Question from Stowe, Vermont, uSA:

Five years ago, after passing out at school, I was diagnosed with hypoglycemia. A general practitioner diagnosed me after seeing blood sugars in the 30s mg/dl [1.7 to 2.0 mmol/L] and referred me to an endocrinologist. I controlled it by eating more frequently and was given a glucometer with instructions to test a few times a day. A few years later, I was referred to another endocrinologist, as my first one moved, and my blood sugars were becoming more erratic again. The second endocrinologist told me my insulin levels were significantly raised, based on fasting C-peptide, insulin, and proinsulin levels. This made sense considering my low blood sugars. My A1c at the time ranged between 4.8 and 5.1.

Now, I still have my meter and am seeing much higher numbers, the highest of which was 291 mg/dl [16.2 mmol/L], with others ranging from 150 to 240 mg/dl [8.3 to 13.3 mmol/L]. I go this high at least once daily, but come down quickly. I still occasionally have lows, but usually only in the 50s mg/dl [2.8 to 3.2 mmol/L] now, not the scary lows where I would pass out before. I started having the highs about two weeks ago. Prior to that, I was noticing hypoglycemia unawareness, feeling fine with blood sugars of 35 mg/dl [1.9 mmol/L] and 40 mg/dl [2.2 mmol/L]. I probably haven’t been that low in two weeks or so now, and only see the 50s mg/dl [2.8 to 3.2 mmol/L] about once a week. I treat lows using the rule of fifteen, as described on this web site, and following up with a protein afterwards.

I told my general practitioner my concerns, so she ran an A1c and a non-fasting glucose. The glucose was in the 90s mg/dl [5.0 to 5.5 mmol/L] and the A1c was 5.8. I have never even seen an A1c close to this before, with 5.1 being my previous highest, last year. I’m a 20 year old female, slightly overweight, but I eat a healthy diet (and have consulted with a nutritionist) and am active. My general practitioner said that I’m fine since my A1c is below 7. I am concerned that highs and lows may be causing my A1c to “normalize.” Should I pursue this further, or is A1c a good indicator and won’t be effected by highs and lows averaging out? Is it normal to spike this high? Am I just worrying too much about this since I am used to running low all the time?