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Old 09-17-2013, 07:02 AM   #1
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Question about FBG and A1c

My husband had a fasting blood glucose of 122. He got a letter from his Dr stating he needed further testing for diabetes, and got a lab slip for an A1c. His A1c came back at 5.4. So his Dr said his blood sugars was good. See you in a year.

I don't understand?????

My fastings were 105 and I had a A1c of 5.8. I changed my diet and brought it down to 5.2, then 5.5.

Post meals for me are good.

My husband checks his post meals and they are below 110. So he is not pre-diabetic then? He is not changing his diet. But his trigs were very high at 385.

Advice?
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Old 09-17-2013, 10:15 AM   #2
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Hi ocean, My husband's situation is similar to yours, but his fasting glucose is not as high, it's usually around 105 and his A1c is normal like your husband's at 5.4. Is your husband overweight? If so, he may have Metabolic Syndrome or Insulin Resistance which is what my husband was diagnosed with. Elevated triglycerides point to that as well. Did your doctor check his fasting insulin? If it's high, that also points to Insulin Resistance, as his body is resistant to insulin so it produces more of it. I'm also confused as to how my husband's A1c is normal, while his fasting sugars are in the prediabetes range. By the way, your husband only had one fasting test that was in the prediabetic range; he would need at least two to point to diabetes. Plus, the level at which diabetes is diagnosed for fasting glucose is 126. He may very well be prediabetic and watching his carb intake (and losing weight if he needs to) and exercising could probably bring everything back to normal. I'd be interested in learning what others have to say about people who have fasting sugars in the prediabetic range, but normal A1c's.
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Old 09-17-2013, 11:34 AM   #3
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fasting glucose levels don't have that much influence on the A1c. That's sort of a running average on 24 hours a day for a few months. neither of them is the most crucial thing (from everything I have read) which is the amount of time one spends with it over 140, which is bad.

so overall, his blood sugars seem good. that doesn't stop high fasting numbers from being a red flag though. don't concentrate on a formal diagnosis of diabetes, because an impaired insulin metabolism should be dealt with in any case.

Probably he would benefit from Metformin. Sometimes people try hard to avoid taking meds, but in this case, the earlier a person starts taking it the better and longer it will work. and if he has an impaired insulin metabolism, the chances of him becoming diabetic at some point are a lot higher.

Metformin is very safe and is also associated with less risk for some cancers and dementia as one ages. win win! helps weight loss too if that is needed. and it's cheap. it can take some getting used to it--many have digestive problems at first. but if you just start with a small dose and work up, and keep with it, that will almost certainly pass in a month or so.

as to the triglycerides, you probably know this but just in case, they are pretty much a straight indication of carbs consumed. cutting his carbs will probably lower them a lot, even if he is still eating a lot more than what we consider low carb. of course in some cases there are just genetic reasons for high triglycerides, but in most cases this works.

good luck!
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Old 09-17-2013, 05:38 PM   #4
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I forgot to mention that my husband is on Metformin; the doctor just upped his dose from 1000 to 2000 because his insulin was still high. He sometimes has digestive issues from it, sometimes not. I have read that this a good drug and that it is protective (as raven mentioned), so I'm glad he's on it. Problem is, the medical profession seems to still associate this drug with diabetes only, not with Metabolic syndrome. Recently when my husband had hernia surgery, during the pre-op prep period the nurse took his glucose and was delighted to see that it was 101. We weren't quite sure why. Then another nurse was talking us and she said said something about him having diabetes. We corrected her and she was very surprised to learn that our doctor prescribed Metformin for insulin resistance.
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Old 09-17-2013, 08:08 PM   #5
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According to the Blood Sugar 101 site, a truly normal A1c (meaning someone who does not have diabetes or prediabetes) is between 4.6 and 5.4 and a truly normal fasting blood sugar is between 70 and 92

BS101 also says that several studies suggest that people whose fasting blood sugar is over 92 are more likely to be diagnosed with diabetes over the next decade.

Looks to me like something he needs to monitor closely.
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Old 09-18-2013, 07:07 AM   #6
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I know I don't have a FBG of 92 or under. I don't think in all my life I have had that. Is that a Dr. Bernstein thing? Not to cause a debate but his BS levels seem pretty strict, and hard to obtain by many people. Even with a strict no sugar/low carb diet, my A1c came in at 5.2. Currently I am at 5.5. And my Dr. feels that is fine. My husband is changing his diet. Low carbing/cutting back on sugar. He is very active during the day because of his job.


One has to wonder. Why so many people with "insulin resistance" nowadays? I never even heard of this until maybe the past 10 years or so. And these studies, is it to push more drugs from the pharma companies, or are they *really* concerned over our health.?

My FBG is 105. Has been that way now for about 7 or 8 years. I have had random blood draws and my BS are usually in the 80's.

I know I do not want diabetes. I think I would die if I had to depend on a meter all the time, and have to give myself insulin, and worry about blodd sugar crashes. I know a lot of diabetics, and their lifestsyle does not seem fun at all. I am staying on my low carb/low to no sugar diet. And hoping that the big D is not in my future.

I do not have a family history if any diabetes in the family, never had gestational diabetes either. And not on my husbands side.

Just wondering why the sudden increase in all of this prediabetes stuff and insulin resistance. And, is it ineveitable...that once you start falling in the prediabetic ranges, you will eventually, without a doubt be a type 2?
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Old 09-18-2013, 07:26 AM   #7
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The blood sugar 101 website is based on reliable research (not all research is reliable). If you do some reading there, your questions should all be answered.
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Old 09-18-2013, 09:33 AM   #8
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Quote:
Originally Posted by oceanlover66 View Post
Just wondering why the sudden increase in all of this prediabetes stuff and insulin resistance. And, is it ineveitable...that once you start falling in the prediabetic ranges, you will eventually, without a doubt be a type 2?
The A1c numbers are confusing because of what the experts consider 'normal'. For example, under 6 is 'normal', but 5.7 is pre-diabetic. Logic says pre-diabetic is not normal so how can anything above 5.7 be considered normal?

The skinnygeneproject (and I use their chart because it seems to coincide with what my A1c is and what my glucose levels have been) says that an A1c of 5 indicates an average glucose level of 101. Most experts believe that non-diabetics run around 85-100. So sounds like 5 or under is 'normal'.

The skinnygeneproject says that for every 1% increase of A1c over 5, there is a 20% increase in the occurrence of a cardiovascular event. Between 5 and 6.9, every 1% increase indicates a 40% increased risk of coronary heart disease. So it sounds as if 5 or under is where we want to aim.

I've seen a number of sites that say that once a person is diagnosed as pre-diabetic, it is inevitable that they'll end up on insulin at some point in their life. Given that the ADA diet is still quite high in carbs (around 140gm a day) and still allows refined carbs, it makes sense.

Dr. Bernstein believes that insulin resistance can be reversed by a strict low carb diet that allows only protein, fats, non-starchy vegies and less than 25gm of carbs per day. Which means it is likely that this prediction of inevitably ending up on insulin may not hold true in such a case.

My .02...if someone has an A1c over 5, their best course of action would be to immediately go low carb because over that and they may start heading off into the land of insulin resistance and diabetes.
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Old 09-18-2013, 12:05 PM   #9
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Originally Posted by oceanlover66 View Post
is it inevitable...that once you start falling in the prediabetic ranges, you will eventually, without a doubt be a type 2?
Definitely not. According to the ADA, an A1c of 5.7 to 6.4 is prediabetic and A1c of 6.5 and above is diabetic. 2 1/2 yrs. ago I was diagnosed prediabetic at 6.0 and DH was diagnosed diabetic at 6.7 We immediately started eating low carb/high fat and my last A1c was 5.5, DH's was 5.7 Does that mean I am no longer prediabetic? No. A non-diabetic's bg never goes above 140, no matter what they eat, but sadly that isn't the case for someone who has been diagnosed with prediabetes. So the bad news is once you have it, you have it, but the good news is as long as we keep eating this way, we have every reason to believe our diabetes will not progress. There are lots of diabetics out there who have controlled with diet alone for a lot more years than I have.

I am one of those who believes there is no such thing as prediabetes, which would be like being a little bit pregnant, you either have diabetes or you don't.

Quote:
Originally Posted by oceanlover66 View Post
I think I would die if I had to depend on a meter all the time, and have to give myself insulin, and worry about blodd sugar crashes.
Some people choose to take Metformin or use insulin even if they don't have to. I prefer to control with diet alone. As long as you aren't taking insulin and are eating low carb, you should never have to worry about sugar crashes.

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Originally Posted by oceanlover66 View Post
Currently I am at 5.5. And my Dr. feels that is fine.
When it comes to controlling diabetes, different people have different goals. Some want 'normal' A1c's, fasting readings and 1 and 2 hour post-meal readings. Others stay in ketosis at all times because they want lower fasting readings or for other reasons. Others believe it is best for their health to eat like 80% fat, 10% protein and 10% carbs. Others, like me, are happy just to keep the bg below 140 at all times to avoid diabetic complications. So it all depends on what your goal is. 5.5 sounds fine to me, and that is the same number I am at. I think you are doing great.
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Old 09-18-2013, 06:22 PM   #10
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Hi!

I was just diagnosed in August, so I can't answer any of your questions.

I just want to thank everyone for answering her questions, because y'all are answering mine too.

I am doing the "control with diet". My dr. was absolutely convinced that I would be fine doing the diet thing and so far my numbers have been stellar.

Funny how all those years, I would just poo-poo how I felt and eat crap that I shouldn't. Now I am like a like a lioness, I am not going to give in to this disease. (This diagnosis, quite frankly, probably saved my life!) I am a woman on a mission.

The weight isn't coming off as fast as I would like, but my blood sugars are good. So I can live with that.

We were at a "gathering" the other day and this lady said, "oh, surely you can have a bit of pie"! I said, "absolutely! But I want to keep my limbs much more than I want to eat that pie, but thanks anyway!"

thanks again for the insights!!
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Old 09-19-2013, 07:03 AM   #11
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I'm sorry, I don't agree that a normal person's glucose never goes over 140. If that were true, most people would be considered diabetic or at least pre-diabetic. I know stricter parameters are out there now (but not accepted by the mainstream...yet). I know loads of people whose A1c's hover around 5.5 and many of them are in their 20's and they will probably never develop diabetes. And I don't trust statistics; there are so many factors involved as to whether a person will develop diabetes....genetics, medications, lifestyle, stress, lack of sleep, other illness....saying a certain percentage of people with an A1c over a certain number are destined for diabetes....I just don't buy it. People are extremely complex beings and I'm tired of all the studies that lump them all together with statistics. I was looking over old blood tests of my Mother's from years ago and her fasting glucose was always over 100...sometimes as high as 120, and she said her doctor always told her it was okay (that was before they were doing tests for A1c). Now, at age 84, her FBG is in the 80's and her A1c varies from 5.4 to 6.1 with no change in her diet. She does not have diabetes. I feel the times her numbers were high coincided with a stressful time in her life which raised her blood sugar....it didn't necessarily mean she was prediabetic. People need to eat healthy and it's becoming more and more accepted that sugar and simple carbs are the culprit, not fat. In the meantime, if your A1c is 5.5 and your fasting blood sugar is in the mid to high 90's, I don't believe this means you're on your way to diabetes. But that's just me.
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Old 09-19-2013, 07:19 AM   #12
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I'm sorry, I posted before I was ready. I just wanted to add that people have all different "set points" at which their body likes to function. Some people's normal...and healthy....weight is over what the charts would consider "normal", but it's normal for them and they function better at that weight. Same thing with body temperature, and probably everything else, like cholesterol. Some people's set points for fasting glucose is 98 and their A1c is 5.5. As long as their fasting insulin is normal, as are their triglycerides, that's probably normal and good for them. Please don't yell at me....this is what I believe and, fortunately, my doctor believes the same. Again, I just don't believe people should be lumped into one category with the same numbers being considered normal for all.
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Old 09-19-2013, 08:21 AM   #13
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I don't think the meter I have is working right. I took my PP readings the other day. At one hour is said 114. At two hours it said 136. Half hour later it said 78????

Then yesterday, one hour and 45 minutes was 124. 15 minutes later at 2 hours was 131. Half hour after(2 hours and a half) was 121, retook it 3 more times in 5 minutes and each time it climbed to 124/127/129.??????????? I gave up and didnt take it again.

Another time it was 121 one hour, 141 2 hour, and half hour later 99???

I should add I have really bad health anxiety. Don't understand why my 2 hours are so much higher, and then drops like a rock 2 and half hours later?

Then I could have 3 cookies, and drink a sugary drink and my BS half hour later is 86?

Random BG through lab in the middle of the day was 82.

My FBG for the past 6 years has been around 105 on the average.

My husband threw out the BS monitor. I was obsessed with taking my readings. I am convinced I am going to get diabetes. Even with my changed diet. I dropped weight. 144-120lbs. In about 6 months. But my meter(and not sure if it was right) is still telling me I am having 2 hour high readings.

I have no family history of heart disease/diabetes. I never had gestational diabetes. All of my kids were under 7 pounds. I did have borderline high trigs last year at 197. Because I was eating tons of resses PB cups and sweet tea all day long, and so many carbs. Snce the diet change they came down to 87. Maybe I damaged my pancreas from ingesting all that sugar all these years.

When I was ingesting tons and tons of sugar my A1c was 5.8. I got it down to 5.2 in May, and it was 5.5 in August.
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Old 09-19-2013, 03:17 PM   #14
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Sometimes your 1 hour post-meal bg will be higher than your 2 hour, and sometimes the 2 hour will be higher, depending on what you ate.

Random testing is pretty much a waste of strips. Testing your fasting is fine, then 1 and 2 hours after you take your first bite of food. If either of those readings is 140 or above, eat less carbs at your next meal. This is called eating to your meter. Before long you will know which foods you can and cannot eat and how many carbs you can eat per meal and still control your blood sugar.

No need to obsess over the meter readings. As long as they are all below 140 - because that is where complications can start, and where diabetes can progress.

I know you are receiving information here that is contradictory and that is confusing. One reason for the contradictions is because there is a lot of diabetes research that contradicts each other out there, and they can't both be right. If you want to clear up the confusion, I advise you once again to do some reading at blood sugar 101. This is considered by many diabetics to pretty much be the diabetic bible because it talks about the research in an easy-to-understand way and tells which research is flawed and why, and which is reliable.
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Old 09-19-2013, 08:59 PM   #15
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I've only been diagnosed for a month. so I only have 1 month of records to go by.

Generally my B.S. peaks at 2nd hour and then goes back down at 3hr. I was expecting 1 hour peak but I seem to just be a 2 hour peak type girl.

I haven't been back to dr yet, but I am assuming that doesn't mean anything more terrible than just the way my body digests...

Oceanlover, just be glad you are fixing your levels BEFORE you get diagnosed... unlike me... who waited until the diagnosis before getting with it.. I am still REALLY angry with myself.

edited to add: Blood Sugar 101 has helped answer a lot of my questions too!

Last edited by helenback; 09-19-2013 at 09:00 PM..
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Old 09-19-2013, 09:25 PM   #16
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A meal that contains mostly processed carbohydrates with little fat or protein, would cause a rapid spike in blood sugar, usually within an hour, and a fast drop.

Eating fat or protein along with carbohydrate foods will slow the digestive process, resulting in a slower blood sugar rise and a little longer time to return to pre-meal levels.

That doesn't mean that fat is bad for diabetics, it is good for us. We don't want any 'rapid spikes' we want a slow, not very high, rise, then a return to pre-meal levels. So peaking at 2 hours is good.
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Old 09-22-2013, 06:33 AM   #17
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A meal that contains mostly processed carbohydrates with little fat or protein, would cause a rapid spike in blood sugar, usually within an hour, and a fast drop.

Eating fat or protein along with carbohydrate foods will slow the digestive process, resulting in a slower blood sugar rise and a little longer time to return to pre-meal levels.

That doesn't mean that fat is bad for diabetics, it is good for us. We don't want any 'rapid spikes' we want a slow, not very high, rise, then a return to pre-meal levels. So peaking at 2 hours is good.
Yeah!! I am so glad that peaking at 2 hours is good news! For someone who has just MISTREATED her body for soooooo many years. Since my diagnosis I a like a "rabid dawg" on trying to do what is right, so I am THRILLED to hear this!

thank you!
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