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Why would A1C have not gone down with glucose number?

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General & Family Physician
Practicing since : 2009
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Hello. About 5 weeks ago I began a strong diet with the recommendations of XXXXXXX My fasting blood glucose had been 117 and A1C 6.1%. Since then I have lost at least 10 pounds and did my blood test again, which shows glucose at 106 and the A1C still at 6.1%. Since I am being very careful about calories and simple carbohydrates I would have thought that my A1C would have gone below 6.0%. I now eat no snack foods, little rice, potatoes, bread or pasta.
Why would the A1C have not gone down with the glucose number? I admit that I have not yet started a proper exercise routine yet and need to still lose 75 pounds. I assume some exercise would help the A1C number. I have seen various opinions about what constitutes a good A1C level. Some say below 6.5% and others say below 6.0%, What is the correct understanding of this? Thank you.
Posted Tue, 17 Apr 2012 in Diabetes
Answered by Dr. Yogesh D 1 hour later

Thank you for posting your query.

I understand your concern. I greatly appreciate your will to loose weight and keep a check on your glucose levels, and I congratulate you on your success so far.

By your lab values I can see that there is some improvement in your blood glucose levels which is very good.

Now as far as the HbA1c levels are concerned I would like to make a few observations here.

1. HbA1c is an indicator of how your blood glucose have been over the last three months.

2. It does not change immediately. For you to see any changes in your HbA1c levels you must check after a minimum period of 3 months.

3. Considering your history I presume that enough time hasn't passed since you started changing your dietary styles, so I request you to keep up the good work and be a little more patient and get these tests repeated after another 3 months to know how you are doing.

4. The immediate change is seen in the blood sugar levels, and if you keep them under control I do not see any reason why your HbA1c levels would remain elevated. So continue with your dietary changes.

5. Exercise is a must for both reducing your weight and to keep your blood glucose levels under control.

Now coming to the exact values of HbA1c levels.

In established diabetics (who have had uncontrolled diabetes for a long time), the the accepted target levels of HbA1c would be under 6.5%. That means it is very difficult to get those levels below 6% for these patients, hence the doctors keep a more realistic, nevertheless aggressive goal of 6.5%.

And when the issue is with a person newly diagnosed diabetes or in whom the glucose levels are well under control, the target would be achieve HbA1c levels below 6%.

These above statements of mine mean that the ideal target level for anyone with diabetes would be less than 6%.

So do not worry. Keep up the good work and please start exercising at the earliest to maximize your outcome.

Hope my answer will be helpful to you. Please do write back if you have any additional concerns.

Please do accept my answer if you have no further queries.

Wishing you good health and all the very best.

Above answer was peer-reviewed by
Follow-up: Why would A1C have not gone down with glucose number? 25 minutes later
Thank you, Dr. Yogesh! I was not diagnosed as diabetic originally.
I will check the AC1 again in 3 -6 months. Hopefully by that time I'll be another 30 pounds less at least.....
My doctor only said that at 117 I was a little above the maximum which is around 110, although in the United States the medical industry a few years ago reduced their range from 110 to 100.
So the industry calls it "impaired" above 100 (previously 110). I have read that this was something of an arbitrary change a few years ago.
In any case, I am surprised that eating so little simple carbohydrates my number isn't below 100! My wife has a very good profile although she is not on the same regime as me and needs to lose weight, and her glucose never exceeds 100 no matter what. Is it so hard for me to get below 100, or is it simply a matter of getting the exercise and then getting off all the weight?
Answered by Dr. Yogesh D 1 hour later

Thanks for writing back.

I can understand your frustration and anguish at not being able to get these sugar levels to within normal limits much faster. But patience and exercise is the key here.

In persons with diabetes and pre-diabetes(Altered glucose tolerance), the metabolism of glucose is impaired. In these people there is always an excess of blood glucose this happens because the sensitivity of the tissue to insulin is diminished.

This diminished insulin sensitivity of our cells leads to what is called as a relative glucose deficiency(Availability of glucose to the cells) even though the actual levels of glucose are within normal limits.

This in turn leads to signals being sent to our liver and other tissues to produce and absorb more glucose, which further worsens the condition.

This excessive glucose in the blood and tissues can not be utilized efficiently by our cells, leading to all the bad things that follow, like excessive weight gain(excess glucose if not used-up by our muscles will get converted into fat), raised cholesterol levels, loss of glucose in the urine, kidney failure, heart failure and so many other problems.

The irony here is, the requiring tissues like muscles fail to utilize the glucose efficiently due to the diminished insulin sensitivity, that leads to poor muscle mass but at the same time this also results in fat deposition leading to obesity and a false sense of well being because we do not look under-nourished, wherein fact our muscles do not have the power to do anything which is reflected in us being easily tired all the time.

So since these changes have already taken place in a person with altered glucose tolerance, it does take time for these changes to change.

With exercise and continued dietary restrictions, slowly but surely you will be able to get these changes back to normal.

So it does take time to see an apparent and a major reduction in your blood glucose levels, but at the rate you are going, I do not think that day is very far.

So please do keep-up the good work.

And these fasting blood glucose levels were reduced in the United States to make sure that more and more people with a tendency to become diabetic are picked-up early so that they do not land up in danger zones. So it always better to be safe than sorry. That is the reason these margins are made much narrower. To help clinicians realize the importance of managing the pre-diabetic state aggressively.

And the studies recently have demonstrated that people with fasting blood glucose levels consistently above 100 mg/dl do have greater risk of becoming diabetics later on. So it is further more important that our fasting blood sugar levels are as close to the normal levels as possible.

I would like to reassure that with time and your efforts to reduce your weight and regular exercise you will be able get your blood sugar levels back to normal.

Hope I have answered your query.

Please do accept my answer if you no more concerns.

Wishing you good life.

Dr. Yogesh.
Above answer was peer-reviewed by
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