Hemoglobin A1c (hba1c) Test For Diabetes
The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It's also called HbA1c, glycated hemoglobin test, and glycohemoglobin. People who have diabetes need this test regularly to see if their levels are staying within range. It can tell if you need to adjust your diabetes medicines. The A1c test is also used to diagnose diabetes. Hemoglobin is a protein found in red blood cells. It gives blood its red color, and it’s job is to carry oxygen throughout your body. The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound. Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher change of getting of diabetes. Levels of 6.5% or higher mean you have diabetes. The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes. A combination of diet, exercise, and medication can bring your levels down. People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year. People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can Continue reading >>
Metformin 101: Blood Sugar Levels, Weight, Side Effects
As a type 2 diabetic, you've probably heard of Metformin, or you might even be taking it yourself. Metformin (brand name “Glucophage” aka “glucose-eater”) is the most commonly prescribed medication for type 2 diabetes worldwide…and for good reason. It is one of the safest, most effective, least costly medication available with minimal, if any, side effects. There are always lots of questions around Metformin – how does metformin lower blood sugar, does metformin promote weight loss or weight gain, will it give me side effects – and lots more. Today we'll hopefully answer some of those questions. How Metformin Works Metformin belongs to a class of medications known as “Biguanides,” which lower blood glucose by decreasing the amount of sugar put out by the liver. The liver normally produces glucose throughout the day in conjunction with the pancreas’ production of insulin to maintain stable blood sugar. In many people with diabetes, both mechanisms are altered in that the pancreas puts out less insulin while the liver is unable to shut down production of excess glucose. This means your body is putting out as much as 3 times as much sugar than that of nondiabetic individuals, resulting in high levels of glucose in the bloodstream. Metformin effectively shuts down this excess production resulting in less insulin required. As a result, less sugar is available for absorption by the muscles and conversion to fat. Additionally, a lower need for insulin slows the progression of insulin resistance and keeps cells sensitive to endogenous insulin (that made by the body). Since metformin doesn’t cause the body to generate more insulin, it does not cause hypoglycemia unless combined with a sulfonylurea or insulin injection. Metformin is one of the few oral diabe Continue reading >>
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Why Hemoglobin A1c Is Not A Reliable Marker
i was recently tested for Hemoglobin A1c because i presented to an endocrinologist with extremely low blood glucose on lab test and some scary symptoms, not the ordinary hypoglycemia symptoms. My A1c was 4.7 which registered as low (L) on the lab print out–it was only slightly low. Does a low score on this suggest a possibility of short-lived RBCs? Does it have any relationship with extremely low blood glucose? my result at the lab, fasting, was 32mg/dL. Not long after that i got a home glucometer and i get the same kind of results on that as the lab got, in the 20s and 30s first thing in the morning, every day. did not know i had hypoglycemia until i had that lab test, though i had had one episode where i woke up with ataxia, i fell while walking to the bathroom first thing in the morning, i got up and immediately fell again. I soon found that i had very impaired coordination. i did not know why and i was very worried. Eventually i wanted to have breakfast but had great difficulty holding the measuring cup under the faucet, to get some water to heat, to make instant oatmeal, i lacked the coordination to get the water into the cup. I persisted and did make the instant oatmeal (pour hot water onto flakes and it’s done), and i got my lap top and was eating the oatmeal and i suddenly was aware that the symptoms were going away. Previously i had been unable to type. While eating the small amount of oatmeal, i realized i could type. That was about a month before the lab test. Since it only happened that once, i put it out of my mind. About 5 days after the lab test, i had the second episode, worse than the first, i woke falling out of bed to the floor, couldn’t use my arm to break the fall, i didn’t have the coordination. i sat on the floor, i could not get up and wa Continue reading >>
When Is The Best Time Of Day To Test?
The preferred time to test isn’t before breakfast any more. Recent research based on studies of hundreds of people with type 2 diabetes show that high blood glucose levels after meals has a greater effect on A1C levels among people who have their diabetes under good control than among those with poor control. When A1C results are low - less than 7.3 percent - mealtime glucose contributes about 70 percent of the A1C. However, when A1C results are high - greater than 10.2 percent - fasting blood glucose contributes 70 percent of the A1C value. If your A1C levels are above 7.0 percent, you run a much greater risk of complications. That means getting your diabetes under control needs to be your top priority. After you do that, you can concentrate on testing after meals. But do we start counting from the beginning, the middle, or the end of the meal? And should we test one, two, or more hours after eating? There is a great variation in the length of a meal. So it is more precise to start counting from the time of the first bite, Dr. Richard Hellman, the lead author of the American Association of Clinical Endocrinologists’s Diabetes Medical Guidelines Task Force, told me. Another reason to start counting from the first bite is because our glucose levels begin to rise about 10 minutes after the start of a meal, a statement from the American Diabetes Association says. Both organization recommend that most of us test two hours after eating. While your blood glucose level could be highest one hour after a meal, there are good reasons to wait until two hours after the first bite. Writing on a diabetes mailing list, someone called Helen said it best: "If I aim for pre-meal levels to occur an hour after eating, I chance going low after two hours and for sure after three hours. M Continue reading >>
A1c-it’s Just A Number
Yesterday, I had my endocrinologist appointment where I found out what my A1C was from blood work I had done last week. I’ve been trying sooooooooooo hard to get my A1C not only Below-Seven but below 6.5 because my hubby and I are planning on trying to get pregnant soon. I was so confident in my blood sugars over the last few weeks and months that I was positive I was going to have an amazing A1C, so positive that my husband and I made the decision for me to get off of my birth control pills so we could actually begin trying to get pregnant within the next few months. The last A1C I had done was 7.3 back in June. However, that was done a few weeks after we went to beach week, where my blood sugars stayed high the majority of the week thanks to grazing and alcohol. It was also after extensive basal testing in March and April, where I purposely kept my blood sugars in the high 200’s because I knew my basal rates were too high. I would drop drastically, more than 100 mg/dls during the tests until I tweaked them enough to stop the dramatic declines. So, my A1C in June of 7.3 made sense because I did have some highs. I was still disappointed though, because I felt that after I had completed the basal testing, my blood sugars were pretty solid, minus the high beach week. After getting the June result, I was more determined than ever to get my A1C Below-Seven. I have done all sorts of things to make that happen. I did a clean eating challenge back in September which resulted in a few changes in my eating habits overall such as limiting my carb intake and for the most part cutting out Diet Cokes. I have been working hard to pre-bolus before meals. I have been running a TON, at least four times per week. I’ve been getting used to lower blood sugar numbers and I’ve been t Continue reading >>
Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>
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Translating A1c To A Blood Sugar Level
In the USA, doctors recommend that you have your Hemoglobin A1c measured at least twice per year. This simple blood test will tell you an approximation of your blood sugar control for the past 3 months based on the amount of Advanced Glycogenated End-Products (AGEs) that have accumulated in your blood. The higher your blood sugar levels are, the more AGEs are present. AGEs are also responsible for the development of complications such as retinopathy and neuropathy, because that accumulation will build and irritate crucial nerve-endings. Now, let’s get back to your A1C: To help people with diabetes understanding their A1C in real day-to-day terms, the medical world has developed the “eAG” measurement. Estimated Average Glucose. Your eAG will give your A1C reading in a blood sugar level of milligrams per deciliter (mg/dL) just like you’re used to seeing on your glucose meter. The American Diabetes Association has this easy calculator, allowing you to enter and translate your latest A1C to your eAG. 12% = 298 mg/dL (240 – 347) 11% = 269 mg/dL (217 – 314) 10% = 240 mg/dL (193 – 282) 9% = 212 mg/dL (170 –249) 8% = 183 mg/dL (147 – 217) 7% = 154 mg/dL (123 – 185) 6% = 126 mg/dL (100 – 152) What can you do with that information? It is recommended that people with type 1 and type 2 diabetes achieve an A1C of 7.0 percent or lower for optimal health, and the prevention of complications. This translates to an average blood sugar before and between meals around 70 to 130 mg/dL. And after meals, under 180 mg/dL. For pregnancy with diabetes, an A1C lower than 6.5 percent is imperative for the healthy development of your baby, and your own health and safety. Post-meal blood sugars for pregnant women is suggested at lower than 120 mg/dL. A non-diabetic’s A1C is Continue reading >>
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How Doctors Choose Medications To Treat Type 2 Diabetes
A national survey of specialists and academic generalists Abstract OBJECTIVE—Glycemic control remains suboptimal despite the wide range of available medications. More effective medication prescription might result in better control. However, the process by which physicians choose glucose-lowering medicines is poorly understood. We sought to study the means by which physicians choose medications for type 2 diabetic patients. RESEARCH DESIGN AND METHODS—We surveyed 886 physician members of either the Society of General Internal Medicine (academic generalists, response rate 30%) or the American Diabetes Association (specialists, response rate 23%) currently managing patients with type 2 diabetes. Respondents weighed the importance of 15 patient, physician, and nonclinical factors when deciding which medications to prescribe for type 2 diabetic subjects at each of three management stages (initiation, use of second-line oral agents, and insulin). RESULTS—Respondents reported using a median of five major considerations (interquartile range 4–6) at each stage. Frequently cited major considerations included overall assessment of the patient's health/comorbidity, A1C level, and patient's adherence behavior but not expert guidelines/hospital algorithms or patient age. For insulin initiation, academic generalists placed greater emphasis on patient adherence (76 vs. 60% of specialists, P < 0.001). These generalists also identified patient fear of injections (68%) and patient desire to prolong noninsulin therapy (68%) as major insulin barriers. Overall, qualitative factors (e.g., adherence, motivation, overall health assessment) were somewhat more highly considered than quantitative factors (e.g., A1C, age, weight) with mean aggregate scores of 7.3 vs. 6.9 on a scale of 0– Continue reading >>
Type 2 Sex & Diabetes: Is Testosterone The Wonder Drug?
Dear Diabetes Health, I am 57 years old. About five years ago, I saw my doctor because I was feeling tired. My waist size was up, and I was not interested in sex. I almost never got an erection. The doctor diagnosed type 2 diabetes and put me on metformin. He also prescribed Viagra, which helped sometimes, but not all the time. My last A1c was 7.3%, but my sex drive is still missing in action. The Viagra isn’t working anymore. It’s difficult for my wife, and I don’t like it either. I don’t want to have injections in my penis or stuff like that, but I’m feeling really down about this. Do you have any advice for me? – Jim in Michigan Dear Jim, We’re not doctors, but you have the classic symptoms of low testosterone. Feeling tired and sad, gaining fat, and losing interest in sex all point to problems with testosterone, or “T,” as it’s often called. You should get tested because there are medical and self-care things that you can do to increase your T levels. The good news is that these things are very good for diabetes, too. Men with diabetes are more than twice as likely as other men to have low T levels. In fact, more than 50 percent of men with diabetes have low T levels. According to Professor Evan David Rosen, M.D., Ph.D., this is not simply due to aging testicles. There is a connection between type 2 (possibly type 1 as well) and low T. According to urology professor Abraham Morgentaler, “Normal T is helpful for diabetes control. T therapy increases muscle mass and lowers body fat, and both of these changes are helpful with blood sugar control. This supports the idea that normalizing T may be helpful for diabetes.” Studies show that raising T levels lowers insulin resistance, improves cholesterol levels, and reduces abdominal fat in men with t Continue reading >>
Overtreatment Of Elderly Diabetics
The last time I was directly responsible for treating diabetes was fifty years ago, when I was an intern in medicine at UCLA. In my subsequent career as a psychiatrist I was not directly responsible for diabetes care, and as an individual, I don’t have the condition. As a result, I haven’t kept up on diabetes treatment, so a June 11 article on “Diabetes Overtreatment in Elderly Individuals: Risky Business in Need of Better Management” was news to me. The opening two sentences of the American Diabetes Association’s article on “Tight Diabetes Control” make it sound as if “tight control” should be the goal of treatment: “Keeping your blood glucose levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many complications of diabetes, giving you extra years of healthy, active life.” In my uninformed state, that’s how I understood how diabetes should be managed, even for over 65ers. But I was wrong. Several paragraphs later there’s a very clear statement that elderly people with diabetes should be treated differently: “Elderly people probably should not go on tight control. Hypoglycemia [overly low blood sugar] can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.” The American Geriatrics Society gives precise guidelines for the goal of diabetes treatment in over 65ers. The key measure of diabetes control is hemoglobin A1c. For healthy over 65ers with long life expectancy, the target should be 7.0 – 7.5%. For those with “moderate comorbidity” (so-so health) and a life expectancy of less than 10 years the targe Continue reading >>
Hemoglobin A1c (hba1c) (cont.)
How Is Hemoglobin A1c Measured? The test for hemoglobin A1c depends on the chemical (electrical) charge on the molecule of HbA1c, which differs from the charges on the other components of hemoglobin. The molecule of HbA1c also differs in size from the other components. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure (or performance) liquid chromatography (HPLC). HPLC separates mixtures (for example, blood) into its various components by adding the mixtures to special liquids and passing them under pressure through columns filled with a material that separates the mixture into its different component molecules. HbA1c testing is done on a blood sample. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten. Fasting for the blood test is not necessary. What Are Normal Levels of Hemoglobin A1c (Chart)? In healthy people, the HbA1c level is less than 6% of total hemoglobin. A level of 6.5% signals that diabetes is present. Studies have demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept below 7%. It is recommended that treatment of diabetes be directed at keeping an individual's HbA1c level as close to normal as possible (<6%) without episodes of hypoglycemia (low blood glucose levels). Chart of Normal and Elevated HbA1c Levels Diagnosis* A1C Level *Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes. SOURCE: Centers for Disease Control and Prevention Normal Below 5.7 % Prediabetes 5.7% to 6.4% Diabetes 6.5% or greater What Are High (El Continue reading >>
Understanding A Type 2 Diabetes Diagnosis
Diagnosing Type 2 Diabetes Type 2 diabetes is a manageable condition. Once you’re diagnosed, you can learn what to do to stay healthy. Diabetes is grouped into different types. The most commonly diagnosed are gestational diabetes, type 1 diabetes, and type 2 diabetes. Gestational Diabetes Maybe you have a friend who was told she had diabetes during pregnancy. That type is called gestational diabetes. It can develop during the second or third trimester of pregnancy. Gestational diabetes usually goes away after the baby is born. Type 1 Diabetes You may have had a childhood friend with diabetes who had to take insulin every day. That type is called type 1 diabetes. The peak age of onset is in the midteens. According to the Centers for Disease Control and Prevention (CDC), type 1 makes up 5 percent of all cases of diabetes. Type 2 Diabetes Type 2 diabetes makes up 90 to 95 percent of all diagnosed cases of diabetes, according to the CDC. It is also called adult-onset diabetes. Although it can occur at any age, it’s more common in people older than 40. If you think you might have diabetes, talk to your doctor. Uncontrolled type 2 diabetes can cause severe complications, such as: amputation of the legs and feet blindness heart disease kidney disease stroke According to the CDC, diabetes is the 7th leading cause of death in the United States. People with diabetes are 1.5 times as likely to die as people of the same age who don’t have diabetes. Many of the severe side effects of diabetes can be avoided with treatment. That’s why it’s so important to be diagnosed as soon as possible. Some people are diagnosed with type 2 diabetes because they have symptoms. Early diabetes symptoms include: increased or frequent urination increased thirst fatigue cuts or sores that won� Continue reading >>
Diabetes Simplified: A1c Testing
By Wil Dubois “Mirror, mirror, on the wall, who’s the best-controlled of all?” —what the Wicked Queen would have asked if she’d had diabetes instead of vanity issues If you’ve had diabetes for any time at all, you’ve probably heard of the A1C test. Sometimes, it’s also called the HbA1c test, the Hemoglobin A1c test, or the glycated hemoglobin test. They’re all the same thing. This is a lab test that allows your doctor, by consulting with a magic mirror, to determine how well your diabetes has been controlled, night and day, for the last three months. If that’s not black magic, I don’t know what is. Of course, as sci-fi writer Arthur C. Clarke famously said, “Any sufficiently advanced technology is indistinguishable from magic.” The A1C has become the widely accepted benchmark for diabetes control. It’s used to classify who is in control and who is not, and to quantify the risk levels of those not in-target. The higher the A1C, the greater the risk of complications. The A1C is now also used diagnostically, with A1C scores actually used to diagnose new-onset diabetes. The A1C Test: How Does It Work? Well, like I said, it’s magic: in this case, the magic of biochemistry. The test measures the average blood sugar level for the past three months. It can do this because glucose sticks to red blood cells, just like powdered sugar sticks to freshly-fried doughnut holes. The result of the test is expressed as a percentage: 6.2 percent…7.8 percent…8.3 percent…9.6 percent…12.4 percent…and so on. Most A1C scores are only expressed in tenths of a percent, but some labs report twentieths, as well, so you might see an A1C of 6.79 percent or 8.32 percent. Wait a sec. A percentage of what, exactly? The percentage of hemoglobin in the sample of red Continue reading >>
Why Raise Your A1c?
Have you been ordered by your doctor to get your A1C (HbA1c) level up? More people are having this confusing experience, as doctors try to implement the 2013 ADA treatment guidelines. Do these orders make sense? Not much, I’d say. What is happening here? In 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) changed the targets doctors should aim for in treating diabetes. They went from a one-size-fits-all target of 7.0% HbA1c to a three-tiered guideline. HbA1c is the test that gives an idea of the average blood glucose level for the previous two months or so. An A1C of 7.0% equals an average blood glucose of around 154 mg/dl, and many people think that number is too high to protect against complications. So there was pressure to lower the guideline. At the same time, many older people found the 7.0% goal too strict. A few studies found an increased risk of falls in older people who run low glucose levels. There was concern about increased risk of hypoglycemia (low blood glucose). As Diane Fennell wrote here, many think that aiming for lower A1C levels leads to an increase in low blood glucose episodes. As many readers commented, hypos are dangerous and unpleasant. For many, they are the worst fact of life with diabetes. So the experts finally recognized that one size does not fit all. Unfortunately, their new guidelines have been misunderstood by some doctors, leading to people being told to raise their A1C numbers, even if doing so increases their complication risk. According to the new guidelines, older or sicker people, or those with many hypoglycemic episodes, might shoot for 7.5% to 8.0%. Younger, healthier, people might want to get their A1C below 6.5%, or even lower. People in between on age and health mi Continue reading >>
Selected Important Safety Information
Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening Tresiba® (insulin degludec injection) is indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus. Tresiba® is not recommended for treating diabetic ketoacidosis or for pediatric patients requiring less than 5 units of Tresiba®. Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Never Share a Tresiba® FlexTouch® Pen Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens Monitor blood glucose in all patients treated with insulin. Changes in insulin may affect glycemic control. These changes should be made cautiously and under medical supervision. Adjustments in concomitant oral anti-diabetic treatment may be needed Hypoglycemia is the most common adverse reaction of insulin, including Tresiba®, and may be life-threatening. Increase monitoring with changes to: insulin dose, co-administered glucose lowering medications, meal pattern, physical activity; and in patients with hypoglycemia unawareness or renal or hepatic impairment Accidental mix-ups betwe Continue reading >>
