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BG Average is terrific, A1c is terrible!

Discussion in 'Parents of Children with Type 1' started by Ed2009, Jun 11, 2013.

  1. Ed2009

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    I wonder if that happened to anyone here:

    After making the 14 year old DS the March A1c (Q1), we got 8.1% up from 7.6% in Dec 2012. OK, BGs were not great for the period, so we start a different routine, like measuring BG every 3 hours, and if there's a high value or food intake, measure BG one hour after, and apply a correction if BG is over 120 or so.

    Doing like that and keeping careful record of BG, the average over the next 3 months (March-June, Q2) is 136 mg/dl, which corresponds to an A1c of 6.4%. On top of that 77% of Q2 BG measurements felt within the 70-170 range we've set as a target (although we also correct when is more than 120). So, the individual numbers cannot get any better. OK, let's be objective: perhaps numbers are not great, but I don't feel they're that bad.

    We go then to do the June's a1C (Q2), waiting very optimistic results and... 8.6%, even worst than Q1 that had even worst BG averages than Q2. 8.6% A1c would be an average of BG of 200 mg/dl for the last 3 months (I think).

    The only odd thing was that the week before the A1c BG was spiky, and we had to increase basals. But even though, this last week the values within range were 65% of the total, with a BG average of 152 (A1c of 6.9%), so it was not what I'd call an uncontrolled disaster.

    I'm puzzled. Of course, it's just numbers, but I'm surprised to see such a wide difference between the day to day BG measurements, and the quarterly A1c.

    The interesting thing is that previously, even with less measurements, we had A1c somewhere within 0.5% of the averages we kept.

    Did something like that ever happen to anyone? Care to share any thoughts? Is it the teen years?
     
  2. Megnyc

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    How frequently do you test?

    What meter do you use and have you compared it to a recent lab BG test?

    ETA: Ok, so every 3 hours? Even at night?
     
  3. Helenmomofsporty13yearold

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    I have found that the values in the last week or two greatly influence the A1C both to the upside or the downside.

    Welcome to the teen years.
     
  4. Lee

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    I would question the meter...and then I would ask for a retest of the A1C - it could be a problem with either machine.
     
  5. TheFormerLantusFiend

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    I would question the test strip accuracy, the A1c, and whether your son might be diluting his blood to get lower numbers. I would ask for another A1c test (or buy an over the counter one) and if that one is also high, consider another blood sugar meter.

    My A1c has not always been exactly where the numbers would predict, but never that far away.
     
  6. Jaredsmom

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    We found that our omnipod pdm consistently read 30 Pts or so below the meter at the drs office and because of this Jared's a1c was always higher than expected when we were using that pdm when we started pinging his a1c came down a lot and was inline with our meter averages.
     
  7. Ed2009

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    Great points from you all. Thank you.

    Megny: No, we do not test often at night as we do not have a story of waking up too high or too low. We test at night if there was some dinner or the day came irregular, but then again, is not too often.

    Lantus:/Lee Yes, maybe the meter. Regarding dilution of the sample, it's not happening, the guy is honest with himself.

    Helenmom: Good point. I've noticed that last values were influencing, but never could think of a number for how many days.

    Jaredsmom: 30 pts below is a lot. If my meter is about the same, then yes, might be there.

    See, the average would be 139 + 30, 169, and the last week (that influences the result) adds to 182, then yes, we are not that far off the ugly number if the meter is reading wrong.

    Last A1c we made at the same time the Bayer one, and the Bayer was 8.6%, the lab 8.1%.

    I'm traveling now, so I asked DS to do the A1c with the second Bayer kit left from the time before (they come 2 per box).

    The meter is an Roche Accucheck Performa, we've been using it for 4 years now. We briefly used the Nano model, but it was consuming batteries by the pound, so we went back to the Performa.

    I think I'll buy some meter and strips to see if it follows more or less the other, that'd be a check to do.

    Anyway, more bright ideas are welcome! And thanks again for the input, I'll start looking after your suggestions!
     
  8. TheFormerLantusFiend

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  9. Megnyc

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    First, I would repeat the A1C and get a new meter to eliminate that variable. But with the additional information about the night I think something might be going on there. It is possible that he is going to bed at say 130, spiking up to 250 or so and then dropping down to 130 (or another in range number) by morning. That would account for the higher then expected A1C since he is actually spending a decent amount of time high.

    I am guessing you are not in the US since you use the Accu-chek performa. If it is available in your country I would suggest doing at least a 3 day trial of a CGM (Medtronic ipro is one) to get a better idea of what is actually happening at night.
     
  10. Megnyc

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  11. swellman

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    IMO either the meter is wrong or the A1c machine is mismanaged.

    We had a long period of time where we were able to look at the OmniPod PDM and make a, pretty much, spot on prediction of A1c. Then, there was a period of about a year where the A1c averages on the PDM were off by about 1 full point. We switched meters and our A1c was perfectly predictable based on our meter averages. During that time the endo agreed to double test the A1c and test our meter against theirs. My only conclusion is that our meter was off.

    We also have a CGM but since it's calibration was always based on PDM tests it's averages were, predictably, the same as the PDM so ... CGM is useless if your meter is off.

    Our PDM averages are pretty much the same as our CGM averages which means even though you test at irregular intervals the PDM is still an accurate predictor of A1c.

    So, in my opinion, either your meter is way off or your endo's A1c analyzer is off or your have really high, mysterious absent periods when you aren't testing.

    So, compare your meter to other meters, get a home A1c test and compare that to your endo on the same day and if both of those fail to answer your issue either get a CGM or test throughout the night.
     
  12. sugarmonkey

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    Maybe you are missing highs at night somewhere, and he's coming down by morning. DS's dad wouldn't test him at night because he said he was always waking up in range. I showed him his logs that showed days where he'd gone to bed in range, gone up a little, not hugely high but out of range, then come back down to range without a correction. Maybe an occasional test once over night might help. We find around 2-3am to be a period where things can change alot.
     
  13. wilf

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    So are the A1C numbers you're quoting coming from a kit or a lab?
     
  14. shannong

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    My son's first A1C post diagnosis was not that great and I couldn't figure out why because his meter average was pretty good. The single biggest factor that helped lower his A1C was frequent testing at night. I realized that even though he came in range by morning, there were many hours spent high at night.
     
  15. Ed2009

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    Big thanks to you all!

    First step, we changed the meter yesterday. I do not have readings yet because I'm traveling and DS has not updated the website.

    Second, got an appointment with a nutritionist, maybe we need to tweak the food dept., although it seems to be OK. His BMI is right on spot, and he's careful with the food intake.

    But after reading your comments, I put my chips to the meter. Yes, it is 4 years old, maybe went off calibration.

    Thanks again for your input!
     
  16. wilf

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    Why blame the meter? Why not the A1C test?
     
  17. Mish

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    yeah, I have to say I agree. We've been having ridiculous weird readings on our a1c. Last fall at the doctors we got 2 finger sticks which were way off from each other and a blood draw which gave another number entirely. We had a blood draw done a few weeks before for something else, at another location, and that more closely matched our averages.

    the problem is, my child is like the only person in a very large hospital who is having weird a1c results. If the machine was busted, it would be busted for everyone.

    We're using freestyle lite which is highly rated - as good as accuchek. So I have no clue what's up.

    Ed. I feel your pain.
     
  18. Ed2009

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    Mish / Wilf:

    I still have to get done the A1c with the Bayer kit. However, the previous one (8.1%), I did the Bayer, that gave me 8.6% at that time.

    And it is very easy to change the meter, as I have a few. A while ago they were giving it for free at he pharmacy (Now I see why!) with the purchase of test strips.

    Changing the meter is the fastest check I can do now. I do not want to prick DS again before ruling out the other possibility.
     
  19. TheLegoRef

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    Have you ever used a cgm? Is it possible to try a blind cgm test? (ipro ?) We had one done before we decided on a cgm. The endo put it in, then a few days later we took it out and I just drove the sensor to the doctor within a few days. They can give you a print out of the readings and you can compare it with your meter readings.
     
  20. MomofSweetOne

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    A1C machines can be off. When we go to one satellite office, my daughter's A1C is always .4 higher than her CGM/meter prediction would indicate. When we go to our usual satellite office, the A1C machine there always matches.
     

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