From Wytheville, Virginia, USA:
I am a diabetes educator at a small community hospital. My recent challenge was a 14 year old black female with DKA. She had been diagnosed with type 1 16 months ago, was hospitalized, and received her initial teaching then. We basically started over, repeated the whole process of education on this last admission for DKA. We obtained an HbA1c and the result was 17.4%. This patient also had a significant weight loss (more that 50 pounds) since she was diagnosed in the spring. When I talked to her endocrinologist for follow-up, he replied that the DKA was the reason her HbA1c was elevated so high. Is that so? I thought it was a test of average glucose. Can you find any supporting documentation for his answer?
The endocrinologist is almost certainly right, a Hemoglobin A1c of 17.4% represents extremely poor control over at least the last three months. The constant high blood sugars not only produce the high A1c, but they indicate that she is not getting enough insulin for any one of a number of reasons. It think she needs the attention of a diabetes team that includes a good medical social worker or a clinical psychologist, and the opportunity for daily telephone contact with someone on the team.
It is just possible though that the laboratory that did the test is using an older methodology that includes fetal hemoglobin in the total A1. Fetal hemoglobinemia is an occasional hereditary blood disorder which can artificially increase A1 levels. The recurrence of DKA [diabetic ketoacidosis] makes this explanation very improbable though and it is easily checked.
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