Does an A1c of 6.1% mean I have diabetes?

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Becki Posted: Wed, Apr 15 2009 8:19

Hello all...

I am a 36 year old overweight female.    About 2 years ago I went through IVF fertility treatments to have my child.    During the 7th month of my pregnancy I developed Gestational Diabetes that was treated with insulin.   After my pregnancy things seemed to resolve.   I continued to test on my own every now and then with my meter that I had from the Gestational Diabetes and the numbers were a little high but not over 200.

As part of my fertility medications the first time around I was on low dose metformin (500-1000mg).   I stayed on the metformin till about the 4th month of pregnancy.

I am getting ready to go through IVF again now.    In preparation I have started my hormones again and the fertility doctor put me back on 1-2 metformin a day.   I have been taking 1 pill a day for about 1 month (I haven't taken 2 pills because they have been causing me diareaha).   And, I am not great about taking the metformin every day.

I recently had some blood work done at the fertility clinic in prep for IVF this summer.  They did an A1c test.   The doctor called me tonight to say the A1C was 6.1% and the IVF clinic wants it at 6.0% or lower before doing the IVF. 

He asked me who I see to manage my diabetes.   I told him that I have never been diagnosed with diabetes.   I had gestational diabetes but it seemed to have gone away.   He seemed surprised and asked me who prescribed the Metformin?   I told him he did and he seemed to have forgotten about that.    He told me to call my PCP or an endocrinologist and bring them into the loop on the A1C #.

He also said that since I had about 3-4 months before the IVF that he thought diet, exercise, upping the metformin does and losing some weight would bring the A1C number down to 6.0% or lower before the IVF.   But he again indicated that I need to call my doctor since the IVF clinic is not going to monitor me long term and that my diabetes will need to be managed during the pregnancy and after...

I am frankly shocked and upset and scared by this phonecall!!  He seemed to indicate that I am a diabetic based on this A1C number.    Is that true?

I was thinking that I might not see my PCP or an endocrinologist right now as I am terrified of being labeled a "diabetic" since from what I have read - once you have that diagnosis it never goes away - it can be controlled - but never gone.   My plan was to go to Weight Watchers ( I lost 20 lbs successfully before my first pregnancy with Weight Watchers), start walking 20 minutes a day or so, and up the Metformin to 2 pills a day.

I am kinda hoping this is something I can do on my own and I can get the A1C down to 5.9-6.0% on my own by doing the above.

I realize that it is a virtual certainty that I will have the Gestational Diabetes again if I am lucky enough to get pregnant a second time.  

So - am I a diabetic?

Should I call my doctor or is it worth following my own plan till June/July when my A1C will be tested again?

I am nervous that if I have a formal diagnosis I won't be able to get additional life insurance which I want/need to get if I get pregnant again.

What is weight loss goal to bring down the A1C?

Should I gradually work up to 3 metformin a day?

Any thoughts or advice greatly appreciated!

--Becki

 

 

 

 

Top 25 Contributor
Male
Posts 133

Becki,

 

You are right to be concerned about the 'label' as diabetic.  It is very important to avoid this label.  My post will probably be quite different from that of others.  A1c tests are generally not used to diagnose diabetes.  That said, your A1c test indicates that you do not have the healthiest blood sugar levels.  Whether you choose to call it diabetes, imparied glucose tolerance, high normal, is a matter of choice, but you need to make changes in your life.  Almost all experts are agreed that increased physical exercise will help.  What I have found most beneficial, is a very low carb diet.  You will probably lose weight on such a diet, which will lessen insulin resistance.  Additionally, because insulin response is muted, you will probably find that you have adequate insulin function.  You may well find that you don't need any medications.

While you will find many references describe normal A1c as less than 6 (and you are practically there), the healthiest of non-diabetics are under 5, and that gives you a better picture of where you are. 

 

Top 10 Contributor
Female
Posts 251

Becki:  You have lots of questions and concerns.  Rightly so, but I am not sure that I can answer them all.

So, let me tell you my story and what I know.

I ,too, had gestational diabetes when I was pregnant with my only child.  I was able to control it with diet and exercise, but the next step would have been insulin.  At that time (23 years ago), oral medications were not prescribed for women with gestational diabetes. 

Following my daughters' birth, my diabetic issues resolved themselves.  However, gestational diabetes is a strong indicator for developing Type II later one.  In fact, that is what happened to me eleven years later. 

I was at normal weight before the birth of my daughter and I resumed normal weight very quickly after giving birth.  Being overweight is another indicator of diabetes.  So, my initial advice to you would be to work on reducing your weight into the normal range immediately, even before you think about a diabetic diagnosis or a second child.  Those extra pounds are complicating things on several fronts.  That should be your first priority.

Depending on the lab your doctor uses, an A1c of 6.1% can be a hair out of the normal range.  Perhaps nothing to worry about generally, but could be significant if you are contemplating a second pregnancy.  Above 6% in many labs is very slightly above the normal range and puts the possibility of a pre-diabetes diagnosis on the table.  Again, it is just very slightly above normal.  Loosing weight could have a big impact on your next A1c test. 

I would not be afraid to talk to your PCP  about these concerns.  You need to have all the "medical ducks" lined up in a row for a successful pregnancy and birth and keeping information away from your medical team is not the way to go.  Speaking from experience, receiving a diagnosis of a chronic disease can be a little scary.  Having that chronic disease without proper medical care is way, way, WAY scarier! Believe me.

Do not play around with medication without a doctor's approval.  Skipping a lot of doses or increasing or decreasing medications without medical supervision can be dangerous.  You do not want to create any additional health issues before you prepare your body to create another little life!

If you are serious about weight loss, Weight Watchers is a terrific program for what you need because the diet plans are very much in line with what diabetic needs are...in fact, the original Weight Watchers meal plans were based on the American Diabetes Association recommendations.  So, tell your doctor you are more than willing to make that a part of your treatment plan.  That's a huge plus for you.

Since you already have a meter, use it.  Take a series of readings every week so that within the entire week you have some readings before breakfast, before and two hours after each meal and at bedtime.  Scatter the readings around, but try to hit those highlights.  Bring those results in when you talk to your PCP.  Don't worry about what the readings mean or try to fudge any of them.  There may be some simple remedies for higher numbers if you are honest about them. 

Good luck to you. BTW, do you have a son or a daughter?  And isn't two the cutest age? 

Spirit

Top 10 Contributor
Female
Posts 384

Becki:

I have been diabetic for 20  years.  I think that to deny that you may be diabetic could cause you more harm than good.  I believe that to get insurance they ask you if your are diabetic, however, if you go to weight watchers and are very careful you might be able to get your A1C below six, but that still does not mean you are not diabetic.  I had mine down to 5.3 for a long time before ai let it get out of hand and now I am working really hard to get back there.  The only way to really find out if you are diabetic is to have an oral glcose tolerance test.  They give you a sickeningly sweet drink to drink and then draw blood over a course of 2-3 hours.  They can tell by how high your BS goes up if you are diabetic. 

I would be more concerned about my baby's health and if you are diabetic it is not going to go away.  My advice would be to go to the doctor and explain and get tested. It is important to your baby that you be treated.  

There are a lot worse things than being diabetic and it is true that while your diaibetes may get down into the normal range, if you are diabetic, you will always be diabetic

I also go to WW.  On their discussion board there is a diabetes support thread and many of the women on that board have been pregant and gone through IVF and it  would be a great resource for you.

Jen  - LevemirConfused and Novalog Wink A1c 5.8

 

 

Top 10 Contributor
Male
Posts 432

Becki, you have some interesting questions and concerns. First I think you need to know is that type 2 diabetes is not a black and white condition. There are many shades of gray, and the middle ground shades are called pre-diabetes. A1C is not used to diagnose diabetes. Diagnosis is based on your fasting BG and or the Oral Glucose Tolerance Test (OGTT). You probably have had an OGTT, if you have had gestational diabetes. The diagnosis criteria can be found here:

Diabetes - Prediabetes Diagnosis

There are no numbers that I am aware of that are similar using the A1C. My guess however would be that 6.0 would be in the lower end of the prediabetes range.

I will leave it to you to figure out the issues of diagnosis and insurance. I can appreciate that insurance costs could be much higher if you are diagnosed with diabetes. However, sooner rather than later you need to know. Diabetes is not a nice disease, and based on what you report you very likely have pre-diabetes or diabetes. If there is any possibility it would be best to get your insurance costs locked up when you don't have diabetes.

Your numbers are not out of the park, and I think if I were you I would take the metformin as prescribed, and do everything reasonable to get your weight down. It will also help to do all the exercise you can including both cardio and resistance (weight) training. The dose of metformin needs to be increased slowly. Normal practice is to increase 500 mg after 2-3 weeks. If you have 4 months to work with, keep in mind that the A1C is based on the two months prior to the test with a bias towards the more recent days. So, in short you have time to get things down, but A1C does not change overnight.

A diet with lots of soluble fiber and/or metamucil (which contains soluble fiber) has been shown to be helpful in lowering blood glucose.

Hope that helps some,

Ron

Not a med prof. Just diabetic type 2 on Prandin, Levemir, ramipril, bisoprolol, & Crestor. Diag. Feb/01.

"I have not failed. I have just found 10,000 ways that don't work." - Thomas Edison

Top 10 Contributor
Male
Posts 134

Becki,  Listen to Jen and Ron!  Don't play with your life or the life of the child you want.  While being diagnosed with diabetes is a shock, "it is not your fault"!  It would be your fault for not having the proper tests and safeguarding your health for the child you already have.  This alone should get you moving to make an accurate determination!

Type 2 (10/2003)   Lantus and Novalog   Now added Metformin      Retired

 

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