The truth behind the A1C – how it can show your secrets

Yesterday I had the opportunity to be a consultant in the care of an older lady who had just had knee surgery. She was placed on her home regimen of 70/30 and had experienced a low blood sugar in the middle of the night, so I was called to assist adjusting the regimen appropriately.{{more}}

On speaking with this lady, she admitted that sometimes she had low blood sugars but not that often. She ate regular meals and checked her blood sugars a few times a day. In her recollection, her blood sugars, always looked great, never above 200. I enjoyed speaking with her and she seemed to have a decent grasp of her diabetes regimen.

Then I looked at her hemoglobin A1C: 11.4%

In case you forgot, the target A1C for diabetics is generally in the range of 7%. Her A1C was very high, and she was shocked when I told her. How could this be, even with an occasional low blood sugar now and then?

Well, first, the low blood sugar highlighted a limitation of 70/30 insulin, in that it cannot be readily adjusted in a flexible way. She had the recent low blood sugar, because she was not eating what she ate at home, which is probably too much food quite frankly. The high A1C was something that puzzled her, but did not surprise me one bit. As I explained to this lady, if you have good numbers when you check your sugars but your A1C is high, the answer is usually that your blood sugars are rising after you eat, but you never see those because you are checking right before you eat. All those blood sugars of 120 and 150 etc that she says she was seeing were drawn right before breakfast and dinner. Had she checked her blood sugars about an hour or two after eating, she would have found them instead up around 300.

This is one big way that your A1C can help you and your medical team in adjusting your medication regimen. People are often frustrated when they have good blood sugars when they arrive at clinic, but their A1C on laboratory draw is high. The reason is that you are missing those high sugars at the time you do check. The A1C is critical in letting us know how your blood sugars are controlled most of the time. You can check your fingers only so much. The A1C gives us an average blood sugar for the last three months, averaging every blood sugar for every minute of every day. That is HUGE information!

So, my plea again this week is for you to get those labs drawn when your medical teams asks you, especially the Hemoglobin A1C. This is why we try to check them on patients when we come for our mission trips. Without the A1C, it is very difficult to get an overall idea of how things are going. It is by no means perfect, and being an average of many numbers has its limitations also. But, all in all, it is extremely useful, so be sure to get those labs drawn!

Until next week stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227