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How High Can A1c Go?

When The A1c Is Unreliable

When The A1c Is Unreliable

Although hemoglobin A1c is usually the best test to estimate the average glycemic control in patients with diabetes, it is unreliable in some clinical circumstances. In select patient populations, measuring fructosamine and glycated albumin levels may also be useful. _______________________________________________________________________________________________________________________________________________________ Related Content Diabetes and Cardiovascular Disease: Does Lowering Hemoglobin A1c Help or Harm? Structured Diet Plan Improves A1c in Type 2 Diabetes _____________________________________________________________________________________________________________________________________________________ Q1. What is the A1c and why is it important? A: A1c represents the percent of hemoglobin A with glucose bound to it. While the percent is normally low, in diabetics the higher glucose circulating in the blood causes more hemoglobin binding which results in a higher A1c level. It also can correlate with average glycemic control during the past 2 to 3 months. The American Diabetes Association recommends measuring A1c—≥ 6.5% (48mmol/mol)—as a diagnostic criterion for diabetes and quantifying A1c as the standard laboratory assessment to determine control of type 1 and type 2 diabetes.1 Since the publication of the Diabetes Control and Complications Trial in 1993, we know that A1c levels also directly correlate to the risk of developing diabetic complications such as retinopathy, neuropathy and nephropathy.2 Q2. When is the A1c unreliable? A: For A1c standard test results to be reliable, normal adult hemoglobin A must be present for glucose binding. However, a number of clinically significant disorders alter hemoglobin either structurally or chemically thereby aff Continue reading >>

Strike The Spike

Strike The Spike

Controlling After-Meal Blood Glucose Highs Today’s the big day! After months of working hard to achieve tight blood glucose control and actually succeeding most of the time, you’re about to get the result of your latest glycosylated hemoglobin (HbA1c) test, the blood test that gives you an indication of your overall blood glucose control over the previous 2–3 months. “It’s just got to be lower than last time,” you think as you wait in your doctor’s exam room. “I’ve been good. Really good. My average on my meter is lower than it’s been in years. He’s going to be impressed for sure. No lectures about the risks associated with a high A1c this time! I’ll be out of here in 10 minutes, easy.” In walks your doctor, with the results of your latest lab work in hand. Thirty minutes later, after a series of careful examinations and a lengthy lecture on the need to get your HbA1c down, you walk out shaking your head. “I don’t get it. How can my A1c still be so high? My mealtime readings are almost always where they should be. It just doesn’t make sense. Maybe the lab made a mistake. Maybe my blood is different from everyone else’s.” Or maybe you’ve been the victim of postprandial hyperglycemia. Post-what? Postprandial hyperglycemia refers to high blood glucose levels that occur soon after eating meals or snacks. For anyone with diabetes, it is normal for blood glucose to rise somewhat after eating. But if your after-meal rises are dramatic and occur consistently, they can result in higher HbA1c test results than your premeal blood glucose readings would otherwise indicate, and the higher your HbA1c, the higher your risk of serious diabetes complications. The HbA1c reflects an average of all blood glucose levels at all times of day — before ea Continue reading >>

Blood Glucose Readings: What They Mean

Blood Glucose Readings: What They Mean

Source: Web exclusive: June 2011 When you have diabetes, perhaps the most important thing you need to know is the level of your blood glucose, also known as your blood sugar. Since many factors can raise or lower your blood glucose, you may have to check it several times a day. But once you obtain a blood glucose reading, what exactly does it mean? Crunch those numbers When you test a drop of your blood with a glucose meter, the big number that pops onto the screen refers to the number of millimoles (mmol) of glucose per litre (L) of your blood. A millimole (mmol) is one-thousandth of a mole, which is a standard unit for measuring the mass of molecules. And if that’s not already confusing enough, the United States uses a completely different system than Canadians for measuring blood glucose. South of the border, blood glucose is measured in milligrams per decilitre (mg/dL). This can sometimes be rather bewildering, especially if you’re brand new to diabetes and researching your disease on the Internet. “I tell people to go to a Canadian site first,” says Tabitha Palmer, a certified diabetes educator at the Centre for Clinical Research in Halifax. Know your targets So what numbers should you be looking for? Your target reading before meals should be between 4 and 7. Your blood sugar normally spikes two hours after a meal, so between 5 and 10 is a good range after you eat. Besides food, other factors that can cause your blood sugar to go up or down include exercise, illness, medications and stress. Your blood glucose readings are hands-down the best way to monitor whether or not your diabetes is generally well managed. "They really help the physicians and educators if we’re trying to look at whether you need to have your medication, insulin or mealtime adjusted, Continue reading >>

Why Hemoglobin A1c Is Not A Reliable Marker

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 >>

Amazingly Easy Ways To Lower Your A1c

Amazingly Easy Ways To Lower Your A1c

What if there were a magical “lower your A1c” wand? You just pull it out, swoop it over your head (or your pancreas) and… voila! A1c lowered. If only it were that simple. Focusing on eeking down that ever shifting number can be one of the most frustrating things a person living with diabetes has to do. But here is some good news: while there may not be a magic wand, there are some pretty simple, pretty cool fixes to help you on your way to lower your A1c. Kick it old school: Remember those bulky paper logbooks we all used to lug around? Yeah, well there’s something about them that just works. Going back to actually logging blood sugars, meals and doses can really help a person lower an A1c. Why? Because while it’s great to have tools that automatically upload to our medical team (and our computers), writing things down forces us to face them more, study them more and yes, not ignore them. (A cool side trick: use one of those pens with four colors of ink in it. Write all of your in range numbers in green, your high numbers in blue and your low numbers in red. Use the black for notes. With this, you can look at a logbook page and the patterns will jump out at you.) Ramp it up new school: Never used a CGM? Or haven’t used it in a while? CGM’s are a great way to help you lower your A1c, says Regina Shirley, RD, LDN and person with diabetes. “I make a commitment with my CGM. I will wear it religiously until I can get my A1c back to where I like it. It is not as easy as it may seem to remember to check blood sugars, and inserting yet one more device in your body adds on time to your diabetes care regimen that you would rather spend doing something else. However, when you know you need to get in better control, either to help with such things as pregnancy prepa Continue reading >>

Why Is My A1c High When My Blood Sugar Levels Are In My Target Range?

Why Is My A1c High When My Blood Sugar Levels Are In My Target Range?

Results of an A1C test and a blood glucose check don't always match up. The A1C test measures your average blood sugar levels over a 120-day period (the lifespan of a red blood cell). But a blood glucose check measures your blood sugar at a single moment. If your blood sugar levels were high last week, and you adjusted your diabetes treatment plan so that your blood sugar returned to normal, the A1C result may still be high, because it includes the high blood sugar levels from the previous week. The A1C test measures the percentage of glycated hemoglobin in your blood. Glycated hemoglobin is created when molecules of hemoglobin (the oxygen-carrying protein in your blood) attach to molecules of glucose (the sugar in your blood). The more sugar you have in your blood, the higher your percentage of glycated hemoglobin. I want you to picture a freshly fried doughnut hole, just out of the deep fryer. Steam wafts from its surface. Still gleaming wet with oil, it’s sent spinning across a tray of powdered sugar. As it tumbles, sugar sticks to the wet oil, coating it, covering it as it rolls and bounces along. Well, the same thing happens to your red blood cells. As they tumble and spin and roll through your blood vessels, sugar molecules stick to their skins. Or another way to think of it is to picture a windshield of a truck after driving through a swarm of mosquitoes. Splat-Splat-Splat-Splat-Splat! (OK, I just threw that in so you wouldn’t log off and drive straight to Dunkin Doughnuts.) So an A1C test is a measure of how much of the skins of your red blood cells are splattered with sugar, which in turn gives as a picture of the blood sugar environment in which the cells lived, which in turn gives us a notion of your average blood sugar over the last several months. So th Continue reading >>

How To Know When You'll Need Insulin

How To Know When You'll Need Insulin

Injecting insulin above and to the side of the belly button can result in more consistent results.(ISTOCKPHOTO) There's no simple way to tell when a patient with type 2 would do best on insulin, says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. But there are guidelines. "In general if a patient has a hemoglobin A1C that is higher than the agreed upon goal and they are not on insulin, we recommend insulin therapy," Dr. Hellman says. The American Diabetes Association (ADA) recommends an A1C of 7% or below, and the American College of Endocrinology and the American Association of Clinical Endocrinologists recommend an A1C of 6.5% or below. If you can't lower your A1C with diet, exercise, or other medications, you may need insulin to do the job. Exceptions to the insulin rule There are exceptions, of course. Someone who otherwise seems to be a good candidate for insulin may not be able to manage such a regimen if he or she has limited vision and dexterity and no family support. Good News About Today's Improved InsulinsAndy switched to once-a-day insulin and uses shorter, thinner needles Read moreMore about using insulin If you do need insulin in the short- or long-term, your doctor may prescribe one of four different types. These vary by how quickly or slowly they reach the bloodstream (the onset), the amount of time they work at maximum strength (the peak time), and how long they continue to be effective (the duration). The goal is to mimic the pancreas The different types of insulin mimic the natural rhythm of a healthy pancreas, which produces a consistent low level of the hormone and occasional bursts of insulin to cope with postmeal boosts in blood sugar. According to the American Diabetes Association (ADA), your need Continue reading >>

Reasons For Elevated A1c Without Diabetes

Reasons For Elevated A1c Without Diabetes

An A1c blood test, also called hemoglobin A1c, is recommended by the American Diabetes Association (ADA) for prediabetes and diabetes screening, and recommended for routine monitoring of blood sugar levels in people with diabetes. A1c is a form of hemoglobin -- a protein in red blood cells -- that has combined with a molecule of blood sugar or glucose. As a marker for how much glucose has been present in the blood over time, elevated A1c values are most commonly seen in people with prediabetes and diabetes. However, in certain medical situations, A1c may be elevated in someone who does not have these conditions. Video of the Day Blood Glucose History A1c forms naturally when glucose is present in the blood. The percentage of A1c increases in proportion to the average blood glucose level over the previous 2 to 3 months -- a reflection of the average lifespan of red blood cells. An A1c test of 5.6 percent or below is reflective of normal blood sugar levels -- or a daily average below 115. According to the 2016 ADA clinical practice recommendations, the A1c test may be used to reliably diagnose prediabetes and diabetes. According to these guidelines, an A1c of 5.7 to 6.4 percent is used to diagnosed prediabetes, and an A1c of 6.5 percent can be used to confirm the diagnosis of diabetes. An A1c value represents the percent of the total hemoglobin in the A1c form. Both an increase of A1c hemoglobin -- due to the presence of high blood sugar -- or a decrease in total hemoglobin can make the A1c percentage higher. Certain types of anemia associated with decreased hemoglobin production or longer lifespan of red blood cells can elevate the proportion of hemoglobin present in the A1c form. People with anemia due to lack of iron, folate or vitamin B12 may have an elevated A1c with Continue reading >>

Research On Type 2 Diabetes/ Prediabetes

Research On Type 2 Diabetes/ Prediabetes

Below you will find a growing collection of dietary research on type 2 diabetes treatment. JUMP TO: Overview | Blood sugar & A1c | Diet Recommendations | Low Carb vs. Low Fat | Weight Loss & A1C Diet Comparison | Carbohydrates | Fat & Cholesterol | Protein | DMP Blog Overview Most people think that when people get diagnosed with diabetes, that’s it, they’re destined to get progressively worse, take more meds and suffer bad health. That’s simply not the case! While type 2 diabetes is not reversible from a diagnostic standpoint (once a person has it, they have it), diabetes can be reversible from a physiological standpoint in many. That is, a person can work to gain excellent control of their blood sugar levels, keeping them within a normal healthy range so that they are functioning like a non-diabetic person. Research shows this is true and in our experience with members and subscribers, people are achieving this everyday, even if they’ve had diabetes for 20 years! NOTE: The majority of the research that follows is around type 2 diabetes treatment. It's important to differentiate ‘reduction of diabetes risk' from ‘diabetes treatment.' These are often lumped into the same category but they are two very different concepts. Here our main focus of research is on diabetes treatment, along with prediabetes diet and lifetsyle interventions. Blood Sugar & A1C BLOOD SUGAR: Blood sugar is a measure of glucose/ sugar in the blood at any one time. Throughout the day blood sugar can fluctuate in response to numerous factors, mainly food but also exercise, stress, sleep, medications and so forth. The body is designed to maintain blood sugar levels in a healthy range. And it is well established that diabetics and prediabetics should work toward the goal of having blood suga Continue reading >>

David's Guide To Getting Our A1c Under 6.0

David's Guide To Getting Our A1c Under 6.0

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells. The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year. If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition. But what do we mean by a “high” A1C level? Here the experts disagree. The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent. The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define “normal.” People who don’t have diabetes have A1C levels below 6.0 percent. That’s the gist of what I wrote here recently in “The Normal A1C Level.” The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That’s what Dr. Richard K. Bernstein wrote in Dr. Bernstein’s Diabetes Solution. No matter what our level is, we can be sure that lower is Continue reading >>

What's A

What's A "normal" A1c? When Is It Misleading?

By Adithi Gandhi and Jeemin Kwon Why we use A1c, what values are recommended, and what impacts A1c – everything from anemia to vitamins Want more information just like this? Hemoglobin A1c (“HbA1c” or just “A1c”) is the standard for measuring blood sugar management in people with diabetes. A1c reflects average blood sugars over 2 to 3 months, and through studies like DCCT and UKPDS, higher A1c levels have been shown to be associated with the risk of certain diabetes complications (eye, kidney, and nerve disease). For every 1% decrease in A1c, there is significant pretection against those complications. However, as an average over a period of months, A1c cannot capture critical information such as time spent in a target range (70-180 mg/dl) and hypoglycemia (less than 70 mg/dl). This article describes why A1c is used in the first place, as well as factors that can lead to misleadingly high or low values. In a follow-up piece, we will discuss time-in-range, hypoglycemia, hyperglycemia, blood sugar variability, and how to measure and interpret them. Click to jump down to a section: What tools are available if an A1c test is not accurate or sufficient? What is A1c and why is it used? A1c estimates a person’s average blood sugar levels over a 2 to 3-month span. It is the best measure we have of how well blood glucose is controlled and an indicator of diabetes management. Though A1c doesn’t provide day-to-day information, keeping A1c low has been proven to lower the risk of “microvascular” complications like kidney disease (nephropathy), vision loss (retinopathy), and nerve damage (neuropathy). The relationship between A1c and “macrovascular” complications like heart disease is harder to show in clinical trials, but having high blood sugar is a major ris Continue reading >>

3 Reasons Your A1c Is Higher Than You Expected

3 Reasons Your A1c Is Higher Than You Expected

Reaching your A1C goals can be frustrating because the balancing act we have to perform in order to achieve optimal A1C levels is never easy! Nutrition, insulin doses, oral medications, exercise, stress, illness–wrap all of these up in up and try to combine them with your everyday life of work, family, chores and friends…that’s a lot on the plate! But there are a few things you can tweak or adjust to help you get the A1C level you’re aiming for, and there are a few things you might be doing that are really preventing you from getting there. Here are 3 things that could be preventing you from achieving your A1C goal: Forgetting to look at the big picture. An A1C level is really an average. For instance, an a1C of 9 percent equals an average blood sugar of 212 mg/dL. Taking time to download your meter or track your blood sugars on pen and pepper now and then is hugely important because it helps you look at all those numbers at the same time, rather than one at a time. It’s easy to see a blood sugar reading of 190 mg/dL a few hours after lunch and think to yourself, “No big deal, that’s just today.” But what if that’s happening almost every day of the week? How often are you waking up with a high number which would mean you spent all night with a high number while sleeping? The little details have a big impact. Take a week or two to write down all your blood sugars or use an app like mySugr to track them on your phone so you can get a real idea of where your blood sugars are overall. Not bothering to make adjustments. Whether you’re on shots, oral meds, or nothing at all, if you haven’t bothered to take action and change the way you handle your blood sugars around food or after seeing a high number on your meter, then it’s no surprise your A1C isn Continue reading >>

Why I'm Motivated To Maintain A 6.0 A1c With Type 1 Diabetes

Why I'm Motivated To Maintain A 6.0 A1c With Type 1 Diabetes

At the age of 13, I was diagnosed with type 1 diabetes (I also have Celiac disease). Somewhere in my 20s—motivated by the promise of better health now, and in the long run—I started making changes to maintain a 6.0 A1C level. I have to admit, maintaining this number wasn’t easy at first. So why go to such lengths to maintain an A1C of 6.0 when the American Diabetes Association says an A1C of 7 or less is desirable for people with type 1 and type diabetes? And the recommendation from the American Association of Clinical Endocrinologist (AACE) is less than 6.5? That’s easy: I slept better, had fewer blood sugar highs and lows, required less insulin and felt much more energetic. When your blood sugars are running in the mid-to-high 100s every day (an A1C of 7) you might not realize just how sluggish you feel until you get them down. High blood sugars take HOURS to get back into range so if you’re working to prevent them from happening in the first place, you’re staving off a lot of stress on your body. I also discovered that high blood sugars during sleep interfered with me getting truly restful sleep. I also felt my muscles’ ability to perform during exercise was worse. The list goes on and on. Without becoming obsessive about my diabetes management, I’ve actually been able to maintain an average blood sugar of 125 mg/dL and an overall range of 100 to 152 mg/dL most of the time. Periodic testing of A1C levels, which cannot be done at home, is important. Research shows that being in a healthy blood sugar range correlates with fewer complications from diabetes, such as kidney disease, diabetic neuropathy and high blood pressure later in life. In other words, better diabetes control translates into better health. If you wind up having a high A1C level it may Continue reading >>

How To Lower Your Blood Sugar When It's Really High

How To Lower Your Blood Sugar When It's Really High

​This article is written for type 2 diabetics who need help coming down from a very high blood sugar during a single, isolated high blood sugar event. If you want to try an stabilize your baseline, consider signing up for my Baseline Blood Sugar Challenge course. ​THIS ARTICLE IS NOT A SUBSTITUTE FOR REAL MEDICAL ADVICE. If you're a type 2 diabetic and your blood sugar is high right now (greater than 300mg/dL for at least 6 hours), the first thing you should do is call your doctor. So, if you haven't called anyone for help yet, please stop reading this article and call your doctor. If your doctor is able to help, then you need not read on. Also, if you are having symptoms of Diabetic Ketoacidosis, stop reading this article and go to the hospital immediately. Diabetic Ketoacidosis can kill you if left untreated. But. If you're in a situation where your blood sugar has been high for an extended period of time, you could perhaps consider taking the following steps to solve your blood sugar problem. Disclaimer: This is friendly, non-medical advice from a random diabetic person you don't even know, which is a very (very) poor substitute for real, actual medical advice. Use at your own risk. First, you should try and lower your blood sugar without injectable insulin by completing the following steps: 1. Check your blood sugar. Write down the time and your blood sugar level. 2. Drink water (this doesn't actually lower blood sugar, but it helps flush sugar and ketones from your body, if you have them). Continue drinking water, but please don't make yourself sick. 3. Move. As in, walk. Walk around the block or walk in place or haul your ass up and down the stairs for 30-60 minutes. Walking helps your cells become less insulin resistant, which is what you need right now. Do N Continue reading >>

In Search Of: The Highest Diabetes A1c In History

In Search Of: The Highest Diabetes A1c In History

My most recent A1C was nothing to be proud of, but I consoled myself with the thought that it was hardly the worst in history. That got me wondering: What was the all-time worst A1C? Who holds this dubious record, and how high is it possible to go? I decided to pound the pavement and try to find out. So where to start when looking for a diabetes record? Well, with the Guinness Book of World Records, of course. But oddly, the Guinness people don’t seem to have any listings related to A1Cs. They do, however, report that Michael Patrick Buonocore survived a blood sugar of 2,656 mg/dL upon admittance to the ER in East Stroudsburg, PA, on March 23, 2008. Michael was a T1 kiddo at the time, and that record-high sugar level was part of his diagnosis experience. So does Michael also hold the record for top A1C? No. Because while he’s living (thankfully) proof that stratospheric blood sugar levels are possible, a sky-scraping A1C requires both altitude and time. Remember that A1Cs provide a three-month average of our blood sugars. Individual high BG readings, even crazy-high ones, don’t alter the test as much as you’d think if they last only a short time. Because type 1 in kids Michael's age hit so quickly, I figured his A1C would have been rather middle of the road. It takes a slow burn to make an A1C boil. But just to be sure, I reached out to his parents, who tell me his A1C was 11.9 at diagnosis. Higher than I expected, but not too high given the four-digit BG reading. (If his 2,656 had been his average blood sugar for three months, his A1C would have been roughly 95! Yes, that’s 95.0, not 9.5). The highest A1C turns out to be a tricky piece of data to ferret out. If you try Google, you find a gazillion people talking about their own personal highest A1Cs, and comp Continue reading >>

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