Fluctuations in HbA1c Levels: A Month of Concerns

There is significant fluctuation in glycated hemoglobin levels within a month?

Hello Doctor: Thank you for taking the time to answer my questions despite your busy schedule.
In my family, aside from my parents, my aunts, uncles, and both sets of grandparents have diabetes, so I am particularly concerned about blood sugar levels.
Since mid-August, I have lost weight from 65 kg to only 59 kg now, and I had an upper gastrointestinal endoscopy on October 5, which revealed erosive gastritis and gastroesophageal reflux, but those conditions have improved.
I am worried that my weight loss might be due to blood sugar issues, so today I went to a medical laboratory to test my glycated hemoglobin, fasting blood glucose, and fasting insulin.
The results were as follows: Glycated Hemoglobin: 5.5%, Fasting Blood Glucose: 77 mg/dL, Insulin: 5.23 µU/mL.
However, on December 2, I went to another medical laboratory, and the results for glycated hemoglobin and fasting blood glucose were: Glycated Hemoglobin: 5.1%, Fasting Blood Glucose: 89 mg/dL.
During the period from December 2 to December 25, I consumed more sugary foods, including beverages and refined carbohydrate snacks, and I also had a significant intake of starch in the past few days.
Additionally, I had a test on September 16 with results: Glycated Hemoglobin: 5.4%, Fasting Blood Glucose: 92 mg/dL.
The difference between these two time periods is that on September 16, school had just started, and I had not exercised much during the summer break, with a moderate intake of refined carbohydrates.
After school started, I have been able to walk nearly 6000 steps daily, with a similar intake to the summer, but my starch intake in December was somewhat higher.
I would like to ask the doctor: 1.
My insulin resistance calculation (0.994) indicates no issues; what could cause such a significant change in glycated hemoglobin within a month? 2.
Could the short interval between tests mean that new red blood cells have not yet been produced, and the increased refined carbohydrate intake in a short time be a factor? 3.
Is my rate of weight loss considered normal? 4.
Should I be concerned about my blood sugar levels? 5.
Given my blood sugar levels, how often should I test glycated hemoglobin and blood glucose? 6.
Will there be changes in glycated hemoglobin levels if tested before and after my menstrual period? Thank you, Doctor, for answering my questions; I have quite a few, and I appreciate your help.

Zhu, 20~29 year old female. Ask Date: 2023/12/26

Dr. Ye Qianyu reply Family Medicine

Hello! First, you should understand that glycated hemoglobin (HbA1c) is an indicator of average blood glucose levels over the past three months, so testing on different dates reflects average blood glucose status during different periods.
Any factors that affect calorie intake and expenditure will influence blood glucose levels, subsequently affecting glycated hemoglobin.
Therefore, increased carbohydrate intake will raise glycated hemoglobin, while increased physical activity will lower it.
Based on the values you provided, the weight loss currently appears to be less related to blood glucose, possibly due to gastrointestinal discomfort affecting absorption.
Strictly controlling starch intake can also lead to weight loss.
If you experience a 10% weight reduction without intentional adjustments, it is advisable to seek medical evaluation.
Given your family history, it is recommended to continue monitoring your diet and exercise.
Current data can be tracked every six months to a year.
If glycated hemoglobin exceeds 6.0%, it is recommended to monitor every three to six months, and if it exceeds 6.5%, it is advisable to follow up with a metabolic specialist every three months.
Additionally, young women may experience slight fluctuations in glycated hemoglobin due to menstrual bleeding, but this is not significant if there is no anemia.
Variations in values are inevitable; as long as you continue to monitor, avoid overeating or undereating, and try to maintain a regular and balanced diet, you can make minor adjustments to your lifestyle based on blood glucose control.

Reply Date: 2023/12/26

More Info

Thank you for your detailed questions regarding your health concerns, particularly about fluctuations in HbA1c levels and blood sugar. I appreciate your proactive approach to understanding your health, especially given your family history of diabetes. Let’s address your questions one by one.

1. Fluctuations in HbA1c Levels: The changes in your HbA1c levels over the month can be attributed to several factors. HbA1c reflects your average blood glucose levels over the past 2-3 months, so a single month may not show drastic changes unless there are significant alterations in your blood glucose levels. The difference between 5.1% and 5.5% is relatively small and may not be clinically significant. Factors such as hydration status, recent dietary changes (like increased intake of refined carbohydrates), and even stress can influence blood glucose levels and, consequently, HbA1c readings.

2. Dietary Impact: Yes, the increased consumption of refined carbohydrates and sugars can lead to temporary spikes in blood glucose levels. If your diet was significantly different between the two testing periods, this could explain some of the variation in your HbA1c. Additionally, the body takes time to respond to dietary changes, and new red blood cells take about 120 days to form. Therefore, if you had a recent increase in sugar intake, it might not immediately reflect in your HbA1c if the testing was done too soon after those changes.

3. Weight Loss: Your weight loss from 65 kg to 59 kg over a few months is notable, especially if it was unintentional. While some weight loss can be normal, especially with lifestyle changes, significant or rapid weight loss can sometimes indicate underlying health issues, including potential metabolic disorders. Given your family history of diabetes, it’s essential to monitor this closely.

4. Blood Sugar Concerns: Your current HbA1c levels (5.1% to 5.5%) and fasting blood glucose levels (77 to 89 mg/dL) are within the normal range. Generally, an HbA1c below 5.7% is considered normal, while 5.7% to 6.4% indicates prediabetes, and 6.5% or higher suggests diabetes. Therefore, based on your current readings, you do not need to be overly concerned about diabetes at this moment. However, continuous monitoring is advisable, especially given your family history.

5. Testing Frequency: Given your current HbA1c levels and the absence of symptoms, it would be reasonable to check your HbA1c and fasting glucose levels every 6 months. However, if you notice any significant changes in your weight, diet, or overall health, you should consider testing more frequently.

6. Menstrual Cycle Effects: Hormonal fluctuations during the menstrual cycle can affect blood sugar levels. Some women may experience higher blood sugar levels in the days leading up to their period due to hormonal changes, while others may not notice any significant differences. Therefore, it’s possible that testing HbA1c before and after your menstrual cycle could yield slightly different results, but these changes are typically minor.

In conclusion, while your current blood sugar levels and HbA1c readings are within normal limits, it’s essential to maintain a healthy lifestyle, monitor your diet, and stay active. Given your family history, regular check-ups with your healthcare provider are crucial for early detection and management of any potential issues. If you have any further concerns or notice any new symptoms, don’t hesitate to reach out to your healthcare provider for personalized advice.

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