question about A1C test for diabetes

bluewillow

Hello everyone,

I wasn't sure where to post this question, so please forgive me if there is a better place for it...

Can anyone out there tell me about the Hemoglobin A1C test for diabetes?   

Here is the reason I am asking: at my cancer check-up back in November, my oncologist recommended that I have an A1C done at my family doctor, since they do not do the test at the cancer center.  So, I went to my family doctor a couple of weeks ago and while I was there, I requested the test and was told that test wasn't ordinarily done and that my family dr. normally just puts his patients on a diet and exercise program who are at risk for diabetes or pre-diabetes.  I thought this was a simple blood test and am left wondering what is the big deal and why my family dr. didn't want to do it.  I am not totally pleased with my family dr. anyway, so this may be the last straw with him.  Anyone have any thoughts on this?  Is the test much more expensive and/or complicated than other tests for diabetes such as the glucose tolerance test, etc. and could that be why my family dr. isn't willing to do it? 

Thank you all very much in advance for your help!!

desdemona222b

The A1C test rates how normal your blood sugar has been for the past 3 months.  The test is for diabetics or for suspected diabetics.  I don't know about the cost or effectiveness comparison with a glucose tolerance test is, but the AC1 test is definitely less of a hassle than the glucose tolerance test.

I cannot for the life of me understand why a doctor is going to refuse to have a blood test done that a specialist requests. 

grama5

Hi blue willow; I am diabetic, type2 and recieve an A1c test every three months. What it tells is how much damage the sugar has done to your red blood cells. Your red cells regenerate every three months so to have the test done more often would not be an accurate measurement. I can't imagine your dr. not doing one. When I was dagnosed in march my A1c was 10.1 NOT GOOD!  and the glucose was 265. My doc put me on metformin, bp meds and colestrol meds immediatly It seems they all go togeather. My second test it was down to 7.6 and I need to get in for my test this month I am hoping this time it will be down where they want it, which is 6 to 6.5. My glucose readings now are between 95 and 118 except for xmas that is. Are you just borderline or pre diabetic or have you been diagnosed diabetic? Do you check your glucose? Not expensive medicare pays all of it. Along with A1c I am monitered for liver and all other functions every 3 months as diabetes affects all organs and the ability to fight infections. which is probably why your onco wnats the test, durung cancer therapy you are much more prone to infections.

Flo

lvtwoqlt

My parents are both diabetic (father insulin dependent, mother on metformin) and the GP office does the A1c test on them. My husband is also a diabetic and takes metformin. He doesn't check his blood glucose level as often as he should so the A1c helps the doctor determine if his meds are working. They have suggested I start getting the A1c because of the family history of diabetes. Des mentioned the glucose tolerance test, that helps determine how well your body produces insulin to bring down high blood glucose.

Sheila

bluewillow

Thank you, Desdemona, Flo, and Sheila, for all your helpful info!  I am really grateful for the explanation of what the A1c test reveals.  I have never been diagnosed with diabetes, but my onc suggested the test because of my family history (my parents do not have diabetes, but my maternal aunts, my sister and her two daughters are all severe diabetics), plus I was exhibiting some possible symptoms (frequent urination, etc. and to rule out nerve damage due to diabetes tho probably from the Taxol)   Also, my glucose has always been low, around 72 (w/the finger stick fasting test), and never got over 86 during chemo-- readings that I thought were good, but my onc said low blood sugar was a signal that diabetes may be on the horizon... is that correct?

Flo, I hope your readings are not too bad after Christmas, and hopefully your meds are working well for you.  Sheila, good luck with your testing and hopefully you won't have to deal with diabetes also.  I'm curious-- when your glucose is high, how do you feel or do you feel bad at all? 

Like Desdemona, I cannot understand why in the world my fam. dr. would refuse to do a test that an oncologist recommended.  I have been less than happy with my family dr. for a long time-- even more so after my bc dx-- now this is pretty much the icing on the cake, no pun intended.  I have an ob/gyn that I adore and trust totally, so hopefully she will do the A1C and then I can quit worrying and wondering!  I wish I could go to one doctor for everything, instead of my parts being farmed out to several different ones! 

Again, thanks for the help!

grama5

bluewillow

With high glucose you have NO energy. Before I was diagnosed I would come home from work and fall asleep in my chair. Sugar is what gives you energy and when your body doesn't utilize it you are fatigued. Also the frequent urination, I used to get up 3 or 4 times a night. Yeast infection because of excess sugar in the urine. Neuropthy...pins and needles and a feeling of cold in your feet even though to the touch they are warm. Again excess sugar kills the nerve endings. You can also have flushing and nausea.

Diabetes is hyperglycemia and low blood sugar is hypoglycemia.. hypoglycemia also causes fatigue, sweating and nausea. But also can cause coma. 86 is fine but 72 is getting to the caution point and you want to bring it up a bit. My goal is to keep it as close to 100 as I can with meds and diet. The only thing I can see for the A1c test is for your doctor to know if your treatment is causing the low count . If you have damage to the red blood cells it would tell him the low counts are not normal for you.

bluewillow

Thanks for the additional info.  I have been tired lately, but I have blamed that on being out of shape and weight gain.  I can't seem to get the pounds off that I gained during chemo.  Now that I am out of treatment, I'm trying to get back to where I was, but I just can't seem to get the weight off. 

I am curious about something else:  could heart palpitations (skipped beats) be related to diabetes or blood sugar problems?  I have been plagued with the heart palps for about three years, blaming it mostly on menopause, which a cardiologist confirmed, but I just have to wonder if there is a connection here to blood sugar problems, now that low is not always good, as I thought...? 

I am not really obsessed with whether or not I have diabetes, but I am still concerned. If my GP had just done the darn test, I wouldn't wonder and worry.  Hope to get in to see my ob/gyn for the test soon-- will keep everyone posted.

grama5

Diabetes affects all organs including the heart. usually high bp and colesterol go along with diabetes. usually it takes time with uncontrolled diabetes before there is damage though. They figured I had uncontrolled diabetes for about 5 years because of the neuropthy in my feet and my heart is fine. I had palps off and on then but associated it with smoking.

Ezscriiibe

I'm at a loss as to why the family doctor would simply say he just puts his patients on a diet or exercise program if they are at risk. . . no offense, but that's really stupid without first doing a test to determine if, in fact, the patient either IS at risk, or, worse, may already be into full-blown uncontrolled diabetes.

One of the biggest problems with diabetes is not simply high blood sugar (high glucose readings) but with the spike and drop of glucose levels. You may well have a low(er) glucose level at certain times of the day, but if your glucose spikes up very high after a full(er) meal, for example, then drops down low because of an insulin dump, well, there is something going on there.

and hbA1c can determine how your glucose levels are behaving over a period of time, unlike a single point-in-time glucose reading.

the hbA1c measures something called Glycated Hemoglobin, which is a substance that forms in red blood cells when blood sugar (which is what glucose is) attaches t hemoglobin. As someone mentioned, the red blood cells usually die off after 3 months, but the glycated hemoglobin stays attached, so by reading how much gylcated hemoglobin there is, doctors can tell how many periods of high glucose you've experienced.

For someone WITHOUT diabetes, glycated hemoglobin will be at roughly 6% (or 6.0). Diabetics strive for numbers below 7% (7.0) as anything above 7.0 indicates you can be at risk for diabetic complications.

In addition, as people age, their insulin-producing or insulin resistence abilities change. So it's not unusual for older patients to be screened with an hbA1c test.

bluewillow

Hi Ezscriiibe and thanks for responding to my post with some really good information.  And I agree with you that it makes no sense that my dr. won't do the test!

I have an appointment in the morning for my physical with my family doctor, and I hope to get some answers.  When I went in for my fasting blood work earlier this week (I wanted my lab work done prior to my physical this time so my dr. could go over them with me, instead of just getting the usual letter in the mail!), I asked the lab tech about the a1c test, and she said my doctor had not ordered it, but had ordered a glucose test.  She said if my glucose came back high, he would then do the a1c.  She also told me that the a1c test is only done for patients alread diagnosed with diabetes.  Does that make sense? 

I intend to ask my dr. tomorrow "why not do the test, like my oncologist recommended, and get it over with???"!!!   As I have said in many of my previous posts, I am disgusted with this doctor.  I wish I had a one-doctor-fits-all-ailments who knows more about physical and mental health issues once one is diagnosed with breast cancer!

wallycat

I personally have the A1c done every 6 months.  My fasting glucose was in the pre-diabetes range twice but my A1C has been between 4.8 and 5.8 over the last several years (this last check it was 5.4).  My twin sister's fasting is 86 and her A1c is 5.9 so I prefer to look at the A1c.

As I have explained to my doctor (I'm a dietitian), I fast once a day; I eat 5-6 times/day and I'd rather know my post-prandial readings than the one time in the morning.

My mom is a diabetic (finally put on insulin) so I am mindful of my genetic predisposition.

A1C is a simple blood draw and my thinking is that your family doctor is in denial about diabetes and who can present with it.  I still remember when I had a higher fasting and I had 3 doctors confused because my BMI was 19.  Most docs assume you have to be fat to get diabetes...weight gain certainly contributes to cholesterol and glucose issues, but it is not a given.  Find a different doc or explain to this one that you are set to have this done and will find someone who will rx it for you.  I'm really surprised your onco won't just order the test.  Especially if he is the one that suggested it.

Ezscriiibe

Bluewillow: The hbA1c is GENERALLY given to known diabetics. But my mother's doctor ordered one for her before she was diagnosed because of her age and some other warning signs.

 He also ordered the glucose tolerance test, but wanted to look at the history of what was going on in the blood stream (which the hbA1c does) and not just a single point in time (such as the fasting glucose tolerance test).

Oh, my brother always "passed" the fasting glucose tolerance test. Then one Thanksgiving holiday, all my family was over and somehow we got on the topic of my glucometer. Everyone wanted to see what their "blood sugar" was. This was about an hour after we ate dinner. Everyone's reading was within the ranges of low to high 90s. Except my brothers. His was something like 465. I almost fell over! He went to emergency room and I think they ended up giving him some insulin.  The next week he got an appointment with his doctor and they did, in fact, diagnose diabetes.

bluewillow

Well, I am back from the appointment with my family doc and finally, he relented and did the a1c test!  He was still very hedgy about the a1c and grilled me about why I wanted it-- of course I explained again that my onc had suggested it because of various symptoms I had mentioned at my last cancer check-up.  When I got to the part about gestational diabetes before my daughter was born (29 years ago), he squirmed and said, ok let's do the test.  So, off again to the lab I go... I'll get those results in about 3 days.  Here's what else he found in relation to blood sugar:  my fasting glucose was 94 (highest it's ever been, has always been around 72).  While I was there, he did a blood stick with one of those home glucose monitor kits and it was 113, and he said he was very pleased with that reading (this was 3 hours after I'd had breakfast), then did a dipstick urinalysis.  I just retrieved those results from the medical center's website and it said "Ketones were present, 5 mg/dl.  And I have no idea at all what that means-- can you all explain that to me?  Are ketones in the urine normal, or is 5 just a high reading? 

Also, when the nurse brought in the home glucose monitor thingy, she went for a finger on my right hand (even tho that's my off-limits side to needles and cuffs) and said "oh this won't matter"....

Wallycat, You are right about my fam. dr. being in denial.  And I wish my onc has just ordered it and saved me from having to "beg" for it.  Of course I do hope and pray that I do not have diabetes, but I would always be thinking "what if", if I hadn't had the testing.

Ezscriiibe, I hope your brother is doing well now.  I bet that was scary indeed!  Hopefully he is having success at controlling it.  My sister (actually my half-sister) has a time getting hers regulated, but I think it is because she doesn't really take care of herself like she should.

Thanks, ladies, for all your help and the best to you!

Anonymous

The A1C test is rapidly becoming the preferred test to diagnose diabetes.  If your PCP doesn't know this, and you have any concerns that you may have diabetes or pre-diabetes, meaning that you will be dealing with this in the future no matter what this test shows, that might be a good reason to find a new PCP. 

Ketones are not normal in urine.  Less than 20mg/dl is low, but a normal reading is negative.  They are the end-product of rapid or excessive fatty-acid breakdown.  If you have been following a very low carb diet that can cause ketones to show up in the urine because your body is burning fat rather than carbohydrates for energy.

My last couple of A1C results were 5.9, but I'm sure that they would be higher without the Metformin that I was put on when the results went from 6.2 to 6.4 in a three month period during which I was losing weight, and also started on Tamoxifen which I noticed affected my daily glucose readings by about 20 points.

wallycat

UGH.....of course doctors don't study nutrition (ok, 1 hour in all 4 years of medical school).

Any woman who has had gestational diabetes AND it is 10 years post delivery should be routinely checked for diabetes.  Yes, A1C is starting to become the preferred method for checking because it doesn't require fasting and gives a 2-3 month window.  A1Cs are not always accurate because red blood cell "issues" occur in a subset of genetics in populations, but for me, it is a more telling test.

I'm glad the goof-ball said yes to the test.

Ketones can show in urine for a variety of reasons and I'm hoping that yours is dehydration and lower carb diet.

113 "random" test is great.   Fasting 94 is still considered well in the normal range.

You are very smart to check this--not knowing does not mean not having it.

Best to you!

bluewillow

Hi,

The thing with the ketones has alarmed me a bit-- the urine test was negative for glucose, so could the ketones results be a fluke or something?   I have definitely not been on a low carb diet, in fact, I eat a pretty high carb diet all the time-- for breakfast, about 3 hours before my urine test, I had an egg, honey ham, and grits for breakfast with sugar-free, caffeinated tea to drink.  Would any of that cause ketones? 

Patmom, thanks for explaining the ketones, and evidently my doctor is not aware that a1c is the preferred testing method.  I really do need to find another PCP, for sure... Wallycat used a good descriptive term: "goof ball".  I think the whole practice is a bunch of gb's.  As I was leaving and heading toward the check-out desk, I was beginning to think the visit went pretty well and better than usual, but alas, at the desk, the lady handed me a sheet with directions to the imaging center downtown, and I said "what?"-- nothing during the visit was discussed about any imaging tests, so apparently they just can't get it together there!

Again, thanks so much for all the helpful info!!

wallycat

You can always have it retested.

eggs, ham and sugar free are all carb free....honey in the ham, depending on how much and the grits would add some carbs.  You may just ask to have it retested and ask for a blood draw to get a general CBC (kidney function, etc..)

Most urine tests are to check for infections; the days of testing glucose spillage into urine are VERY, VERY old and almost never done....which sounds like what they were doing.

If you are concerned, I wonder if you PCP can send you to a diabetes educator/nutritionist/dietitian.  A good one will be able to answer all your questions, look at what you are eating and help you understand any future changes.

Best to you.

bluewillow

Just thought I'd update a bit-- I went for a visit with a nutritionist at my PCPs office yesterday, and asked her about the ketones and also got my a1c results.  She got out her little hand-held gizmo and started punching info into it and said "my elevated ketones are dietary related, since I wasn't pregnant or on a low-carb diet", and that is all she said!  No follow up or suggestion to retest or anything!  My a1c was 5.0, and she said it was "good".  Period.  What a bunch of wackos.  Since I am due for my annual checkup with my gyn, I will talk to her about it all and to heck with my PCP!

lvtwoqlt

The A1C of 5 isn't that bad. My mom has worked to get hers below 6 while on her metformin. I think normal range is 4-5.9. When it gets over 7 or 8 is when they start to worry about better control. I found this site that explains A1C levels pretty good. at the bottom of the page is a chart explaining the relationship between the A1C level and mean blood sugar levels. http://www.medicinenet.com/hemoglobin_a1c_test/article.htm

Sheila

bluewillow

Hi Sheila,

I really do appreciate the information!  And the website has a wealth of info about the a1c.  It sounds like I don't need to worry about diabetes at this point, except the ketones thing has me a bit concerned.  Like Wallycat suggested, I will get retested.

I'm glad your mom has hers under control.  My sister is having problems with her readings right now and she's trying to control hers with diet, although I am still hoping she will kick her smoking habit too-- hard to do, I'm sure.

Are you ready for the big snow coming our way?  I don't think much of NC is going to escape this one, except for maybe Raleigh east.  I have to be in Statesville very early Monday a.m. for the birth of my second grandchild-- hope I don't get stuck somewhere along the way!  Stay safe in the snow/ice and thanks again!

Mary Jo

Ezscriiibe

Wow! I would KILL for an hbA1c of 5!! At one point mine was over 8.7.

Now it's hovering around 7.2, 7.3. I will dance a little jig if it ever gets under 7.0 . . . hmmm....come to think of it, if I would dance jigs more often, maybe it would lower faster? Dang that "exercise" thang. . . 

lvtwoqlt

ez, yep that exercise thing keeps getting in the way.

Mary Jo we ended up with about 6 inches of white stuff on the ground here but quite a bit of sleet with the snow. This morning we had some black ice where it thawed yesterday and refroze overnight. The main roads are pretty clear though. good luck on the birth of your grandchild.

Sheila

Yeng21

I accede with the added posters. Definately get on lath with your diagnosis Gestational diabetes is acquired by the placenta. pass4sure 642-813 So is a lot of cases you will acknowledgment to accustomed afterwards the babyish is born.

My doctor let me go undiagnosed with GD. My son was built-in abortive because of that. pass4sure N10-004 He was a whoppping 6 lbs 9 oz at 33 weeks gestation, and had a affection murmur, hadn't developed the sucking reflex yet so he had to be tube fed, pass4sure 220-701 and chock-full breath at one point. On top of all of that I about died. So amuse do as your doctor tells you.

Buffalocookie

My recent A1C test came back 10.1, previous test was 6.1. I am now taking insulin along with metformin twice a day. Diagnosed with Paget's Disease of the nipple, right breast, in June. Had surgery in July for removal of nipple and surrounding area.  My family doctor tells me my body is not handling the surgery well is the reason for the jump in A1C. Since I am schedule for another biopsy in September he put me on insulin. I hate cancer.

MTwoman

So sorry Buffalocookie! this thread hasn't been active since Jan. 2011. If you want to start a thread to get some discussion going, you'll most likely have a better response. Good luck!

Lula73

hi buffalo cookie – that is correct. If you are diabetic and your body goes through a severe period of stress, whether it's one day or one year or even more, it can cause your sugars to rise significantly. The A1 C test is a three-month average of how much glucose is attached to your red blood cells meaning it's a good predictor of what your sugar range has been over the last three months. 10.1 is definitely not good. Are you checking your blood sugars with your meter daily or at least with some regularity? Or are you just relying on whatever the readings are at your doctor visits? Unfortunately these types of swings in blood sugar can not to be corrected with diet alone and insulin is often need it. Additionally if any of your treatment includes steroids like prednisone, that will also drive your sugar up and insulin is often required to get it back under control.

53nancy

Hello everyone, I am Nancy, and I have been trying to find a page that will tell me how people have managed their diabetes during chemo.

MTwoman, I believe we met on another forum, before I learned of my Triple Negative Status on September 8th. It took eight weeks for that report. I do not know what Stage of cancer I have; the surgeon came in before my node biopsy to say he was sure the nodes would be clear, and the nurses told me afterwards that he only took one node, so I really consider that a PLUS. I see him in three weeks.

Buffalocookie, as others have already said in this forum, A1C is done on an every three month basis and gives you an idea of where your sugar levels sit, and is very important in diabetic treatment. I don't know what glucose tolerance tests are like nowadays; I only had one, in 1990, and one was enough!

My highest A1C in the last year, has been 7.0 (Canadian reading), with the others below 7.0. I take Metformin, 500 mg three times a day, and Insulin Glargine at bedtime, which is designed to keep insulin levels at an even level through 22-24 hours. When I had my lumpectomy in July, my sugars went wild, all over the place, high and low. The same after a sentinel node biopsy last week, though today so far they are stabilized.

I have no idea when I will be starting chemo, but I do know it will impact my diabetes, and am hoping others can help me with suggestions about how to manage it. I don't know if the Triple Negative status will make it even harder. I dread the thought of going on mealtime Insulin, as it means just more needles in an already difficult time, and hope that some feedback will help me there

All the best to you as you continue your journey. I do hope that those who posted in 2010 have had a successful one. Are any of you aware of another thread that is more up to date? Thank you.

Lula73

any stress on the body can make blood sugar go nuts. If your chemo regimen includes a steroid, your blood glucose numbers will go up and likely stay up unless treated for the rise. Odds are your lantus dose will be increased and they may add a mealtime insulin as well. Or they may try a glp-1 like Victoza or even a combination of glp-1 and basal insulin like Xultophy. Glp-1 helps control sugars around the clock-it helps your body's produce insulin at mealtimes (when you're adding sugar by eating -even if you're not eating sweets) Andhelps keep your liver from putting out excessive sugar too.