Is HbA1c Level Of 5.3 A Cause For Concern?

Posted on Sat, 11 Mar 2017

Question: I have been monitoring my blood sugar for several months, maybe even a year since noticing a high fasting glucose level when showing my wife how to use glucometer.
I then did an A1C and it was 5.3

I told my doctor and she checked my glucose mid day and it was 108.
I told her my A1c and she asked some questions, did some tests then said i was worried for nothing and i was fine.
I had full blood panel checking white cells, liver, pancreas, kidneys, etc...
Several times plus an abdominal CT within this last year and all has been normal.

My sleeping habits are weird and i wake up between 3:00am and 6:00 am daily.
During these times my blood sugar will be anywhere from 100 to 135.

I check it again around 7:30am having not eaten anything and it always goes down to around 105.
Ive checked my post prandials many many timez within the last year, always after large carb meals(100 grams) and they arent really abnormal either.
My 1 hour postprandial is 130-150
2- hour postprandial is 100-110

My diet is weird too. I eat maybe a small bite late morning and have juices or sodas during the day
But a really big meal in one sitting at night then fall right to sleep.

My questions are am i testing at the wrong time for fasting because of my wake up times? Or when should i check it?

I do have caloric intake throughout the day but not a set meal. Could eating one large meal and going to sleep immediatly after cause higher readings in the morning only?

All my A1C tests have been 5.3 at the highest but others have been right at 5.0

I take dexilant once daily as well as 500 mg of tylenol 1-2 times a day.
(Im a medic so i try and limit tylenol and i do space it.)

Seems i am seeing gluconeogenisis in the morning for about 2-3 hours.

Could any of the above give me weird readings on morning glucose?

Thanks

My first question is

Answered by Dr. Mirjeta Guni (42 minutes later)

Brief Answer:
About blood sugar levels;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.

Fasting blood sugar measures blood glucose levels after a period of fasting, usually at least eight hours without food or liquid (except water).

Of course after a normal dinner, regardless of the time you usually go to sleep.

What is important to know, is the fact that the blood sugar measuring devices may show results up to +/- 25 mg/dl in comparison with laboratoric venous blood sugar.

If you have risk factor for developing Diabetes in the future (are overweight, have positive family history for type 2 Diabetes, had gestational Diabetes etc.) you should check fasting and postprandial glucose in laboratory as well as HbA1C levels, once in a every year.

HbA1c over 5.7 is indicative for prediabetes or Diabetes. So in your case there is no reason why to check the blood sugar so often.

PPI (Dexilant) and Tylenol do not raise the blood sugar.

Hope this helps.
Feel free to ask further.

Kind regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (45 hours later)

Why would my fasting be so high between 5-7am?
Is it normal that blood sugar will rise for a short time when the liver dumps glycogen in the early am?
If so, is that likely what im seeing?
Again, the earlier i wake up the lower my blood sugar is.
Ive also used different glucometers to check this.

Answered by Dr. Mirjeta Guni (40 minutes later)

Brief Answer:
You are experiencing '' XXXXXXX phenomenon'';

Detailed Answer:
Welcome back!
The phenomenon you have noticed is called ''dawn phenomenon ''.

Between 3 a.m. and 8 a.m., your body starts to ramp up the amounts of certain hormones ( including cortisol, glucagon, and epinephrine).

All these work against insulin's action to drop blood sugar levels.
Experts disagree on how many people have a XXXXXXX phenomenon. Estimates range from 3% to 50% of Type2.

The levels will settle down a few hours after waking, regardless of whether you eat or not.
So, your glucometer is right, you are experiencing ''dawn phenomenon''.

Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (26 hours later)

I noticed you said type 2, does that mean im diabetic?
Today at lunch i had protein and around 50 grams of carbs.
1 hour was 112
1.5 hour was 122
2 hour was 103

Seems like these numbers dont make sense with a high fasting glucose

Answered by Dr. Mirjeta Guni (16 hours later)

Brief Answer:
The levels you reported are normal.

Detailed Answer:
Hi again,
To make a diagnosis of pre Diabetes, fasting over 110 mg/ dl or postprandial over 140 mg/ dl and HbA1c over 5.7% are necessary.
So in your case we can not say you have Diabetes, but the only way to explain the high blood sugar during 3-5 a.m ( that i do not know why you check them so often), is a XXXXXXX phenomen that usually is present at Diabetic patients but at a normal person ( with normal HbA1c) it does not have any significance.

As long as your HbA1c, fasting and postprandial level are within the normal limits and you do not have signs or symptoms that suggest for hypoglycemic events that may modify the HbA1c, i do not see any reason why to check the blood sugar so often.
Regards,
Dr.Mirjeta

Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Prasad