February 12, 2006
A1c (Glycohemoglobin, HgbA1c), Diagnosis and Symptoms
Question from Kent, England:
Recently, I went to see the doctor due to a virus. I had been suffering from frequent urination, lethargy, excessive thirst and some weight loss, but not dramatic. I am currently 33 years old, 5 feet, 10 inches, weigh around 140 pounds and have never been overweight. Two fasting blood sugar reading were taken. The first came back at 7.2 mmol/L [130 mg/dl] and the second, a week later, came back at 7.8 mmol/L [140 mg/dl]. I have always eaten a balanced diet. My father is an insulin dependant diabetic so I am aware I could have a tendency to follow suit. I have always watched what I eat, I exercise regularly and am generally very active, although it is becoming a real effort lately.
The doctor did an A1c test which came back as 5.8, normal. After the elevated fasting tests, I bought a home testing kit and tested my blood sugars over a week. The readings taken before breakfast were 7.2 mmol/L [130 mg/dl], 7.9 mmol/L [142 mg/dl], 7.8 mmol/L [140 mg/dl], 7.6 mmol/L [137 mg/dl], 7.3 mmol/L [131 mg/dl], 7.4 mmol/L [133 mg/dl], and 7.8 mmol/L [140 mg/dl]. I took two readings two and a half hours after meals and they were 11.5 mmol/L [207 mg/dl] and 11.4 mmol/L [205 mg/dl] after eating a sandwich. By evening, approximately six hours after eating and only drinking water, they were down to 5.6 mmol/L [101 mg/dl] and 9.8 mmol/L [176 mg/dl].
I went back to the doctor’s to voice my concerns only to be told as the A1c had come back normal, that there was nothing to worry about and that, even if I were diabetic, fasting levels in the 7s mmol/L [126 to 142 mg/dl] were good so I was to continue with what I was doing. Am I worrying unnecessarily or should I be asking for a second opinion? If so, what questions should I be asking? Also, would fasting levels only in the 7s mmol/L [126 to 142 mg/dl] cause any diabetic symptoms? I asked if maybe the lethargy could be caused by depression if not the diabetes as it really is beginning to affect my day to day life. All the doctor said was that I wasn’t suffering from depression.
Answer:
Normal hemoglobin A1C readings are really less than 5%. When they get close to 6%, that is, by definition, two standard deviations from the mean. Although it is in the “normal range,” there is a suggestion that it may be higher than desired. Some of your readings are not necessarily normal for a person without diabetes. Since persons with a family history of type 1 diabetes are still at increased risk of developing the disease, you may want to speak with a specialist with an interest in diabetes. Autoantibodies can be measured that demonstrate risk for autoimmune destruction of the insulin-producing cells. At many research institutions, there is a demand to see these patients as they may be successfully recruited into research protocols and followed. This would also bring closure to the issues you are worried about. In the end, I would check with your regional research institution and see if there is a study protocol in which you can participate.
JTL
