What's your A1C?

What's your A1C?
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internalheights
Message 1 of 6 , Aug 8 10:52 AM
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Hello group,

I am wondering what values of hemoglobin A1C you find concerning? Do you follow the standard ADA guidelines for diagnosing Pre-DM of 5.7-6.4%? For prevention of blood sugar/insulin issues, when are you initiating treatment?
How often do you see health oriented natural minded patients - active, whole foods diets mostly plant based, healthy body weight, etc with higher A1C values 5.4 or 5.5, essentially getting close to Pre-DM values?
I've seen a couple patients recently with a higher A1C 5.5, who live really well and eat consciously. They both have a family history of diabetes, but I still was surprised by the A1C.
So it got me wondering and I tested my A1C and it was 5.4 - I very much practice what I preach regarding diet and lifestyle and consider myself healthy and fit. I was surprised at my result, compared to my sibling who is overweight, has poor eating habits and other health issues with an A1C of 5.0. We also have a family history of diabetes. Speaking of which, how much do you feel a family history plays a role in a condition that is so heavily influenced by diet/lifestyle?
So healthy naturopaths, what are your A1C values?

Andrea Minesaki, ND
Phoenix, AZ



davidrfield
Message 2 of 6 , Aug 8 11:18 AM
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Regarding A1C:
I am releasing personal medical data here!  63y.o. male.  Rx meds 1.5 gr Westhroid Pure.  Boatload of excellent supplements.  FH of both parents with Type 2 DM.  My A1C is consistently 5.7-5.9, with the lower results being when I carb-restrict (so much so that my recent weight loss prompted labs and consult with the MD, the conclusion being I don't eat enough carbs and I work too hard physically).  Unlike Dr. Minesaki's family, MY  younger brother who drinks a quart of either house brand cola, house brand DIET cola, or house brand "cranberry juice" (red-dyed fructose water) is obese, hypertensive, and diabetic.  I'm no Moorstein or Epstein, but for months I did a LOT of carb/sugar restriction, and the A1C STILL remains in that range (albeit the lower end).  In my 30's - 40's I ate the famous "plant-based diet" that was the ND party line (grain-based with occ. fish and LOTS of veggies) and had higher A1Cs.  As for "healthy" diet, I do not eat a "plant-based" diet, but TONS of veggies and plenty of organic meats, wild caught seafood, our own OG eggs every day (sorry, Dr. Chong), but I believe my diet is "healthy" given my diabetic propensity.

I still favor exercise and movement as the first line of diabetic prevention, followed closely by carb restriction.  I'd be curious if there were some kind of "anti-inflammatory" diet or such that would prevent Type 2 DM.  So far so good with me; my dad was on medication well before his 60's (lunches of Snickers bars and skipped meals).

Keep us posted!
David Field, ND, LAc
Santa Rosa, CA



Mona Morstein
Message 3 of 6 , Aug 9 6:35 AM
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Okay, a few things about the A1C values.

The lab variance is about 0.5% so an A1C of 5.7 can actually be 5.2-.6.2%.   Also, aging, like causing wrinkles on the skin, can cause elevation of A1C values outside of actually being a glucose reaction.  Third, A1C needs to be compared to fasting glucose and post-prandial glucose—if the glucose numbers are great, the A1C is elevated from age or maybe is a little off with the lab variance, and don’t worry.  I always check Glycomark with A1C in diabetic patients (not with non-diabetics, and I’m not sure insurances want to cover it in non-diabetics).  Forth, family history does count with T2DM; those with a clear history of it may while being healthy may have a tendency to have higher A1Cs a little.  Also, aside from diet and exercise, remember that stress, sleep, environmental toxins and your capacity to detox, and the health of your gut microbiome also impact on glucose and A1C levels.  So, it’s not that simple, easy lab value we think it represents.

Mona Morstein, ND, DHANP
Tempe, AZ



Ian Bier
Message 4 of 6 , Aug 10 5:10 AM
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Hi Mona,

Do you have a citation for that 0.5% figure? On a reading of 5.7% that would be almost 9% variance which seems really high.

What I could find was lower at about 3.5% - http://archinte.jamanetwork.com/article.aspx?articleid=412871

3.5% on 5.7% would be 0.2, so 5.5%-5.9% test-retest.

Thanks,



Ian D. Bier, ND, PhD, LAc, FABNO
Naturopathic Doctor, Licensed Acupuncturist
Fellow, American Board of Naturopathic Oncology
Vice-Chair, Board of Medical Examiners, American Board of Naturopathic Oncology



Mona Morstein
Message 5 of 6 , Today at 7:06 AM
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024379/

Analytical variation
There are ∼100 different methods used to measure A1C. The most widely used commercial methods use either antibodies (immunoassays) or cation-exchange chromatography (most commonly high-performance liquid chromatography) to separate the glycated (A1C) from the nonglycated hemoglobin (24). The National Glycohemoglobin Standardization Program (NGSP) has been instrumental in standardizing A1C testing among laboratories (58,59), particularly (but not exclusively) in the U.S. The NGSP has markedly improved the performance of A1C testing (58). At the time of writing, the vast majority (93%) of clinical laboratories that participate in CAP surveys use methods with between-laboratory CVs <5% (www.ngsp.org). Within laboratory CVs for some methods are as low as <0.5%. In addition, the International Federation for Clinical Chemistry (IFCC) developed a reference method using mass spectrometry (or capillary electrophoresis) for A1C measurement, which should result in international harmonization as it facilitates traceability to a metrologically sound accuracy base. It is important to emphasize that the IFCC method is technically complex, time consuming, and expensive and is not designed for routine analysis of patient samples.

https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/comparing-tests-diabetes-prediabetes/Pages/index.aspx
With a coefficient of variation as large as that allowed by the National Glycohemoglobin Standardization Program, a reported A1C result of 7.0% could indicate a true A1C of anywhere from ~6.5 to 7.5%.

Mona Morstein, ND, DHANP
Tempe, AZ



J. Claire Green, ND
Message 6 of 6 , Today at 7:24 AM
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I have a 49 yo female patient,  no significant family history for t2d, weighs about 110 pounds, eats clean, negative work up for LADA, with A1c of 5.9.  Her postprandials always normal but she has significant fasting morning sugars.  It appears related to her snoring. ...she did not fit the criteria for apnea after a sleep study, but does have airway resistance syndrome.  My guess is she is getting cortisol surges from drops in her oxygen levels through out the night.

This is a work in progress, trying to figure out work around since insurance won't pay for cpap since the sleep study was inconclusive. She is solidly perimenopausal, so looking into hormone balancing as that can improve snoring.

If anyone has feedback on various devices out there for snoring that are more high tech then raising the head of the bed would love to hear.

Anyhow,  Mona is right, so many factors involved in elevated A1c, not just diet.



J. Claire Green ND
Santa Rosa, CA