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An_202838 posted:
Hi, Folks! My A1C, according to my lab results for a life insurance policy is 6.3, which indicates diabetes Type II, my physician explained. I have been monitoring my blood sugar for the past 2 days, eating the worst types of foods imaginable: street tacos (double tortillas), sweets, and even fast food, all foods that I don't regularly eat. My glucose levels have been perfectly normal after meals and while fasting.

My questions: Does the A1C test capture something that the home blood glucose test does not? Can one have an A1C test that indicates diabetes while the home glucose tests indicates that no diabetes is present? I understand that the A1C is an average over the past 120 days. I would think that I would have attained an abnormal result on my home blood glucose test as well, no?

Thank you all very much for your responses. --L
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phototaker responded:
What you're not taking into account is what your normals are during the night.

Also, do you test two hours afterward? If I eat too many carbs at one time, my numbers will rise two hours afterward, much higher.

Lab results are different than home results, not as accurate.

Our meters sometimes don't measure as accurately as a lab test.

You don't know if you're going really low sometimes, too.

Two days might not be enough to really evaluate your bs numbers. Your pancreas may be functioning pretty well, but as time goes on, it functions less and less when stressed with high blood sugar numbers.
 
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leopo76 replied to phototaker's response:
I have been taking my blood sugar two hours after meals and my results are normal. You mentioned that I'm not taking into account what my normals are during the night. Did you mean while I am asleep? Is it possible that my blood sugar spiked while asleep and this is why my A1C is 6.3?
 
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mhall6252 replied to leopo76's response:
It is possible that you might have an impaired fasting glucose problem. That would make your glucose levels rise overnight/early morning and might account for a higher A1C.

This helps explain IFG:

http://en.wikipedia.org/wiki/Impaired_fasting_glycaemia

Michelle
 
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phototaker replied to leopo76's response:
For me, my fasting blood glucose numbers are always over a 100, yet my A1C is 5.9. I am definitely diabetic, as I cannot even eat a piece of fruit alone, or my blood sugar numbers will rise. I'm not on medicine for diabetes. Before lunch and dinner, I can find my numbers as low as 85, but the minute I have more than 40 or 45 carbs at once, my sugar levels go up. I have to keep my carb levels lower, in order to maintain good blood sugar control without medicine. I think at some point this is going to change, and I will need to be on medicine.

What I do to get a little lower fasting numbers is to eat a snack around 9:00-9:30 at night, just about 10-15 carbs, maybe a small apple and some nuts. That helps me to have some food in my body overnight, so my liver doesn't kick in, and cause my morning numbers to go up further. The longer I sleep in, in the morning, the higher my numbers go, so I make sure I wake up and have breakfast.
 
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laura2gemini2 responded:
Try also checking 3 or 4 hours after eating something really "bad". Fat impares insulin, and sometimes it can cause a spike later than if you ate something without fat. I know with my insulin pump there is a function called a "duel-wave" which is supposed to help with the later spike with the high fat foods.
 
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flutetooter responded:
You seem to be posting under two different names unless someone else is undergoing the same tests for life insurance and has an A1c of 6.3 and "perfectly normal" home glucose test numbers, and a "no diabetes" diagnosis after the glucose tolerance test. This is very confusing.

It just occured to me to ask what those "perfectly normal" home test numbers were, and how many hours after what meals were they taken?

This might shed some light on the apparent discrepancy between A1c, home tests, and the glucose tolerance test. Home tests are good for tracking what foods and activities affect your blood sugar, but they are not accepted by insurance companies to diagnose diabetes or no diabetes because there are too many uncontrolled circumstances.
If at first you don't succeed, try, try again!
 
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Laurie Anderson, MSN, RNP, CDOE responded:

Hi,
In June 2009 the American Diabetes Association announced at their scientific sessions in New Orleans that a group of diabetes experts had determined that using the hemoglobin A1C test was a reliable and more convenient way to diagnose diabetes. The members of this expert panel decided that an A1C cut-point of 6.5% or higher would be used to establish a diagnosis of diabetes. They also recommended that the diagnosis be confirmed with a repeat A1C test unless the person had clinical signs or symptoms of diabetes overall glucose levels over 200 mg/dl. they also suggested that people with an A1C in the range of 6 to less than 6.5% are at higher risk of developing diabetes (also called glucose intolerant or pre-diabetes in some sources). These individuals should be targeted for lifestyle modifications to prevent or delay the development of diabetes.

The committee also said A1c values are more stable after collection compared with the other tests. Blood glucose levels in samples taken from nondiabetic patients have been known to decrease by 3-10 mg/dl in as little as one to four hours when kept at room temperature. While that may seem like a small decrease, it is enough to move someone out of the diagnostic category of having diabetes if their blood glucoses are borderline, causing individuals and their health care providers to have a false sense of security. Hemoglobin A1C values vary less than fasting plasma glucose, or FPG, levels, and the measurement of an A1c has technical advantages compared with fasting glucose testing. These include the ability to test without regard to fasting state, to test immediately when in the office rather than requiring the patient to travel to the lab on another day, and the stability of the A1C test within the test tube versus that loss of glucose over a few hours time.

On a personal level, I find that many individuals test at times of the day during which they may get their best readings, such as in the fasting state. As others point out, your "worst" readings may be in the first 1-2 hours after eating a meal, rather than in the fasting state when you first arise for your day. So if a person misses seeing those points where there glucose is high, they might think that things are ok. This was the reason for the development of a number called the estimated average glucose, or eAG. This calculation turns your A1C into a number you are familiar with, such as you might see on your meter. The eAG for an A1C of 6.3% is 134 mg/dl, which is above the range of "normal" glucose. Your health care provider is being a wee bit aggressive (?) shall we say by calling you a diabetic, however he or she is probably looking at your lifetime risk of developing diabetes and assisting you now to control your risk of uncontrolled blood glucose and the complications that come with it.

I hope this is helpful, Laurie