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What Does This A1c Level Of 6.5 Indicate?
Question: I had diabetes probably about A1C of 6.5. I went on Byetta and over several years, my A1C went down to 6.1 I then went on a low carb diet and was able to get off Byetta and no drugs, and maintained my A1C at 6.0. Suddenly, 6 months later, under significant stress, my fasting sugar began to rise to 120- 165 and my pp 150 to 300. I do not have an endo any longer but now a PCP. Found my thyroid under active. Perhaps this caused the change in blood sugar levels? My PCP says she only gives Byetta or Metformin, etc. at A1C of 6.5. But I am on a low calories and very low carb diet and exercise. Do you think she is wrong is her personal guidelines? I have put on 15 pounds in one month, where my weight had been satble for a couple of years. I can't separate if it is the low thyroid or the not being on Byetta with pretty high blood glucose readings. I am trying to get back into an endocrinologist, but wonder if you have any comments? Thanks
Brief Answer:
See Endocrinologist
Detailed Answer:
I follow your situation.
With your fasting glucoses hovering in the 120-165 range and with PPG in 150 to 300 range, it is unlikely your A1c will be less than 6.5%
So if your PCP is willing to consider offering you those medications after seeing this, then you should be fine.
However there is more to this.
Regulating the thyroid well is important. So make sure your TSH is at goal with thyroid medication.
Inadequately treated hypothyroidism results in weight gain. Byetta would have had caused you some weight loss. Stopping that may have caused that weight to come back. When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies 12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
See Endocrinologist
Detailed Answer:
I follow your situation.
With your fasting glucoses hovering in the 120-165 range and with PPG in 150 to 300 range, it is unlikely your A1c will be less than 6.5%
So if your PCP is willing to consider offering you those medications after seeing this, then you should be fine.
However there is more to this.
Regulating the thyroid well is important. So make sure your TSH is at goal with thyroid medication.
Inadequately treated hypothyroidism results in weight gain. Byetta would have had caused you some weight loss. Stopping that may have caused that weight to come back. When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies 12 hour Fasting Lipid profile
Urine albumin to Creatinine Ratio (early sign of diabetes affecting the kidney)
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. So you think it might be closer to A1C 7.0. I do too.
My PCP is reluctant to put me back on Byetta because she doesn't follow. I am now sending her my fasting and PP's so she sees the real data, since she thought it might have just been a temporary rise due to my thyroid being suddenly hypo.
I had the whole thyroid panel done, no anti-bodies, TSH normal to high, Free T 4 low, out side of normal range. That is why she put me on .5 mg Armour, which we will monitor.
I did have a recent metabolic, a couple months ago and everything was in target, but my I don't know if being hypothyroid will change that. I have had lipid and advance lipid testing, and am on statins for several months now, and almost to goal. Need Vitamin D to be checked, since the new norms I see are above where the old norms were, so I am under where I should be.
I have not had CBC in at least a year so I will ask for that.
I am getting hsCRP done as well.
This is very helpful, validating, and hopefully my PCP will come around on the Byetta otherwise I will see an endocrinologist, but they are hard to get into. And I am feeling impatient and well somewhat panicked with the weight gain and high blood sugar. If I get stressed it has shot up to 500 before. Then I would need to go to the hospital, and I feel helpless because I eat right and try to stay calm, but without th medication and on the right diet I am helpless to these blood glucose changes.
Thanks, and if you have any other info, I will listen.
My PCP is reluctant to put me back on Byetta because she doesn't follow. I am now sending her my fasting and PP's so she sees the real data, since she thought it might have just been a temporary rise due to my thyroid being suddenly hypo.
I had the whole thyroid panel done, no anti-bodies, TSH normal to high, Free T 4 low, out side of normal range. That is why she put me on .5 mg Armour, which we will monitor.
I did have a recent metabolic, a couple months ago and everything was in target, but my I don't know if being hypothyroid will change that. I have had lipid and advance lipid testing, and am on statins for several months now, and almost to goal. Need Vitamin D to be checked, since the new norms I see are above where the old norms were, so I am under where I should be.
I have not had CBC in at least a year so I will ask for that.
I am getting hsCRP done as well.
This is very helpful, validating, and hopefully my PCP will come around on the Byetta otherwise I will see an endocrinologist, but they are hard to get into. And I am feeling impatient and well somewhat panicked with the weight gain and high blood sugar. If I get stressed it has shot up to 500 before. Then I would need to go to the hospital, and I feel helpless because I eat right and try to stay calm, but without th medication and on the right diet I am helpless to these blood glucose changes.
Thanks, and if you have any other info, I will listen.
Brief Answer:
Follow up
Detailed Answer:
Armor is not deemed safe by most thyroid specialists worldwide. Levo thyroxine is the recommended treatment
Follow up
Detailed Answer:
Armor is not deemed safe by most thyroid specialists worldwide. Levo thyroxine is the recommended treatment
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Oh. Thank you. Is that because it does not have a consistent release rate?
Brief Answer:
Second follow up
Detailed Answer:
It has variable amounts of T3 and T4. That makes it unsafe. Thyroxine (T4) is the 'pro-hormone' ie it gets converted to T3 inside the cells based on the body's requirements. T3 is the main hormone. But it is best to let the body determine its need instead of directly supplementing it from outside
Second follow up
Detailed Answer:
It has variable amounts of T3 and T4. That makes it unsafe. Thyroxine (T4) is the 'pro-hormone' ie it gets converted to T3 inside the cells based on the body's requirements. T3 is the main hormone. But it is best to let the body determine its need instead of directly supplementing it from outside
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks to both of you. I will mention to my PCP and see her response, and if I feel an endocrinologist would be a better doctor for me to see, I will see one. I am actually waiting for a call from one, hopefully when the holiday is over.
Best wishes,
XXXX
Best wishes,
XXXX
Brief Answer:
Best wishes
Detailed Answer:
for good health
Best wishes
Detailed Answer:
for good health
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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