What could low glucose but normal H1ac levels mean? (YANAD/YANMD)
December 22, 2016 4:59 PM Subscribe
Saw my primary care doc for annual physical. She did a metabolic panel and my glucose came up as 64 (70-110 is normal for this lab), 2 hours after eating, and my H1ac was 5.1 (Which falls within normal limits for them). I have an appointment with an endocrinologist in a week, which in my experience is very quick. However, what could I be looking at with this? Yes, you're not a doctor/my doctor, but thanks for any insight!
No one in my family has diabetes. I am not anorexic, nor do I drink alcohol or take medications containing quinine. (Stuff which I have read can lead to hypoglycemia). I have had blurry vision and sweats/night sweats and rapid heartbeat but assumed this was due to anxiety. Have an eye MD apt in Jan once I get better insurance. Am always horrible to be around when hungry; I am the stereotype of 'hangry.'
No one in my family has diabetes. I am not anorexic, nor do I drink alcohol or take medications containing quinine. (Stuff which I have read can lead to hypoglycemia). I have had blurry vision and sweats/night sweats and rapid heartbeat but assumed this was due to anxiety. Have an eye MD apt in Jan once I get better insurance. Am always horrible to be around when hungry; I am the stereotype of 'hangry.'
Best answer: 5-year Type 2 here. Your finger-stick glucose test of 64 is what your blood glucose is RIGHT NOW. Conversely, your A1C is a look at what your blood glucose levels have been over a 90 day period, weighted more heavily toward the last 30 days or so. The A1C is a much more complete picture.
All this 64 means is that your blood sugar was low-ish the moment you had the test. It's pretty low given that it was two hours post-prandial, but a lower-carb meal the night before and a fairly low carb count in your breakfast could account for this. And yes, your A1C is normal, though on the lower-ish end of normal.
I am not a doctor, but as a layperson who is editing a book on diabetes-related topics, and with five years under my belt at keeping my own glucose numbers in line, I can tell you that this ONE number means nothing on its own. You may have a tendence toward hypoglycemia, or you could have some metabolic condition (not sure if the blurry vision and night sweats are recent and/or why you went to the doctor), but 64 on its own isn't indicative of much, and along with the healthy A1C, I urge you not to stress. But I would encourage you to learn more about eating a balance diet to make sure you're eating enough carbs per meals or snacks.
posted by The Wrong Kind of Cheese at 5:20 PM on December 22, 2016 [1 favorite]
All this 64 means is that your blood sugar was low-ish the moment you had the test. It's pretty low given that it was two hours post-prandial, but a lower-carb meal the night before and a fairly low carb count in your breakfast could account for this. And yes, your A1C is normal, though on the lower-ish end of normal.
I am not a doctor, but as a layperson who is editing a book on diabetes-related topics, and with five years under my belt at keeping my own glucose numbers in line, I can tell you that this ONE number means nothing on its own. You may have a tendence toward hypoglycemia, or you could have some metabolic condition (not sure if the blurry vision and night sweats are recent and/or why you went to the doctor), but 64 on its own isn't indicative of much, and along with the healthy A1C, I urge you not to stress. But I would encourage you to learn more about eating a balance diet to make sure you're eating enough carbs per meals or snacks.
posted by The Wrong Kind of Cheese at 5:20 PM on December 22, 2016 [1 favorite]
Response by poster: Wrong Kind of Cheese- Thanks for the info breakdown. I am confused because I feel like I eat a lot of carbs, if anything too many! I have Celiac and eat a lot of whole grain rice, buckwheat, corn flour. I went to my primary doc for just an annual checkup, nothing specific.
posted by ShadePlant at 5:24 PM on December 22, 2016
posted by ShadePlant at 5:24 PM on December 22, 2016
Are you saying that your primary care doctor referred you to an endocrinologist without telling you why?
I'm a type 2 diabetic and with my home meter, at least, I have never taken two readings minutes apart that varied by less than 6 points. So, unless your doctor actually told you that a 64 rather than a 70 was significant, I wouldn't assume it's out of the normal range when statistical variation is taken into account.
posted by XMLicious at 5:25 PM on December 22, 2016 [1 favorite]
I'm a type 2 diabetic and with my home meter, at least, I have never taken two readings minutes apart that varied by less than 6 points. So, unless your doctor actually told you that a 64 rather than a 70 was significant, I wouldn't assume it's out of the normal range when statistical variation is taken into account.
posted by XMLicious at 5:25 PM on December 22, 2016 [1 favorite]
Response by poster: Clarification: MD referred me to an endo re: a prior diagnosis of Hashimoto's. Another endo had said, after an ultrasound, that I have Hashimotos but I have never been given meds for it. Current TSH is normal. I got the glucose test results AFTER I had already made the endo appt. So, MD didn't know about the glucose when I was referred. An RN called me today and told me to request my appointment be moved up and to keep sugary snacks available if I felt dizzy. That's all the info I got.
posted by ShadePlant at 5:28 PM on December 22, 2016
posted by ShadePlant at 5:28 PM on December 22, 2016
Best answer: Your postprandial glucose is low-normal but that's still normal. If it were lower (like, under 50), one plausible explanation could be postprandial/reactive hypoglycemia. I don't think the endocrinologist will find the 64 glucose too remarkable, especially in conjunction with a thoroughly normal A1c, unless you present with significant weight changes or other symptoms or history.
posted by gemutlichkeit at 5:49 PM on December 22, 2016 [1 favorite]
posted by gemutlichkeit at 5:49 PM on December 22, 2016 [1 favorite]
Best answer: Maybe it's a mild form of insulin resistance or prediabetes? Both of which can happen to people who have a high body fat percentage, regardless of weight.
Whether it's that or reactive hypoglycemia, the same lifestyle changes are recommended. (Exercise being important in there - both cardio, to help regulate hormones more directly, and resistance training, to increase lean mass [and help regulate them more indirectly, by improving body fat percentage. You need to consume a decent amount of protein to help muscle mass along, though]).
posted by cotton dress sock at 6:45 PM on December 22, 2016
Whether it's that or reactive hypoglycemia, the same lifestyle changes are recommended. (Exercise being important in there - both cardio, to help regulate hormones more directly, and resistance training, to increase lean mass [and help regulate them more indirectly, by improving body fat percentage. You need to consume a decent amount of protein to help muscle mass along, though]).
posted by cotton dress sock at 6:45 PM on December 22, 2016
What did you eat before the test?
posted by pintapicasso at 7:00 PM on December 22, 2016 [1 favorite]
posted by pintapicasso at 7:00 PM on December 22, 2016 [1 favorite]
FWIW, when I was in my twenties, I think I had similar results, though my symptoms were more clear cut low blood sugar-y-- brownouts, feeling shaky, etc. my PCP sent me off to a lab to get an 8 hour glucose test, to track my blood sugar response through an entire day. Ugh! Miserable, but really fascinating to watch how your glucose can go up and down and back up and back down-- sometimes sharply, sometimes gradually, sometimes like a stair step. Anyway, in my twenties, I was hypoglycemic. In my thirties, I was insulin resistant. In my forties, I am hanging on to insulin resistant and trying not to slip over into prediabetic. I'm not sure how much of a difference having a better understanding of what was up with the hypoglycemia would have made, since Type 2 diabetes runs on one side of my family generations back. But I do wish I'd known more then-- back in the early nineties when everyone was all zero fat Susan Powter-ing? I'd have been much better off with an understanding of how that wasn't so great for my blood sugar.
posted by instamatic at 7:22 PM on December 22, 2016 [2 favorites]
posted by instamatic at 7:22 PM on December 22, 2016 [2 favorites]
Oh, yeah, and hangry was one of the main symptoms that sent me to the doctor for a glucose test to begin with.
posted by instamatic at 7:24 PM on December 22, 2016
posted by instamatic at 7:24 PM on December 22, 2016
Response by poster: Prior to the test I ate two hershey kisses with almonds, 2 gluten free quinoa blend toaster waffles, a teaspoon of maple syrup and 2 maple chicken breakfast links.
posted by ShadePlant at 8:04 PM on December 22, 2016
posted by ShadePlant at 8:04 PM on December 22, 2016
Best answer: Celiac and Type I diabetes are linked, so that's probably why they are more concerned about a slightly out of normal result.
posted by fshgrl at 10:33 PM on December 22, 2016
posted by fshgrl at 10:33 PM on December 22, 2016
Sometimes if the blood ha been sitting around in the tube for too long before being put in the centrifuge the cells will eat up some of the glucose. I've had a nonfasting glucose of 45 due to this. One reading means nothing
posted by genmonster at 4:04 PM on December 23, 2016 [3 favorites]
posted by genmonster at 4:04 PM on December 23, 2016 [3 favorites]
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However those other symptoms seem like they should be addressed. Maybe the doc can eliminate those, whether or not that is really a low number. Good luck.
posted by Kalmya at 5:17 PM on December 22, 2016