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low HbA1c

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Cindi, Aug 27, 2011.

  1. Cindi

    Cindi Senior Member

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    hi all

    my last test result is 4.7 %. limits 4.8-5.9.

    is this significant? what could be the cause?could it be low cortisol? thanks.
  2. rlc

    rlc Senior Member

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    Hi Cindi, the HbA1-c test is usually used to screen for diabetes theres some information on the test here http://www.labtestsonline.org.au/understanding/analytes/a1c/test.html

    Decreased HbA1-c is found in different types of anaemia, and other diseases that are listed here http://en.diagnosispro.com/differen...a1c-glycated-hgb-lab-decreased/11900-153.html It would be worth getting a doctor to look at that list and see if any of them fit your symptoms just in case. But its also possible that because it is only just below the reference range that it is just a minor fluctuation, and next time you get the test done it will be normal, I think it would be a good idea to get it tested again in the near future to make sure of whats going on, as I understand it HbA1-c fluctuates a lot depending on different things especially glucose levels.

    Hope this helps in some way

    All the best
  3. richvank

    richvank Senior Member

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    Hi, Cindi.

    I think it's possible that low cortisol could produce low HbA1c. As you may know, HbA1c is produced when glucose reacts with hemoglobin. If the average glucose level is low over the average lifetime of the hemoglobin molecules in your blood (a couple of months), then I think that would produce a low value for HbA1c. If you don't mind saying, has your fasting glucose level tested on the low side? And do you have low cortisol?

    Best regards,

    Rich
  4. Cindi

    Cindi Senior Member

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    Thanks so much Ric. You have been so helpful. First article says iron deficiency may cause falsely low HbA1c results.I had some iron deficiency recently. So,I guess I will have to repeat the test some time later.
    best wishes
  5. Cindi

    Cindi Senior Member

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    Hi Rich

    Thanks for your answer and the information you have given.My fasting glucose was 88.8 limits:70-105 mg/dl at the time of the HbA1c test.My cortisol is low. I am on adrenal cortex extract supplements.I have terrible burning feet problem and I was trying to find out if I had diabetes problem.Would you think fasting glucose of 88.8 will exclude diabetes?

    When the HbA1c result came out low I thought if this could mean low cortisol but according to the info given at one of the links Ric has given iron deficiency would produce falsely low HbA1c result.I was on iron treatment until about two weeks ago.So,I will have to repeat the test some time later.
    best wishes.
  6. richvank

    richvank Senior Member

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    Hi, Cindi.

    That's not a bad fasting glucose number. It doesn't seem that your low HbA1c number is due to low glucose. I think that checking your iron level is a good idea.

    It doesn't seem that you have diabetes mellitus, either, with that fasting glucose number and a low, rather than high HbA1c. Please note that I'm not a physician, though, and it would be best to get a physician's interpretation of these results.

    Best regards,

    Rich
  7. Cindi

    Cindi Senior Member

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    Thnnks so much Rich.
  8. rlc

    rlc Senior Member

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    Hi Cindi, glad to help, if your glucose is 88.8, Im making the assumption that this is mg/dl ( different countries use different units of measurement so it can all get horribly confusing) then you should be fine as far as Diabetes goes. Its fine as long as it is under 100mg/dl (5.5mmol/l) There is a condition called impaired glucose tolerance which tends to get missed by not doing the right test and not using the right reference ranges Dr Mirza explains it in this article NICE and CDC miss the boat found by scrolling down this page http://www.bmj.com/content/335/7617/446.extract/reply#bmj_el_175577

    He says Many of these have impaired fasting glucose or impaired glucose tolerance (IGT). These pre- diabetic conditions cause fatigue via glycosuria. Fasting glucose measurement is not nearly sufficient to detect early glucose intolerance. A 2-hr glucose tolerance test (OGTT) is abosoluitely necessary to detect IGT defined as plasma glucose of > 130 from 30 minute- 120 minute during OGTT

    So that is still possible, Im not a doctor but I would have thought that your fasting glucose level means youre probably ok, but it something to keep in mind if nothing else is found.

    Burning feet thats a interesting one, Ive looked it up and these are the conditions that can cause it which youll have to get your doctor to investigate and see if you have any of them http://en.diagnosispro.com/differential_diagnosis-for/burning-feet/24711-154.html

    Im not seeing a pattern that is linking all your test results to one illness so it is possible you have a couple of things going on, which is confusing things a bit. Hope this helps and you get everything worked out soon!!

    All the best
  9. Cindi

    Cindi Senior Member

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    Thanks Rich

    You said "Fasting glucose measurement is not nearly sufficient to detect early glucose intolerance. A 2-hr glucose tolerance test (OGTT) is absolutely necessary to detect IGT "
    AFAIK HbA1c also will give an idea on IGT. Is that wrong?. I am reluctant to take OGGT as I heard it might be hard on adrenals.
    I actually made a mistake by saying "burning feet" due to my brain problems. It is actually burning feet and legs up to knee. Right leg being worse. It feels like a circulation problem. It gets worse when I smoke(unfortunately I smoke) and after coffee enemas(adrenaline constricting the vessels?).I am afraid doing coffee enemas because of this problem.It is so much that it does not allow me to go into sleep at night. I do not know why this happened. I do smoke but not much.
    You are right.I have even more than couple of things going on.These are secondary to CFS. Result of living with CFS for more than 20 years. Best wishes.
  10. rlc

    rlc Senior Member

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    Hi Cindi, regarding HbA1-c and IGT this article http://pmj.bmj.com/content/early/2010/10/17/pgmj.2009.091215 says

    Abstract
    There is a need to simplify screening tests for type 2 diabetes mellitus (T2DM) so patients can be identified earlier and more efficiently. Glycated haemoglobin (HbA1c) has been recommended by some international organisations as a diagnostic tool for detecting T2DM and impaired glucose regulation (IGR, also termed prediabetes and includes impaired fasting glucose and/or impaired glucose tolerance). The HbA1c cut-point of ?6.5% (48 mmol/mol) has been selected as diagnostic for T2DM, while the cut-points for IGR are debated by the different international organisations: an International Expert Committee has suggested using HbA1c 6.06.4% (4246 mmol/mol); however, the American Diabetes Association has recommended using HbA1c 5.76.4% (3946 mmol/mol). Some countries will adopt a new method of reporting HbA1c values in millimoles per mole (mmol/mol). Use of HbA1c has some logistical advantages over using an oral glucose tolerance test (OGTT). As patients do not need to fast, appointments do not need to be limited to the morning. The HbA1c result reflects longer term glycaemia and is less affected by recent physical/emotional stress. However, there is some debate as to whether HbA1c should replace fasting plasma glucose or the OGTT. As the two tests detect different people, some individuals with diabetes detected on OGTT will no longer be classified as having T2DM using HbA1c ?6.5% criteria. Furthermore, some medical conditions can result in HbA1c assay measurements not reflecting glycaemic control over the last 23 months; these include haematological disorders, renal failure, and chronic excess alcohol consumption.

    If Im reading this correctly (sorry tired today) your 4.7% means that you are in the safe range, but it would appear that there is no real international consensus on this yet. However you need to get your iron rechecked because if it is still low, it will be lowering the result of the HbA1-c and giving a corrupted reading, so the iron has to be rechecked first before the HbA1-c can be relied on to rule out IGT.

    IF it has to be done, I cant see why the OGTT tests would cause any lasting damage to the Adrenals its just a drink of Glucose and then measuring the bodys response to it information on it here http://en.wikipedia.org/wiki/Glucose_tolerance_test

    What your describing does sound very much like a vascular problem, has your doctor been ordering tests for this? If not kick them in the butt!

    If you go to this page on burning legs http://symptoms.rightdiagnosis.com/cosymptoms/burning-legs.htm and then scroll down to where it says narrow your search add a second symptom, you can then add more of your symptoms and it will come up with illnesses that cause that combination of symptoms, if you have symptoms that occur at the same time as the burning in legs they would be good ones to add first. This may help you narrow down what might be causing the problem.

    This site doesnt have burning legs just burning feet, but it does have a list for causes of leg/lower extremity pains if youre interested, unfortunately it lists 107 of them.http://en.diagnosispro.com/differen...-leg-lower-extremity-pains/24715-154-240.html

    Id recommend staying well away from coffee enemas until this is sorted out, and coffee is very hard on the adrenals.

    Do you have any other failed tests? For the iron test did you just fail the Ferritin part or were things like iron saturation low as well? How low is your cortisol?
    If you let me know Ill see if I can figure anything useful out,

    All the best
  11. Cindi

    Cindi Senior Member

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    Hi Rich

    Thanks so much for all the info you have given. You have been very helpful.Only it will require some time for me to process and digest this information.My thinking is slow due to my brain problem.

    OGGT test is also difficult for me as i can not be active for two hours especially at a stressful situation.I still have noted it on my `to do` list.

    I could not yet have a chance to visit a doctor for this. I am so fatigued. I can find energy to visit a doctor only once in about two years.Hope I will soon find a chance to visit one.

    My iron was low because I had some leech therapy. I only tested ferritin and CBC. Hb was lower than my usual . Ferritin was at low end of normal and I was more exhausted than usual.So I supplemented iron.Ferritin and CBC are okay now. My cortisol is low. I am under naturopathic therapy for that.Thanks so much for your concern and best wishes.

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