Reversible Glycosylation

[Pritzlaff]

Type 1 - 26 years.  Pumper.  Been working extremely hard at control.  Just visited the doctor and had an average BG of 160 for 280 tests.  A1C was 8.0 which doesn't seem consistent with average BGs.  Had about ten tests in the 300- 400 range. Otherwise variance was +/- 20. Endo tells me because glycosylation is irreversible, it's these ten tests which cause the A1C to appear perhaps higher than the average BGs indicate.

This is the first I've heard of this in 26 years from a specialist.  Can anyone verify this or is it an assay problem where the office A1C units likely measure higher than a lab?

Thanks in advance for the assistance.

Frank

[JDRF-Team-gg]

Hi Frank!  As the mom of a 18 year old who was diagnosed at the age of 21 months, I can only offer my personal experience with A1C results - I am not a medical professional.  The 8.0 doesn't seem high to me if your average bg was 160.  I guess what I don't understand is an average should reflect just that...an average.  Those ten tests are calculated right in along with the other readings to create your average bg.  The only time you can know what your bg is, is the actual moment of when you test.  Because of bg fluctuation from minute to minute, you cannot assume you are in good control or poor control based on the recorded readings.  This is where the A1C can be used as a tool to make lifestyle or dose changes to obtain more optimal results.
     When did you get your pump?  How often are you changing your site?  The reason why I'm asking is that my daughter, since going off to college two months ago, has gone from changing her site every three days, to every four days (you can tell a college kid, but you can't tell them much!) and I have noticed a marked difference in her readings on that fourth day.  We are trying to figure out these high, unexplained readings and this factor could definitely play a role.  Are you noticing any patterns?  Just a thought for you to consider.
     Keep up the hard work!

[JDRF-Team-LRS]

Dontcha just hate that?  We think we're doing well and then our spirit gets dashed with a number from the lab doesn't reflect it???  We can all relate to that emotion!

A coupla thoughts to build on GG's Answer.  Does your meter average look similar to what you expected your a1c to be or more similar to your actual a1c?  If it's similar to what you expected, then probably you're just not testing when your BG is higher.  That can be cuz of chance, pattern, or sleep!  :-)

Do your high numbers tend to be in the morning?  If so, do some overnight tests to see if you can benefit from some tweaking in you overnight basal.  That's the hardest time to get a handle on, of course, cuz most of are asleep.  While those numbers may be higher than our waking averages, we don't have as many data points in that set of 280 either.

GG's point to look for patterns is about all we can do when trying to improve our control.  'til we find a pattern, it seems we've got nothing but "too many variables."  If you don't see any immediate patterns, try looking at these times first:
(1) fasting & then overnight (midnight, 2-4am, 6-7am)
(2) 2 hours after eating (our boluses last about 5 hours, but how high do you get after a typical meal? ... try different "typicals" ;-)  )
(3) pre-meal

If you're exercising regularly (shouldn't we all!), then do check about lows or rebound highs that may accompany your exercise.

Finally, don't be discouraged by the lab numbers.  This disease takes marathon skills ...