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Forum Name: Endocrinology Topics

Question: Problem re: HBA1C Test


 wizbanger - Sat Mar 13, 2004 8:47 pm

Trying to be helpful to a friend and I am running low on thoughts. My Friend was tested twice both HBA1C test were elevated (7.1 once in October and now in March). The first his doctor thought was perhaps a false positive so he re-ran the test in March but the results stayed basically the same. His Doctor on receiving the second elevated number then ran a fasting glucose test which produced a 79 result (good as I know it). At this point my friend asked me what I thought. My friend is an Afro-American male about 57. His family has had a history of diabetes and I suppose why his Doctor ran the A1C before the Fasting Glucose Test.

1). My friend is not at all overweight(he is trim).
2). His Lipid panel is excellent in my opinion as of last Oct. HDL(102) LDL(90) T(46).
3). Not hypertensive.
4). I looked over his CBC (again as of last Oct.) and all was alright (I was looking for anemic/low iron) but his numbers looked fine(least as far as a CBC goes).
5). His basic diet to me is fairly good. Breakfast light mostly orange juice and unsweeten oatmeal, lunch a small salad, dinner mostly veg/some starchs and light on red/white meats and fish several times a week. He drinks unsweeten coffee. I should be so good.
6). He performs light exercise several times a week(4 days) for about 1/2 hour, his job is sedentary.

I then asked my friend to see if his Doctor would run a sickle cell test and do a glucose tolerance test. My friends Doctor agreed and ran these two additional test. I was surprised to hear from my friend the glucose tolerance test report back normal (I don't have the specific numbers yet) and no sickle cell. To look at my friend I can see no signs of cushing. I am running out of ideas to suggest and as of yet his Doctor has not ordered an additional test. So what else to look for? What is driving the A1C results up if all these other test show negative. Would you possible think that he is off and on again producing insulin as needed? Perhaps someother blood disorder? What additional test/markers would you suggest. I think that some of the test that were ran last October should be repeated now as well to get everything in sync. I like a good puzzle, I am not in the medical field and have just about exhausted off the top what I can think of to add. I am hoping his Doctor thinks of something and perhaps you can chime in a thought or two - but if not perhaps my friend should see and Endro whom I know and have alot of confidence in.

Any help would be appreciated - thanks for sharing - a helpful puzzled person trying to be helpful to a friend. :)
 Dr. Yasser Mokhtar - Sun Mar 14, 2004 5:10 pm

User avatar Dear Wizbanger,

The diagnosis of diabetes does not rely on a hba1c test results.

The diagnosis of diabetes is based on the results of either a high fasting blood sugar or a glucose tolerance test.

By definition of your friend's fasting blood sugar, your friend is not diabetic. As regards to the oral glucose tolerance test, if all the values were normal as well, your friend is not diabetic. There is a condition called pre-diabetes but it has a definition too according to the glucose tolerance test. If you friend does not fulfill the criteria these criteria, he does not have diabetes.

Now for this mildly elevated hba1c levels and the fear that there is hyperglycemia somewhere during the day that's not detected by the glucose tolerance test, there is a device now that can measure blood glucose level for 24 hours period but the person has to know how to count carbs and has to measure his blood sugar at least 4 times a day for calibration of the device and lots of other things. This is not an easy process and i am not sure that in your friend's case whether the insurance will pay for this device, it is usually used for diabetics who are very tough to control.

At any rate, the one thing that has been proven to prevent and/or delay diabetes is performing exercise, so this is the best thing that your friend can do.

Thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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