Low blood sugar, high A1c

I’m sorry this is all so confusing. I’m also sorry that your doctor and endocrinologist are right. Your A1C (fasting blood sugar level average over 3 months) is reporting you’re diabetic. Diabetes is confusing.

I’ve been diabetic for 21 years. Sticking my finger a few times a day never truly gave me the full picture of my diabetes. Only the fasting A1C blood test would show me a 3 month window of my disease state. I’ve had a CGM (continuous glucose monitor) for 7 years. Now I can finally get a better picture of my blood sugars because I can see every 5 minutes what it is.

Even so, CGMs aren’t as accurate as A1C. I’d trust the fasting blood test your doctor ordered. That gives you the average of what your blood sugar is over three months. My Dexcom CGM only lasts for 10 days. Its tiny filament doesn’t go into a blood vessel. It goes into the interstitial fluid. Blood is more accurate than interstitial fluid.

Once in the past I’ve had my CGM register that my 3 month average was 7, but my A1C report stated 8. I was disappointed to know there was that much of a difference because I was counting on the CGM to be more accurate.

Because of that inaccuracy, I still stick my finger a couple times a day to verify the CGM reading. If I see the CGM is off (lower) than 30 points from my finger (blood) stick, I can recalibrate my CGM meter to help it get closer to what my blood test strip reported.

Also when I apply a new CGM, it can take up to 24 hours to register correctly. It’s frustrating to constantly hear the warning alarm for LOW blood sugar during those first 24 hours when my finger stick registers normal levels.

Like I said, diabetes is confusing. But the technology and medical advances for treatments and meds are better than they were 21 years ago when I started this journey. Back then the doctor just gave me Metformin and had me see a diabetic nutritionist.

Don’t get me started on the “diabetic diet”. I’ve had diabetic nutritionists tell me to limit daily carbs to 45 per meal and another 45 for one snack. That’s 180 carbs per day! Maybe because I’ve been diabetic for 21 years, but my body can only handle 10-15 carbs per meal for a total of less than 60 carbs per day! Is there such a thing as being too sensitive to carbs?

Bottom line: trust the A1C, get on board with your endocrinologist, use CGM and finger stick, be compliant with taking your meds, count carbs, keep a food journal, and ask about supplements. My endocrinologist recommended dihydro-Berberine & alpha lipoic acid. Today I’m taking both of those supplements + metformin + Farxiga + Mounjaro. I’m finally seeing my blood sugars in the target range.

The a1c should reflect your average blood sugar over the last 3 months. If you have any lows, I’d figure a way to confirm it and show your doctor. Initially, I’d get 2 manual blood meters and do finger sticks 3 times a day in both back to back with a log. You can use your phone and take a pic of the results.

I’d also get another CGM and wear it. Why not get a prescription? Insurance should cover it. If cgm says low, do a finger stick to check. A cgm can give false lows. It’s not uncommon. I always finger stick to confirm a low. Take a pic with your phone of the low readings. If they are actually low, like in 30-40s, I’d contact my doctor immediately to report it, even if you have no appointment. Always keep sugar source nearby if you are having a hypo that low.

Having a blood sugar level of 30-40 would likely cause something to feel off. Do you have symptoms? What made you finger stick before?

Many people who have type 1, such as myself, can get lows. Many cannot function below 50. They require help getting juice or a glucose injection. I have actually been mobile and able to get my own juice at 25, but it’s rare that can happen. I haven’t had that happen since getting an automated pump/cgm.

Good luck with everything. Please post an update. I’d be very interested in what you discover.

Just to clarify, when I talk about my low numbers I'm not just talking about the CGM, which screamed at me for the entire 15 days, but also my regular sugar meter. I've been known to get a wild hair and start checking my blood sugar every 15 minutes just to see exactly what it's doing and I've actually watched it drop and then spike. So for instance start at 83 before eating. Go up to 122, plummet down to 35, before spiking to 290. All within 2 hours. If I had only checked it at the two hour mark it would have been 290 and I probably wouldn't have thought much about my A1C. Except I had a manager that was a former paramedic who said my numbers weren't matching what I was eating and asked me to start checking it like that. This has been an on going battle since 2019.

I don't feel it at all when my sugar drops. Checking every 15 minutes I watched it go down into the 50s, 40s, 30s and then up to almost 300, several times. I never felt any different. No shakes, no headaches, no palpitations. And there in less the biggest problem I'm having. I have severe ADHD and quite often forget to eat. I've gone as long as two days before just being busy and not realizing I wasn't eating till my stomach started yelling at me. That's dangerous. As are the constant ups and downs.

Just spoke to my PCP Wednesday. I start a 72 hour fast today and go back for blood work on Monday. I'm a little nervous because I already know it's going to yoyo all weekend and this is usually done in the hospital but hopefully he'll be able to get something out of the blood work Monday.

Oh and my insurance only covers a CGM if you are type 1 or type 2 and insulin dependent.

Can you afford a Stelo or other over the counter monitor?

From my experience as a diabetic patient for the past 30 years:
1. Trust your A1C lab results (they are the most accurate measure you can get); aside from being an avg for the past 3 months, I understand that it measures the daily peak and then, it calculate the avg; I can be wrong on thist one.
2. As the last comment said, try to get a Stelo or any other OTC CGM. Typically all work for a 2 weeks period; try to use it right before your next appointment with your PC, Internal Med Dr. or Endocrinologist. Print / Show them the report. They should be able to better picture what is going on.
3. From a CGM, check the daily avg graphics and daily pattern rpts (by period - 7, 14, 30, 90 days); you will see approximately, when throughout the day is your peak; then, adjust your food intake around those hours. Try not to peak above 185.
4. Understand your ADHD, you need to be on top of your diabetes for best quality of life in the long term; believe me, you will appreciate your good behavior or pay the price for not taking enough precautions while there is still time to avoid consequences.

Hope you finally get the answers to your questions and stay as healthy as you can. Based on your concerns, I know you will get better control of your diabetes. Enjoy life and keep safe!

If your doctor suspects your A1C is falsely skewed by an underlying blood condition, they may order a fructosamine test, which measures your average blood sugar over a shorter 2- to 3-week window.

@anonymom3

I was looking into different cgm’s and found a link for a free trial of the freestyle Libre. I can’t post the link apparently but you could google free trial.

I know people say to prioritize A1C but you also want to be safe so getting someone to pay attention to the lows seems equally important.