May 14, 2007
A1c (Glycohemoglobin, HgbA1c)
Question from Syracuse, New York, USA:
My 17 year old daughter has been on an insulin pump for two and a half months. She tests her blood sugars at least five to seven times per day. Her average blood sugar is in the 120s mg/dl [6.7 to 7.1 mmol/L]. Her doctor put her on a three day continuous glucose monitor and confirmed that her blood sugars were in the normal range. Her A1cs are still over 14%. They are dumbfounded and don’t know how to handle the problem. All her blood work comes back normal. We need to get a second opinion or find a doctor that has experience with this situation. Please point me in the right direction.
Answer:
I would look for an alternative test to the A1c to see if this confirms the high values, i.e., fructosamine. She could have a variant hemoglobin that interferes with the assay correctness. If the second test also comes back high, then she may need to be in the hospital to have more monitoring done since this remains an unexplainable discrepancy. Your local diabetes team should be able to sort this out and review options with you. Downloading the actual pump information and delivery information would also be extremely helpful, if they have not already done so.
SB
