:57Z")
@Eric I have a 98% capture rate consistently in xDrip+. The A1c estimate it gives me is exactly what the A1c blood test shows. I also get readings during sensor warm-up, with only 3 or 4 being erroneous. I am sure that within a short time the FDA will give Dexcom the OK to start doing the things that xDrip+ does now ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 27, 2017, 2:54am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/59 "2017-06-27T02:54:47Z")
> [@docslotnick](#): > > I am sure that within a short time the FDA will give Dexcom the OK to start doing the things that xDrip+ does now I am not sure that is the direction Dexcom is going. What functionality are you thinking of? (I am not familiar with xDrip+ other than the general concept.) ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 27, 2017, 3:01am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/60 "2017-06-27T03:01:35Z")
Yeah, I guess xDrip gives you better coverage times compared to what the regular receivers give you. My last sensor coverage was basically useless. ---
**Author:** ![Thomas](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/thomas/32/1719_2.png) [@Thomas](https://forum.fudiabetes.org/u/Thomas)\ **Post date:** [June 27, 2017, 3:36am UTC](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240/61 "2017-06-27T03:36:36Z")
> [@Eric](#): > > My last sensor coverage was basically useless. Switch to one of the [updated] smartphone apps for a receiver. [Previous page](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240.md?page=2) [Next page](https://forum.fudiabetes.org/t/relationship-between-a1c-and-number-of-lows/1240.md?page=4)