I am 33, female, with NMOSD. Why do I have low HbA1c?

Question

Hello doctor,

I am a 33-year-old woman living with NMOSD (neuromyelitis optica spectrum disorder) for the past three years, and I have been on immunosuppressive therapy since my diagnosis. While my vision and neurological symptoms are currently stable, I have recently started experiencing persistent fatigue, shakiness between meals, and episodes of dizziness.

My recent laboratory report showed an HbA1c of 4.0%, which seems lower than usual, even though I have never had diabetes or taken any glucose-lowering medications. Alongside this, I have been dealing with irregular menstrual cycles and was told I might have a hormonal imbalance, possibly linked to ovarian dysfunction.

Sometimes I skip periods altogether, and other times they come with intense cramping and mood swings. I am starting to wonder if all these symptoms, especially the low HbA1c and menstrual irregularities, could be connected to my autoimmune condition or the medications I am on.

Could there be an underlying hormonal or metabolic issue related to NMOSD that needs further investigation?

What can I do?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern regarding your symptoms.

Your symptoms, particularly the low HbA1c (glycated hemoglobin), fatigue, shakiness between meals, and menstrual irregularities, appear to be interconnected and may be related to both your NMOSD (neuromyelitis optica spectrum disorder) and the long-term effects of immunosuppressive therapy.

NMOSD is an autoimmune condition that can involve or indirectly affect various systems in the body, including the endocrine system. Chronic autoimmune activity, especially in women, has been associated with hormonal imbalances such as ovarian dysfunction or premature ovarian insufficiency. These conditions can lead to irregular menstrual cycles, missed periods, and pronounced premenstrual symptoms like mood swings and cramping.

Immunosuppressive medications, particularly corticosteroids or agents that impact hormone-producing glands, can also disrupt normal hormonal signaling over time. On the metabolic side, your HbA1c of 4.0% is notably low, indicating that your average blood glucose levels are at the lower end. This could explain the episodes of reactive hypoglycemia you are experiencing, which result in dizziness and shakiness between meals.

Such hypoglycemia may stem from impaired glucose regulation, which is often influenced by hormonal fluctuations (such as low estrogen or cortisol irregularities) or medications affecting liver glucose output.

Fatigue is a common symptom in both autoimmune and metabolic disorders. In your case, it may be compounded by low blood sugar levels and disrupted hormonal rhythms. These findings suggest a possible underlying hormonal and metabolic imbalance, potentially involving the adrenal, ovarian, or pituitary axes, warranting further evaluation.

To gain more insight into your condition, I recommend checking the following tests:

Thyroid panel test.
Cortisol.
LH and FSH (luteinizing hormone and follicle-stimulating hormone).
Estradiol.
Insulin.

These tests will help clarify the underlying causes and allow us to develop a more targeted treatment strategy alongside your ongoing NMOSD management. Once the above tests are completed, we can discuss a personalized plan for treatment and prevention.

Please do not hesitate to reach out at any time. I am always here to help.

Thank you, and I hope this brings some clarity.

Warm regards.