A1C low but Fasting blood Glucose above 100

Posted by sreesatya @sreesatya, Jan 4 3:31pm

Hi,
This is for one of my friends..
for the last 5-6 years A1C is on the lower side below max being 4.5 but Fasting blood Glucose above 100 ranging between 100 and 115.
Fructosamine test have been done couple of times and they were also with in range all the time.
The other medications they take is for Epilepsy (earlier Tegretol and then Lamotrigine for the last couple of years.
Their Hemoglobin also has been low below 13 for the last couple of years.
Is this normal or Is there anything to worry?
-Thanks

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Cheryl, Volunteer Mentor | @cehunt57 | Jan 8 1:12pm

@sreesatya Welcome to Mayo Clinic Connect. It sounds like your friend has a lot going on! I want to make sure I’m not missing something.

1). A concern about blood sugar and A1C. The numbers you mentioned sound good to me. I am not familiar with the “Fructosamine Test”.
2). Epilepsy and seizure medications.
3). Hemoglobin monitoring (for lowness).

I do not know how the epilepsy & meds relates to this. What I do know is that there may be a connection between the first and third thing. Another name for A1C is glycosylated hemoglobin test. It is a measure of the hemoglobin that have glucose stuck to them. It stands to reason that if the hemoglobin is low the A1C might be low also. (However the fasting blood sugars are pretty good.) Whether this is “normal” or not is a question for your friend’s providers. Remember that everyone has their own “normal”. Does your friend have good trusted providers?

sreesatya | @sreesatya | Jan 9 4:46pm

@cehunt57 - Thanks you very much for your response and the information you shared here. It actually makes sense considering the connection between A1C and hemoglobin. It is true that my friend has a lot going on!
Your question "Does your friend have good trusted providers?" is an interesting question... I am not sure if I can answer this. Here there is another twist..he also has dental issues.
His dentist suggests from his experience, his dental gums issue could be due to being diabetic. This is where he gets lost on how all these are related and who is right and who is wrong. What does the blood tests mean and to interpret them.

my44 | @my44 | Jan 10 7:29am

In reply to @sreesatya "@cehunt57 - Thanks you very much for your response and the information you shared here. It..." + (show)

Yes, people with diabetes can be prone to dental issues. Here's the link to an informative article by the NIH.
https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems

sreesatya | @sreesatya | Jan 10 10:06am

@my44 - Thank you.
The article is helpful but raises more questions on the diabetic state. What are the other ways to find the right levels of a person's diabetic status other than the fasting Glucose test, A1C and Fructosamine test.
My friend is in the San Jose area, Can anyone suggest any physician or institution he could reach out to for advice.

my44 | @my44 | Jan 10 11:55am

In reply to @sreesatya "@my44 - Thank you. The article is helpful but raises more questions on the diabetic state...." + (show)

@sreesatya, even with your friend's fasting glucose level being 100- 115, her A1C is 4.5 which is well within the normal range of 4% and 5.6% for person without diabetes.
Doctors can do a glucose tolerance test. If she doesn't already, your friend could use a finger stick meter or a continuous glucose moniter to see what her numbers look like at various times throughout the day. If those are all normal, then perhaps your friend's fasting glucose of 100-115 is normal for her. Everybody is different and their bodies and glucose levels respond differently to various factors. But it seems like your friend's numbers throughout the day would fall within the normal range since her A1C is 4.5. Not being from the San Jose area, I don't know anything about institutions there that could help, Has your friend's doctor expressed any concern regarding her fasting glucose level?

foster1980 | @foster1980 | Jul 19 11:45am

In reply to @cehunt57 "@sreesatya Welcome to Mayo Clinic Connect. It sounds like your friend has a lot going on!..." + (show)

Thanks I was trying to Google the same information. I have come back with a glucose of 100 but my a1c is consistently 4.5-4.7
I am also on several medications for epilespy/mental health
- lamictal
- trazadone
- Topamax
- gabapentin
- klonopin
I used to take high blood pressure meds but no longer need them as we are not struggling to keep my blood pressure up since it rests now in the 80s/60s.
She did just ad lipitor but I'm pretty sure I can fix that with diet.
I am also have red and white blood cell issues. Too many red and larger than normal and too many white. (Anemia & dehydration)

ksdm | @ksdm | Jul 20 8:25am

I wouldn't worry about your blood sugar. Well within normal range. You've got enough on your plate without this worry!

carbcounter | @carbcounter | Jul 20 12:54pm

My fasting blood glucose reading is often higher than my pre-lunch reading, so your friend could have lower blood glucose readings later in an average day, resulting in lower A1C. It's only a couple of tenths off corresponding even as it is.

I just Googled to see what they say about low hemoglobin and diabetes and they say if anything it should raise A1C not lower it! That seems curious, but that's what it says. I don't know about any effects these meds may have. It's possible for meds to affect the test rather than the blood glucose itself. Can of course ask the doctor, but maybe ask them offline so they can research it!

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