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Medical Forum / Diseases and Disorders / Diabetes / March 2007Higher A1c, aargh!
I went to the Endo. last week and was in a good mood because not only had I lost weight but my numbers have been down for the whole three months. Now granted I had been very sick from that danged Prevacid I was taking. Was eating only two meals if day, if you could call one of those snack-like things a meal, because I couldn't seem to keep the food in me. It was rushing right through, or so it seemed. I had very few numbers out of normal range (higher) and a few hypos. Dr. looked at my log book and was pleased. Had assorted labs done at my GP for yearly checkup, so all he ran was the A1c. Just got it back today and it was 7.2!!!! My highest yet aside from when I was first diagnosed and three weeks later. I don't get it. I just do not get it. I know some of you would freak over this and say I need to be put on insulin or something. But he won't do that. I am producing waaay too much insulin on my own. Byetta is no longer an option now that we know I probably have delayed stomach emptying. My digestion problems seem to be my biggest problems at the moment, all things considered. I haven't been able to do much in the way of exercise either. Being so sick for so long has left me really weak. Even lifting a bag of groceries is a chore. *sigh* Okay. Rant over. > I went to the Endo. last week and was in a good mood because not only had I > lost weight but my numbers have been down for the whole three months. Now [quoted text clipped - 17 lines] > > Okay. Rant over. Sorry, Julie, that the results were so disappointing. Is it possible that you're not turning over RBCs very rapidly? Susan In alt.support.diabetes on Wed, 28 Mar 2007 20:49:57 -0400 in Msg.# > Sorry, Julie, that the results were so disappointing. Is it possible > that you're not turning over RBCs very rapidly? Is that something that is variable?  SignatureDonnaB "Every day when you do well, you put a brick in the wall. And on days you don't, you don't tear the whole wall down. You just don't put in a brick for that day." - Dr. Harding > In alt.support.diabetes on Wed, 28 Mar 2007 20:49:57 -0400 in Msg.# > >> Sorry, Julie, that the results were so disappointing. Is it possible >> that you're not turning over RBCs very rapidly? > > Is that something that is variable? Yes. There are various medical conditions that render the A1c useless. Anemia is one such. But it's not just blood disorders that cause problems. The woman who used to run the diabetes support group I belonged to in CA was a brittle type 1. She refused to take the A1c because her BG was all over the place all the time. Each day was a series of hypos and highs, with her rarely ever getting into the normal range. She had been this way her entire life. > In alt.support.diabetes on Wed, 28 Mar 2007 20:49:57 -0400 in Msg.# > >>Sorry, Julie, that the results were so disappointing. Is it possible >>that you're not turning over RBCs very rapidly? > > Is that something that is variable? Yes. Susan > Sorry, Julie, that the results were so disappointing. Is it possible that > you're not turning over RBCs very rapidly? Distinct possibility. Brother and possibly dad have spherocytosis, a blood disorder that is somewhat complicated to explain. Blood cells are not the right shape, they are round and tend to die off young. So their A1c's are not accurate. I was tested for it but the test was not done properly. Alas, few Drs. are familiar with it. I brought printouts from the Internet to my Dr. some years ago when my brother was diagnosed with it. According to the information he printed off, the test needs to be done almost immediately after the blood is drawn or it won't be any good. If the blood is sent off to a lab (mine was, hospital across the street), the test isn't valid. I've mentioned this disease/disorder to several of my other Drs. but it fell on deaf ears. I don't think the Dr. who diagnosed my brother with it is still in the business or I would just see if he takes my insurance and go to him. I don't think my dad had the official test done but he is basing his opinion that he has it on his symptoms. I do not seem to have some of the same symptoms as they do, such as getting jaundice whenever I get sick. >I went to the Endo. last week and was in a good mood because not only had I >lost weight but my numbers have been down for the whole three months. Now [quoted text clipped - 17 lines] > >Okay. Rant over. Hi Julie, I too had an increase of A1c this past quarter so undertand your frustration. Had finally made the 5% club and now back up to 6.3%. Was not happy. My numbers have been pretty well controlled and yet I went up like you. I really thought I had maintained below 6%. I'm scheduled for a lumbar epidural next week (my first) so maybe after that I can stand to get some exercise in and get things moving in the right direction again. Hang in there, I'm sure you will get back to where you want to be. RB > I went to the Endo. last week and was in a good mood because not only had I > lost weight but my numbers have been down for the whole three months. Now [quoted text clipped - 7 lines] > aside from when I was first diagnosed and three weeks later. I don't get > it. I just do not get it. Julie, Like you I often get high A1C's when I feel best about my bg control and get low A1C's when I'm less than perfectly satisfied with my bg control. One issue is the variability of A1C measurements - reference ranges vary from lab to lab, sometimes labs change their reference ranges, etc. I'm not particularly new at this, I've been looking at my historical A1C's compared to how I feel for more than 20 years now. > I know some of you would freak over this and say I need to be put on insulin > or something. But he won't do that. While 7.2 isn't as good as some of the numbers folks here brag about, my impression is that it's pretty good for diabetics at large. Either folks who post their numbers here are lucky and have exceptionally easy-to-control diabetes, or they are smarter and can control their diabetes better than average, etc. Baffles me too. My personal attitude is that I do my best with my day-to-day (hour-to- hour) bg control, and the A1C falls where it falls. I can do something to control the individual bg numbers but where the A1C falls seems like playing the lottery sometimes! If the A1C is low (for me that's in the 5's) then I often ask "how the heck did it end up so low?". That doesn't stop me from bragging about the numbers in the 5's, though! When I ask my docs if there's something unusual about me or my chemistry that might make the A1C numbers artificially low, they say that no, if that were the case there would be other lab numbers indicating that. Tim. >Just got it back today and it was 7.2!!!! My highest yet >aside from when I was first diagnosed and three weeks later. I don't get >it. I just do not get it. Bad luck, Julie! But I feel sure it's a consequence of all the gastric issues you've been having. Is there any sign of that settling down? Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.5% BMI 25 >>Just got it back today and it was 7.2!!!! My highest yet >>aside from when I was first diagnosed and three weeks later. I don't get >>it. I just do not get it. > > Bad luck, Julie! But I feel sure it's a consequence of all the gastric > issues you've been having. Is there any sign of that settling down? Alas, problems seem to be starting up again now that I'm on this new med. Took one bite of food the other day and had to run into the bathroom to throw it up. Stomach felt dicey the whole rest of the day. Am hoping it was just an isolated incident, but it's too soon to tell. > Alas, problems seem to be starting up again now that I'm on this new med. > Took one bite of food the other day and had to run into the bathroom to > throw it up. Stomach felt dicey the whole rest of the day. Am hoping it > was just an isolated incident, but it's too soon to tell. Julie, nausea and vomiting can be signs of adrenal insufficiency, and I experienced them when I was suppressed by metformin. Is there any chance that your new med is lowering cortisol levels? Susan > x-no-archive: yes > [quoted text clipped - 6 lines] > experienced them when I was suppressed by metformin. Is there any chance > that your new med is lowering cortisol levels? The med is for GERD. I didn't have any nausea. Just a feeling that food was stuck in my throat, and that's a symptom of GERD. Also stomach pain and a feeling of fullness. The weird thing is, I don't the typical symptoms of GERD such as a feeling of acid reflux if I am not taking a med for GERD. This is the third med I've tried and on all of them, I get acid reflux and have to be careful what I eat. For instance, tomatoes, spicy foods and chocolate all cause me trouble. When not on the meds, I don't get the feeling of reflux but clearly there is damage because I have Barrett's Esophagus so this is why I need the med. It is also thought that I have gastroparesis but we'll never know for sure because of my egg allergy. I can not eat the eggs needed to do the test. As for my cortisol levels they are normal. Or they were. Dr. tested me for that. I do not have any symptoms of adrenal insufficiency aside from excess weight around the middle, if indeed that is a symptom. x-archive: yes > The med is for GERD. I didn't have any nausea. Just a feeling that food > was stuck in my throat, and that's a symptom of GERD. Also stomach pain and [quoted text clipped - 8 lines] > It is also thought that I have gastroparesis but we'll never know for sure > because of my egg allergy. I can not eat the eggs needed to do the test. All of this must be very mystifying and frustrating. > As for my cortisol levels they are normal. Or they were. Dr. tested me for > that. I do not have any symptoms of adrenal insufficiency aside from excess > weight around the middle, if indeed that is a symptom. You actually can have normal cortisol tests even with insufficiency, as I did last summer while in an Addisonian crisis. I also had hypercortisolemia with AI symptoms due to pituitary/adrenal dysfunction. If you've read about Cushings and AI on the Cushing Help board, you'll find that even the most obvious Cushing's patients and many with known tumors have repeatedly normal results for a whole variety of reasons. Because of your vascular and allergic problems, and the fact that a doc thought you looked Cushingoid, according to you, it's an avenue worth pursuing, potentially, as it's clear you have a lot more than DM going on. A very significant % of DM patients have Cushing's or sub clinical Cushings, and the diagnosis is extraordinarily hard to come by, due to confusion about how cyclical and highly changeable hormone secretion can be day to day or week to week, etc... I experience both highs and lows, unpredictably. My A1c has crept up to 5.7 despite the lowest post meal numbers I've had in years, during this illness. Susan > x-archive: yes > [quoted text clipped - 34 lines] > unpredictably. My A1c has crept up to 5.7 despite the lowest post meal > numbers I've had in years, during this illness. Well, I will ask my Dr. about it again. According to the hospital, he is the best Endo. in this area. I did go through that period of about a year or so where I had near constant hypos before my BG shot up to around 200 and stayed there no matter what. So yes, it is frustrating and I don't seem to fit the typical pattern of diabetes. > Well, I will ask my Dr. about it again. According to the hospital, he is > the best Endo. in this area. I did go through that period of about a year > or so where I had near constant hypos before my BG shot up to around 200 and > stayed there no matter what. So yes, it is frustrating and I don't seem to > fit the typical pattern of diabetes. Julie, the only two reliable endocrinologists in the U.S. for evaluation of Cushing's syndrome are in Seattle and LA. People with cyclical Cushing's get hypos when the tumor or other cause stops pumping out cortisol suddenly and bg drops. Neuroendocrine tumors are characterized by very erratic patterns of hormone secretion, and that would explain why nothing you do has the expected effect. I've experienced a lot of that lately, too. My bg barely rises after I eat at all, but my fbg and pre meal numbers are up, hence a higher A1c, for instance. You'll find you have a LOT in common with the other women here; many of them have experiences and symptoms like yours: http://www.cushings-help.com/intro.htm Susan That's for sure!! And for a long time, too! It has always amazed me how much Julie and I have had in common. I never dreamed there was any possibility she could also have Cushing's. Interesting. Julie, I think of you often, and do hope you are able to find some kind of answers soon. It will benefit you so much because of your age, and the fact of your having a young daughter growing up that you need your health to improve for to keep up with her as she will be approaching those teen years before long (weeeeell, at least pre-teens.... LOL). : as it's clear you have a lot more than DM going on. : Susan > That's for sure!! And for a long time, too! It has always amazed me how > much Julie and I have had in common. I never dreamed there was any [quoted text clipped - 8 lines] > : as it's clear you have a lot more than DM going on. > : Susan Julie, you were sick and the A1C showed it. I would not worry about it. Just keep trying. I had a tooth abcess and my A1C was way too high but the Dr. was not too concerned. I get another one in June. I know it will be better. He said crossing his finger and making the sign of the cross and saying 10 Hail Mary's Ira T2 |
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