FUDiabetes

What's up with my A1c?

So I’ve been on the OmniPod since the end of May and the estimated average glucose calculated in Glooko is running at 124. The pump trainer last week looked at my trend info and was very excited about the improvements in BG that she saw, especially time in range. So why did my A1c come back as 7 percent?? :scream_cat:

The PA ordered some more blood tests (fructosamine, anemia, something else I can’t remember) to see if there’s some other problem that would confound the A1c. But I was so flustered I nearly left the office without a new insulin RX!

Just had to get that off my chest 'cos I know you guys will totally get my feelings of distress.

ETA 9/22/17: The fructosamine test confirmed the A1c result and we are flummoxed. The only good thing that might come out of this is maybe insurance will approve Afrezza??

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What the hey?

My first thought: are you using the freedom meter on the PDM?

We started testing the PDM meter against our old meter, and it seems to run on average about 12 lower (so you end up adjusting high). This result is only preliminary for us though, through about 10 strips.

I feel good about the average results of our old meter (Verio), because, when we started titrating, my son did not feel low at Verio-70, but felt low at Verio-60.

Which A1c test did they use, i.e. laboratory or finger stick? If finger stick, could be variablity in the test.

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Although this is technically outside the edge of being outside the error rate, right? I thought the error was around 1% on A1C.

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True, but if they haven’t calibrated their equipment in some time, it could be machine error. I have much more faith in a well run laboratory number.

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Let me reassure you that it just takes time to get it dialed in.

You were on MDI before, right? And if you started in May, that’s only 4 months ago. If you are looking at a 3 month A1C, that means you really only had 1 month to get used to it before your BG started “counting” for this most recent A1C.

A pump is different. Basal, bolusing all of it. Infusion sites you are using now that you maybe never did with MDI. And places you used to inject that you are no longer using.

The first one is just a rehearsal. :wink:

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Laboratory test. I will ask next time how often the system is calibrated.

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Comparing your meter average BG to A1C only makes sense if you test throughout the day. If your checks are mostly before meals and some 2-3 hours later your meter average will not be a good estimator if you spike after meal but down again at 2-3 hours.

Unless the glooko app tries to estimate BGs between tests based on other info it may have regarding food intake. I am not familiar with the app.

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I do use a CGM as well as a pump and calibrate twice a day. One thing I have really been working on is averting spikes sooner and also generally eating fewer carbs (20-30 per meal). Sigh…hence my discouragement (if that’s a word)…

No need to ask, if it is a laboratory measurement, you can be sure it is a good measurement.

Don’t be discouraged by A1C results - BUT I know that feeling :slight_smile: .

There are lots of things that impact the A1C number as you . One is the lifespan of your red blood cells and another reason is the just the overall accuracy of the test.

I got a CGM last September and quickly improved my numbers based on the CGM data. I was expecting great things for my end of November A1C but had the same disappointment as you - the A1C did not show a huge improvement and did not match the 90 day meter average. For some reason, I had a blood test a month later in December and the A1C was re-ran. It was 0.6 lower but I still had the exact same 90 day average! - I was happy :slight_smile: as this A1C was closer to the meter average but it still was higher than expected.

My A1C from the lab is usually about 0.5 higher than expected from the BG meter average. If I correlate my red blood cell count with the A1C, when my RBC count is above the reference range, the A1C is usually higher than my meter/cgm average. When the RBC count is normal, the A1C tends to be closer to the expected value. (There is no science behind this - it is just an observation that I had).

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Another thought - before you made the changes, did your A1C’s match your BG meter average using the formula?

I don’t know how well they matched but the Dexcom report usually ran a little lower than the lab result. My current 30-day meter average is 129. I dunno…maybe other issues pertaining to the blood cells as you suggest so they are checking.

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Glooka is only indicative of the times that you’ve checked your BG’s with the PDM. If you have highs where you haven’t checked BG’s this would add to the A1C…even if the data isn’t showing up on Glooka. Have you experienced a lot of highs that have perhaps not been accounted for with finger sticks?

Regardless of what Glooka/PDM show, the actual blood check that the Endo does will be the correct gauge of your actual A1C, but I would ask them to recheck…perhaps it was a false result?

The neat thing about Glooko is that one can send Dexcom data to the app via the iPhone’s Health app.

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@CatLady, this must be so distressing :frowning: It distresses me right now.

I think about it over and over – I agree with @Eric that it should not be discouraging since it’s the first time in a full cycle. But:

  • if you like the curves you saw,
  • if they look better than they did before
  • and if your dexcom numbers are better than they used to be

It is quite possible that the glucose levels are off from your last meter, in which case it is an easy fix. I have read about the same thing happening to others :frowning:

I am disturbed by this happening to you – as I was when @Irish had that awful appointment with her endo from hell.

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I so appreciate everyone’s support and insights! :smiley_cat:

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Well, @CatLady, I’m really sorry to hear this too. There’s nothing more frustrating than working hard and feeling like you’re spinning your wheels (or worse). I wish you had heard better news! I would be curious about the meter you’ve been using. Is it one that squares with the list of meters we’ve recently discussed on the forum?

And there’s nothing like having to deal with unexpected news on the fly at an appointment to cause confusion. As @Michel reminds us, I know my way around being flustered at the endocrinologist’s (my appointment is tomorrow. He’s gonna just love that 33 I had a week ago). I credit you with remembering the insulin prescription at all.

I am confident that you will get this reigned in with more experimentation. Looking forward to a good appointment in the near future for you (and hoping that the other tests come back clear for you). Please keep us posted as you can!

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Perspective - while an A1c below 7 would be nice, having an A1c in the low 7’s means you have reduced most of the additional complication risk that comes from having diabetes. If you can achieve a lower A1c, awesome, it is a goal worth achieving, but living in the flat part of the curve isn’t all bad. Until the newer generation of tools became available, almost everyone lived with a quite high A1c and many of them are doing great.

image

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@Chris, Terrific graph! :smiley_cat:

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