HomeAnswersInternal MedicinediabetesIn thalassemia minor, is HbA1c test a reliable one?

In thalassemia minor, is HbA1c test a reliable one?

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In thalassemia minor, is HbA1c test a reliable one?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At July 29, 2017
Reviewed AtJanuary 18, 2024

Patient's Query

Hi doctor,

I am diabetic since last 9 years and thalassemia minor as well. Recently, the fatigue symptoms have increased, especially when I am not able to sleep properly. I am 45 years old. My height is 167.5 cm and weight is 85 kg. Being thalassemia minor, is my HbA1c test reliable to decide my diabetic medication? If doctor increases the dose of medication, then my sugar levels drop below 70. Rarely, in the last 9 years my blood sugar level has crossed 200 in some two or three occasions. My fasting sugar level is normally between 130 to 140 or less. Postprandial is also surprisingly the same. Owing to HbA1c test, the doctor changed my medicines three days back and prescribed Glycomet GP 2 forte, Zemiglo 50 and Voglibose 0.2. Earlier, I had Glycomet GP 2, Voglibose 0.2 and Janumet 50/500. I have also attached my recent blood test report.

I also have BP problem since last four months and on medication too. Can you please elaborate what should I do? I have read HbA1c test in thalassemia minor is not reliable. I am a female and heading towards menopause. I have undergone gallstone surgery 20 years back. The symptoms of fatigue have increased and it has started hampering my physical activity, which is must for diabetes. Please help.

Hello,

Welcome to icliniq.com. The main concern you are currently experiencing is fatigue and sleeplessness or insomnia. Sleep greatly affects our cognitive abilities, including thinking, reaction time, memory, and problem-solving skills. I would like to gather some information about your sleep history. How long have you been having sleep problems? How many consecutive days do you experience disturbed sleep? Do you struggle with falling asleep or staying asleep? Do you have excessive daytime sleepiness? Are you experiencing any of the following symptoms: missing work, making bad decisions, difficulty concentrating, irritability, or depression?

Now, let's discuss some manifestations of fatigue. Please let me know if you have any of the following symptoms: weakness or low energy, lack of motivation, poor performance, memory problems, decreased productivity, increased tendency to make errors, mistakes, or accidents, feelings of depression, or a reduced interest in socializing.

If you answered yes to any of the questions above, it is possible that your fatigue is related to lack of sleep. Improving the quality and quantity of your sleep can help alleviate your fatigue. Regarding the HbA1c test, it may not be as reliable in diagnosing diabetes mellitus in patients with anemia. Variant hemoglobins can influence the results, leading to either high or low readings. Therefore, its reliability is highly variable. Instead, laboratory tests such as fasting blood sugar (FBS), postprandial blood sugar (PPBS), and oral glucose tolerance test (OGTT) are considered more credible for diagnosing diabetes.

There are alternative glycated proteins, such as glycated albumin or fructosamine, that can be used to monitor glucose control. However, they are more expensive and mainly used for evaluating glucose control over the previous two weeks.

Regarding your new medication, how do you feel since starting it? Have you experienced any episodes of hypoglycemia? Have any tests been conducted following those episodes? If you are experiencing symptoms of hypoglycemia or your blood sugar levels are consistently low, it may be necessary to adjust your medication. Remember to maintain a healthy and nutritious diet, engage in physical activity or yoga, take your medication on time, read uplifting books, and prioritize getting a good night's sleep.

Patient's Query

Thank you doctor,

I am not sure as I had been on new medicines only for the last three days. As per sleeplessness, I am a bit sensitive even a slight sound disturbs me. Doctor has given me Etizola to be taken when I am under stress, but the next day I feel dull with it. I take a very short nap during the day as I am afraid if I sleep more say for an hour during the day I get sleepless night. So, I prefer a short nap of 15 to 20 minutes. Someone suggested that I should get my blood sugar reading continuously for 12 weeks and then take an average, which will give a correct reading instead of HBAc1 test. Is this advisable to adjust the medicine?

Hello,

Welcome back to icliniq.com. The primary purpose of HbA1c is to identify the average plasma glucose concentration over a period of three months. HbA1c levels reflect blood glucose levels over the past six to eight weeks and do not capture daily fluctuations or depict the daily ups and downs of blood glucose. That is why the criteria for diagnosis and management of diabetes include fasting blood sugar (FBS) and postprandial blood sugar (PPBS), rather than relying on HbA1c alone. It provides a more holistic view of the patient's condition. If you wish to calculate your HbA1c from daily readings, you can do so by averaging twelve weekly readings and then using an A1c and average blood glucose conversion calculator. Remember, good sleep is crucial for maintaining a healthy and sound mind.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Geetha Priyadarsini Kamminana
Dr. Geetha Priyadarsini Kamminana

Internal Medicine

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