High Glycated Hemoglobin with Normal Blood Sugar: Is It Prediabetes?

Q: High Glycated Hemoglobin with Normal Blood Sugar: Is It Prediabetes?

Hello, dear mother： A glycated hemoglobin level between 5.8 and 6.4 can be classified as prediabetes. <br>Please continue to maintain a healthy diet and engage in moderate exercise, and make sure to have regular follow-ups at the outpatient clinic. <br>Additionally, the presence

Is a high level of glycosylated hemoglobin (HbA1c) with normal blood glucose levels indicative of prediabetes?

I have been taking antihypertensive and lipid-lowering medications for many years, and I have blood tests every three months.
In January, the abnormal results included total protein (urine) at 26.3, Upcr at 155.3, hematocrit at 47.3, MCV at 99.2, MCHC at 30.0, and hemoglobin A1c at 6.3.
Starting in January, I adjusted my diet, and in April, I had another blood test, during which I lost 3% of my body weight.
The abnormal results included total protein (urine) at 25.3 and hemoglobin A1c at 6.4 (which slightly increased compared to January after dietary adjustments).
RBC was 6-8, Upcr at 143.9 (within normal range).
My fasting blood glucose in January was 102, and in April it was 85.
I have been on chronic disease medications for many years, and my fasting blood glucose has always been within normal range.
In January, I had a glucose comparison test, with fasting blood glucose at 110 and two hours postprandial at 110.

Given that my blood glucose levels are normal but my hemoglobin A1c is elevated, aside from prediabetes symptoms, are there other possibilities? Could abnormal RBC levels affect hemoglobin A1c?

Bao Ma, 50~59 year old female. Ask Date: 2022/04/11

Dr. Hou Angting reply Family Medicine

Hello, dear mother: A glycated hemoglobin level between 5.8 and 6.4 can be classified as prediabetes.
Please continue to maintain a healthy diet and engage in moderate exercise, and make sure to have regular follow-ups at the outpatient clinic.
Additionally, the presence of abnormal red blood cells in the urine does not affect the glycated hemoglobin levels.
Wishing you good health.

Reply Date: 2022/04/11

More Info

When evaluating the relationship between high glycated hemoglobin (HbA1c) levels and normal blood sugar levels, it is essential to understand the implications of these findings in the context of diabetes and prediabetes. Your HbA1c levels of 6.3% and 6.4% indicate that you fall within the range that is considered prediabetes, which is defined as an HbA1c between 5.7% and 6.4%. This means that while your fasting blood sugar levels are normal, your body is showing signs of impaired glucose metabolism.

The fact that your fasting blood sugar levels have remained normal (85 mg/dL in April, down from 102 mg/dL in January) is a positive sign. However, the elevated HbA1c suggests that your average blood sugar levels over the past two to three months have been higher than normal. This discrepancy can occur for several reasons:
1. Glycemic Variability: It is possible that while your fasting blood sugar is normal, you may experience spikes in blood sugar levels after meals that are not captured in fasting measurements. This can lead to an elevated HbA1c.

2. Red Blood Cell Turnover: Certain conditions can affect the lifespan of red blood cells, which in turn can influence HbA1c levels. For example, conditions that lead to increased red blood cell turnover (such as hemolytic anemia) can result in lower HbA1c levels, while conditions that decrease turnover (like chronic kidney disease) can lead to falsely elevated levels. However, your reported RBC values do not indicate a significant issue that would affect HbA1c.

3. Dietary Factors: Changes in diet can also impact blood sugar levels and HbA1c. If you have made dietary adjustments, it may take time for these changes to reflect in your HbA1c levels.

4. Medications: The medications you are taking for blood pressure and cholesterol may also have indirect effects on your glucose metabolism. It is essential to discuss with your healthcare provider how these medications might interact with your blood sugar levels.

5. Other Health Conditions: Other underlying health conditions, such as hormonal imbalances or chronic inflammatory states, can also affect glucose metabolism and HbA1c levels.

Given your family history of diabetes and your current HbA1c levels, it is crucial to monitor your blood sugar levels regularly and maintain a healthy lifestyle, including a balanced diet and regular physical activity. You should also continue to follow up with your healthcare provider for regular blood tests to monitor your HbA1c and fasting blood sugar levels.

In conclusion, while your normal fasting blood sugar levels are encouraging, the elevated HbA1c indicates that you are at risk for developing type 2 diabetes. It is essential to take proactive steps to manage your health, including lifestyle modifications and regular monitoring. If you have concerns about your HbA1c levels or how they relate to your overall health, discussing these with your healthcare provider is advisable. They may recommend further testing or adjustments to your management plan to help prevent the progression to diabetes.

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