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[IP] A1C - what's the real story here?

> >Based on what I've read and heard, I thought the A1C indicated
> >how often the blood sugars have been high, not an average of the
> >bg's.
> This is correct according to the Pink Panther book, 9th ed., ISBN
> 0-9675398-0-3, p. 132.

Alright Medical Professionals out there, help us out here!  According to the
Joslin Guide, the test "reflects the average of your glucose control over
the past 2-3 months".  Also, it adds:

    It is important to note, however, that in interpreting tests for
hemoglobinA1, near-normal results don't necessarily mean that you have
maintained acceptable blood sugar levels on a day-to-day basis.  In fact, a
satisfactory reading may actually reflect the average of some very high and
very low blood sugar levels during the eight-week period.  In such cases,
the amount of sugar that becomes attached to the hemoglobin could be similar
to readings obtained when blood sugar is consistently closer to normal.  You
could be getting a distorted view of what has really occurred.

In the John Hopkins Guide, the following is offered:

    If glycated hemoglobin provides the big picture, it doesn't give the
WHOLE picture.  It does not, for example, tell you whether the overall
control is fairly stable at a particular level or whether you have many
highs averaged in with many lows.

These two books have been my "diabetes bibles" for the past few years...are
they steering me wrong on this?  And no, I'm not "anti-HbA1c testing" - I do
understand the benefits it can provide by lettinng you know that if it is
NOT in aggreement with you self-monitering records, then something may be
happening when you are NOT testing that needs looked into...there's a lot of
value in that, as sort of a double-checking system.  What I AM worried about
is people seeing a "good" HbA1c & believing that means all is well, & that
it indicates good control overall with no highs & lows involved.

Since we've got different resources giving us different information
here...anyone have some good strong light they can shed on the topic?


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