Is A Lower A1c Level Better Or Worse?
It seems logical that the lower our blood glucose levels are the better we will be. Most of us have always assumed that lower blood glucose levels would protect us better from the complications of diabetes. In fact, during the past two decades several studies showed a linear relationship between blood glucose, as measured by A1C levels, and worsened health. But now, several recent A1C studies have shown a J-shaped relationships, in which at the lower end some bad things happen, at the center things are better, and at the top end things are terrible. While linear relationships are the rule in observational studies, U-shaped and J-shaped curves aren’t uncommon, and some authors lump both of these shapes as U-shaped. All of the studies relating A1C levels and ill health — the earlier ones and the recent ones alike — are observational. They study correlations, which aren’t proof, because other confounding factors that the researchers didn’t take into account could have been the problem. 5.4-5.6 Seems Safest The first of these newer studies showing that a very low A1C level is unhealthier than a higher one came out in the February 2015 issue of Diabetes Care. This analysis of the German National Health Interview and Examination Survey 1998 that studied about 6,300 people for about 12 years indicated that people with an A1C level of 5.4 to 5.6 had the lowest risk of excess mortality. Because this result puzzled me so much, I asked Dr. Richard K. Bernstein for his reaction. “These A1c measurements were made years ago in Germany,” he replied, “before international agreement on how it would be measured. The modern elution method would likely give considerably different results. It is even possible that several different methods were being used at different sites Continue reading >>
Diabetes Blood Sugar Levels Chart [printable]
JUMP TO: Intro | Blood sugar vs blood glucose | Diagnostic levels | Blood sugar goals for people with type 2 diabetes | Visual chart | Commonly asked questions about blood sugar Before Getting Started I was talking to one of my clients recently about the importance of getting blood sugar levels under control. So before sharing the diabetes blood sugar levels chart, I want to OVER EMPHASIZE the importance of you gaining the best control of your blood sugar levels as you possibly can. Just taking medication and doing nothing else is really not enough. You see, I just don’t think many people are fully informed about why it is so crucial to do, because if you already have a diabetes diagnosis then you are already at high risk for heart disease and other vascular problems. Maybe you've been better informed by your doctor but many people I come across haven't. So if that's you, it's important to know that during your pre-diabetic period, there is a lot of damage that is already done to the vascular system. This occurs due to the higher-than-normal blood sugar, that's what causes the damage. So now that you have type 2 diabetes, you want to prevent any of the nasty complications by gaining good control over your levels. Truly, ask anyone having to live with diabetes complications and they’ll tell you it’s the pits! You DO NOT want it to happen to you if you can avoid it. While medications may be needed, just taking medication alone and doing nothing is really not enough! Why is it not enough even if your blood sugars seem reasonably under control? Well, one common research observation in people with diabetes, is there is a slow and declining progression of blood sugar control and symptoms. Meaning, over time your ability to regulate sugars and keep healthy gets harder. I Continue reading >>
Borderline Diabetes: What You Need To Know
The term borderline diabetes refers to a condition called prediabetes. Prediabetes is a condition in which blood sugar levels are higher than normal but not high enough to be classed as type 2 diabetes. Prediabetes is to be considered a risk factor for type 2 diabetes. It is estimated that 10 to 23 percent of people with prediabetes will go on to develop type 2 diabetes within 5 years. Prediabetes can be accompanied by other risk factors. It is associated with conditions such as obesity, especially abdominal obesity, high blood pressure, high blood fat levels and low levels of "good" cholesterol. When these risk factors "cluster" together in a person, there is a higher risk of not just type 2 diabetes but heart disease and stroke as well. Other medical terms used when talking about prediabetes include: Symptoms of borderline diabetes Prediabetes is not the same as diabetes. However, neither prediabetes nor diabetes have clear symptoms. Both can go unnoticed until prediabetes has progressed to type 2 diabetes, or until another complication such as a heart attack occurs. Some people may experience symptoms as their blood sugars remain high. Passing urine more often and increased thirst can be symptoms of type 2 diabetes before it is diagnosed and treated. Prediabetes is not found unless testing is done for it. Testing is carried out when there are risk factors that make prediabetes more likely. Causes and risk factors of borderline diabetes The main risk factors for prediabetes are being overweight or obese, not getting enough exercise, and having a family history of type 2 diabetes. Other risk factors include: Drinking a lot of high-sugar drinks may also increase the risk. One study found that people who regularly drink sugary products - 1 or 2 cans of soda a day, for ex Continue reading >>
Why Smoking Is Especially Bad If You Have Diabetes
Smoking is a health hazard for anyone, but for people with diabetes or a high risk of developing the disease, lighting up can contribute to serious health complications. Researchers have long known that diabetes patients who smoke have higher blood sugar levels, making their disease more difficult to control and putting them at greater danger of developing complications such as blindness, nerve damage, kidney failure and heart problems. Now a new study offers the most definitive evidence why: the nicotine in cigarettes. Xiao-Chuan Liu, a professor of chemistry at the California State Polytechnic University, presented results from his study of blood samples from smokers at the American Chemical Society national meeting and exposition. He found that nicotine, when added to human blood samples, raised levels of hemoglobin A1c (HbA1c) by as much as 34%. Liu expects a similar effect occurs with diabetic smokers, whom he hopes to test in a follow up study. Hemoglobin A1c — a combination of hemoglobin (which ferries oxygen) and glucose — is a standard indicator of blood sugar content in the body. Doctors always knew smoking can make diabetes worse, but, Liu says, “now we know why. It’s the nicotine. This study also implies that if you are a smoker, and not diabetic, that your chances of developing diabetes is higher.” The higher A1c levels rise in the blood, he says, the more likely it is that other protein complexes, which build up in various tissues of the body, from the eyes, heart and blood vessels, can form, leading to blockages in circulation and other complications. But perhaps more importantly, the results also suggest that nicotine replacement products such as patches and nicotine-containing electronic cigarettes, aren’t a safe option for diabetes patients Continue reading >>
Voice Of The Diabetic
A Wake-Up Call From the Editor: Marilyn Brandt Smith lives in Louisville, Kentucky, with her husband Roger and their son Jay. The Smiths are retired teachers, and Marilyn is also a freelance writer and editor. My husband's talking watch announced that it was 6:00 p.m. when the phone rang. Thanks to his audio caller ID, he knew instantly who was calling that April evening. But the doctor's office should have been closed. Did surgeons work this late? "You have to get your blood glucose down, or we aren't doing your surgery next week," said the voice on the other end of the line. My fifty-six-year-old husband Roger had been suffering from infections, headaches, congestion, and pain, and, when he went to the doctor to investigate the cause, they found a tooth fragment lodged in his sinus cavity, the result of a routine tooth extraction last summer. Since Roger was diagnosed with type 2 diabetes at age forty-eight, he had been managing with oral medication, improved diet, and increased exercise. He lost fifty pounds, and, although his A1C has crept up in recent years, he thought he was in reasonably good control. Then the surgeon called to report a blood glucose level of 270 mg/dl, more than double what a fasting glucose should be. Something had to change and fast. Diabetes runs in Roger's family, and he has always known he might someday need to go on insulin. Although Splenda and other sugar-free goodies appear regularly on our grocery list, his diet is not as good as it should be. He was, and still is, a great fan of the all-you-can-eat buffet. The morning after that disappointing phone call, we went to see our family doctor, and Roger got an A1C test. The result left everyone speechless: His A1C was 9.3 percent--far too high. Our doctor knew that Roger would prefer to avo 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 >>
This information describes diabetes, the complications related to the disease, and how you can prevent these complications. Blood Sugar Control Diabetes is a disease where the blood sugar runs too high, usually due to not enough insulin. It can cause terrible long-term complications if it is not treated properly. The most common serious complications are blindness ("retinopathy"), kidney failure requiring dependence on a dialysis machine to stay alive ("nephropathy"), and foot and leg amputations. The good news is that these complications can almost always be prevented if you keep your blood sugar near the normal range. The best way to keep blood sugar low is to eat a healthy diet and do regular exercise. Just 20 minutes of walking 4 or 5 times a week can do wonders for lowering blood sugar. Eating a healthy diet is also very important. Do your best to limit the number of calories you eat each day. Put smaller portions of food on your plate and eat more slowly so that your body has a chance to let you know when it's had enough to eat. It is also very important to limit saturated fats in your diet. Read food labels carefully to see which foods are high in saturated fats. Particular foods to cut down on are: whole milk and 2% milk, cheese, ice cream, fast foods, butter, bacon, sausage, beef, chicken with the skin on (skinless chicken is fine), doughnuts, cookies, chocolate, and nuts. Often, diet and exercise alone are not enough to control blood sugar. In this case, medicine is needed to bring the blood sugar down further. Often pills are enough, but sometimes insulin injections are needed. If medicines to lower blood sugar are started, it is still very important to keep doing regular exercise and eating a healthy diet. Keeping Track of Blood Sugar Checking blood sugar wi Continue reading >>
What Does Your A1c Number Really Mean?
We dFolk are bombarded with numbers, goals, and targets. We’re frequently told where we should be, but not how high our risk is when we can’t reach our targets. Here, we break down A1C numbers into a simple green-light, yellow-light, red-light format, to give you perspective on when (and how much) to worry, when to relax, when to call your doc, and when to call 911. Green-light A1C score For most people, the target for A1C, the green light, is between 6.0% and 6.9%. These numbers are commonly expressed simply as 6.0 and 6.9, without the % sign. If your A1C falls into this zone, you’re considered to be in control. For perspective, these numbers can be converted into “meter” numbers called estimated average glucose—eAG for short. The green light eAG range is 126 mg/dL (7 mmol/l) to 151 mg/dL (8.39 mmol/l). But what if your numbers are higher than target? Or lower than target? When are you actually in danger? Yellow-light A1C score If the light turns yellow as you approach the intersection, you need to either speed up or stop. Whichever is safe under the circumstances, right? If your A1C is between 7.0 and 8.9, you’ll be classified as “out of control.” But how much danger are you in? Frankly, it depends upon how close you are to either end of the spectrum. Yellow-light A1Cs are higher than is strictly healthy, but pose no immediate harm. However, the higher you are in this range, the closer you are to a red light. We’ll talk about just how serious that can be in a minute. I should point out that there are some special cases. If you’re a very young type 1, a yellow-light A1C score may be considered in-target for you until you get older. Similarly, if you’re an elderly type 2, or have a history of severe hypoglycemia, you doctor may choose to “green Continue reading >>
Delaying Joint Replacement Surgery Until Hemoglobin A1c Is Less Than 7%
Delaying Joint Replacement Surgery Until Hemoglobin A1c is Less Than 7% Allan S. Brett, MD reviewing Giori NJ et al. J Bone Joint Surg Am 2014 Mar 19 The benefit of this practice, which delays or prevents surgery for some diabetic patients, is unclear. Increasingly, orthopedists are insisting that diabetic patients lower their glycosylated hemoglobin (HbA1c) levels to less than 7% before they undergo total joint arthroplasty. But this is far easier said than done, particularly in older patients, in whom tight control increases risk for potentially dangerous hypoglycemia. A study from the orthopedic clinic at a U.S. Veterans Affairs hospital illustrates this problem. During a 5-year period, 59 diabetic patients who were deemed otherwise suitable for total hip or knee arthroplasty were not scheduled for surgery because their HbA1c levels were >7%. The patients were referred back to their primary care physicians to intensify glycemic control. After an average of 8 months, 35 (59%) achieved HbA1c levels 7%, but the remaining 24 patients (41%) were unable to do so. Only 5 of those 24 patients ultimately had surgery. Reluctance to perform total hip or knee arthroplasty on diabetic patients with HbA1c levels >7% is based on assumptions that this threshold is a good predictor of risk for postoperative complications (especially deep infection) and that preoperative lowering of HbA1c reduces that risk. But observational studies do not uniformly support the first assumption ( NEJM JW Gen Med Mar 28 2013 ), and no randomized trials have tested the second one. Indeed, it might be that glycemic control immediately after surgery is more important for preventing complications than control during the months before surgery. EDITOR DISCLOSURES AT TIME OF PUBLICATION Disclosures for Allan Continue reading >>
Does Diabetes Raise Knee Replacement Risks?
Research is mixed on how diabetes affects surgery results. When arthritis makes it too painful to walk or climb stairs, a knee replacement could be the solution to help you get around more comfortably again. Yet this surgery, like any other procedure, comes with risks that may be even more pronounced if you have diabetes. The issue is an important one, considering that about half of people with diabetes also have arthritis, and many may eventually need a new knee or two. Possible Diabetes-related Surgery Complications: Two studies published in the Bone and Joint Journal in 2014 and 2009 — from Sichuan University in China and Duke University in North Carolina have suggested that people with diabetes face a significantly higher risk of postsurgical complications such as wound infection, stroke, deep vein thrombosis (blood clot), fracture around the implant, and joint loosening, particularly when their diabetes isn’t well controlled. High blood sugar, the hallmark of diabetes, is thought to cause surgical complications through its adverse effects on many organs and processes in the body. However, a 2013 study published in The Journal of Bone & Joint Surgery failed to find any association between diabetes and negative surgical outcomes. In that study, researchers retrospectively reviewed the electronic health records of more than 40,000 Kaiser Permanente patients who had a knee replacement. The investigators looked at three main surgical outcomes: deep infection, blood clots in the legs or lungs, and revision surgery (an operation to replace a failed knee implant). They compared outcomes in people with controlled and uncontrolled diabetes. After adjusting for age, sex, weight and other health problems, the researchers saw no differences in outcomes in patients with cont Continue reading >>
Diabetes And The Hemoglobin A1c Test
Walter L. Aument Family Health Center The hemoglobin A1c ("A-one-C") test is a blood test used in the care of people who have diabetes. The hemoglobin A1c percentage is a way of looking at your average blood sugar control over a period of 3 months. Sugar absorbed from your digestive system circulates in the bloodstream. When the blood sugar is high, the sugar attaches to the hemoglobin protein in red blood cells, forming hemoglobin A1c. Red blood cells live 90 to 120 days. This means that once sugar has combined with the hemoglobin in red blood cells, the hemoglobin A1c stays in the blood for 90 to 120 days. This means the amount of hemoglobin A1c in your blood reflects how often and how high your blood sugar has been over the past 3 months. Hemoglobin A1c is an excellent way to check how well you are controlling your blood sugar over a 3-month period. Hemoglobin A1c measurements are important because: They confirm your daily home blood sugar monitoring results. They help predict your risk of diabetic complications. The higher the hemoglobin A1c percentage, the greater the risk of developing diabetic eye, kidney, cardiovascular, and nervous system disease. No preparation is necessary. One of the advantages of this test is that you do not have to fast before you take it. A small amount of blood is taken from your arm with a needle. The blood is collected in tubes and sent to a lab. There are also portable machines that can determine the value from a fingerstick – these can be performed in physician offices or even in a patient’s home. The hemoglobin A1c percentage rises as your average blood sugar level rises. For adult diabetics the results are usually judged as follows: less than 7%: excellent blood sugar control (some experts recommend less than 6.5%) less than 8% Continue reading >>
A1c And Pregnancy
Because women in America are not routinely tested for diabetes before they conceive and between each pregnancy, the incidence of preconception diabetes is unknown but it can be estimated by considering risk factors. The 2004 National Health and Nutrition Examination Survey reported that 12 percent of women age 18 to 44 have high blood sugar and 26.5 percent are obese. Having A1C blood testing for diabetes annually means a woman never has to guess. Video of the Day Type 2 Diabetes If you're considering having a baby, the time to find out you have diabetes is before you stop using contraception and try to conceive, according to the American Diabetes Association. This is also the time to correct the amount of glucose floating around in the blood, unable to get into the body's cells where it can be used for energy. Insulin, a hormone produced by the pancreas, is required to move glucose out of the blood and into cells; but when the cells become overwhelmed by the amount of sugar in the diet, or they become resistant against the action of insulin, the glucose stays outside the cells. As a result, you feel chronically tired, and the pancreas works too hard trying to make more insulin. The test used to determine the percentage of glucose unable to get into cells is called a glycosylated hemoglobin, or hemoglobin A1C, percentage. An A1C up to 5 percent is normal. A level between 5.1 and 7 percent is called a prediabetic state and is a precursor to diabetes because it indicates insulin resistance. At 7 percent, diabetes is diagnosed, according to the National Institutes of Health. The National Institute for Health and Clinical Excellence, or NICE, Guidelines call for women to reach and achieve an A1C of less than 6.1 percent before becoming pregnant to optimize their own health Continue reading >>
Healthy A1c Goal
Ads by Google Don't think as unattainable by staring up the steps; you must step up the stairs to achieve. Fit non-diabetic person’s A1C percentage is always within 4.2 to 4.6%. These numbers are only from individuals who is fit, non-obese, active, and on a healthy diet. The A1C result depends upon how well you are maintaining your blood-glucose level. If you are maintaining your blood sugar at an optimal range 70-85mg/dl (3.9-4.7mmol/l) at most of the time, then your A1C be in the normal range 4.2-4.6%. A1C goal advised by American Diabetes Association (ADA) A1C goal of 6.5% or less is a more stringent goal. This A1C target is for people who does not experience many hypoglycemia episodes. This may be for individuals who have recently diagnosed with diabetes. A1C goal of 7% is reasonable. This A1C target is for many adults with diabetes who are not pregnant. A1C goal of 7.5% is for children with diabetes (0 to 18 years old). In children, younger than 6 years may be unable to recognize hypoglycemia symptoms. A1C goal of 8% or less is considered a less stringent goal. This A1C target may be for people with severe hypoglycemia experience. This may be for individuals who have many years of diabetes and who have low life expectancy. A1C goal advised by Canadian Diabetes Association (CDA) A1C goal of 6.5% or less is for type 2 diabetics to lower nephropathy and retinopathy risk further. They must balance against hypoglycemia risk. A1C goal of 7.1-8.5% is for those who has longstanding diabetes with a history of recurrent severe hypoglycemia. And for those who has limited life expectancy. This target is for those who is hard to achieve an A1C ≤7%. That too after effective doses of multiple anti-hyperglycemic agents, including intensified basal-bolus insulin therapy. A1C go Continue reading >>
What Is Hba1c And A Normal Hba1c Range? Explained In Plain English
Those with type 1 or type 2 diabetes may have seen it before, but what is a normal HbA1c range? This article explores what your HbA1c reading should be and how you can improve it. What is HbA1c (Hemoglobin A1c)? HbA1c is a marker that can determine your average blood sugar (glucose) levels over the previous 3-months (1). That means it can be used to assess the quality of your diabetes management, as well as to diagnose pre-diabetes and diabetes. Sometimes HbA1c is also called glycated hemoglobin, hemoglobin A1c or just A1c. The ‘Hb’ refers to hemoglobin, a part of red blood cells that carry oxygen throughout your body. ‘A1c’ refers to a minor part of hemoglobin that sugar molecules attach to. The amount of sugar attached is directly proportional to the amount of sugar in your blood at a given time, so this reading is used to accurately reflect average blood sugar levels. If you’ve had high blood sugar levels in the past month or so, your HbA1c levels will be higher too. Summary: HbA1c is a marker that reflects your average blood sugar levels in the previous 3 months. It’s also called glycated hemoglobin, hemoglobin A1c or just A1c. Normal HbA1c Range The HbA1c test is measured as either a percentage or in mmol/mol. Below I’ve listed what is considered a normal HbA1c range, and what values would be considered outside of normal (pre-diabetic or diabetic): HbA1c range for normal (non-diabetic) adults: Below 6.0%, or below 42 mmol/mol HbA1c range for pre-diabetes: 6.0% to 6.4%, or 42 to 47 mmol/mol HbA1c range for diabetes: 6.5% or above, or 48 mmol/mol or above. Target ranges are also shown below in this table: HbA1c % mmol/mol Normal Below 6.0% Below 42 mmol/mol Pre-diabetes 6.0% to 6.4% 42 to 47 mmol/mol Diabetes 6.5% or above 48 mmol/mol or above Normal Hb Continue reading >>
Hemoglobin A1c Test (hba1c, A1c, Hb1c)
Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>