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c/bloodwork·posted 1 year ago by u/laila_yilmaz

A1c: what the trials say vs what this community says

Discussion Clean Column ×5

A1c: what the trials say vs what this community says. It is the sort of thing everyone half-believes and nobody writes down.

My A1c moved and I spent a fortnight convinced I knew why. The repeat six weeks later was back in range and I had changed nothing.

Compared two draws across two labs and spent a week worrying before finding out the assays were different.

Time of day, fasting state, hydration and recent exercise all move common markers. Standardising the draw conditions is free and it removes most of the apparent variability.

Corrections welcome, especially the pedantic ones. Pedantry is how this board earns its reputation.

4,318 up / 3,812 down53% upvoted27 commentsid 1rxtpi6 Apr 2025

27 comments

21 in this archive, depth 5

best — the order this archive was captured in

u/santiago_rasmussen41 points·1 year ago

ApoB counts atherogenic particles rather than the cholesterol they carry, which is why it can diverge from LDL-C and why it is the addition most worth making.

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u/tidy_vialdrawer_watch20 points·1 year ago

ApoB counts atherogenic particles rather than the cholesterol they carry, which is why it can diverge from LDL-C and why it is the addition most worth

Agreed — and standardising the draw conditions is the cheapest improvement available.

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[deleted]14 points·1 year ago

[deleted]

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u/osman_eriksen4 points·1 year ago

Correction: that marker is reported in different units by different labs, which explains the tenfold difference you are seeing.

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u/sanne_novak2 points·1 year ago

fasting state and time of day change more than people expect

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u/copay_card_cc32 points·1 year ago

Same lab as the previous draw?

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u/customs_seizure_sid20 points·1 year ago

Why so many single values look alarming and turn out to be nothing.

A reference interval is built to contain about 95% of a healthy reference population, so one test in twenty falls outside one by construction. Add biological variation, assay imprecision, fasting state and time of day, and a genuinely stable person will produce occasional out-of-range results.

That is why repeat testing before acting is standard. Regression to the mean handles most of it. None of which means an out-of-range value should be ignored — it means it should be repeated and taken to somebody who can put it in context, which is emphatically not a ranked feed.

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u/thermal_mass_tom23 points·1 year ago

Added ApoB to the panel after a thread here. It told me something the standard lipid panel had been hiding.

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u/santiago_rasmussen12 points·1 year ago

Same view — ApoB if you add one thing. It answers a question the standard panel only gestures at.

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u/ahmed_fonseca8 points·1 year ago

Same view — ApoB if you add one thing.

Adding the obvious one — take it to whoever ordered the panel. This board cannot read it for you.

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u/anya_rautio4 points·1 year ago

Same view — ApoB if you add one thing.

santiago_rasmussen is right that a reference interval is not a target. It is a description of a population.

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u/santiago_szabo2 points·1 year ago

Push back: a value just outside a reference interval is a common finding in healthy people. It is a reason to repeat.

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u/laila_yilmazOP18 points·1 year ago

That is a non-fasting value and the interval you are comparing it against is a fasting one.

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u/laila_yilmazOP7 points·1 year ago

Small fix — a reference interval is not a treatment target, and the post above uses them interchangeably.

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u/chidi_abubakar6 points·1 year ago

one measurement is a point, two is a line, three is a trend

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u/freya_baptista0 points·1 year ago

one measurement is a point, two is a line, three is a trend

This is the sentence to read before anybody panics about a single value.

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u/kofi_balogun15 points·1 year ago

What did the repeat show?

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u/anders_vermeulen15 points·1 year ago

Right, and weight loss itself moves several markers, so attribution is harder than these threads assume.

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u/nnt_nate-38 points·1 year ago

Brought the whole set to my clinician rather than one flagged value. Completely different conversation.

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u/isabela_guerrero1 point·1 year ago

nothing on this board interprets your results for you

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u/cormac_roos1 point·1 year ago

I would not draw a line through two points, especially when the second was taken at a different time of day.

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About c/bloodwork

What to measure before you start, what to re-measure, and how to interpret movement without panicking. ApoB over LDL-C, HOMA-IR as a crude free tool, ALT and the fatty-liver story, eGFR noise during rapid loss, and the deficiencies that a 1,100-calorie appetite will hand you.

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