If you’ve been checking your blood sugar before meals and noticing high numbers, but your A1c test comes back normal, you might be wondering—what’s going on? Is your blood sugar really high, or is the A1c wrong?
For people with liver cirrhosis, the answer is a little complicated. Catalina, MS, RD, explains:
"Liver cirrhosis can cause a falsely low A1c because it shortens the lifespan of red blood cells. In this case, your daily blood sugar readings are a better reflection of your blood sugar control than A1c."
Why Does This Happen?
A1c measures your average blood sugar over the past 2-3 months by looking at sugar attached to red blood cells. But in liver cirrhosis (and conditions like kidney failure and hemolytic anemia), red blood cells don’t live as long, meaning they don’t collect as much sugar. This makes A1c seem lower than it really is.
What Should You Do?
- Keep checking your blood sugar before, and 2 hours after meals and at other key times such as fasting and bedtime, or as your doctor or dietitian recommends.
- Talk to your doctor about additional alternative tests, like fructosamine or glycated albumin, which can give a more accurate picture of your blood sugar.
- Monitor symptoms like fatigue, frequent urination, or thirst—these can be signs of high blood sugar even if A1c looks normal.
- Work with your healthcare team to adjust insulin or medication based on your actual blood sugar readings.
- Use alternative monitoring methods like a continuous glucose monitor (CGM) to keep closer tabs on your glucose and get an estimated A1C, known as Glucose Monitoring Indicator (GMI) in real-time to get a more accurate estimate of A1C than lab values.
Takeaways
If you have liver disease, A1c might not tell the full story. Daily glucose checks and additional lab tests can help you and your doctor get a clearer picture of your blood sugar control. If you have questions, reach out to your healthcare team—they’re here to help!
