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October 4, 2005

A1c (Glycohemoglobin, HgbA1c)

Question from Logan, New Mexico, USA:

My 17 year old son has been a type 1 diabetic since he was six. He has been on a pump for approximately five years. His daily numbers from his glucose meter give him averages that should put his A1c at around 6. However, for nearly a year, his A1c has run between 10.0 and 12.0. He see Dr.Ellen Kaufman, MD, who is a pediatric endocrinologist in Albuquerque. She is going to put him in the hospital for 48 to 72 hours and monitor him to see if she can see why his averages are not matching his A1c. She says she is stumped and, in 33 years of practice, has never come across this problem. I have searched the Internet for information on this problem, but cannot find anything related. Can you help me to understand how this could be happening?

Answer:

I would worry about the numbers. Regrettably, many of us regard the glucose number as a test, one which you either pass or fail as opposed to a check or a number, something without any moral value. That said, children do like to have happy parents and if the process is like a test, then the kids will try to pass the test rather than provide information that is used to make a decision.

I have seen the wrong code used in the meter. I have seen control solution used in the meter. I have seen one brand of control solution used in another meter and it gives results not control values. I have seen dilution of blood and other things that give meter numbers that don’t fit the A1c. Likewise, there are sometimes attributes in the blood, unusual hemoglobins, etc. that give false A1c values. Has he had numbers in the 6.0 to 8.0 range in the past? This is a challenge that likely has high glucose values at the root.

LD