Odd A1C/Insulin results

[cdamaden]

All,
I have been Intermittently Fasting and eating lower glycemic index foods in order to reverse insulin resistance. My doc took another panel and I go these results:
June 30, 2016 - VA Clinic
HGBA1C = 5.8% (ref 4.1-6.0)
eAG = 120 mg/DL - High - (ref 74 -118) - I recognize that this is a calculated value.
Insulin (fasting) = 2.0 uIU/mL - Low - (2.6-24.9)

February 15, 2016 - True Health Diagnostics
HGB1AC = 5.7% - Intermediate risk - (optimal <5.6, Intermediate risk 5.7-6.4, High risk > 6.5)
eAG = 116.9 mg/DL - Intermediate risk - (optimal <116.8, Intermediate risk 116.9-139.8, High risk > 139.9)
Insulin (fasting) = 4.0 uIU/mL - Optimal - (optimal 3-9, Intermediate risk 10-11, High risk > 12)

April 3, 2015 - VA Clinic
HGBA1C = 5.3% (ref 4.1-6.0)
eAG = 105 mg/DL (ref 74 -118)

Historically my fasting blood glucose (FBG) had been in the 90s to low 100s. Then I started my intermediate fasting and bought a glucose meter. On this new regime, I typically had a morning FBG in the mid 80s but sometimes in the upper 70s or low 90s. My 1 hour after meal could be as high as 140s but often much less. However, I wasn't able to get the doc to order a FBG test during my June blood draw to confirm that my glucose meter is properly calibrated.

I'm now scratching my head. My FBG numbers were giving me some confidence that my dietary changes were going to lead to an improved HGBA1c, but instead it crept up. The low insulin numbers now make me wonder if my problem wasn't insulin resistance, but instead Type 1 Diabetes?, some other pancreatic issue?

Any thoughts or suggestions are welcome.
Thanks,
Chris

[JulieAnnie]

Perhaps you are in the honeymoon stage of late onset Type 1 diabetes. This happened to me at 47. Did you get the GAD auto antibody test? Also C-peptide levels. Make sure you double check your labs as sometimes the lab reports the results ias "not detected"and "detected." My endocrinologist misread the results, but I caught it.

[cdamaden]

Hi JulieAnnie,
Thanks so much for your reply. I double checked the results and they are as indicated. I haven't had GAD or C-peptide testing yet. I found a website that recommended the following six tests:
C-Peptide—
Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)—
Insulin Autoantibodies (IAA)—
Insulinoma-Associated-2 Autoantibodies (IA-2A)—
Islet Cell Cytoplasmic Autoantibodies (ICA)—
Zinc Transporter 8 (ZnT8Ab)—

Keep the ideas coming!
Chris

[Tincup]

Chris,

A couple of thoughts.

1. There are assumptions that go into A1c - see https://chriskresser.com/why-hemoglobin ... le-marker/
2. Next time you go in, see if you can take a reading with your glucometer and get them to run a blood test at the same time. Doesn't have to be fasting.
3. If VA won't cooperate, for $ you can order your own test to check your glucometer at a LabCorp through one of the online services like DirectLabs or WalkinLabs - search online blood tests for a list of companies to get the best deal. Here is an option https://www.directlabs.com/OrderTests/t ... fault.aspx for $32. There could be better deals through other vendors. In the case of each vendor, you locate a LabCorp near you. You order and pay for the test(s) you want. The vendor will give you a requisition to print and take in. You go to the location and give then the order and tell them it is prepaid. You get your blood drawn and in a few days (depending on the test) you get your results, either in an email or by accessing your account with the vendor.

[KatieS]

Chris,

I had the same problem, higher than expected A1c and very low fasting insulin levels (2). My work-up included all the antibodies (neg), an insulin level 1- hour after ingesting a high carb meal (spiked to 19), a FBG (85) & 2 hpp (104) after the 75 carb drink at the lab and fructosamine (confirmed slightly high like the A1c) test that Chris Kessler mentions should your RBCs be longer-lived. All these tests occurred over three years ago, so only this last year has my A1c dipped to 5.3-5.5 from the high of 5.8. My initial progress was avoiding those postprandial spikes while continuing to cut down carbs. Now I can maintain a flattened glucose curve which I attribute to increasing my fasting periods from 11 to at least 13 and a few days/week up to 18 hours.

[cdamaden]

George - thank you for the links and suggestions. I will try Kresser's advise on measuring blood glucose to see what that yields.

Katie - very helpful! I wonder if I'm have some low-grade autoimmune attack on my pancreas but since I eat very close to Dr. Ballantyne's autoimmune protocol that I'm keeping it at bay. Or ...

As to further testing, my VA primary care doctor is not convinced. He says that I have "impaired fasting glucose" and that "current guidelines recommend yearly testing with fasting glucose and HgbA1C." He's going to check with the endo, but says that even if those other tests I'm interested in came back as positive it wouldn't change my management of the condition. Translation - we don't worry about disease until you fully have it and it's too late!

[cdamaden]

I decided to follow the Glucose test that Chris Kresser recommends. This is a 4 day test. For the first three days you take a morning fasting blood glucose, before meal, 1-hr after, 2-hr after and 3-hr after blood glucose tests. On day 4 you do the same but for your meal you eat 1 cup of white rice only.

I've tried to attach a graph showing the results (yellow is day-4 with just rice).

For days 1-3, my morning results were 75, 85, 85 mg/DL. Most days, it dropped as I continued to fast before my 11am-ish meal. A sample meal was: 2.4oz of lettuce, 9.2oz spaghetti squash, 4.2oz steamed cauliflower, 3.7oz liverwurst, 2 tbs avocado oil, supplements.
1-hr blood glucose were 106, 89, 107.
2-hr were 92, 101, 102.
3-hr were 'not taken', 82, 79

For day 4 my fasting value was 94, before meal was 82, 1-hr was 161, 2-hr was 109, 3-hr was 110, 3.5-hr was 84.

It appears that I peak around 1 hour most meals. For the rice test, I was under 120 by 2 hours. I think that looks pretty descent. I'd love to hear other thoughts on this testing.

[Tincup]

Chris,

If your meals are typical for you, then I wouldn't worry about it. You likely are keeping your red blood cells around a lot longer than normal - a good thing. You don't look like you are getting anywhere near a 120 average. Your insulin is responding well enough. I also have a fasting insulin of 2 while my A1C is 4.9.

My suggestion is to keep on doing what you are doing!

[Stavia]

Chris I agree with George. You likely have longer lived red cells than average. The Hba1c does not reflect your glucose values you have posted.
You appear insulin sensitive to me and your response to the rice load looks great.
Keep on your path!
Celebrate your healthy red cells!!

[KatieS]

Chris, you can see if the longer-lived RBCs are the culprit by the fructosamine blood test which does not rely on RBCs. However, both my tests were slightly high, confirming the A1c. Your glucose testing reflects good control, so do not get discouraged. Somewhere I read that A1c tests can be falsely lower in the diabetic population, so we might be some variation of normal for this specific test. My endocrinologist could not explain it, but MarcR posted an explanation a few months ago.