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Is HbA1c Of 5.4 A Cause For Concern?
Question: I have not been disgnosed with diabetes or prediabetes but have taken a home a1c test which came back at 5.4. My post meal glucose levels are also fine. What concerns me is my fasting glucose which I have monitored over the last week. I had a couple days at 101, one day at 100, 1 day at 91 and then two days where it was pretty elevated (112 and 119). If it werent for those inflated days I wouldnt be overly concerned. Is it ok to fluctuate like that and not be on the path to diabetes
Brief Answer:
Not ok
Detailed Answer:
Hello.
Thanks for writing to hcm. Noted your concern.
The values are widely different from day to day. Not being fairly consistent is something of a concern. Capillary glucose measurement with a glucometer is not the best when you would want to clinch diagnosis of diabetes / pre diabetes. Like wise the point of care (POC) measurement of hba1c is not a standardised way to assess your glycemic status.
Have you checked your fasting sugars and Hba1c at a laboratory?
Have you ever done a glucose tolerance test?
Warm regards.
Not ok
Detailed Answer:
Hello.
Thanks for writing to hcm. Noted your concern.
The values are widely different from day to day. Not being fairly consistent is something of a concern. Capillary glucose measurement with a glucometer is not the best when you would want to clinch diagnosis of diabetes / pre diabetes. Like wise the point of care (POC) measurement of hba1c is not a standardised way to assess your glycemic status.
Have you checked your fasting sugars and Hba1c at a laboratory?
Have you ever done a glucose tolerance test?
Warm regards.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Why would the variance be a concern? Is it a pre cursor to a diabetic diagnosis? It was also mentioned that I may have insulin resistance. I am not clear on the difference between that and diabetes. Lastly, my levels never go to the point of being in the diabetic range. Does that mean that, worse case, I may be pre diabetic
?
?
Brief Answer:
As explained below
Detailed Answer:
Hello. Well insulin resistance is the root cause for diabetes. Resistance to insulin cause more insulin to be released to maintain glucose levels in the body. In the initial phases the levels of insulin go up even four to five fold and that helps keep your glucose levels in the normal range. However that doesn't happen forever and at some point the insulin released is not at par with the degree of insulin resistance. That is when the sugars start to creep up as in your case. Prediabetes and diabetes are nothing but a continuum in the degree of the issue. The fasting sugars are primarily from the liver and it again shows the insulin in your body isn't meeting the need and that's why its moving into the pre diabetic range. The importance lies in the fact that in the majority of cases as studies have shown is that the glucose tolerance test can put many patients in the diabetic category unmasking the true picture. So many patients even in my practice has pre diabetic fasting levels with diabetic range gtt values for which as per evidence medications was started additionally. These are patients who would have most definitely moved into the diabetes category over time. So an early initiation of treatment thus gives us the opportunity to decrease the glucose levels and the hyper insulinemia and thus gives us the most valuable chance and additional time to prevent complications in the future. Hope I have answered your doubt. I will be disuss further if need be.Warm regards.
As explained below
Detailed Answer:
Hello. Well insulin resistance is the root cause for diabetes. Resistance to insulin cause more insulin to be released to maintain glucose levels in the body. In the initial phases the levels of insulin go up even four to five fold and that helps keep your glucose levels in the normal range. However that doesn't happen forever and at some point the insulin released is not at par with the degree of insulin resistance. That is when the sugars start to creep up as in your case. Prediabetes and diabetes are nothing but a continuum in the degree of the issue. The fasting sugars are primarily from the liver and it again shows the insulin in your body isn't meeting the need and that's why its moving into the pre diabetic range. The importance lies in the fact that in the majority of cases as studies have shown is that the glucose tolerance test can put many patients in the diabetic category unmasking the true picture. So many patients even in my practice has pre diabetic fasting levels with diabetic range gtt values for which as per evidence medications was started additionally. These are patients who would have most definitely moved into the diabetes category over time. So an early initiation of treatment thus gives us the opportunity to decrease the glucose levels and the hyper insulinemia and thus gives us the most valuable chance and additional time to prevent complications in the future. Hope I have answered your doubt. I will be disuss further if need be.Warm regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
I went in today for an ogtt test but they only wanted fo do an A1C test and fasting glucose. The results of my glucose the last week in Aug were at 90. Could they go up that sognificantly in 6 weeks?
Also what is your opinion on the correlation between elevated ALT and diabetes? At my last check it was 93. Hopefully todays resilts will show a decline as I havent drank. I also know I dont have Hep as I have been tested .
Also what is your opinion on the correlation between elevated ALT and diabetes? At my last check it was 93. Hopefully todays resilts will show a decline as I havent drank. I also know I dont have Hep as I have been tested .
Brief Answer:
Fatty liver possibly
Detailed Answer:
Hello again. It would have been nice if they agreed to do it. However as they didn't do it you could just continue with the improved lifestyle, diet and exercise. The values you mentioned are normal. Yes they can increase but no particular time frame can be speculated. With a good lifestyle it can be prevented from increasing. Alt levels rise could be related to a condition called fatty liver. It can increase as a result of alcohol use too. Fatty liver is almost like a marker showing increased risk of diabetes. Its due to insulin resistance as well. Its treated with weight loss and medications from a class called statins which is basically indicated for high cholesterol levels. Hope this helps. Warm regards.
Fatty liver possibly
Detailed Answer:
Hello again. It would have been nice if they agreed to do it. However as they didn't do it you could just continue with the improved lifestyle, diet and exercise. The values you mentioned are normal. Yes they can increase but no particular time frame can be speculated. With a good lifestyle it can be prevented from increasing. Alt levels rise could be related to a condition called fatty liver. It can increase as a result of alcohol use too. Fatty liver is almost like a marker showing increased risk of diabetes. Its due to insulin resistance as well. Its treated with weight loss and medications from a class called statins which is basically indicated for high cholesterol levels. Hope this helps. Warm regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
I received the results. My fasting glucose was 85 but my A1C was 5.7%
Additionally my AST and ALT are worse than the prior month
6 weeks ago
AST: 45
ALT: 93
Today
AST 68
ALT 178
The CT scan last month did not detect the presence of any issues with liver, pancreas, spleen or kidneys. I also dont have a gallbladder. I had an ultrasound this morning and while he couldnt tell me the results, inferred that the results would match the CT. The CT did not some calcification around appendix but since the gastro doc didnt require any follow up, assume she isnt concerned.
I am raising this because I cant understand what is causing those high levels. I dont have hep or fatty liver. The only meds I take are birth control (started last month) and advil.
Without the presence of a fatty liver, could the A1C results
Additionally my AST and ALT are worse than the prior month
6 weeks ago
AST: 45
ALT: 93
Today
AST 68
ALT 178
The CT scan last month did not detect the presence of any issues with liver, pancreas, spleen or kidneys. I also dont have a gallbladder. I had an ultrasound this morning and while he couldnt tell me the results, inferred that the results would match the CT. The CT did not some calcification around appendix but since the gastro doc didnt require any follow up, assume she isnt concerned.
I am raising this because I cant understand what is causing those high levels. I dont have hep or fatty liver. The only meds I take are birth control (started last month) and advil.
Without the presence of a fatty liver, could the A1C results
Brief Answer:
Can be so
Detailed Answer:
Hi again. The initial levels of sgot and sgpt was itself on the higher side. Its surprising that the USG and ct didn't pick up anything. The most common condition is fatty liver. Ocp medications that you are taking can increase the liver enzymes transiently and so would alcohol use. The a1c is in the prw diabetic range but the FBs is ok. USG scan and ct are reader specific. Various doctors can have various opinions. Get a second opinion. Just focus on weight loss and being active. Eat healthy. Cut down the alcohol. Try to do a full lft test. The GGT could point out to alcohol if its high that could be it. Please check your fasting lipid profile as well. Plz discuss with your Ob gyn if the ocp can be changed to something else. Regards.
Can be so
Detailed Answer:
Hi again. The initial levels of sgot and sgpt was itself on the higher side. Its surprising that the USG and ct didn't pick up anything. The most common condition is fatty liver. Ocp medications that you are taking can increase the liver enzymes transiently and so would alcohol use. The a1c is in the prw diabetic range but the FBs is ok. USG scan and ct are reader specific. Various doctors can have various opinions. Get a second opinion. Just focus on weight loss and being active. Eat healthy. Cut down the alcohol. Try to do a full lft test. The GGT could point out to alcohol if its high that could be it. Please check your fasting lipid profile as well. Plz discuss with your Ob gyn if the ocp can be changed to something else. Regards.
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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