I am 31 years old, have had type�1 diabetes for the last 13 years, and my husband and I are considering pregnancy. I am very worried about any possible “congenital malformations” that my child may end up getting. Although I have high sugars (200-300 mg/dl [11.1-16.7 mmol/L]) several times a week, my HbA1c has consistently been in the normal range (5.8-6.2%). My doctor cannot understand why. Could the low numbers be due to my thalassemia trait? Is it possible that the HbA1c is not an accurate measure of overall control in my particular situation?

You have raised some great questions. First, it sounds like you are worried about a falsely low hemoglobin A1c. Since the hemoglobin A1c level is dependent on a normal red cell survival, anything that causes premature red cell destruction can falsely lower the hemoglobin A1c. Your physician should be able to help you answer this question. Falsely elevated values come from persistent fetal hemoglobin and hemoglobin S because they appear to separate out on the instrument that measures hemoglobin A1c at the same point as hemoglobin A1c. Your doctor can order another test which reflects persistent elevation of blood sugars. Both the glycated albumin and the fructosamine levels reflect average blood sugars over approximately two weeks time. This will allow you to compare to your hemoglobin A1c with the knowledge that hemoglobin A1c reflects the previous three months.

I know that it is a tough decision regarding pregnancy. I wish you the best as you make your decision.

JTL