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Pre-Diabetes A1C with normal Glucose Meter Tests during the day

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Posted 10/10/2012 3:23 PM (GMT 0)
New to forum and surprised to be here.  I am almost 50 (male) and thin (always have been).  I exercise regularly and have low triglycerides and high HDL.  I read a book in the spring (Dr. Agus, "The End of Illness") and based on his recommendation got a fasting glucose and A1C.  Fasting 96 and A1C 5.8.  Retested A1C on 1 Oct and it came back 6.0.  I know the tests are not perfect (0.5 possible error?) but will assume A1C actually went up a bit.  Between A1C tests, I bought a glucose meter and tested fairly extensively.  Summary:  immediately upon waking (i.e. stumble to test) I am normally in 80s with low of about 83.  If I shower and move around a bit, I go into the mid 90s (dawn effect?).  ALL random tests during the day have been in 80s or 90s (and premeal too).  ALL my two hour post meal readings have been <120 and this after eating carbs in low moderation.  I have drastically reduced my carb intake based on April A1C.  As a test, I ate 3 White Castle burgers and big fries...1 hour was 180 and 2 hour was 116.  This morning I ate 24 g of oatmeal, 4 strawberries, walnuts and 12g protein powder and 2 hour post reading was 94. 

Question:  My A1C indicates average glucose of 126.  I have tested from waking to bed time (not at night yet...but wake in 80-90s) and except for the post meal period, I don't have a test over 100 and by 2 hours I have been < 120 EVERY time.  So, where is this 126 average coming from if all my tests are no where near the average? 

BTW...my family practice provider can't answer this and still won't send me to endo as she says they will say the same thing....she offered me 3 month retest or a start on Metformin (500 mg I think).

Thanks,

Scott

Posted 10/10/2012 4:18 PM (GMT 0)
Hi Scott, welcome to the Forum.  There are margins of errors for all tests including our own glucose meters, so I guess you have to take that into account.  The A1c is an average of your glucose that includes while sleeping and all day, every day, every minute, for about 90 days.  I can't answer your question as to where the average 126  (A1c of 6.0) came from other than what I understand about this, that your blood sugar could have been more elevated at times when you didn't take it and the margin of error of your meter.  The industry standard allows for a deviation up to + or - 10% or more.

The differences in your blood sugar readings after the burgers and fries vs the oatmeal, etc. could be in the kind of food.  The burgers's buns and potato fries would be fast-acting carbs and most likely cause a high post-prandial reading, as your 180 and 116.  Oatmeal and strawberries have fiber; walnuts have protein and oil and the protein powder has protein, all of which will lessen spikes and draw out blood sugar more evenly.  This is why dieticians recommend a high-fiber diet for diabetics.  Many popular diets are protein-based and low-carb which also help keep blood sugar down.

I'm not a doctor but I am insulin resistant, so I can only give you my observations.  It seems to me you might be a little insulin resistant which would explain the higher than normal blood sugar after the burgers and fries.  A non-diabetic's blood sugar would not spike that high (180).

For all intents and purposes, you're not diabetic, but you may be seeing some elevated blood sugar, and this sometimes happens as we get older.  Yeah, I know you're not 50 yet!  tongue    Are there any diabetics in your family?  If there are, you might have a tendency toward it, too.  Keeping your weight normal is great and will help you in this.  If you want to keep your blood sugar at normal levels, you should cut down on the amount of fast-acting carbs (which you may have already done) like white bread, bagels, cakes, cookies, anything made with sugar and white flour, potatoes.  Understand that high fiber carbs will help even out blood sugar; fats and protein will do this too.  Up your veggies and salad food.  If you're not getting any exercise, try to get involved in some; even lifting weights will be beneficial for your health and blood sugar.

I think if you start a daily journal of food and blood sugar readings, you will see where the spikes happen and you can adjust your diet.  I don't think you are at the point to go on meds for diabetes.  The only way you would find out if you are really having trouble metabolizing carbs (which is insulin resistance) is to that a GTT  (glucose tolerance test).

I wouldn't be overly worried about this though.

Posted 10/10/2012 4:27 PM (GMT 0)
Lanie,
Thanks for the reply. I am trying not to freak out, but I am a bit of a worrier. I am exercising and fairly aggressively low carb (not 30g a day, but no white stuff). about the White Castle binge...I did it after being very strictly low carb...I read that before glucose tolerance tests you have to eat carbs for 3 days due to low carb diet induced IR? Is that right? Also, the big thing about insulin resistance that I have read is that IR is highly correlated with high triglycerides and low HDL and I am very opposite that with really low trig (low 50s) and high HDL (71). I work out intensely and often. 6'1" and a bit under 160 lbs.
Scott
Posted 10/10/2012 4:34 PM (GMT 0)
I don't know.  You seem to have read more about IR than I have! 
Posted 10/10/2012 8:22 PM (GMT 0)
The next time you have blood work to check your A1C make sure that your get iron checked. If you don't have enough iron in your bloodstream your A1C test results may be falsely high. While you are at it also get your blood levels of vitamin D checked too. Adequate levels help prevent diabetes.

Whenever I get blood work done I use my meter to check my blood sugar while in the waiting room and check it again immediately after the blood was withdrawn. That way I can compare the accuracy of my meter to what was measured by the lab.
Posted 10/10/2012 10:34 PM (GMT 0)
My goodness, I forgot that being anemic can skew the A1c results. This happened to one of the mods here who is also a diabetic. Good idea to have your iron checked.
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