Diabetes Control ...
If you are a diabetic, you need to know your HgA1c level
Photo by Myriam Zilles on Unsplash
Diabetes can be a daunting illness. It requires a team approach between patient, doctor, nurse, and dietitian. And I always tell my patients that they are the center of the team and I rely on them to take control of their illness. I am just a coach. After all, I only see them once every 3 to 4 months for a brief visit, and 99.9% of the time they are on their own.
I still believe that home sugar monitoring has an important role in controlling diabetes. There is some controversy about that and I'll address it in a future article. But today I wanted to talk about a very important number that every diabetic should know. That number is known as the hemoglobin A-1 C or HG A1c, or A1c for short.
This blood test is done about once every 3 to 4 months and as I like to say, it is a thermostat that lets us know if you are controlled in regard to your diabetes or not. So let's take a look at what this test is all about.
What exactly is Hg A1c?
Hemoglobin is a substance that helps red blood cells to carry oxygen in our bloodstream and deliver it to our other organs. If your blood sugar is uncontrolled, that extra sugar joins to the hemoglobin through a process called glycosylation. We measure this level of glycated hemoglobin, or OK wet towel I gotta eat after you're right yeah i'll wait for you what time, by checking the hemoglobin A-1 C level. The higher your sugar is the higher your hemoglobin A-1 C level will be.
So what's so special about this test compared to sticking my finger and checking my blood sugar right now?
That's a very good question and here's how I like to explain it. Sticking your finger and getting a blood sugar result right now is like taking a selfie picture with your smart phone. It tells me about your blood sugar at one specific moment in time.
Hemoglobin A-1 C levels on the other hand actually give us a picture of what your sugar has been like over the last eight weeks or so. In keeping with our metaphor about the selfie picture, the A1c is like having a surveillance video for the last eight weeks running 24 hours a day and gives us a better idea of what your average blood sugar has been like.
Typically, we ask patients to check their blood sugar at home before breakfast and before dinner. The goal is to have a level less than 130. Now if they achieve that it could give us a false sense of security because if their sugars are high the rest of the day we wouldn’t know about it. And that could cause damage to organs like the eyes, the heart and the brain as well as the kidneys over time. But the A1c level lets us know what's been going on for a longer period of time and helps to guide us with our therapy to keep you controlled.
So what should my Hg A1c level be?
First, know that A1c levels are not measured on the same scale as blood sugars are when you stick your finger or when we take it for you in the office. So a finger stick blood sugar can range anywhere from less than 100, all the way up to 500, 1000 or more.
Hg A1c levels can range anywhere from about 4 to about 15 or so. The reason why the number values are so different is because we're not measuring the same thing. So what's a normal value?
If you're not a diabetic your hemoglobin A-1 C level should be less than 5.7.
If your level is over 6.5 on two occasions that means you are indeed a diabetic. If your level fall somewhere between 5.7 and 6.5, that means that you are pre-diabetic and unless you do something for prevention there's a high likelihood that you will become diabetic in the next 5 to 7 years.
What's the best thing you can do to prevent yourself from becoming a diabetic? The American Diabetes Association has information on their website that states that by losing 5% of your body weight you'll decrease your risk of diabetes by 58%. That's a pretty astonishing result for a very low investment if I do say so myself.
Now back to you if you're diabetic and what your level should be.
For diabetics, ideally your level of A1c should be less than 7, but there are a few caveats.
We never want patients to suffer from low blood sugars in the attempt to achieve the Holy Grail. Low blood sugar is evidenced by confusion, shakiness, sweating, and sometimes slurring of speech as if someone was drunk. If you are a patient who suffers episodes of low blood sugar then your doctor may adjust the acceptable range for your A1c level upward.
So for patients like you who have low sugar episodes, or someone who has a lot of other illnesses in addition to their diabetes, or may be elderly, or have a limited life expectancy due to a terminal illness, a level of about 8 is acceptable. Again this is something that should be discussed between doctor and patient and hopefully arrive at a mutually agreed upon goal.
Why are the goals different for the above patients? Because studies show that we might actually cause more harm to people in situations like these instead of helping them. There is a dictum in medicine taken from Latin which is, Non Primum Nocere- first do no harm.
Treating your diabetes to an optimum A1c level will require diet, exercise, and adjustment of your medication regimen. As I said above, A1c levels are typically checked 3 to 4 times per year.
Diabetes is a numbers game. There are other number you need to know about in regard to your diabetes and for preventing complications, but I will speak to those in an upcoming post. In the meantime I hope I demystified this term for you and that it makes sense. In addition I hope it will help you understand what your doctor’s goals are when they discuss the results with you.
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See you next time!