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Short Summary
Main recommendation: Dr. Ergin's main recommendation: don't accept an A1c result at face value when it doesn't match your finger-stick readings or when you have anemia, blood disorders, or recent iron/B12 treatment; he suggests discussing with your doctor whether A1c is valid for you and considering alternative tests. The speaker, Dr. Ahmed Erik, an endocrinologist, says A1c can be falsely high or low in these situations, so patients should understand what their number means and question inconsistencies.
Key Points
- A1c is an average of blood sugar over roughly three months, expressed as a percentage, measured through how much glucose is attached to hemoglobin in red blood cells (glycated hemoglobin).
- A mismatch between A1c and home blood sugar readings (for example, A1c of 7% with sugars in the 200s, or A1c of 9% with sugars in the 80s–100s) signals that the A1c may be inaccurate.
- Hemoglobin variants, common in people of Mediterranean descent (thalassemia) and African descent (sickle cell trait), can distort A1c results.
- Anemia and its treatment change red blood cell age, which can make A1c falsely high or low.
- Alternative tests the speaker mentions are fructosamine (reflects roughly the last two to three weeks) and glycomark.
Details Worth Noting
- Concrete instructions:
- Ask your doctor to look at your CBC (complete blood count), specifically hemoglobin (Hb) and hematocrit (Hct), to see whether they are abnormal.
- If your CBC shows abnormal hemoglobin or hematocrit, or you are anemic (for example, hemoglobin around 10–11), raise the possibility that A1c is unreliable for you.
- Compare your A1c against your home finger-stick readings; a clear mismatch is a reason to question the A1c.
- Discuss with your doctor whether fructosamine or glycomark is appropriate as a substitute; the speaker says glycomark cannot be used if you take an SGLT2 inhibitor such as Jardiance, Farxiga, or Invokana.
- Ask that your chart note that the A1c is not valid for you and explain why, so insurers and other clinicians are not misled.
- Thalassemia is linked to Mediterranean ancestry and sickle cell anemia to African ancestry; carrier status may alter hemoglobin variants without the person knowing.
- After iron or B12 deficiency is treated, new young red blood cells can dilute the older ones, potentially making A1c appear falsely good.
Bottom Line
A1c is a useful but imperfect average; when it conflicts with home readings or your blood counts show anemia, hemoglobin variants, or recent treatment, the number may mislead, so verify it with your doctor before relying on it.
