More about HbA1c limitations

[MarcR]

Many of us are aware that normal variations in red blood cell turnover can account for large variations in HbA1c test results from one person to another and introduce substantial uncertainty regarding estimated average blood glucose levels. Starting at 11:00 in this fascinating podcast from Dr. Chris Masterjohn, he describes another significant factor affecting HbA1c levels - deglycation of HbA1c by fructosamine 3-kinase. He also explains the science that absolves HbA1c of responsibility for causing diabetes-related disease and highlights a couple of processes that do drive accumulation of advanced glycation end products (AGEs).

Regarding those AGE accumulation processes, I recommend his recent Examine.com article in which he explains why very low carbohydrate diets may not be optimal for most people. The title exemplifies a key reason that I love his work - with straightforward research-driven logic, he reminds me of nuance, U-shaped response curves, feedback loops, and what we don't know:

Sugar is the ultimate antioxidant and insulin will make you younger: Appreciating a few poorly recognized but critical contributions of carbohydrate

Sometimes with biomarkers I feel like the guy searching for his keys under the lamp post. "Did you lose them near here?" "No, but this is where the light is." Masterjohn's podcast is a persuasive reminder that our bodies are much more complex than the tests that we sometimes obsess over.

[circular]

Sometimes with biomarkers I feel like the guy searching for his keys under the lamp post. "Did you lose them near here?" "No, but this is where the light is." Masterjohn's podcast is a persuasive reminder that our bodies are much more complex than the tests that we sometimes obsess over.

Yes! And we can't forget that the only way we get biomarker/lab results is via a commercial enterprise! We're quick to jump on published papers with a conflict of interest, but tend to assume that lab results are some sort of given. One of the reasons I started that spreadsheet was not only to record data, but to better observe patterns and identify questions worth pursuing. Einstein tried hard to educate us that there's no such thing as objectivity and here we all are desperately trying to be as objective as possible. A worthy effort in any event, but methinks meditation may have more inherent wisdom

[KatieS]

Marc, thanks for posting a possible explanation for my A1c averaging 5.4, despite lower FBG, fasting insulin (2) and low postprandial glucose tests verified by the lab. Perhaps, both my mom and I have less FM3K, hence a higher A1c. In the future, we might be measuring some of the chemicals he notes as the real culprits (methylglyoxal).

[BethJ]

I monitor glucose and ketones. Forgive me, but are you referring to ketones when monitoring HbA1c at home?

[MarcR]

I don't think anyone in this thread is discussing home monitoring of HbA1c. I'm not aware of a practical way to do that.

[Orangeblossom]

In the UK, we can get this online testing which does 3 monthly tests of e.g. HBA1C, along with some other things. I haven't done it but it seems relatively easy and quick to do.

[MarcR]

We can order our own labs in the US as well, OB - I think BethJ is asking about self-testing at home in the way some do with glucose and ketones.

[NF52]

I don't think anyone in this thread is discussing home monitoring of HbA1c. I'm not aware of a practical way to do that.

Marc,
Do you view the home testing kits available through Walgreens, CVS and Amazon as not reliable? This article seems to indicate that at least the Walgreens and CVS tests are fairly reliable for diabetics to use monthly at home, although maybe because they are backed up by testing every 3 months by a doctor.
https://www.thediabetescouncil.com/at-h ... g-systems/

[MarcR]

I did not know that home testing for HbA1c was a thing until now, so I have no opinion regarding reliability.

[BethJ]

So, when we talk about our HbA1c #, are we referring to the # from our most recent blood work?