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Why Hemoglobin A1c Is Not a Reliable Marker


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Over the last few years doctors are increasingly relying on a test called hemoglobin A1c to screen for insulin resistance and diabetes. It’s more practical (and significantly cheaper) than post-meal glucose testing, and it’s less likely to be skewed by day-to-day changes than fasting blood glucose.

What is hemoglobin A1c?

Sugar has a tendency to stick to stuff. Anyone that has cooked with sugar can tell you that. In our bodies, sugar also sticks – especially to proteins.

The theory behind the A1c test is that our red blood cells live an average of three months, so if we measure the amount of sugar stuck to these cells (which is what the hemoglobin A1c test does), it will give us an idea of how much sugar has been in the blood over the previous three months.

The number reported in the A1c test result (i.e. 5.2) indicates the percentage of hemoglobin that has become glycated (stuck to sugar).

Why is hemoglobin A1c unreliable?

While this sounds good in theory, the reality is not so black and white. The main problem is that there is actually a wide variation in how long red blood cells survive in different people. This study, for example, shows that red blood cells live longer than average at normal blood sugars. Researchers found that the lifetime of hemoglobin cells of diabetics turned over in as few as 81 days, while they lived as long as 146 days in non-diabetics.

This proves that the assumption that everyone’s red blood cells live for three months is false, and that hemoglobin A1c can’t be relied upon as a blood sugar marker. In a person with normal blood sugar, hemoglobin will be around for a lot longer, which means it will accumulate more sugar. This will drive up the A1c test result – but it doesn’t mean that person had too much sugar in their blood. It just means their hemoglobin lived longer and thus accumulated more sugar. The result is that people with normal blood sugar often test with unexpectedly high A1c levels.

This confused me early in my practice. I was testing blood sugar in three different ways for all new patients: fasting blood glucose, post-meal blood sugar (with a glucometer) and A1c. And I was surprised to see people with completely normal fasting and post-meal blood sugars, and A1c levels of >5.4%.

In fact this is not abnormal, when we understand that people with normal blood sugar often have longer-lived red blood cells – which gives those cells time to accumulate more sugar.

On the other hand, if someone is diabetic, their red blood cells live shorter lives than non-diabetics. This means diabetics and those with high blood sugar will test with falsely low A1c levels. And we already know that fasting blood glucose is the least sensitive marker for predicting future diabetes and heart disease. This is a serious problem, because fasting blood glucose and hemoglobin A1c are almost always the only tests doctors run to screen for diabetes and blood sugar issues.

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Another condition that affects hemoglobin A1c levels is anemia. People who are anemic have short-lived red blood cells, so like diabetics, they will test with falsely low A1c levels. In my practice, about 30-40% of my patients have some degree of anemia, so this is not an uncommon problem.

What blood sugar markers are reliable?

Testing accurately for blood sugar is like putting pieces of a puzzle together. Fasting blood glucose, A1c and post-meal blood sugar are all pieces of the puzzle. But post-meal blood glucose testing is by far the most reliable and accurate way to determine what’s happening with blood sugar, and the most sensitive way of predicting future diabetic complications and heart disease.

For more on why post-meal blood sugar is a superior marker, read my article When Your Normal Blood Sugar Isn’t Normal (Part 2). To learn how to test your post-meal blood sugars at home, and what healthy targets should be, read my article How to Prevent Diabetes and Heart Disease for $16.

Another useful – but underused – blood sugar marker is fructosamine. Fructosamine is a compound that results from a reaction between fructose and ammonia or an amine. Like A1c, it’s a measure of average blood sugar concentrations. But instead of measuring the previous 12 weeks like A1c, fructosamine measures the previous 2-3 weeks. And unlike A1c, fructosamine is not affected by the varying length of red blood cell lifespans in different individuals. Fructosamine is especially useful in people who are anemic, or during pregnancy, when hormonal changes cause greater short-term fluctuations in blood glucose levels.

To put the most accurate picture together, I like to have all four: fasting blood glucose, A1c, post-meal glucose and fructosamine. But if I only had to choose one, it would definitely be post-meal glucose.

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Join the conversation

  1. I read your article–Question. My AIC has never been high. I have not been officially diagnosed with any Diabetes.. My Fructosomine was just checked it is alos normal. WHy am i concerned? MY blood glucose level was 168 on Monday..it has never been this high. DO I have other symptoms? YES–dehydration chronic for past few months, CANDIDA (My tongue is actually blue and wehite ) wuth positive testing for a rare form of fungi. (unresponsive to diflucan or Voraconazole or Nystatin) (I need IV therapy but they refuse to admit for some reason)…Other ongoing issues– some tingling in toes a long time. What is your opinion? Had I eaten before the blood glucose was taken..NO. It was NOT a fasting glucose. Still 168 is high..it has never approached that. Coupled with unresponsive repeat candida…dehydration—some other odds blood markers– recent spike in phosphorus and triglycerides… opinion? further possible test?
    Have I had any other recent illness? YES–I was in hopsital twice this summer for a form of pneumonia and My urine was ORANGE for a month…they claim it was from taking an anti biotic and dehydration..I am not sure..as my curerent spefic gravity in urine is OVER 10.40+ (extremely high) AND I have had repeat protein in urine. MY total proten and protein ratio in the blood was NORMAL . ?? strange

  2. I have a puzzling problem. I have been on a strict AIP diet for about a year now and when I first started the diet I was having very horrible bouts of hypoglycemia, post prandial sugars sometimes in the 50s. It leveled off as I got used to my diet of normally 60-100 carbs however even now, I’m having very bad hypoglycemic episodes after exercise. My A1c is low (4.5), normal fasting glucose is in the low 80s, fructosamine is 268, glycation gap is -1.71, but my postprandial glucose index is off the chart at 13.9! I don’t understand. Any ideas would be welcomed. Insulin resistance markers are: leptin (18), adiponectin (26), free fatty acid 1.02- very high, ferritin 81-high, a-hydroxybutrate 10.3-super high, oleic acid 101-super high, linoleoyl-GPC (11.9). C-peptide (1.0), insulin and pro insulin (3) and antigad negative. Sorry for all the nerdy info but I’m a nerd…(and a nurse) anyone? Chris?
    I have stopped exercising due to the anxiety of having another blood sugar drop that sends me to the ER.

  3. YOu may need to get your thyroid checked, make sure htey order TSH, Free T 3 and Free t 4 etc., check outMary Shomon’s site on FB. KIf you are entering menopause this could be an additional reason for weight gain

  4. My A1c is 5.4, and my fasting glucose is always between 104 and 120. However, after a meal, it usually never gets higher than about 110. (I eat low carb for the last 3 years). My issue is not my health–which has been fantastic since I started low carb paleo, three years ago. My issue is that as my health improved, my weight went up (even as my hunger went down–and I ate less, as more healthfully). I am about 20 pounds overweight, but regardless of how much exercise and weight-lifting I do, (in addition to my fabulous diet–and I have already tried giving up this and that–please do not tell me to avoid nuts or I will go nuts!), I still remain too heavy. Why are so many middle-aged women (I am 48) struggling with excess weight???

    • If you are exercising, your weight could be muscle, since muscle weighs more than fat. Unless your clothes aren’t fitting, I wouldn’t worry too much about the weight, especially if you are feeling healthy otherwise.

      • Yes, I am exercising, and the extra weight has put my clothing up a couple of sizes. I feel healthy, but frustrated about non-muscle, weight gain…

  5. I would like to add to my pervious comment, First off not every ones body acts the same to Diabetes or also the treatment. Doctors each have there own theory on treatment which proves its not an exact science and there is no perfect way.

    All the drug companies are rushing to give you the magic bullet and all they are doing is modifying what has be already successful in one form or another.
    Don’t let Doctors scare you with the A1C base lines,, I found that its always best to research from the considered best and that’s the top research Medical Facilities,
    No family doctor is an expert or can he be the one to make the BOOBOO go away. He can only recommend what he feels is best, But always get more opinions and try and find those that only specialize in the problem you have.
    And use common sense in your eating and exercise, check your sugar after fasting and not all day .
    If you want a pasta have it but not a dump truck full, Have a piece of Pie, but small and cut out something else.
    And you are diabetic Type 2 and that as called the drunks disease not fat persons and or even diabetes in my day, But you got some sugar,,smile
    I have a guy in my Block 76 years old that is 6ft 4 about 130 pounds and walks 7 miles a day,, He is a wreck because he is so hungry and afraid to eat, As his sugar was 140 and his doctor right away put him on Metformin and he is told to not walk 12 miles a day like he was but cut back to 7. He is too skinny and I told him he needs to eat if he wants to exercise that much. But he is getting all the wrong signals from his doctor.
    My sugar on average for 25 years has never been below 140, Since I have now went on Insulin and P[ills never did work well some I couldn’t even take My sugar can be as low as 67 abut I don’t like it there and strive for 125 to 140,, Now some Doctors will say I am about to die,,ha,ha,, Of course I am I am 81 years old served in two wars and have been exposed to years of asbestos and every cancer giving product in the Military known to man, I worked in Radiation and Aviation high led fuel and many other bad things, But yet her I am, Blowing off on the net,,I must be doing something right,,,
    By the way, When I was determined to be diabetic 35 years ago, My Sugar was 850, My cholesterol was 900 and my Triglycerides was 2700 and 85 pounds over weight. I was given one pill three times a day, and changed my life style drastically. I quit red meat and beer and walked 12 miles a day.Now my sugar is 100 to 170 fasting and I don’t walk any more than I have to,

  6. I am glad to see that some one has written the facts on A1C testing, I am 81 years old and been treating my Type 2 for 35 years, The old fashion way and my older doctors way of fasting sugar.
    I have fired several Young doctors with there lack of Knowledge and or wisdom. I have researched for years on all the Meds and note when I started there were only two pills. I always stay in contact with Johns Hopkins and Mayo clinic as well as Harvard Medical. On what’s new,, Not what some young Doctor that is just selling drugs.
    I tell them right out I care less about A1C I go by what my fasting sugar is and its worked for me for 35 years. I still can see and have my legs as well my Kidney function, Yes I had triple bypass sugar but am sure it was from my life style years back .
    Doctors are scaring the hell out of their patience instead of helping them understand,
    My daughter was claimed to have type 2 and she was a nervous wreck from what doctors was doing to her until I talked to her.
    I fought Hospital Dieticians that there is no such things a Diabetic diet, and Now I read the AMA and ADA has agreed.
    Find a doctor that relly knows what Hypoglycemic feels like and don’t try and sell you every dam drug on TV and works with you, Remember as I tell them all, YOU WORK FOR ME NOT ME FOR YOU.

  7. I am having a rather unusual problem as well as described by some of the comments that I have seen. I test daily for a fast and post meal glucose with my home test kit and I am consistently at between 77-114 for blood sugar. However, I just had an A1C test and it came back at 10.7! Something here is not adding up and I am going to try and make an appointment with an endocrinologist to see if we can figure this out. At my physical in March my A1C was 7.1 and then when I began having symptoms in mid to late April, I had an A1C test and it came back at 11.7. I have since been prescribed medication and have engaged in a diet restriction plan and workout program to lose weight as well as to lower my glucose levels. However the disparity that I am seeing in my home test versus the A1C has me somewhat concerned. Is this normal?

    • I am not a Doctor but you are on the right track getting a specialist or endocrinologist, I have as just wrote that have fired several Family doctors as they are hung up on the A1C and try selling every drug they see on TV. I have also had Doctors fire me because I refuse to be bullied by there demanding I go by their treatment or they will refuse to treat me. Lets face it The diabetes type 2 is a cash cow now days for Drug companies and Doctors.
      I have been Type 2 for over 35 years and am now 81 with both legs, eyes ok and my fasting sugar has been any where from 67 to 170 and my so called A1C since they started it has never been good so Doctors now get in my face about it where as the Doctors of past never mentioned it, I started with a BSD of 825, and now I am on insulin and was on Metformin for past 35 years but have quit it as I want to give my liver a break. So far se no difference by quitting.
      I am by all means agreeing on loosing the weight as I lost 70 pounds, how every insulin has put 20 back on and at 81 I don’t exercise that much as I should. I have had triple bypass three years ago and have starter to enjoy some old comfort foods I gave up years ago as I believe that at 91 I don’t expect to be 100 and what time I have left I want to enjoy. So the hell with A1C I will stick with what has worked for me the last 35 years. My advice is use common sense and find a doctor that also dose the same.

  8. Thanks for this article, as it shed some light on what I’m currently going through. I just recently tested at 3.5 for A1c, and am going tomorrow to do a 2 hour fasting test. Something is definitely wrong with me; I’ve had symptoms for the past 6 months or so that point to some sort of blood sugar problem (in my opinion!). But my doctor says that an A1c at 3.5 is normal, and a random blood sugar level test performed showed 103. I practically had to beg for the fasting test, as he didn’t think I needed it. I suspect my A1c reading is off due to 2 things: Firstly, I have a 20 plus year history of anemia, and secondly, I am half Asian, half Caucasian.

    I’ve been monitoring my blood sugar levels at home for 2 weeks and notice that after meals it averages 145, and first thing in the morning I’m at around 115. I bought a meter after having what felt like a hypoglycemic episode. My recurring symptoms are the usual in blood sugar disorders: fatigue, frequent urination, deteriorating vision, edema, headaches, pre-hypertension, bad reaction to sugar and I’m always thirsty. I have other symptoms as well. I’m frustrated because I’ve been to 2 different doctors who discount my symptoms, and tell me I could have anxiety (I’m guessing the anxiety diagnosis stems from the fact that I’ve told them I’m in grad school). Just because I’m 37 and slim doesn’t mean I’m in good health!

    Thanks again, Chris. Very informative article.

    • Hi Mel,
      Have you tested for Celiac Disease? I have exactly the same symptoms that you describe and I was just diagnosed with Celiac. I’ve never had any of the GI symptoms normally associated with Celiac, but I’ve struggled with anemia for 20 years despite a healthy diet and exercise lifestyle. Celiac was the culprit. You should insist they test you for Celiac. Good luck!

  9. I have microcytic anemia and my recent a1c was 5.6%. According to the ADA I am perfectly healthy. However, I know that when the ADA was coming up with the diagnostic criteria for diabetes decades ago they used a secluded population away from the rest of the world. They chose that population because they wanted a population where everyone behaved the same so it was easy to define a point of guaranteed diabetes. They also made it high because insurers would deny people coverage for diabetes and get fired from their jobs for it. I have been testing my glucose at home and I can get highs up to 170 mg/dL. I already paid out of pocket for my own a1c away from my PCP and I’m planning on paying out of pocket for an OGTT. Of course, until I lose a limb I won’t have a medical professional listen to me. Anyways, I’ve done the research and I know that all the methods for diagnosing diabetes are flawed except maybe the PP and Fructosamine.

    • Breanna,
      Purchase a blood glucose monitor and test strips for home use if you haven’t already done that.
      Walmart’s Relion Ultima is one of the least expensive and most practical. Test strips are individually foil wrapped so are not damaged by exposure to air & moisture.

      I find my meter reads 10-15 high so test it against a fasting blood glucose test rather than A1C. It is usually the actual test strips that make it vary since exposure to heat can damage them.

      Dr. Richard Bernstein is an 80+ year old Type 1 diabetic. Check out his books on Amazon or elsewhere. It might be helpful to you.

      • Mary,

        Right now I am using the Contour Next EZ meter and stripes. I pay around $25 a month for strips and lancets. If you think the Relion Ultima ones would be better than I would be willing to happily switch. Like I mentioned I can get highs up to the 170s and at the same time hit lows in the 60s. I’ve noticed it doesn’t matter what I eat or drink for the crazy range I experience. I’ve read that with my a1c of 5.6% that the range could be a low of 5.1% to high of 6.1%.

        That range still ignores any impact my anemia plays on things. My last CBC was in November so without a CBC around the a1c draw date of April 8 its hard to know what to figure about the a1c other than its right on the cusp of to start worrying. I should mention I already have diabetic symptoms so I don’t feel I’m imaging things contrary to that a1c result. Some selected symptoms: thirst, urination, yeast infections, weight loss, headaches, plus numbness and tinging in extremities.

        With my extreme range of readings at home I don’t feel its worth mentioning the average because crazy highs and lows dramatically affect the result. What I end up doing is graphing the results as I have a reading and since I started testing at home the results scare me. If you have some specific books by Dr. Richard Bernstein that you would recommend I would happily listen.

        • Before changing meters, I would suggest you go to the library and find Consumer Reports’ glucose meter reviews. The Walmart meter is cheap, but you get what you pay for.

          • The Walmart Relion Ultima meter works as long as the test strips have not been exposed to extreme temperatures.
            Abbott Laboratories makes meter & strips. The strips are individually foil wrapped so are not exposed to air each time you test.

            I had a more expensive meter that does lots of stuff except get an accurate reading that came up with an 84 for after meals. NO WAY for me!
            Fortunately, I got it from Costco and was able to return it.

            • Breanna, find and endocrinologist and get your GAD antibodies tested and your c-peptide, you could be getting type 1.5 diabetes/Latent Autoimmune Diabetes in Adults ( type 1 as an adult). It’s an autoimmune attack and very real, follow your gut!

  10. Cinzia,
    I am also a hypoglycemia. I noticed you said that you don’t eat white bread, so I wanted to add that for me usually any time of bread is a problem and also crackers. I’ve found that they usually even add sugar to the wholegrain breads so I just stay away from all bread unless it is Ezekiel bread which takes longer to break down in the body.

    • you do realize that yeast needs sugar to bloom? otherwise bread wouldn’t rise.

  11. Thank you for this article. It has really helped me to understand what is happening with my blood sugar and the A1C test and it’s given me some hope for my future.

    After Christmas my office had a huge supply of chocolate covered this and thats, gummy worms, and all sorts of sugar. For a few weeks between stress at home and at work I was on a high confection diet. Then gave my head a shake and started eating healthy again. I must have been eating 2000cal of sugary stuff a day.

    A few weeks later I had a blood test and my doctor tells me I have diabetes. He said the fasting number was very good but the A1C number was too high (I don’t know what it was – I’ll ask next time).

    I’ve asked several people if it’s possible my intense sugar intake overloaded my system and skewed the results; but they all say “no”. But now I’m wondering if that might have been the case.

    I have a glucometer and I’m doing daily testing. After fasting I read about 4.6mmol, after a normal meal 5.8mmol, after a horrible heavy meal 6.4mmol. I’m not on any medication.

    As you can imagine I’m quite upset at being diagnosed with diabetes and I’m trying to make sense of this.

    Whatever happens, I’ve had a huge wake up call. It’s all healthy eating and lifestyle for me now!

    • My HBA1C went from 5.1 to 5.4 on a test in February and I was pretty alarmed. My doctor asked did you do anything unusual food-wise over the holidays? I told him I went on a 6-day cruise and it was nonstop eating and drinking. He told me that would definitely have skewed the results.

  12. I always get normal A1c and slightly high Glucose level in my tests, what do you think the problem is? Male 32 now.

    A1c=4.6 Glu=107

    A1c=4.9 Glu=109

    A1c=5.2 Glu=95

    • Your glucose levels are not high. I get these numbers first thing in the morning (fasting), and I know they are normal. I have a type 2 diabetes that I control with diet.

  13. I know you say the HBA1C is not reliable, but what if you are see in a trend of increasingly higher numbers? Over the past two years mine has gone from 4.9 to 5.1 to 5.4. On the same day of my 5.4, my fasting was 88, triglyceride 85, HDL 91, and LDL 87. A couple days after this test I had another glucose test done and it was 83, and that wasn’t even fasting. So I’m not sure what to think.

    I recently started taking rhodiola. Could this raise my levels?

  14. This is exactly what i needed to know.

    I’m in Paleo (not nazi-strict Paleo though) and my hba1 is strangely raising while all my other blood tests are getting better and better.

    • How much protein are you eating?
      Remember gluconeogenesis that can turn protein into glucose.
      How high?

      • That should not matter. If he is a non-diabetic the gluconeogenesis should not change his blood sugar numbers.

  15. Hello sir, My daughter age 1 y 5 m having problem of lesser HB 6.2 due to Due to Heart beat max 75. kindly advice prefer foods for raising her HB level.

  16. I’m 41 yo, 6′ 3″ and 205lbs. About 6 months ago I started having LUQ pain, diarrhea, and some kind of like systemic neuritis. My GI doc tested my exocrine pancreas enzymes at super low and put me on an enzyme replacement. The nerve pain continued though, so my primary doc checked my A1c and found it to be 5.4. When I compared it to a previous result 6 months earlier and 3 others going back 5 years they were all 4.5 or below. I am scheduled to have it checked again soon but my question is whether a jump of .9% within the “normal range” is a significant number, or does it not matter until it reaches minimum unhealthy threshold?
    I have researched this since July and can find no information about how to judge A1c movement in non-diabetics. I have gone to a basically paleo diet for fear that a jump of that much, combined with my apparent PEI, means something not great is going on with my pancreas and that diabetes is inevitable. Maybe I’m wrong though and someone can educate me. My neuritis remains unabated, though my doctor assures me that at my current levels, it’s not related to blood sugar.

    • I came upon your query in searching for info on A1C, for my husband. But I want to reply to you regarding the “enzyme treatment” you mention above , if you have been given the RX drug “CREON” make sure to note there is a side effect noted on their website (ID taken this for 8 years and have “Fibrosing Colonopathy!” http://www.creon.com

      I now take OTC enzymes, Essential Enzymes, available from Vitamin Shoppe. Have you had lipase amylase and protease checked again? For years I haas undiagnosed/untreated **LYME I have Sjogren’s induced pancreatitis, which will result in some diarrhea. Please get that checked via SSA-SSB test, I test NEG on that, which happens in about 40% of patients, but I am diagnosed with Sjogren’s because of the loss of teeth , pancreatitis dry eye and mouth and some salivary stones. I suffered though MANY MRI’sw/ contrast, for most part for undiagnosed Lyme and one for pancreatitis.

      **get checked thru Igenix in CA as Labcorp & Quest’s testing are kept intentionally high with criteria to avoid diagnosing and treating patients because they don’t want to reveal the amount of Lyme cases are really out there (TEN time stye national average!) http://www.cbsnews.com/news/cdc-lyme-disease-rates-10-times-higher-than-previously-reported/

      If your neuritis is not being relieved, is it possible that you have ever had any MRI’s with contrast in your health workups? I feel my retention of GADOLINIUM contrast has caused so many issues from fibrosis added into colon/bowel, pain, dermal fibrosis, yellowing in whites of eye, contractures of hands and feet, etc. IF you HAVE had MRI’s w/contrast get blood checked, your local doc can order these thru Mayo Medical Labs:


      Page upon which “G” catalog tests appear:


      Gadolinium, 24 Hour, Urine
      Gadolinium, Dermal, Tissue*
      Gadolinium, Random, Urine
      Gadolinium, Serum
      Gadolinium/Creatinine Ratio, Random, Urine
      Gadolinium, Dermal, Tissue, will need to be done if and when I test POSITIVE for GADOLINIUM In blood and/or urine.

      (next note is for your doc if they WON’T listen to you!)

      If you are REFUSING to order any lab studies, I would like to request that you sign a copy of this letter and place it in my medical chart. You will also receive a copy of this letter via registered mail.
      Mayo Medical Laboratories: Reference Laboratory services for hospitals worldwide

      AUNT MINNIE & GE & $5 Million verdict


      Study links Gadolinium MR contrast to brain abnormalities
      By Wayne Forrest, AuntMinnie.com staff writer


      Radiology. 2014 Mar;270(3):834-41. doi: 10.1148/radiol.13131669. Epub 2013 Dec 7.
      High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material.

      Kanda T1, Ishii K, Kawaguchi H, Kitajima K, Takenaka D.


      Specter of MRI Disease Haunts General Electric
      GE Failed to Adequately Warn about Dangers of its MRI Dye, Jury Finds

      by Jeff Gerth
      ProPublica, March 22, 2013, 2:41 p.m.

      $5 Million Verdict In The First Gadolinium Injury Trial

      Tags: claims, Gadolinium Verdict, GE Healthcare, lawsuit, lawyer, litigation, Product Liability
      A federal jury in Ohio has awarded $5 million in the first case to go to trial in the multi district litigation involving patients who claim injury from the body scan contrast agent gadolinium. The jury found that GE Healthcare failed to provide adequate warnings of the health risk posed to those with impaired kidney function from Omniscan. As we have reported, the GE product is a gadolinium-based contrast dye used in MRIs and other imaging scans. The plaintiff in the case, Paul Decker, contracted a debilitating skin disease — nephrogenic systemic fibrosis (NSF) — as a result of being injected with Omniscan for a magnetic resonance angiogram in 2005. At the time, Decker was also undergoing dialysis for end-stage kidney disease.

      also ask docs to check you for the following: FMD & AS,
      FMD=FIbromuscular dysplasia and Ankylosing Spondylitis; after 20+ years of feeing mistakenly told I had “FIBROMYALGIA” I recently found out these within the last few months. http://en.wikipedia.org/wiki/Fibromuscular_dysplasia and

      PS there are a lot of variables w/A1C and serum glucose and continuous checking to make sense of what YOUR body is doing in relation to Diabetes. Just because you have neuritis/neuropathy in the States, doesn’t mean it’s CAUSED form Diabetes, there are OTHER causes to this condition PN(peripheral Neuropathy also being caused from FLUOROQUINOLONE antibiotics such as Cipro, Avelox and Levaquin,

      FDA Strengthens Neuropathy Warning for Fluoroquinolones

      Robert Lowes

      DisclosuresAug 15, 2013

      which you may have taken months to years ago and would NEVER think to associate with current conditions. How are your calves and Achilles tendons and rotator cuffs? and statins may cause damage to body as wellStatins:
      http://www.spacedoc.com and http://www.webmd.com/cholesterol-management/news/20130319/high-dose-statins-linked-to-acute-kidney-damage

      • Catherine, thank you for all the info in your 11/10 comment. The gadolinium info is important. i worry about the many people who are exposed to it. i wonder if chelation therapy can help reduce its effects. i just stumbled on information about the recent findings that gadolinium persists in the body indefinitely, contrary to what has been previously believed. There is plenty of info on the web about it. I happened to need an MRI soon after i learned this and when i filled out the form before the procedure, there was a place to give consent to having contrast. It was explained that all of the contrast would be eliminated from the body within 24 hours in people with healthy kidneys, and to inform the technician of any kidney problems. i did not give the consent. i was asked about it and i said i was concerned about the recent findings of indefinite persistence in the body of people with normal kidney function.

        When the tumor they were looking for (a pancreatic insulinoma) was not found by the MRI, the radiologist’s report said something about the patient refusing the contrast and that more information might have been obtained if not for that.

        Regretfully, i had a CT scan soon after that which also didn’t locate the tumor, so that was a waste of radiation exposure for nothing.

        The tumor was found by endoscopic ultrasound (EUS). It was only 1cm in diameter which is common for insulinomas, and they are often not found by CT and MRI. If i had it to do again i would just have the EUS and avoid exposure to harmful radiation and contrast media.

        It was the effects of my insulinoma which brought me to this site. Before it had been diagnosed, and before i had ever heard of it, i knew i was having fasting hypoglycemia, infrequently but severe, waking up on the floor, unable to get up, no memory of how i got there, unable to move, unable to enunciate words, the symptoms resolved quickly when eating a small amount of complex carb (oatmeal, rye bread). These and other symptoms only happened on waking.

        I had a CBC blood test in late February which showed my fasting glucose was 32mg/dL That is extremely low, the bottom of the normal range is 65. But i was asymptomatic except for on 5 occasions over 8 months.

        I was referred to an endocrinologist. What an idiot. He spent at least an hour with me but he said my symptoms were probably caused by my liver and he did not see any thing endocrinological about them.

        i’ve had hepatitis C, asymptomatic, for decades, i have mildly elevated liver function tests. That’s why the endo said it must be the liver. Idiot. I went to a gastro doc who said there was no reason to think the liver was involved (duh) and he said he thought it was odd that no one had checked my insulin levels to rule out insulinoma. He ordered that test. My insulin was higher than my glucose which was below normal, and that was diagnostic of the insulinoma. Low glucose is the signal to the normal pancreas to stop putting out insulin. An insulinoma just keeps putting out insulin.

        The endocrinologist had done blood tests and that was the first and only time i ever had an A1c test. It was slightly below the normal range.

        The endocrinologist wrote on the copy of the blood test results he faxed me, “sugar is great!” and “See a liver doctor!” My nonfasting glucose was slightly below the bottom of the normal range. By then i was eating at least 5 times a day and had eaten three times before the bloodtest, including in the car on my way to the doctor. I had shown him my home meter results which showed morning glucose in the 20s and 30s, and going up during the day to a maximum of in the 50s or 60s. i showed him my 30 or so bloodtests going bad to the 80s, and showing that my glucose was always in the normal range in the 80s and 90s and until 2006, when it was low for the first time, and all the blood tests i had after that one were low, including one in 2010 that was 33ml/dL. That was the last one i had until 2014.

        Insulinomas are almost always benign and are 100% curable by surgical removal. but many people go years undiagnosed because it’s rare and doctors don’t think to test for it. But an endocrinologist?? i would think someone with that training would at least want to rule it out. But no. Fortunately, that was the first thing the gastro doctor i saw thought of. At least some people have a brain.

        After the insulinoma was removed, i had very high glucose. My normal pancreas islet cells had not had to function to lower glucose in apparently about 8 years, 2006, so they didn’t function initially. i was given insulin when i was in the hospital recovering, but i didn’t have to take any at home. My glucose continued to be usually above the normal range in the weeks after the surgery, but only in the low 100s, like 101 to 120, and over time, it continues to average lower. In the past couple of weeks it has been in the 80s and 90s with one result in the 70s, so it appears the pancreas is becoming normal again, hopefully. I’m only 13 weeks post op.

    • Good morning,

      I am a 56 year old female who recently took a blood test. My doctor told me over the telephone that my blood test was good but I had one test for liver functions that was a bit high. He suggested for me to retake this test in a month. So I asked his office to send me my results via mail. I got it finally yesterday and noticed that my AC1 test was elevated 6.6 and my glucose test was within the normal range. Does that mean I have Diabete? Why didn’t my doctor tell me anything? Is he incompetent? If I didn’t ask for my copy if the test I wouldn’t even have known about it. What should I do now!
      Thank you for any advise.

    • Good morning,

      I am a 56 year old female who recently took a blood test. My doctor told me over the telephone that my blood test was good but I had one test for liver functions that was a bit high. He suggested for me to retake this test in a month. So I asked his office to send me my results via mail. I got it finally yesterday and noticed that my AC1 test was elevated 6.6 and my glucose test was within the normal range. Does that mean I have Diabetes? Why didn’t my doctor tell me anything? Is he incompetent? If I didn’t ask for my copy if the test I wouldn’t even have known about it. What should I do now!
      Thank you for any advise.

  17. My A1C is down to 6.1. Is there a normal level? Do you ever reach a level where you can stop medication? I will ask my doctor at my next appointment. Just wondering out loud..

    • Bill,
      Most physicians expect diabetics to have complications. What do you want in your life? There are also some Youtube videos on this subject that might be useful.

      Dr. Richard Bernstein (an 80 year old Type 1) is one who says blood sugars should be lower than others advise in order to avoid the many complications of diabetes.
      My own A1C was 5.4 about a month ago. Dr. Bernstein feels that 5.6 is diabetic.
      Most labs seem to say that 7 is okay. At 7 your blood sugar is high enough where it may cause real damage.

  18. Thank you Chris, for this article. I don’t know how I missed finding it until now. My A1c has been 5.8 – 5.9, but insulin as well as triglycerides are very low, and fasting bg normal. I had been concerned about the elevated A1c until now.
    Also thank you Kurt Harris for the helpful comments above.