Troubleshooting Diabetic Patient with Persistently High Hemoglobin A1c

Does the patient's glucose monitoring log show the same ink and handwriting for many days in a row?

Is the glucose monitoring log free of blood spots, smudges or other signs of regular use?

Do the actual numbers recorded on the glucose monitoring log show a random distribution?

Do the glucose values of the monitoring log all fall within a narrow range for days or weeks at a time?

Is the patient unwilling to produce the glucose monitoring logs?

Do records of the patient's insulin and testing supply purchases match the numbers expected based on the glucose monitoring logs?

Does hemoglobin testing show that the patient has an abnormal hemoglobin?

Do first degree relatives of the patient without diabetes mellitus show elevated hemoglobin A1c levels?

Is the serum fructosamine value normal?

Does using an alternative method for measuring hemoglobin A1c give a lower value?

Does the patient have hypertriglyceri-demia?

Is the patient being treated with hydroxyurea?

Has the patient performed glucometer maintenance as instructed?

Has the patient performed regular quality control on the glucometer?

Does simulatenous glucose testing between the patient's glucometer and another glucometer differ significantly?