# Is there a risk to slightly elevated glucose with normal A1c? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 21, 2025, 4:58am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292 "2025-04-21T04:58:02Z")\ **Posts on this page:** 14\ **Page:** 7
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [May 2, 2025, 10:31pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/121 "2025-05-02T22:31:29Z")
> [@Dr.Strangelove](#): > > The Stelo gives a “target range” of 96% of the time between 70 and 140. That’s only 20 minutes, not 3 hours! Uh, math is hard today, apparently. And language. 96% in range leaves only 4% out of range, which is approximately 1 hour (not 20 min). Still, the rest of the point stands. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [May 2, 2025, 10:47pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/122 "2025-05-02T22:47:11Z")
> [@Dr.Strangelove](#): > > Isn’t HbA1c a marker for mean glucose, though? I.e., shouldn’t prediabetic patients by definition have elevated mean glucose since they have elevated A1c? Or is the observation that mean glucose can actually diverge from A1c? Or that the CGM, measuring interstitial fluid rather than blood, can diverge from blood glucose levels and/or H1c? I wondered the same thing. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [May 2, 2025, 11:07pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/123 "2025-05-02T23:07:28Z")
With a little help from AI, I can see the problem. From the study itself, the mean normoglycemic A1c was 5.2% and 5.5% for prediabetes. That corresponds to 103 and 111 mg/dl blood levels. As measured by the CGM, the levels were 114.5 and 123.1. Those are higher than the A1c equivalents, so maybe the CGMs aren’t calibrated very well or there’s some other difference. Regardless, it still shows a meaningful difference between normoglycemia and prediabetes, and at about the same magnitude, around 8%. So I don’t think there’s any real discrepancy except for some kind of fixed offset. The “similar range” just means that they’re both roughly in the 100-140 range, not that they’re actually the same. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [May 2, 2025, 11:08pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/124 "2025-05-02T23:08:08Z")
From where I sit, the CGM is not precise enough to give info that is actionable, as in life changing. It helps to tell you which way you’re heading. So it is useful in creating a mindset that makes you more aware of your overall condition. In your own body/day that can give you great results. If you listen. I still finger stick everyday. Not 12 times a day like I used to. I also have a dog who realizes when my BG is off. I can’t really trust that. He might just want a treat. He’s kinda goofy like that. I can feel the drops easily. The rises are harder..I sorta get drunk and don’t really care. There’s not much chance a stranger would notice or act. In fact I’ve had actual medical persons see me laying on the floor and not be certain whether I needed help or not. So, you see…it’s a dilemma. Studies are needed. Research is not funded well enough. Diabetes needs a cure now. I thought, forsure since age 10, there would be, by now. If you need to, for your own peace of mind, to do your own research at least add it to the data base. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 7, 2025, 10:44pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/125 "2025-05-07T22:44:35Z")
It seems likely that continuous glucose monitoring is soon to get a big Federal endorsement as the best possible means to achieve ideal health and cures of all chronic disease: Dr. Casey Means, Trump’s new nominee for surgeon general, is a co-founder of Levels, one of those digital health companies that uses continuous glucose monitoring to scam people … I mean, track metabolic health and _help_ people. Expect the unbiased endorsement of the evidence behind this approach when do you think? ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [May 10, 2025, 7:01am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/126 "2025-05-10T07:01:01Z")
Two weeks are over. With a fair amount of difficulty, I disassembled the unit. It’s basically a small circuit board potted in stiff silicone rubber, with a small needle poking out one side. [![Imgur](https://i.imgur.com/CwG3izP.jpeg "imgur.com") ](https://imgur.com/CwG3izP) [![Imgur](https://i.imgur.com/aqmOLoi.jpeg "imgur.com") ](https://imgur.com/aqmOLoi) Coin cell, Bluetooth antenna, a few control chips… pretty standard stuff. Not sure how the needle is designed. It doesn’t have a particularly sharp tip, though clearly sharp enough to get through skin. Probably listed in a patent somewhere.. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [May 10, 2025, 7:23am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/127 "2025-05-10T07:23:21Z")
Yes. I just read about their many patents. Theres is one RD that will use radar( 😳) That is just wild. Needleless ones and ones with an array of micro needles sounds interesting. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [May 12, 2025, 11:49pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/128 "2025-05-12T23:49:30Z")
Another non-diabetic CGM result: > **[Continuous glucose monitors reveal variable glucose responses to the same meals...](https://examine.com/research-feed/study/1jjKq1/)** > > In this exploratory analysis of 2 highly controlled crossover studies in 30 participants without diabetes, the same meals led to highly variable glucose responses, as measured with continuous glucose monitors. Basically, lots of variability in glucose response to the same meal. This fits with what I observed. Even the response to my morning banana was pretty variable, and _not_ in an obvious riper-bananas-spike-more sense. So as usual, the results from a CGM should be taken with a grain of salt. If you think a certain meal is causing a particularly bad spike, it may just be an outlier. This also seems to fit with the study above in that non-diabetics may be spending much more time than expected outside the “normal” range. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 13, 2025, 12:59am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/129 "2025-05-13T00:59:31Z")
> [@Dr.Strangelove](#): > > lots of variability in glucose response to the same meal Which makes such perfect sense to me. There are … many … hormones and other factors interacting at any particular moment. Responses to stress, physical and psychological, time of day factors, and on and on. These are not meals given with every other potential confounder tightly controlled. But I am also very sure that few grains of salt are being taken by those selling the idea of flattening glucose curves and their services to that end. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [May 13, 2025, 3:24am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/130 "2025-05-13T03:24:08Z")
> [@Dr.Strangelove](#): > > Basically, lots of variability in glucose response to the same meal. This fits with what I observed. Even the response to my morning banana was pretty variable, and _not_ in an obvious riper-bananas-spike-more sense. That’s what i observed, too. Lots of variation. > [@DSeid](#): > > Which makes such perfect sense to me. There are … many … hormones and other factors interacting at any particular moment. Responses to stress, physical and psychological, time of day factors, and on and on. Yeah. I read a study that was all alarmed that people might make bad decisions because the peakedy peak of glucose as measured by the CGM wasn’t highest on the same carefully controlled meal as it was with a finger stick. And therefore people might be misled into making bad decisions. But i have the same breakfast every day, and my response was different every day. Which seemed perfectly reasonable. And i looked at the numbers in that study, and thought, “those are all the same result. There’s not a single meal there that varies significantly from the others, given the variation around these things.” ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [May 13, 2025, 3:29am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/131 "2025-05-13T03:29:04Z")
And to be clear, i don’t think the variation is from “bad measurements”, although there may be an aspect of that. I think the variation is real, and that normal blood sugar is all over the place. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [May 13, 2025, 3:31am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/132 "2025-05-13T03:31:24Z")
> [@Dr.Strangelove](#): > > Not sure how the needle is designed. It doesn’t have a particularly sharp tip, though clearly sharp enough to get through skin. Probably listed in a patent somewhere.. With the I’ve i used, the sensor isn’t a needle, it’s just a filament. The gadget that inserts it had the needle. Which looked more like a thumbtack than a needle, really big. But you press the button, and it jams a needle into you, taking the filament with it. And then the needle is retracted and thrown away with the rest of the insertion device. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [May 13, 2025, 5:34am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/133 "2025-05-13T05:34:36Z")
> [@puzzlegal](#): > > With the I’ve i used, the sensor isn’t a needle, it’s just a filament. Ok, yeah, I can see how it works now. Can see the needle within the applicator (which I saved). Not nearly as thick as a thumbtack, though fairly long. There are two springs, one that shoves the device onto your skin and another that retracts the needle. I wonder how it successfully lets go of the filament. The needle is actually U-shaped, with the filament presumably tucked inside. There’s some goop at the tip. Could be adhesive or just blood. Seems like it would need adhesive or something to successfully inject, but then how does it release? It’s fast enough that it can’t just be something that dissolves when wet. Probably another patent to read… ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [May 13, 2025, 6:51am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/134 "2025-05-13T06:51:48Z")
Let me know when you find out. I’ve been wondering about that little b\*\*\*\*\*d for months. You gotta be careful where you place it, some areas hurt more than others. My upper arms are thin, it really hurts me there. I generally use the tummy. But recommendations are move it around. The skin gets weird after awhile. So needs, must. I could use my thighs. That tends to be more in my way. I always check with finger sticks if how I feel doesn’t jive with the monitor. [Previous page](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292.md?page=6)