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What do these HbA1C levels indicate?

Answered by
Dr.
Dr. Saumya Mittal

Diabetologist

Practicing since :2004

Answered : 2881 Questions

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Posted on Tue, 6 Sep 2016 in Medicines and Side Effects
Question: I have been trying to make sense of abnormal blood sugar levels for months and notice i feel spacey sometimes.
My Alc was 5.3
My post prandials vary but average
126-160 1 hr postprandial
100-118 2 hr postprandial

My fasting glucose is the number that can be way off.
My blood sugar after midnight ranges between 90-115 until around 6-7am.
At 6-7am my sugar goes up without eating.
Sometimes only a few points and has gotten up to 150. Im assuming this is increased gluconeogenisis.This only lasts for anywhere from 45 min up to 2 hours and will always drop to normal right after i eat.
Regardless of if i eat during my spike my sugar wont go over 170.
After this blood sugar spike event in the morning, my sugar remains well below 130 all day, even if i eat.
My blood sugar also continues to consistantly get lower the closer it gets to evening.
Before i eat at 8-9pm im always between 70-80 (mostly in 70 range)
After i eat dinner my blood sugar doesnt get over 120(normally not more than 110).
My GP said not to worry but start exercising.

Ive noted a few other things.
I normally only eat 1 large meal at night and seems maybe when i eat a few meals during the day my numbers are normal in the morning or just above 100.
Diabetes does not run in my family but my mother, grandfather and brother have hypoglycemia issues and started noticing issues when in their 40's, which i am in now.
They all just watch how much sugar they eat, none take anything medicinal.
I dont know what to make of all this. Any idea of whats going on? Thanks
doctor
Answered by Dr. Saumya Mittal 3 hours later
Brief Answer:
Possible type 2 diabetes like features

Detailed Answer:
Your HbA1C is a bit on the lower side- normal is about 6.
Post prandial sugars are fine.
Your midnight samples are ok even if on a lower side.
Random sugars are slightly raised but acceptable (I assume these are glucometer readings- takes as = or - 20 from the lab range.
The fact that your sugars about dinner are good are a good thing.
The disturbing fact is that you dont take regular meals- that wrecks havoc with the hormonal systems.
I am assuming you need to know why the fasting is raised - the question is not stated in that summary clearly.
I am assuming you take no medicines at all as there is no history given for the same. I assume you have never consumed steroids in your life.
I am assuming you have never noted a actual drop of sugars to hypoglycemia range, unlike your family.
In the early morning hours, hormonal changes in your body will naturally cause blood glucose to rise. For people who don't have diabetes, the increase in blood glucose is offset by increased insulin production. For people with diabetes, this can be a problem.The liver is supposed to release small amounts of glucose when you're not eating. In type 2 diabetes, liver pours more glucose than what is needed into the blood at night/early morning. So, your hormones are cause a natural rise in blood glucose. However, in your case, your liver is releasing even more sugar into your blood.
There may be some developing insulin resistance due to which muscle and fat cells do not use the sugar. Therefore, your blood glucose level rises.
As you eat, more insulin is secreted making the sugars better.
I agree with your doctor, at the time only exercise is needed.
I suggest testing insulin and glucagon levels.
Best of luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal 1 hour later
Yes, im on no meds. Yes, i wonder why fasting is so high.
So is this a pre diabetic type situation?
Ive done a few glucose tolerance tests at home with 75 g of glucose and all are below 140 2 hours postprandial. My fasting glucose seems to be related to 3 things.
1- if i eat multiple normal meals during the day fasting sugar is lower.
2- reducing sugar intake though this doesnt seem to make as much of a difference as eating more of a normal 3x per day diet.
3- eating another snack at midnight somehow lowers my fasting glucose.
If i just eat 3 meals per day ive gotten many fasting readings in the 90's.
My GP says maybe some level ofinsuline resistance but probably more to do with eating schedule or lack of meals.

doctor
Answered by Dr. Saumya Mittal 10 minutes later
Brief Answer:
suggestions

Detailed Answer:
Hi
Thank you for your response.

I agree with you that meals are definitely involved.

Also as of now, by labs there is no diabetes. But symptoms do suggest insulin resistance. And glucose tolerance test may not yield results yet.

That diet pattern also suggests that you need to have frequent meals.
That's what I had commented in my prior responses.
Taking once a day meals is a much stressful system for the body functions and hormones.

I would suggest exercise regime and frequent meals.

Best of luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saumya Mittal 10 hours later
Today upon waking my sugar was
105 at 4:30am
130 at 6:45am
93 at 7:50am

This is a pretty consistant picture of what my glucose readings are the majority of the time in the morning.
As i said, after the morning my glucose responds pretty normal
.
doctor
Answered by Dr. Saumya Mittal 11 hours later
Brief Answer:
2 possibilities

Detailed Answer:
Yes,
First, you should not be up at 0430 hours-in the sense that night was made to sleep and humans are not natural night creatures- the hormonal cycle is set a such.
If you usually get up at that time, the body attunes to that time.
The hormonal changes happen and spontaneously body assumes 0430 as the fasting.
So, if you regularly get up at 0430, that is your fasting level, not 0645 hours.

If that is not the case, this is a typical picture of someone who has a mild hypoglycemia during night. It would be advisable to take a mid night snack before sleeping.
It may help return your sugars to normal during night, thereby correcting the fasting sugars.
- in the above statement, I assume you had no calory intake between 0430 and 0645, and took something between 0645 and 0750.

Do you get any symptoms?
Best of luck.
Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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