Fasting Blood Sugar 89.7, PPBS 144.2, HbA1C 8

by MAGAN
(RAJKOT)




Quick Answer
An HbA1c of 8.0% shows that average glucose was above the usual target over the previous two to three months, even though one fasting result was 89.7 mg/dL and one post-meal result was 144.2 mg/dL. Later post-meal readings of 190–194 mg/dL suggest glucose peaks that the earlier tests missed. Glycomet SR 500 and Cetapin XR 1000 are extended-release metformin products, but they contain different strengths and should not be substituted or combined without confirming the prescription and kidney function.



QUESTION

Submitted by Magan, Rajkot


I am sharing my blood-sugar reports and prescriptions from July 2016 to April 2017:



  • 06/07/2016: Random glucose 204 mg/dL

  • 09/07/2016: Fasting 89.7 mg/dL; PPBS 144.2 mg/dL

  • 04/08/2016: Mean plasma glucose 184 mg/dL; mean whole-blood glucose 166.8 mg/dL

  • 10/08/2016: HbA1c 8.0%

  • 19/11/2016: Fasting 100 mg/dL; PPBS 190 mg/dL

  • 21/11/2016: Random glucose 83 mg/dL

  • 30/12/2016: Random glucose 96 mg/dL

  • 21/01/2017: Fasting 112 mg/dL; PPBS 194 mg/dL

  • 24/01/2017: PPBS 172 mg/dL

  • 24/02/2017: Fasting 109 mg/dL; PPBS 156 mg/dL

  • 08/04/2017: Random glucose 125 mg/dL; HbA1c 7.21%


Dr. Vimal prescribed Glycomet SR 500, and Dr. T.K.M. Ishwar later prescribed Cetapin XR 1000. Based on these reports, do I need medicine, and which one is suitable for me?




Answer by Dr. Albana Greca, MD, MMedSc



Hello Mr. Sagathiya,



Your fasting glucose, post-meal glucose and HbA1c measure different parts of glucose control. An HbA1c of 8.0% corresponds to an estimated average glucose near 183 mg/dL, so one satisfactory fasting or post-meal reading cannot rule out higher glucose at other times. This is explained further in our guide to understanding HbA1c and average blood sugar.



Why Did the Results Differ?



The fasting value of 89.7 mg/dL and PPBS of 144.2 mg/dL were snapshots from one day. Later post-meal results of 190 and 194 mg/dL show that glucose sometimes rose higher. Meal composition, timing, activity, illness and medication can all change individual readings.



If HbA1c repeatedly does not match glucose records, the clinician should consider anemia, recent blood loss or transfusion, altered red-cell lifespan, kidney disease or a hemoglobin variant. Some variants are more common in South Asian populations and can affect certain HbA1c methods.




Important: These reports are from 2016–2017. They cannot determine which medicine or dose is suitable now. Current treatment requires current HbA1c, glucose patterns, kidney function, other conditions and a medication review.


Are Glycomet SR and Cetapin XR the Same?



Both brand names are commonly used for extended-release metformin, but the active ingredient must be confirmed on each package. “SR” means sustained release and “XR” means extended release. Glycomet SR 500 generally contains 500 mg, while Cetapin XR 1000 generally contains 1,000 mg.



The 1,000 mg tablet is a higher strength. It should not replace a 500 mg tablet unless the prescriber intentionally changes the total daily dose. Do not take both brands together unless specifically instructed.



Which Medicine Should You Take?



I cannot safely select one of these prescriptions from historical reports alone. Extended-release metformin is often started at a low dose with food and increased gradually, but the exact dose depends on effectiveness, digestive tolerance, kidney function and the particular product. The practical differences are covered in our metformin dosage and safety guide.



There is no universal rule that everyone should increase to 1,000 mg twice daily. Do not double the dose or change brands without the prescriber’s instructions.



Metformin Safety Checks




  • Kidneys: eGFR should be checked before treatment and periodically. Metformin is contraindicated when eGFR is below 30 mL/min/1.73 m².

  • Digestive effects: nausea, diarrhea, abdominal discomfort and bloating may occur, especially after rapid increases.

  • Vitamin B12: long-term use can contribute to deficiency, particularly with anemia, numbness or neuropathy.

  • Acute illness: dehydration, surgery or some contrast procedures may require temporary instructions.



Metformin alone has a low hypoglycemia risk, but combinations may change that risk.



Was the Treatment Helping?



The reduction in HbA1c from 8.0% to 7.21% suggests improved glucose control, although diet, activity, adherence, dose and laboratory differences may all have contributed. For many nonpregnant adults, an HbA1c below 7% is a common goal, but the target should be individualized.



Common monitoring targets for many adults are 80–130 mg/dL before meals and below 180 mg/dL one to two hours after the start of a meal. These targets and diagnostic ranges are compared in the normal blood sugar level chart.



What Should You Do Now?




  • Obtain a current HbA1c and laboratory fasting glucose.

  • Check creatinine/eGFR and urine albumin-to-creatinine ratio.

  • Bring both medicine packages and prescriptions to one treating clinician.

  • Record fasting and selected one-to-two-hour post-meal readings.

  • Ask whether vitamin B12, a blood count or hemoglobin-variant assessment is appropriate.

  • Do not change the brand, strength or frequency independently.




Seek urgent care for persistent vomiting, severe dehydration, deep or rapid breathing, confusion, marked drowsiness, chest pain or very high glucose with ketones.


My Advice



The historical results show improvement, but they do not determine today’s prescription. Have one clinician review current glucose, HbA1c, kidney function, side effects and the exact products.



Hope this helps.



Dr. Albana Greca



Related Questions




Related Resources




References





Educational only — not personal medical advice. Metformin dose and formulation must be selected using current results, kidney function, tolerability and the prescriber’s instructions.


Click here to post comments or follow up

Ask the Doctor now? Simply click here to return to Diabetes Test and Levels.