What is going on: An A1C Mystery

I am a little bit confused. When Ellie and I arrived at the endo’s office I was basically just trying to get myself calm and cool and ready for the A1C number that would tell me whether my feelings of slacking off were valid. i.e. using Dexter (Dexcom CGM) to log and keep track of Ellie’s carbs and insulin, instead of a log book that would offer more detailed information.
When she was diagnosed in January of this year, she was at 8.2. Three months later she was at 8.3. This (see previous blog) made me wonder a little…I now know they probably didn’t just make the number up. This time, another three months later, it is 8.2. For me this was not logical. My endo took it at face value initially. He only thought this was the second time we did an A1C test…so I could see that. However, when I looked at him like he was crazy-flat-out of his mind and said, “Really? I mean no offense, but NO WAY IS THAT POSSIBLE!”. I’d like to think that we are that consistent. I’d like to think that she is at an 8.2 and good for a little girl her age…but…I’m no D expert and it wouldn’t take one to know that is just not possible. Not with the diagnosis, then 4 months later the pump, and the first months of Type 1 diabetes. Not a chance!

Once the endo (who is the best around by the way…really love the guy he is my fave) looked at the charts and saw what I was saying…well he too was a bit confused.  It showed on his face and he looked over at me and said, “I don’t have an answer for you”.  He said of course it’s possible, but usually it’s not possible in a child, not enough consistency in the days and weeks of a four-year old to really get this result over the course of 8 or 9 months.  So two things are racing through my head.  First, what on earth is going on here.  Second, what’s wrong?  We Fincham’s are not always blessed with the most obvious luck.  We are lucky, we always have been really.  But our luck tends to come in tandem with some bad luck.  So it’s like winning the lottery on the day your family dog dies…your lucky, but you’re looking over your shoulder for the little disaster that comes with it!  Not complaining…just acknowledging the tendency for this to happen to us. 

So I ask anyone reading this.  Got any suggestions?  I tried to Google it of course.  But I found nothing that clearly stated this was possible, nothing that said this could be a result of this or that, nothing that I could read anyway.  An A1C is actually extremely complicated and you would have to be a bit more educated than I to understand how the test is done.  I get what it’s reading, but how it’s reading that…beyond my mathematical, biological know how!  (Not that it’s real hard to get to!)  I look forward to the answer at this point.  I hope it is not some quirky issue that causes more pain or problems for my little girl.  But I am VERY curious what the doc will have to say.

Otherwise we are on a bit of a roller coaster with Ellie’s numbers this week.  From what I see on a few other blogs, we are not alone.  I’m calling it:  Allergies, weather change and the way the wind has been blowing! HA!  No basal changes yet, but a lot of corrections and a lot of worry with those corrections.  I’m a huge fan of the Continuous Glucose Monitor when these blood sugar challenges come. 

Peace to all who read, and throw us a little heads up if this A1C thing rings a bell.  I’m not a fan of surprises when it comes to the D!

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6 Responses to What is going on: An A1C Mystery

  1. Reyna says:

    Hi…my name is Reyna from Beta Buddies. I stumbled onto your blog through Stephanie’s Blog. Anyway, I haven’t read your whole story yet, but I do know that A1Cs can be inaccurate with some blood disorders etc. I know with Sickle Cell Anemia (for example) that they need to use a different test in order to establish diabetes control. I will look into your story more and research it a bit…seems strange that the A1C has not budged with your due diligence friend.

  2. Reyna says:

    http://www.nih.gov/news/pr/nov2007/niddk-28.htm

    Above, please see a link I just found…I am not sure if it is applicable to Ellie, but wanted to pass on the information.

  3. Thanks for the sites! I ended up getting anxious and calling the lab to make sure they sent the results to the endo’s office. Then I sent a text to the endo’s phone and told him to read them and get back to me!!! I was starting to worry and needed to put the questions to rest. He sent a text not to worry, she is fine. A1C is 8.2 and her Fructosamine is 383 which equals an A1C of 8. Wha??? Ha! Ok! I have not received a call from him yet and I haven’t had time to look that big ol’ word up…so I’ll have to wait and see what that all means!?
    Thanks again Reyna for all the information. Mostly thanks for taking the time to help!!! Sara Fincham

  4. Sometimes we do everything we think we possibly can and the A1c still comes back with a really disappointing number.

    For her age, your endo would probably suggest being between 7 and 8. If that is the case then you are on track.

    Sometimes it’s the tiniest change that can make the biggest difference. We recently lowered our daughter’s A1c dramatically between visits.

    You can see our frustration and success here:

    http://www.d-mom.com/a1c-ugh/

    http://www.d-mom.com/a1c-work-in-progress/

    http://www.d-mom.com/a1c-yes/

    Of course some of the changes we made were only possible because of the insulin pump and being able to adjust basal rates and give partial pre-boluses. But maybe you can find something small that we did that you could also implement.

    The hardest thing is not to let the A1c feel like a report card or a judgment of your parenting. You just need to do what you can with the resources you have.

    Good luck!

  5. Nate’s a1c actually went up after dx. He was dx at 8 it then went up to 8.5 and it had taken me a year to get it down to 7.3
    As you know we had to switch practices to get the kind of care I was looking for for Nate. I think if you talk to your endo about lowering Ellie’s target range you will see more movement.

    I’m NO endo. Just what we had to do to see movement and once we did we saw the movement FAST! 🙂

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