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Medical Forum / Diseases and Disorders / Diabetes / March 2006Baffling Labs
I'm completely baffled by my latest labs. My control as measured by my bg meter has gotten much much better, and my A1c has gone up! I've been using basal insulin since the beginning of January and my fasting and post prandial readings have dropped by at least 20 mg/dl from what they were this fall. Testing 5 times a day my average reading of over 100 readings is 100 mg/dl. So how the hell did I end up with an A1c of 5.8%? My meter reading matched the lab reading closely. So there's nothing wrong with the meter. To make it even more baffling, the lipids read as if I'd cut my carbs, not raised them and added insulin. TGs have dropped from 106 to 85 mg/dl and HDL has risen from 67 to 75 mg/dl. Anyone have something like this happen to them? --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control A1c is wrong. :: I'm completely baffled by my latest labs. My control as measured by :: my bg meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 21 lines] :: http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood :: Sugar Under Control First verify that A1C number is right. As some one here said for < $10.00 you can get a Cosco kit to do the testing. Buy to kits just in case. If you want to go over board you can get one from CVS as well for $20.00. If all of them roughly give you the same numbers, only thing I have to ask is do you test your BG in the middle of the night? Is it possible that BG is high at night for what ever reason when you are not watching? Sorry to hear you got such mixed up results, but 5.8 by itself aint that bad. To reflect average of 100 though you should have seen A1C as 5.0 that is an error of 16%! Hope the lab is not that messed up! I have always wondered though how often they test accuracy of their own meters. I do suspect they must be doing these checks almost every day. The liability is simply too big. Anil > First verify that A1C number is right. As some one here said for < > $10.00 you can get a Cosco kit to do the testing. Buy to kits just in [quoted text clipped - 5 lines] > that BG is high at night for what ever reason when you are not > watching? I have used the home A1c tests in the past and they were .5% higher than the lab test, so I don't trust them. The margin of error is 1 full percentage point according to the docs that come with the home meters, so that level of precision wouldn't help me much. I have tested at night a few times and except when I'd eaten Dreamfields Pasta, I hadn't seen highs. My fasting number is way down, too. > Sorry to hear you got such mixed up results, but 5.8 by itself aint > that bad. To reflect average of 100 though you should have seen A1C as > 5.0 that is an error of 16%! Hope the lab is not that messed up! That's what I thought, but this is the lab I usually go to and the first time I've had a result that far off. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control :: Anil wrote: ::: First verify that A1C number is right. As some one here said for < [quoted text clipped - 23 lines] :: That's what I thought, but this is the lab I usually go to and the :: first time I've had a result that far off. That's a good thing, right? >> I have used the home A1c tests in the past and they were .5% higher than >> the lab test, so I don't trust them. The margin of error is 1 full >> percentage point according to the docs that come with the home meters, >> so that level of precision wouldn't help me much. In past the result of verifying with home kits were indeed close to what lab gave you. That iis a good thing. Do it again now as you are having a difference of 16% well outside the margin of error for home kits if I understand you correctly. If the home kits come close to 5.8 lab test result then the only conclusion you are left with is to changing your test patterns. It just would mean your PPBG is peaking erratically and is perhaps happening outside the 2 hr window. Your best bet is to test more often say take 10 readings or 12 reading in 24 hr period. At some point you continue testing you will find a region where you are exceeding the observed values. Hopefully it is just the lab goofup. Wish you the best. Would be curious what you find. Anil >>> I have used the home A1c tests in the past and they were .5% higher than >>> the lab test, so I don't trust them. The margin of error is 1 full >>> percentage point according to the docs that come with the home meters, >>> so that level of precision wouldn't help me much. > In past the result of verifying with home kits were indeed close to > what lab gave you. That iis a good thing. > Do it again now as you are having a difference of 16% well outside the > margin of error for home kits if I understand you correctly. If the [quoted text clipped - 4 lines] > 12 reading in 24 hr period. At some point you continue testing you will > find a region where you are exceeding the observed values. > Hopefully it is just the lab goofup. First rule of experimental science as in DIY woodwork: if the number looks funny take the measurment again.  SignatureChris Malcolm cam@infirmatics.ed.ac.uk +44 (0)131 651 3445 DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] > First rule of experimental science as in DIY woodwork: if the > number looks funny take the measurment again. That would be my thought, but my insurance won't pay for another test and I doubt my doctor will order it. They already believe they are doing me a huge favor by testing 3 times a year. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny <lottadata@hotmail.com> wrote in news:LLOdnRPktOG0hIfZnZ2dnUVZ_t- dnZ2d@rcn.net: >> First verify that A1C number is right. As some one here said for < >> $10.00 you can get a Cosco kit to do the testing. Buy to kits just in [quoted text clipped - 27 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control I was surprised the other way. My A1c was lower than I thought. I went back through the numbers and found several places that I had retested a high two or three time and forgotten to mark them to be uncounted in the average. Perhaps you had some lows you rechecked and made the average reflect a lower number than it should have? <snip> > I have tested at night a few times and except when I'd eaten Dreamfields > Pasta, I hadn't seen highs. My fasting number is way down, too. <snip> > --Jenny Jenny, I am interested in that pasta. My wife got a box and read the label.... they have more carbs than regular pasta and more sugars. Their claim, which is not supported by any labeling method that they "must use", is that adding guar gum and some other thickeners (similar to those found in ice cream) make you unable to absorb those carbs. I think this is a pile of crap. Their web site doesn't support their numbers on their box either. Another sign of some serious flim flam. Also, I sent them an emial (after discovering that their web based message tool doesn't work properly) which they have never responded to. Personally, I won't eat their product. I don't see why I wouldn't spike. I wouldn't take the chance. What are your experiences? I hope that I am remembering the brand correctly but if it is what I remember, they seem like a flim flam operation. I am interested in your findings. Thanks, Sax > What are your experiences? I hope that I am remembering the brand > correctly but if it is what I remember, they seem like a flim flam > operation. I am interested in your findings. Re: Dreamfields. My experience is that it is slower than regular pasta, but the carb impact over time is considerably higher than the label claim. I eat it every now and then but expect to see a higher fasting number when I do (maybe 10 mg/dl). If I got my basal too high (as happened when I was first trying to establish the dose) I'd have some as a slow release carb to keep me from going low at night. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control <snip> > Re: Dreamfields. > [quoted text clipped - 6 lines] > to keep me from going low at night. > --Jenny The real label shows that they have as many, if not more carbs, than regular pasta. The advertising on the box claims lower "digestable" carbs. If they are not lieing I would expect to see pasta, undigested, a few hours later ;-). I go with the approved box nutrition label, not the advertising. Therefore, I didn't eat this, or the regular pasta, yet. -Sax : <snip> : > Re: Dreamfields. [quoted text clipped - 7 lines] : > to keep me from going low at night. : > --Jenny : The real label shows that they have as many, if not more carbs, than regular : pasta. The advertising on the box claims lower "digestable" carbs. If they : are not lieing I would expect to see pasta, undigested, a few hours later : ;-). I go with the approved box nutrition label, not the advertising. : Therefore, I didn't eat this, or the regular pasta, yet. : -Sax From what I gather from reading on this group, but not eating it (I worry about loosing it-runswise, due to a bad past experience) there is something in the pasta that FOR SOME people, either prevents or slows the absorbtion of the carbs IF the pasta is cooked by package directions. THe only way to find out is to try it for yourself adn see how it works for you. That would involve testing at the regular 2 hour time, but also each hour after that until about 5 hours. Once you have done this once, you should know if this pasta works for you or doesn't It has worked for some peole, but not for others. Obviously, a total YMMV food. Wendy >I have always wondered though how often they test accuracy of their own >meters. I do suspect they must be doing these checks almost every day. >The liability is simply too big. Due to the nature of the A1C test, labs would not do the test more often than once per day, if that, and at the time 3 controls should be done. However, from my experience A1C is one of the more temperamental tests because it is done on whole blood instead of just plasma. To do a test with cells in the mix instead of just the plasma just creates more room for error. (I won't bore you with the examples.) So even if the controls checked out okay, there could still have been some glitch with your sample. However, since your A1C result is within normal range, it wouldn't set off any bells with the tech running the test. Michelle, T2 Former lab tech > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 21 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control Guess you aren't testing enough to have the meter average equal the actual A1c. The fault is with neither test. the "fault" is with your testing patterns. This is an issue that's been going on since A1c tests and meter readings have been compared. Do you understand, or are you going to be argumentative? If so, I'll give up explaining anything. I'm so sick of the people in this newsgroup not having the most basic understanding of their disease and their equipment. I haven't got enough quarters for you all to buy clues. Dave >> I'm completely baffled by my latest labs. My control as measured by >> my bg meter has gotten much much better, and my A1c has gone up! >> I've been using basal insulin since the beginning of January and my >> fasting and post prandial readings have dropped by at least 20 mg/dl [quoted text clipped - 8 lines] >> To make it even more baffling, the lipids read as if I'd cut my >> carbs, not raised them and added insulin. TGs have dropped from 106 >> to 85 mg/dl and HDL has risen from 67 to 75 mg/dl. >> [quoted text clipped - 10 lines] > testing patterns. This is an issue that's been going on since A1c > tests and meter readings have been compared. Do you understand, > or are you going to be argumentative? It's certainly possible that a week of more frequent testing may shed some light. I was just about to mention it > It's certainly possible that a week of more frequent testing > may shed some light. I was just about to mention it My doctor wrote me a prescription for 200 strips a month and I have used all of them. I also have strips for a back up meter I bought myself which I've used to confirm odd readings. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > Guess you aren't testing enough to have the meter average equal the > actual A1c. The fault is with neither test. the "fault" is with your > testing patterns. This is an issue that's been going on since A1c tests > and meter readings have been compared. Do you understand, or are you > going to be argumentative? Testing pattern: fasting pre-lunch 1-2 hr after lunch (varies from day to day) pre-dinner 1-2 hr post dinner (varies again from day to day) 10 pm when carbs higher than usual at dinner. Any time I feel strange. When else could I be testing? --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 14 lines] > > Anyone have something like this happen to them? My labs are always a mystery to me. The only time the A1c was not real shock was when it was something like 4.3 and I was passing out right and left with hypos. My triglycerides seem to do what they want to. Sometimes they are close to range and other times they are whopping high. The rest of my cholesterol numbers are usually pretty much in range, but the one HDL is always a tad low no matter what I do. Is it possible that you have some sort of blood disorder or a thyroid problem? I do have anemia, but it is being treated so currently that's in range. However my brother and my dad both have something called spherocytosis. For them the A1c will be no different than a finger stick taken at that time. They use the Fructosamine test instead. SignatureSee my webpage: http://mysite.verizon.net/juliebove/index.htm > Is it possible that you have some sort of blood disorder or a thyroid > problem? I've been tested with the expensive tests for thyroid numerous times in the past couple years but the tests always come back not only normal, but in the middle of the normal range so that won't explain it. I do have anemia, but it is being treated so currently that's in > range. However my brother and my dad both have something called > spherocytosis. For them the A1c will be no different than a finger stick > taken at that time. I have had the experience of testing very high on an A1c because of an unusually high blood sugar the day before the test. That's happened twice over the 8 years I've been getting tested. For example, previous A1c would be 5.2% (this was when I was in the weight loss stringent LC period) and next A1c would be 5.1% but the one in the middle (not 3 months from the other two) was 6.2% because the experimental hormone pill the gynecologist gave me, which I took only one of--pushed my blood sugar over 200 for a day and my family doc sent me for another A1c the next day. But in this case, the A1c doesn't correspond to anything that happened with my bgs over the past week. And my lab fasting plasma glucose was 95 mg/dl from the same draw from which the A1c was taken. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny: I don't think a "high A1c can be a result of a high BG the day before". Yes it would be affected but ever so slightly based on the approximate 3 month accumulation principle. Larry > > Is it possible that you have some sort of blood disorder or a thyroid > > problem? [quoted text clipped - 28 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control >Jenny: I don't think a "high A1c can be a result of a high BG the day >before". Yes it would be affected but ever so slightly based on the >approximate 3 month accumulation principle. The more I read, the less I think that "3 months" term should be used when discussing A1c. Read the mhd FAQs http://www.faqs.org/faqs/diabetes/faq/part2/ - and it becomes clear that one month would be a better term to choose, and even then it is weighted to the later weeks. My haemotologist mentioned this a couple of days ago, noting that an A1c is only truly indicative of the past month's BG levels. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. Alan: Great information!! I'll be sure to show my doctor as well as he is perhaps relying to much on a 3 month A1c cycle. Larry Hi Alan: >>Jenny: I don't think a "high A1c can be a result of a high BG the day >>before". Yes it would be affected but ever so slightly based on the [quoted text clipped - 5 lines] > - and it becomes clear that one month would be a better term > to choose, and even then it is weighted to the later weeks. One article cited in the FAQ has been subsequently cited in the following which was published in February 2006. OBJECTIVE—Mean blood glucose (MBG) over 2–3 months is a strong predictor of HbA1c (A1C) levels. Glucose instability, the variability of blood glucose levels comprising the MBG, and biological variation in A1C (BV) have also been suggested as predictors of A1C independent of MBG. To assess the relative importance of MBG, BV, and glucose instability on A1C, we analyzed patient data from the Diabetes Control and Complications Trial (DCCT). RESEARCH DESIGN AND METHODS—A glucose profile set and sample for A1C were collected quarterly over the course of the DCCT from each participant (n = 1,441). The glucose profile set consisted of seven samples, one each drawn before and 90 min after breakfast, lunch, and dinner and one before bedtime. MBG and glucose instability (SD of blood glucose [SDBG]) were calculated as the arithmetic mean and SD of glucose profile set samples for each visit, respectively. A statistical model was developed to predict A1C from MBG, SDBG, and BV, adjusted for diabetes duration, sex, treatment group, stratum, and race. RESULTS—Data from 32,977 visits were available. The overall model was highly statistically significant (log likelihood = –41,818.75, likelihood ratio {chi}2[7] = 7,218.71, P > {chi}2 = 0.0000). MBG and BV had large influences on A1C based on their standardized coefficients. SDBG had only 1/14 of the impact of MBG and 1/10 of the impact of BV. CONCLUSIONS—MBG and BV have a large influence on A1C, whereas SDBG is relatively unimportant. Consideration of BV as well as MBG in the interpretation of A1C may enhance our ability to monitor diabetes management and predict complications." Source: Mean Blood Glucose and Biological Variation Have Greater Influence on HbA1c Levels Than Glucose Instability - http://care.diabetesjournals.org/cgi/content/abstract/29/2/352 If I remember the initial article, the figures are based on type 1 DMs (DCCT), yet the number of samples per individual is fairly high. At the same time the BG distributions were generally higher than type 2 DM such as seen in the 6% club. As has been discussed before, when A1c measurements are lower, the postprandial BG levels have a greater impact on the A1c than when they (the A1c) are higher. As can be seen from figure 1 very few points on the scatter diagram are below 6% or 6 mmol/L. None were below A1c of 5% and only a few below MPG of 5 mmol/L. Figure 1— MPG versus HbA1c - http://care.diabetesjournals.org/cgi/content/full/25/2/275/F1 Defining the Relationship Between Plasma Glucose and HbA1c - http://care.diabetesjournals.org/cgi/content/full/25/2/275 " The relationship between HbA1c and PG is complex. Many studies have shown that HbA1c is an index of MPG over the preceding weeks to months. Erythrocyte life span averages ~120 days. The level of HbA1c at any point in time is contributed to by all circulating erythrocytes, from the oldest (120 days old) to the youngest. However, recent PG levels (i.e., 3–4 weeks earlier) contribute considerably more to the level of HbA1c than do long- past PG levels (i.e., 3–4 months earlier). Therefore, HbA1c is a "weighted" average of BG levels during the preceding 120 days; PG levels in the preceding 30 days contribute ~50% to the final result, and PG levels from 90–120 days earlier contribute only ~10% (12,13). This explains why the level of HbA1c can increase or decrease relatively quickly with large changes in PG; it does not take 120 days to detect a clinically meaningful change in HbA1c after a change in MPG." For those that are talented in calculus, the formula included in the following extract could be incorporated into a model, i.e., perhaps using Excel. On the Weighted-Average Relationship Between Plasma Glucose and HbA1c - http://care.diabetesjournals.org/cgi/content/extract/29/2/466 I had forgotten about the weights of BG levels having decreasing influence on the A1c as time passed by. Or that the most current BG levels are the most significant. [The original of the post seems to have been lost in cyber space. ;)] Frank > OBJECTIVE—Mean blood glucose (MBG) over 2–3 months is a strong predictor > of HbA1c (A1C) levels. Glucose instability, the variability of blood [quoted text clipped - 9 lines] > same time the BG distributions were generally higher than type 2 DM such > as seen in the 6% club. Much higher as 7% was about as low as most of them got, if I recall correctly. The formula derived from this same DCCT data was MBG = (36.5*Hba1c) - 77. That would put me with a predicted MBG of 135mg/dl and you a whole lot higher than that. Maybe the whole thing does break down at lower A1cs. The only measurement I didn't test, which might possibly be a factor here would be the 1/2 hour post-meal spike which, with the UL for me is the highest reading. But in that case, it would be interesting to know why the 1/2 hour spike would set the A1c level when with worse control (and thus much higher 1/2 hour spikes) it doesn't. A friend suggested that it is possible that normalizing the blood sugar completely causes the hemoglobin to live longer and thus skews the results. What do you think of that? Also, check the email address you use with these postings. I sent you an email. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >Hi Alan: >>>Jenny: I don't think a "high A1c can be a result of a high BG the day [quoted text clipped - 82 lines] > >Frank Hi Frank I'll trust you when it comes to the statistical analysis. One of the difficulties I have with the various agencies who come up with formulae is that they are looking either at type 1, who necessarily test frequently, or at type 2 who test sporadically and usually only at the recommended fasting, pre-meal and two-hour times. So a formula combining those is flawed to start with. To then apply it to people like ourselves who actively test to find our peaks - and add them to the "mean" or "average" is not valid. Personally, I don't see the need for that direct link; A1c is related to, but not the same as BGs and the two tests are useful for different purposes. On a personal aspect - my 30-day average of all my tests is 6.0(126), including a significant proportion of post-prandials. But my A1c is still over 6 at 6.2%. I haven't applied those formulae, but I'm sure they would put me under 6 for an average BG of 6(126). It's rather frustrating, but I'm not overly concerned yet. It's an incentive to exercise more. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. > On a personal aspect - my 30-day average of all my tests is > 6.0(126), including a significant proportion of [quoted text clipped - 3 lines] > frustrating, but I'm not overly concerned yet. It's an > incentive to exercise more. Check out this study where they measured the lifespan of hemoglobin cells and discovered that the more diabetes the shorter the lifespan. This makes it clear that at both poles--much too high and near normal--the formulas and other information we've treated as gospel breaks down. As your blood sugar approaches normal, according to this, the cells live longer and longer, and continue to glycate so that the A1c will be higher than if they were turning over more swiftly as they do in people with worse control. It also suggests you should only test every 6 months if you are approaching normal control. People with poor control may have cells that turn over every 81 days while normal people's may turn over every 146 days! Relationship Between GHb Concentration and Erythrocyte Survival Determined From Breath Carbon Monoxide Concentration http://care.diabetesjournals.org/cgi/content/full/27/4/931 --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! <snip> Another thought is that your labs got mixed up with someone else's. I've seen this happen. I once saw two lab techs who were baffled by a mystery blood sample that remained unlabeled at the end of the day. They went back through their list and surmised that it must belong to this one woman because they didn't see anything with her name on it. And even when they are labeled correctly, sometimes charts and things get mixed up. A woman I used to work with got an unsettling call at work, telling her she had a fatal disease and that she needed to come in right away to discuss it. While she was in the personnel office trying to get the rest of the day off, another call came in, telling her a mistake had been made and it wasn't her, but another person. She was fine! She wound up getting the day off anyway because she was so shaken by the whole thing. When I was in NY, the lab I went to required me to write my name on a sticker and label my own vial. This was greatly annoying, especially the time they took 12 vials, but at least I knew for sure they were mine! Other labs have required me to verify that my name was indeed on the vial(s) and sign a form stating that. SignatureSee my webpage: http://mysite.verizon.net/juliebove/index.htm >> I'm completely baffled by my latest labs. My control as measured by my >> bg meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 19 lines] >labs have required me to verify that my name was indeed on the vial(s) and >sign a form stating that. Good point, Julie. I once had to defend a sailor at a court martial who was told that his urine sample had tested positive for metabolites of marijuana. It seems that he had given his sample in due course, and after all the samples from his unit had been turned in to the specimen "collectors", he had been called back and told they had a sample from everyone, except him. Then they told him they had found an extra bottle with no label, and that it must be his, so they were putting his name on it. Well, as Gomer would say, "surprise, surprise, surprise", when the test results for him came back positive! Lucky for him, I got him off, but it just goes to show that no test is better than the tracking procedures used, starting at the collection point. I hope you are well these days. Will, T2 >Good point, Julie. I once had to defend a sailor at a court martial >who was told that his urine sample had tested positive for metabolites [quoted text clipped - 4 lines] >bottle with no label, and that it must be his, so they were putting >his name on it. I repeat--flogging is in order! Michelle T2 former lab tech A woman I > used to work with got an unsettling call at work, telling her she had a > fatal disease and that she needed to come in right away to discuss it. > While she was in the personnel office trying to get the rest of the day off, > another call came in, telling her a mistake had been made and it wasn't her, > but another person. She was fine! She wound up getting the day off anyway > because she was so shaken by the whole thing. What a terrifying experience! That is a possibility. My fasting glucose and cholesterol were done at the local hospital where I had the draw but the blood for the A1c was done at the regional hospital forty-five minutes away. This is noted on the results page. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > A woman I >> used to work with got an unsettling call at work, telling her she had a [quoted text clipped - 12 lines] > the regional hospital forty-five minutes away. This is noted on the > results page. At least the trigs are good - and the A1c isn't bad, at 5.8. Maybe all you need to do is see what your next 3-monthly check shows? If it's an anomaly, you can just shrug and forget it, otherwise it needs investigating further. Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg > My fasting glucose and cholesterol were done at the local hospital where > I had the draw but the blood for the A1c was done at the regional hospital > forty-five minutes away. This is noted on the results page. Was the lab the same, just the sample-draw in different places? If different labs, how do their "reference/normal ranges" compare? bj > Was the lab the same, Yup. For the past 2.5 years I've been going to the local hospital lab. The local hospital is affiliated with the regional hospital. > If different labs, how do their "reference/normal ranges" compare? Both hospital labs I've used for the past 7+ years use the range where 6.0% is the beginning of the abnormal range. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >Another thought is that your labs got mixed up with someone else's. I've >seen this happen. I once saw two lab techs who were baffled by a mystery >blood sample that remained unlabeled at the end of the day. They went back >through their list and surmised that it must belong to this one woman >because they didn't see anything with her name on it. They should have been flogged! The proper procedure is always to re-draw. Michelle T2 Former lab tech Does your meter read whole blood or plasma? > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! > Does your meter read whole blood or plasma? Plasma. I got a new Ultra in early February and bought a second one for my purse about 10 days ago when they had an offer where you got it for free. Both read much _lower_ than the Aviva I'd been using. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control The same happened to me. Just after diagnosis my A1c was 5.6 (My TGs 1.5 mmol) My meter average, testing 4 times a day was 8.6 (155) After adding Metformin, diet and exercise improvements, my average bg dropped to 6.4 (115) My A1c rose to 5.8. TGs dropped from the 1.5 to 1.2 mmol. my GP insists I had good control, but I know I didn't because I spent most of my time either shaking unable to sleep or in a sweat falling asleep after meals. I also suffered blurry vision and restless legs which have since mostly stopped. I am left to presume.. before diagnosis I spent most of my time too low with a massive spike once or twice a day. After gaining control my spikes (low and high) leveled out making the overall average higher. Sue type2 A1c 5.6/5.8 Metformin1g > I'm completely baffled by my latest labs. My control as measured by my bg > meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 21 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control While doing more research on the subject I found the following page that explains lab results. http://www.amarillomed.com/howto.htm If you go to the section on A1C you will see following caveat. "Standardization for glycohemoglobin from lab to lab is poor, and you cannot compare a test from different labs unless you can verify the technique for measuring glycohemoglobin is the same. The only exception is if your lab is standardized to the national DCCT referenced method. You can ask your lab if they use a DCCT referenced method. " I am not sure if you want to take this trouble. I would just take a test using Home test kit. Anil Hi Jenny: > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! In an earlier post,(maybe the recent A1c thread), you had mentioned this topic. At that point I did not have my A1c result from a 3/2/06 draw. I do not test BG as frequently as you do, but my overall BG for the 3 months before the A1c was 101.1 mg/dl and 181 readings (5.6 mmol/l using factor of 18) whereas my A1c was 6.4%. My FBG for the same period was 89.4 mg/dl (91 readings). Similar tests for 8/19/05 were correspondingly 106 mg/dl (5.9 mmol/L) and A1c 5.9%. Likewise results from 3/17/05 were 104.6 mg/dl (5.8 mmol/L) and A1c 5.7%. The 3/17 and 8/19 units in mmol/L and % were very close whereas the 3/2/06 was different by .8. I also took my meter in and tested a few minutes before the lab tech did her draw for FBG. My meter was 99 and her test was 101 mg/dl. While I don't ususually test more than 2 times a day, my testing pattern is fairly constant. No, it does not make sense given the information I have. After all the effort confirmation with better results would be encouraging. This ;) or that :( As the frog said I could almost ----. (snipped) > Testing 5 times a day my average reading > of over 100 readings is 100 mg/dl. [quoted text clipped - 3 lines] > My meter reading matched the lab reading closely. So there's nothing > wrong with the meter. (snipped) > Anyone have something like this happen to them? Continuous monitoring would be the only comparison worth mentioning. Even then you would not know your individual hemoglobin life. If I am a blood donor I get better A1c results. Frank > In an earlier post,(maybe the recent A1c thread), you had mentioned this > topic. At that point I did not have my A1c result from a 3/2/06 draw. I > do not test BG as frequently as you do, but my overall BG for the 3 > months before the A1c was 101.1 mg/dl and 181 readings (5.6 mmol/l using > factor of 18) whereas my A1c was 6.4%. HMMMMM. Does Ultralente do something horrible to A1c? You're doing the low dose UL regimen too, right? >> No, it does not make sense given the information I > have. After all the effort confirmation with better results would be > encouraging. This ;) or that :( As the frog said I could almost ----. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Hi Jenny: > HMMMMM. Does Ultralente do something horrible to A1c? > > You're doing the low dose UL regimen too, right? I have had 4 A1c test with Quest Diagnostics since taking UL. The 3/02/06 test was the only peculiar one compared to my meter readings. With QD and my previous lab the difference between average BG and A1 were always within .2 until this last difference of .8. I will not have another A1c for 6 months. By that point I will run out of my UL supply. (I resent this because it did not appear on my newsreader.) Frank > I have had 4 A1c test with Quest Diagnostics since taking UL. The > 3/02/06 test was the only peculiar one compared to my meter readings. [quoted text clipped - 3 lines] > > (I resent this because it did not appear on my newsreader.) This message didn't appear on my newsreader either. I just heard from a friend with Type 2 who is a more stringent low carber than I am. She was using Lantus for almost a year but stopped taking it because even though her home test results were much better, her A1c (around 6.2%) never budged. Since so few people with blood sugars in our range use basal insulins, there probably isn't any way to know if this kind of response is more common than one would think. What bothers me is not knowing if the A1c maintains its usefulness as an indicator of cardiac risk. My guess, based on the decreased lipids is that it might not. OTOH, if the hemoglobin is in fact, glycosylating away, then probably other things are too which is what one would like to avoid. The heart attack risk is my #1 concern since a first, fatal, heart attack, often at an age not a whole lot greater than mine, now, is the usual manifestation of abnormal blood sugars in the side of the family that carries the diabetes gene. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny, I see this is a long thread. I dont understand how insulin works, but my two cents worth is why are you upset with a 5.8 aic. I guess that there might be times when you didnt test that your numbers were higher. Loretta -- In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism. > Jenny, I see this is a long thread. I dont understand how insulin > works, but my two cents worth is why are you upset with a 5.8 aic. Not upset, baffled. I knocked myself out for three months doing everything I could to get truly normal numbers, tested like a maniac, saw my test numbers get better and better, and ended up with a worse A1c than what I'd gotten on three straight tests over several years of far looser control. Odd. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny, I( see now why you are so baffled. Have you spoken to your doctor. Loretta -- In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism. > Jenny, I( see now why you are so baffled. Have you spoken to your > doctor. The test was done for my upcoming appointment on Thursday. But what I'll probably hear is what I usually hear from this doctor, which is "Most of my other patients are in such poor control compared to you I don't really have any experience with this kind of situation." The friend who had the same experience with Lantus--seeing lowered bgs on testing with the Lantus but higher A1c results is also a patient of this same doctor, and she didn't get any explanation from her either. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > I'm completely baffled by my latest labs. My control as measured by my bg > meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 16 lines] > > --Jenny <snip> You test might have been done wrong, or not at all. I want to believe that the lab is gospel but I know it isn't true. About 15 years ago, during a yearly physical my tests came back and indicated I had gout! So, my doctor ran another test, no gout! He ran another test, gout! He ran another test, no gout! He ran another test, gout! I was back in the office for the 6th time in about 2 months and he told me he wanted to run the test again. He explained that I might have some kind of eratic situation that is causing this. While waiting for the doctor I was looking at my test results myself. What I discovered was: Lab A: 3 test results for gout Lab B: 2 test results for no gout Lab C: 1 test result for no gout So, I told him, I'll make you a deal, I'll take one more test but I get to select the lab the sample gets sent to! He asked me what I meant and I showed him what I had discovered. He agreed to my conditions (no gout was the result) and he reported the one lab to the FDA and the state for action. He told me that faking tests isn't unknown but usually you spot this easily as the same results are reported time after time! It is possible that your results are invalid, for reasons of accuracy, error, or maybe even fraud. The lesson: test, and test often. Sound familiar? -Sax > Lab A: 3 test results for gout > Lab B: 2 test results for no gout > Lab C: 1 test result for no gout Curious! If this test had been taken at one of those fleabag labs in shopping centers I'd be more likely to suspect that kind of problem. But if the lab at the regional teaching hospital is making up results, we're in serious trouble. I just heard from another friend who is a low carber with A1cs in the low 6% range who had been on Lantus for a year who told me she stopped taking the Lantus because even though all her tests showed much lower blood sugars, her A1c did not decrease at all. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny, Here is the deal. You can get a kit for about $10.00 (check here: http://tinyurl.com/q38yz) Buy three kits, use two to do the tests on same day same time, a third 24 hrs later. Post your results here. You will benifit from it. We all will benifit from your readings. If you let me, I will even buy the kits (we will split the cost) and have them sent to you directly. What do you think? Anil >> Lab A: 3 test results for gout >> Lab B: 2 test results for no gout [quoted text clipped - 18 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control The blood draw was done in the office and the work sent out to labs. I don't recall the names of the labs any more but there weren't fly by night places. When I saw the correlation I was shacked as well. I had no reason to have gout but the doctor didn't trust me and kept running tests to confirm. Personally, I hate needles so it was in my best interest to get things decided with as few sticks as possible! -Sax > I'm completely baffled by my latest labs. My control as measured by my > bg meter has gotten much much better, and my A1c has gone up! [quoted text clipped - 5 lines] > > So how the hell did I end up with an A1c of 5.8%? Jenny, Couple of things 1) What as your earlier A1c? 2) Why are you so worried unless the increase is very huge - i.e. last time you had 4.5 & this time it's 5.8 If it's something like 5.5 increasing to 5.8, why should it be a cause for alarm as long as you monitor your PP & FBG & they are in the excellent range? If they are better than before & your a1c's has still increased it may just mean that your lows may not be as low as before i.e. your sleeping bg's may have been in the 70's earlier & now may be in the 80's. Or maybe you are very concious of the insulin & hence snacking more to make sure your don't hypo - the post snacking peal maybe in the good range & hence no reason to worry about. Also, if your PP & FBG is better than before but your a1c is higher, it may also mean that you are yo-yo'ing less than before. > My meter reading matched the lab reading closely. So there's nothing > wrong with the meter. [quoted text clipped - 11 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control > Couple of things > 1) What as your earlier A1c? 5.7% for 2 years. One 6.0% but that was after a week when my readings were near 200 after most meals. > 2) Why are you so worried unless the increase is very > huge - i.e. last time you had 4.5 & this time it's 5.8 Because I lowered my fasting by 20 mg/dl and my post meal readings by an average of 30 mg/dl. > If it's something like 5.5 increasing to 5.8, why should > it be a cause for alarm as long as you monitor your > PP & FBG & they are in the excellent range? Because my readings for the past couple years were so much worse than the readings over the last couple months, and the A1c did not improve at all but got worse. > If they are better than before & your a1c's has > still increased it may just mean that your lows may > not be as low as before i.e. your sleeping bg's may > have been in the 70's earlier & now may be in the > 80's. My sleeping bgs were in the 110-120 range and went down to the 90s with insulin. If they'd been in the 70s to start with, no way I'd have started insulin! I keep my carbs pretty well controlled so I don't have reactive lows. > Or maybe you are very concious of the insulin & > hence snacking more to make sure your don't > hypo - the post snacking peal maybe in the good > range & hence no reason to worry about. I have my basal set to where if I eat nothing I don't go below 80 so I'm not eating more. > Also, if your PP & FBG is better than before > but your a1c is higher, it may also mean that > you are yo-yo'ing less than before. I'm yo-yoing about the same spread except at lunch time when the basal peaks, the main difference is that the basal drops the floor. So instead of going from 115-135 I'm going from 85-105. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control |
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