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December 7, 2003

A1c (Glycohemoglobin, HgbA1c), Family Planning

Question from Wheaton, Illinois USA:

I have been having severe menstrual bleeding for about 5 weeks out of the last 2 1/2 months. My blood levels were determined to be lower than normal--mainly my Hemoglobin, RBC Count, Hematocrit. I have always controlled my sugars very well. My last A1c two months ago was 7%, which was 1% higher than I normally keep it, so I increased my insulin intake dramatically and began a very strict diet. We are starting an ART (in vitro) cycle next week, and I wanted to verify that my A1c level was appropriate. To my shock and horror, my A1c was 10%! I have none of the symptoms of hyperglycemia. I never feel well when my sugars are higher than 150 mg/dl [8.3 mmol/l] (over time). I test several times a day and I am NEVER over 150. I know that I have lost a great deal of blood over the past 2 months, and I also know that I am anemic. Could that be causing this very aberrant A1c result? If so, how can I get an accurate result so that I can determine if it is safe to proceed with the IVF cycle? My questions need urgent consideration, so I am discussing this with my doctor, but I want a second opinion, and someone else might benefit from your answer since this is such a bizarre circumstance I am in.

Answer:

The A1C can be affected by many factors. A low hemoglobin, depending on the method, may be one of these. Given your circumstances, I would repeat the test at another facility and discuss this with your physician. I definitely agree that if your A1C is that high, I would rethink proceeding with IVF.

ABS