8/7/2015 1 ADA Type 1 Diabetes Guidelines Pediatric and Adult Patients with T1D: Glycemic Targets and more Lori Laffel MD MPH Chief, Pediatric, Adolescent & Young Adult Section Senior Investigator, Genetics and Epidemiology Section Professor of Pediatrics Boston, USA AADE New Orleans, LA Disclosures Consultant â€¢ Johnson & Johnson, Eli Lilly, Sanofi-Aventis, NovoNordisk, Bristol Myers Squibb, Menarini, Bayer Healthcare (grant support), LifeScan/Animas, Roche Diagnostics, Oshadi, Dexcom, Boehringer Ingelheim Content of lecture unrelated to above 2014 CDC June Report â€¢ Prevalence estimates of T1D in youth 0-19 and T2D in youth 10-19 in 2001 and 2009 in 5 representative US areas in the SEARCH Study â€¢ T1D prevalence: 1.48/1000 in 2001 (1/676) 1.93/1000 in 2009 (1/518) â€¢ T2D prevalence: 0.34/1000 in 2001 (1/2941) 0.46/1000 in 2009 (1/2174) â€¢ T1D increased 21.1% (95% CI, 15.6-27.0%)* â€¢ T2D increased 30.5% (95% CI, 17.3-45.1%)* * After adjustment for case ascertainment T1D in Adults â€¢ No precise estimates of T1D in adults >20 y/o â€¢ Greatest number of patients with T1D are adults: â€“ Increasing numbers of patients diagnosed with T1D at all ages â€“ Patients w/ childhood onset T1D survive to adulthood â€¢ Estimated that 50-75% of T1D diagnosed in childhood (25-50% diagnosed in adulthood) â€¢ LADA: latent autoimmune diabetes in adults â€“ ~9% of adults with diabetes ages 30-70 have +GAD ab â€“ Prolonged period of residual beta cell function (T1DX) â€“ Additional peak age of onset of T1D in 6th to 7th decades of life â€¢ Diabetes Care. 2015 Mar;38(3):476-81. Diabetes Care. 2015 Mar;38(3):476-81. Residual C-peptide present in 1/3 persons with T1D of 3+ years duration 8/7/2015 2 â€¢ Glycemic tar Continue reading >>
The A1c Test & Diabetes
What is the A1C test? The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research. How does the A1C test work? The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent. Can the A1C test be used to diagnose type 2 diabetes and prediabetes? Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes.1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes. Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis. Why should a person be tested for diabetes? Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and li Continue reading >>
Understanding Your A1c
The A1C is a blood test that helps determine if your diabetes management plan is working well. (Both Type 1 and Type 2 take this test.) It’s done every 2-3 months to find out what your average blood sugar has been. (You may also hear this test called glycosylated hemoglobin, glycohemoglobin, hemoglobin A1c, and HbA1c.) A1c is the most common name for it though. How the test works Essentially, the test can tell how much sugar is in the blood stream by looking for proteins (hemoglobins). When glucose (sugar) enters the blood, it binds to the protein in the red blood cells. This binding creates “glycated hemoglobin”. The more sugar in the blood, the more glycated hemoglobin. It’s important to test your blood sugar levels (BGLs) throughout the day; however, an A1C test gives you a bigger picture with a long-term average of those blood sugar levels. What do these numbers mean? The A1c is an average of what your blood sugar levels have been over the 3-month period. In general, the higher your A1C number, the higher your likelihood of diabetes complications. (You don’t want a high A1C; it means there is too much sugar in your blood and your body isn’t absorbing it.) A1C number 4.6 – 6.0 Normal (does not have diabetes) 5.7 – 6.4 Pre-diabetes (warning that someone may develop Type 2 or have the beginning onset of Type 1) 6.7+ Diabetes (someone diagnosed with diabetes) <7.0 – 7.5 Target range (for adults diagnosed with diabetes – children diagnosed with diabetes) This target range varies between individuals, some people naturally run a little higher, some lower. It is important to note that especially in children a higher A1C (of 7.5) is recommended. The A1C number will help you and your doctor determine though if your diabetes management plan is working well. 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 >>
Managing Diabetes With Blood Glucose Control
There are two common ways that physicians assess how well diabetes is controlled:  Frequent measurements of blood glucose, and  measurement of glycohemoglobin (A1c). Each method has its good and bad points, but combined they give a fairly accurate picture of the state of glucose control in a diabetic. Most physicians will use both methods. Why Tight Blood Glucose Is Important Measurement of Blood Glucose (Blood Sugar) When we speak about measuring blood glucose levels, it can be done 2 different ways. Blood glucose can be measured randomly from a sample taken at any time (called a "random blood sugar" or RBS). Blood glucose can also be measured in the "fasting" state, meaning that the person has not eaten or taken in any calories in the past 8 hours (usually this is done overnight and it is referred to as an overnight fast and is called a "fasting blood sugar" or FBS). In a person with normal insulin production and activity (a non-diabetic) blood sugar levels will return to "fasting" levels within 3 hours of eating. People with diabetes (type 1 and type 2) may not be able to get their blood glucose down this quickly after a meal or drinking a calorie-containing drink. More about this can be found on our Diagnosing Diabetes page. Learn More about How to Manage Diabetes Remember, the normal fasting blood glucose level is between 70 and 110 mg/dL. Frequent Measurements of Blood Glucose. The goal in this part of diabetes management is to strive to keep fasting blood sugars under 140 mg/dL and preferably closer to the 70 to 120 mg/dL range. Ideally, one could monitor blood sugars 4 times per day (or more) to follow how well the sugars are controlled. This information could be used to adjust your diet and medications to achieve this goal. Usually blood glucose measureme Continue reading >>
- Self-Monitoring of Blood Glucose: An Essential Weapon in Managing Diabetes
- Managing Your Blood Glucose Ups and Downs
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
Ultimate Guide To The A1c Test: Everything You Need To Know
The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. The A1c goes by several different names, such aswa Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. What is Hemoglobin? Hemoglobin is a protein in your blood cells that carries oxygen. When sugar is in the blood, and it hangs around for a while, it starts to attach to the red blood cells. The A1C test is a measurement of how many red blood cells have sugar attached. So, if your A1C result is 7%, that means that 7% of your red blood cells have sugar attached to them. What are the Symptoms of a High A1C Test Level? Sometimes there are NO symptoms! That is probably one of the scariest things about diabetes, your sugar can be high for a while and you may not even know it. When your blood sugar goes high and stays high for longer periods of time you may notice the following: tired, low energy, particularly after meals feel very thirsty you may be peeing more than normal, waking a lot in the middle of the night to go dry, itchy skin unexplained weight loss crave sugar, hungrier than normal blurred vision, may feel like you need new glasses tingling in feet or hands cuts or sores take a long time to heal or don’t heal well at all frequent infections (urinary tract, yeast infections, etc.) When your blood sugar is high, this means the energy that you are giving your body isn’t getting into the cells. Think about a car that has a gas leak. You put gas in, but if the gas can’t get to the engine, the car will not go. When you eat, some of the food is broken down into sugar and goes into your bloodstream. If your body can’t get the sugar to the cells, then your body can’t “go.” Some of the sugar tha Continue reading >>
The Hemoglobin A1c Blood Test For Type 2 Diabetes
The hemoglobin A1C is a great blood test for a diabetic. You can know how well your blood sugar control has been over a few months. But this test will not replace daily glucose monitors. It has other limitations too. Still, the HbA1C blood test is my favorite of all type 2 diabetic tests. For one thing, it does not require fasting. For another, it can be done in the doctor's office with a single fingerstick just like a glucose monitor test. You get results in six minutes. Best of all, it lets you know how your blood sugar has been doing over the past two or three months. The test sounds perfect, but it is not. For diabetes management you need to know what your blood sugar levels are every day. Daily blood testing is still necessary, because a type 2 diabetic on insulin needs to know his glucose levels several times a day, not just every three months. A great HBA1C reading does not mean there have been no hyperglycemic (high blood sugar) or hypoglycemic (low blood sugar) episodes over the last few months. So the hemoglobin A1C cannot replace daily checks with your glucose monitor and good log book records. Your doctor always asks what your last daily reading was, and he likes to see your log book too. Daily readings along with the A1C give a complete picture of what is going on with your diabetes treatment. Taken together with daily readings, the hemoglobin A1C tells you if your blood sugar is staying in the range that will keep away the complications. There is more and more evidence that an A1C between 6.5 and 7 will do just that. And here's an encouraging fact. If your A1C was 9 and you lowered it to 8, there is a 20% reduction in your risk of complications. That means you do not have to be in the best range yet to see benefits from better blood sugar control. Hemoglob Continue reading >>
Your A1c Levels – What Goal To Shoot For?
Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>
Diabetes 7.5 A1c Diabetes Direct
An atmosphere of itchiness in your skin is an indication of diabetes. Disproportionate appetite It is likely to have diabetes using just very mild symptoms or without developing any indications whatsoever. Cases can render some individuals and treatable. This happens in roughly 1 / 2 of individuals who have type two diabetes.1,2 If youre more than fifty and undergo regular or constant erectile dysfunction (erectile dysfunction), it could possibly be a sign of diabetes. This might be the result of the above symptom (intense hunger). Numbness or tingling, particularly on your toes and hands Cuts and bruises do not heal correctly or quickly Repeated gum disease/infection Type1 diabetes may go unnoticed but is likely to want to do so. A number of its symptoms can come on abruptly and be accompanied by nausea, vomiting or stomach pains.2-4 Frequent symptoms of diabetes Your nerves can be damaged, then because can the blood vessels which nourish people nerves when there is an excessive amount of sugar on your body. You can experience tingling and/or tingling on feet and your hands. The International Diabetes Foundation highlight 4 symptoms that should prompt someone to get checked for diabetes as soon as Diabetes can frequently be found by carrying out a urine test, which finds out whether excess glucose is present. This is backed up by a blood test, which can confirm whether the cause of your signs and symptoms will be still diabetes and also affects blood sugar levels. Tissue being pulled away from the eye lenses can causes this. It affects your eyes capacity to target. With appropriate cure this can be treated. You will find severe cases where by protracted or even blindness vision problems can take place. Does one detect cuts and bruises take a lot more time than normal Continue reading >>
What Is The A1c Test? How Does A1c Relate To Blood Glucose?
Anyone with diabetes will be familiar with finger-prick testing for monitoring blood glucose to see how well they are managing their disease. This kind of regular testing is essential for most people with diabetes, but what role does an occasional hemoglobin A1C blood test play in controlling blood sugars, and how does it work? Contents of this article: What is the A1C test? The abbreviation A1C is used in the US (sometimes with a lower-case 'c' - A1c) and is short for glycated hemoglobin (sometimes called 'glycosylated' hemoglobin or glycohemoglobin). The other abbreviations in use are: HbA1c (widely used internationally) HbA1c Hb1c HgbA1C. The A1C test is a blood test used to measure the average level of glucose in the blood over the last two to three months. This test is used to check how well blood sugar levels are being controlled in a person with diabetes and can also be used in the diagnosis of diabetes.1 Hemoglobin is the protein in red blood cells which is responsible for transporting oxygen around the body. When blood glucose levels are elevated, some of the glucose binds to hemoglobin and, as red blood cells typically have a lifespan of 120 days, A1C (glycated hemoglobin) is a useful test because it offers an indication of longer term blood glucose levels.2 The particular type of hemoglobin that glucose attaches to is hemoglobin A, and the combined result is call glycated hemoglobin. As blood glucose levels rise, more glycated hemoglobin forms, and it persists for the lifespan of red blood cells, about four months.2 Therefore, the A1C level directly correlates to the average blood glucose level over the previous 8-12 weeks; A1C is a reliable test that has been refined and standardized using clinical trial data.3 There are two key things to know about the appl Continue reading >>
- Home blood glucose test: How to test for diabetes at home
- Diabetes and the A1C Test: What Does It Tell You?
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
Diabetes By Number
This week has been interesting. I have nearly OD’ed on diabetes, but not quite. I’ve still got a few more things to say. I spent the time leading up to the weekend going to my endocrinologist, seeing a nurse-diabetes educator (about maybe getting a pump!) and then over the weekend, I was privileged to speak to several hundred people at JDRF Type One Nation events in Boston and Rhode Island. I also got to screen Project365 at the first Rock Type 1 event at Rockspot Climbing near Providence–it was very full, and in a word, awesome. So about that diabetes… I got my A1c result back last week, the dreaded “grade” that you get for your blood sugar management. A1c measures your average blood glucose for the preceding 3 months and because it only comes every several months, it feels like a really big deal. It’s not like a normal “finger-stick” blood test–if those readings come back high, you take some insulin and more or less, it comes down. Take your reading again in a couple hours and it’ll be better. Immediate results. A1c measurements carry more weight because they are less frequent and when you get a reading that you’re not happy with, you have months before you can hope to get a better “grade”. My A1c was 6.5. I wasn’t happy with myself. That’s an average reading of about 150. My diabetes and how I deal with it is intensely personal. Just like the concept of “normal”. Or “good” or “bad” or any of the words we are always told not to apply to our diabetes because it’s all “just information”. I don’t dwell on dissatisfaction, I try to improve it–and improvement is relative. Over the last years, my A1c has crept up from 5.9, 6.0, 6.0, 6.2, 6.4 and now 6.5. 6.5 isn’t anything to sneeze at. It’s not a “bad” A1c. I kn Continue reading >>
Uk Study Finds That People With A1c’s Of 7.5% Run Less Risk Of Death Than Those With Lower A1c’s
Results of a 22-year study by researchers at Cardiff University School of Medicine in Wales indicate that older type 2s who try too hard to drive their A1c’s down to “normal” (4.5% to 6%) may significantly increase their chances of early death. In fact, the study, just published in the British medical journal The Lancet*, found that type 2s with the lowest risk of death had A1c’s of 7.5% — a figure that few authorities on the disease have recommended as ideal. The study, which tracked almost 48,000 patients age 50 and older, also found that type 2s who used insulin to drive down blood sugar levels over the course of the study were 49 percent more likely to die than type 2s who used oral drug combinations, such as a sulfonylurea and metformin. The study examined data that was collected from November 1986 to November 2008 for the UK General Practice Research Database. Overall, patients with the highest blood sugar levels over the course of the study ran a 79 percent greater risk of death, while patients with the lowest levels ran a 52 percent greater risk. The “safest” group was the patients with A1c’s of 7.5%. The large-scale study confirms fears that were raised in the wake of the massive ACCORD study in the United States. That study, which tracked more than 10,000 type 2 patients, attempted to discern whether very tight control of blood sugar levels would lessen the risk of cardiovascular disease, a common result of diabetes’s inflammatory effects. Its sponsor, the U.S. government, abruptly terminated ACCORD in 2008 when a statistically significant number of diabetes patients with heart problems who had achieved tight control died from cardiovascular events. The finding that using insulin as part of intensive treatment increased the risk of death led Continue reading >>
7.7 A1c -- How Bad Is That For A Newly Diagnosed Diabetic?
7.7 A1c -- How bad is that for a newly diagnosed diabetic? Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. 7.7 A1c -- How bad is that for a newly diagnosed diabetic? I was just diagnosed two weeks ago, and today I was given a A1c test. I tested out at 7.7. Being newly diagnosed, I haven't been treating my diabetes long, and i hope after a few months that that number will be alot lower. But for right now, how bad is that number? Have I already started having organ damage or eye damage or whatever? (I go for an eye exam next week, but I'm just wondering what you all think based on what you know about A1c's.) That's not too bad and remember that this is a measure of your levels have been in the past 60-90 days. Look at it as a starting point and plan for the future. My A1c was 11.6 at diagnosis, so you have a head start on me I would not worry about complications at this point, just focus on getting and maintaining control Pretty good actually. Most are much higher at diagnosis. I was 9.6 at diagnosis, so you could certainly be much higher. Don't worry, just do all you can do to keep your numbers as close to normal as possible, and your next A1C should be much lower. 8.3 here and have been struggling for control ever since. Worry about getting control -- having control will keep damage away, and can even let your body heal damage if it exists. But with a not-so-high number, I honestly wouldn't worry about complications yet. An A1c of 7.7 corresponds to an average BG of 175, using the most recent conversion formula (I am using the converter at Blood Sugar 101). Research shows that glucotoxicity sets in at about 140, so you don't want to mainta Continue reading >>
What Do Your A1c Test Results Really Mean?
The hemoglobin A1c test, as we all know, is supposed to give a sense of your average blood glucose levels over the past three months. But here’s a question for you: have you ever tried to figure out what those average blood glucose levels actually are? Say you have an A1c of 6.5% — what, in mg/dl, does that translate to? Try searching Google — it’s hard to find an answer. To quote from a post I wrote a few years ago (see entry from 4:45), that’s partially because: “Not only is there no one standardized definition as to the correlation between A1c and mean glucose levels (JDRF says 1% = 24.4 mg/dl, ADA says 28.7), but different people have different correlations. For example, if you are a ‘high glycolator’ (more glucose sticks to your hemoglobin than the average) you can have a relatively high A1c but a low mean glucose. The speaker gave the example of a patient who had a 8.2% A1c, but a mean glucose of 159 mg/dl (he was speaking using the generally accepted idea that 7% roughly equals a mean of 154 mg/dl). Treat him more aggressively, and you’ll end up with hypos. And if you’re a ‘hypoglycolator,’ it’s the opposite.” Well, just this week, a new paper was published in the American Diabetes Association’s Diabetes Care journal that provides a more solid answer to this question than I’ve seen — even though, as I must warn you, personal variability (as described above) means there’s still no precise answer. In the study, researchers wanted to find out what your average blood sugar would have to be in three situations — fasting, after meals and before bed — in order to achieve a particular A1c. Here are their results: A1c test results of 5.5-6.49% were associated with an average fasting blood glucose level of 122 mg/dl. A1c test results 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 >>