LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Saturday, January 15, 2011

The Saturday Share #9

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at
Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.

Sharecare Question: Why is my A1C high when my blood glucose levels are in my target range?

My “Expert” answer: I want you to picture a freshly fried doughnut hole, just out of the deep fryer. Steam wafts from its surface. Still gleaming wet with oil, it’s sent spinning across a tray of powdered sugar. As it tumbles, sugar sticks to the wet oil, coating it, covering it as it rolls and bounces along.

Well, the same thing happens to your red blood cells. As they tumble and spin and roll through your blood vessels, sugar molecules stick to their skins. Or another way to think of it is to picture a windshield of a truck after driving through a swarm of mosquitoes. Splat-Splat-Splat-Splat-Splat! (OK, I just threw that in so you wouldn’t log off and drive straight to Dunkin Doughnuts.)

So an A1C test is a measure of how much of the skins of your red blood cells are splattered with sugar, which in turn gives as a picture of the blood sugar environment in which the cells lived, which in turn gives us a notion of your average blood sugar over the last several months.

So the A1C test looks at average blood sugar, while your fingersticks look at moments in time. The most common cause of a difference between A1C and fingersticks is that the fingersticks are not frequent enough, or are not at the right times to catch the elevated blood sugars that are jacking your A1C to higher levels.

For instance, if you are only testing in the morning, you are missing possible elevations after meals or overnight while you are sleeping. The A1C test is not perfect. For instance, if your sugar was ranging scary low to scary high you might get a number that looked pretty good. That said, most “false reads” are good looking numbers that mask troublesome variability. Additionally, if you are anemic, you can also get a false low, as your blood cells don’t last as long as typical.

But if your A1C is high, there are some high blood sugars lurking somewhere. And that is exactly why we do both fingerstick testing a A1Cs. They serve as checks and balances against each other.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

Then select the “Answers” tab near the top left.


Anonymous sysy said...

Very nicely done :)

11:44 AM  
Blogger Natalie said...

You neglect to mention that there are low-glycators and high-glycators (as well as medium ones!). The year before I was diagnosed, I had fasting BGs of 138 in June and 131 in September. In this day and age, these BGs would surely be diagnosable, No? But My A1c in November was 4.8. DISCONNECT!!!
A further proof was that I went into a life-threatening coma at an A1c of 10.7, whereas I know people who were walking and talking at 12, 13, 14 and even 17.
Which just goes to prove that the A1c is not such a gold standard as professionals are trying to make it out to be.

8:26 AM  

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