Inaccurate A1c

Not expressing an opinion, just asking ‘cause I was confused!

My original question may have been unclear so let me give you a little more information. When I was diagnosed about thirty years ago I used MDIs and tested my blood sugar 8 times per day with a blood glucose monitor. I had my A1c tested every 3 months and rarely had a number above 5.0 - usually I measured between 4.5 and 4.8. The doctor thought my A1c was amazing, but meanwhile my blood glucose monitor numbers were all over the place and I rarely had low numbers. Over the years, like most of us I moved onto a pen and ultimately to a pump. Before I had my CGM (got it two years ago), I still used the blood glucose monitor and had my A1c done every 3 months. The download of my monitor showed frequent high numbers while my A1c still measured under 5.0. My doctor made the assumption that I must be having a lot of lows (not the case) to end up with such a low A1c. Fast forward to two years ago when my endo retired and I started seeing a doctor more recently out of med school. I got my CGM and when my new doctor looked at the numbers she said there is no way the A1c could be accurate. She sent me to a hematologist where I had a bunch of tests done and the consensus was that my red blood cells looked fine but I must be one of a small number of people that turns over red blood cells quicker than “normal.” My new endo had me tested with the fructosamine test which consistently shows that my blood sugar is around 6.5, while the A1c still measures around 4.5. I’m trying to find out if anyone else has had a similar condition as it relates to red blood cells.

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If your CBC is off - specifically areas related to RBCs (MCHC, MCV etc) there you go. But there was also a recent study that proved a certain % of A1Cs are inaccurate in certain patient populations. I had same issue except mine showed A1C of 4. I had to prove to docs via fructosamine and CGM. Many fall into habits

Thank you for your response. It’s nice to hear I’m not the only one with this issue.

Remember - you know your body better than any doctor. Often they forget that though. Also they have a default as doctors. Human just like we are so never stop being your own advocate! Carry on & stay strong!!!

Lots of folks have posted on the “range” - yours, the lab’s and standards “in general.”

My sense of your post however, is that your former endo totally missed the boat with respect to your medical necessity. A patient who consistently asks for a pump is asking for help relieving the relentless burden of dealing with T1D manually. Your new endo may (not) recognize that either but and has the added ammunition of numbers “out of range” or some such.

Burnout and emotional stress are very real. Check out the good work (not new just gaining more traction) from Behavioral Diabetes Institute (Dr Polonsky) and TCOYD (Dr Edelman). Perhaps endos focus mostly on the metabolic issues due to their specialized training. CDEs (now CDCESs - certified diabetes care & education specialist) may be in a better position to work with us on the non-numbers demands …

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