What is your clinics average a1c range?

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What is your clinics average a1c range?


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Old 11-12-2013, 03:38   #1
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Default What is your clinics average a1c range?

I got my a1c back last week and it was 5.8 up from the nice 5.3 that i had while on metformin and the lab range says 3.9 to 5.9 so I asked my Dr. if that meant if I went to 5.9 would I be considered lab wise diabetic and he said that 6.5 and above was diabetic (I remember when it was 7.0) but I could swear at my last clinic it was 6.1 because my a1c then was 6.0 and she said I was right straight on the border. so just wondering what some of your labs might justify Pre D and D?

And of course his course of action is to stay the course, diet and exercise...will start the exercise soon here I hope.

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Old 11-12-2013, 04:25   #2
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Why do I get notified of my OWN posts? Most annoying.

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Old 11-12-2013, 06:36   #3
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My lab says < 6.0 % is normal.
But you are right once upon a time the diabetes label was at 7.0%, then revised to 6.5%, then 6.3% and now to 6.0%. Looks like the pharma industry is working overtime.

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Old 11-12-2013, 08:30   #4
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Bottom line, they don't know. A lot more tracking is needed and it's not clear such a "boundary" even exists. For example, if some one is at 6.2 and then lives 40 more years without going above that, we'd have to say that their 6.2 was NOT diabetic.

On the other had if another person just drifts up from say 5.0 and at some point takes off to 12.0 and then gets diagnosed, we know they are diabetic at 12.0. But, exactly WHEN did they cross from "non" to diabetic? Not a question that can be really answered.

What's important is "trajectory". If you're 6.5 but unchanging for several years, maybe you're not diabetic and never will be. If you get 5.2, 5.5, 5.8, 6.0 in successive years you're probably heading to the big D. Bouncing around in "normal" range is of course not a sign of anything wrong - more likely margin of error.

Most labs I've been to use things like "moderate risk of diabetes" (I think that one was from 5.8 to something) and "increased risk of diabetes (a higher range I don't remember). That's much more reasonable language.

Ultimately, we're probably measuring the wrong thing. IMO, we should be measuring INSULIN response to glucose. When insulin is excessive relative to the normal population, T2 is beginning. This is typically several years before any blood sugar symptoms.

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DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
A1C 9/2011: 5.6 (DX + 2 years)
A1C 7/2012: 5.5 (DX + 2 years 10 months)
A1C 1/2019: 5.5
Diet: Approximately C:10;P:15;F:75 (as % calories)
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Old 11-12-2013, 10:48   #5
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My doctor's lab considers diabetes as greater than 6.5. They also state right on the lab test something like this - "An A1C of 5.6 or greater has been linked with an increased risk of diabetes."

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Old 11-12-2013, 11:22   #6
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Quote:
Originally Posted by Mary0110 View Post
My doctor's lab considers diabetes as greater than 6.5. They also state right on the lab test something like this - "An A1C of 5.6 or greater has been linked with an increased risk of diabetes."
Yeah, I like that and think it's very precise language. In other words, there's a mid-range where we just don't know. That person may or may not go on to become diabetic. Of course that's true for everyone, even at A1C=4.6. But if it can be determined that n% of those found at 4.6 end up diabetic later on whereas y% do so who are found at 5.8 (where y is a bigger number), then a case would be made for "higher risk".

I'm not convinced that's even been done - and I could see it going either way. For example, in the real population the vast majority of whom are eating a very similar diet:

IF T2 is indeed the gradual increase of IR because of high glucose AND insulin, and

IF T2 then progresses to degradation of the insulin production capacity of the pancreas (relative to the abnormally high need because of IR)

Then two cases seem equally plausible:

1) The one with an A1C in the "high normal" range like 5.8 is more likely to progress to frank diabetes because this number reflects that the process has already begun, OR

2) The one with the 5.8 is LESS likely to progress because he's not producing large amounts of insulin in order to wear out his capacity, OR

3) the one with the 4.6 is less likely to progress because they just dispose of glucose so darn well, OR

4) the one with the 4.6 is MORE likely to progress to T2 because they are "hyper-regulators", squirting out massive amounts of insulin to quickly and efficiently get rid of glucose as it arrives. Taking the general assumptions that high insulin aggravates insulin resistance and high output from the pancreas hastens it's demise, THIS groups with the excellent starting A1Cs (again, barring any major differences in diet, probably a valid assumption for most of the population) would be the most likely to become diabetic.

I don't think we have enough data to solve this. If anyone knows otherwise, please post.

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DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
A1C 9/2011: 5.6 (DX + 2 years)
A1C 7/2012: 5.5 (DX + 2 years 10 months)
A1C 1/2019: 5.5
Diet: Approximately C:10;P:15;F:75 (as % calories)
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Old 11-12-2013, 11:26   #7
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My French lab used to report "normal" as lying between 4.3% and 5.7% but I've just noticed that my last one shows normal as 4% to 6%. So do the French now think diabetes starts at 6%? - I don't know and I suspect that neither do they!

I think Salim is right. The HbA1c is an easy measure to take and that's why it gets used but by the time it's abnormal, we're too late!

Again, I think that putting people into little boxes
"normal",
"metabolic syndrome",
"impaired glucose tolerant",
"pre-diabetes",
"diabetic"

(I'm sure the others can think of even more categories)
is virtually meaningless. There are no simple crossover points.

When we know that our handling of carbohydrates is impaired, we need to take steps to manage them ourselves.
In my view we should start with diet and exercise and move to medication when necessary but not just because a doctor decides that we now belong in another box!

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Old 11-12-2013, 12:40   #8
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That's right about the insulin. A couple years ago when all this started when I had the 6.0a1c Mr Dr also tested my insulin and if was 16 and she said 17 was diabetic. So 6.1 a2c and 17 insulin was diabetic and I was one point off on both. This Dr more duds not think testing insulin is necessary and goes only by the a1c.

Quote:
Originally Posted by smorgan View Post
Bottom line, they don't know. A lot more tracking is needed and it's not clear such a "boundary" even exists. For example, if some one is at 6.2 and then lives 40 more years without going above that, we'd have to say that their 6.2 was NOT diabetic.

On the other had if another person just drifts up from say 5.0 and at some point takes off to 12.0 and then gets diagnosed, we know they are diabetic at 12.0. But, exactly WHEN did they cross from "non" to diabetic? Not a question that can be really answered.

What's important is "trajectory". If you're 6.5 but unchanging for several years, maybe you're not diabetic and never will be. If you get 5.2, 5.5, 5.8, 6.0 in successive years you're probably heading to the big D. Bouncing around in "normal" range is of course not a sign of anything wrong - more likely margin of error.

Most labs I've been to use things like "moderate risk of diabetes" (I think that one was from 5.8 to something) and "increased risk of diabetes (a higher range I don't remember). That's much more reasonable language.

Ultimately, we're probably measuring the wrong thing. IMO, we should be measuring INSULIN response to glucose. When insulin is excessive relative to the normal population, T2 is beginning. This is typically several years before any blood sugar symptoms.


Last edited by John.in.France; 11-12-2013 at 13:25.
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Old 11-12-2013, 13:56   #9
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I've never had my insulin levels tested, at least that I know of. That would probably be good information to have. Must remember to ask for it next time.

Looking at yesterday's A1c lab results, the interpretive guidelines say:
Non Diabetic = < 5.7
Increased Risk = 5.7 - 6.4
Consistent with Diabetes = > 6.5

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Old 11-12-2013, 20:36   #10
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On my latest test my lab says normal range 4.4-6.4%. On the test when I got my dx (feb 2012) it said 4.8-6.0%. Guess they broadened the range of normal?

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