Update: Racial And Ethnic Differences In The Relationship Between Hba1c And Blood Glucose: Implications For The Diagnosis Of Diabetes
Received 2011 Jun 29; Accepted 2011 Dec 13. Copyright 2012 by The Endocrine Society This article has been cited by other articles in PMC. Hemoglobin A1c (HbA1c) is widely used as an index of mean glycemia in diabetes, as a measure of risk for the development of diabetic complications, and as a measure of the quality of diabetes care. In 2010, the American Diabetes Association recommended that HbA1c tests, performed in a laboratory using a method certified by the National Glycohemoglobin Standardization Program, be used for the diagnosis of diabetes. Although HbA1c has a number of advantages compared to traditional glucose criteria, it has a number of disadvantages. Hemoglobinopathies, thalassemia syndromes, factors that impact red blood cell survival and red blood cell age, uremia, hyperbilirubinemia, and iron deficiency may alter HbA1c test results as a measure of average glycemia. Recently, racial and ethnic differences in the relationship between HbA1c and blood glucose have also been described. Although the reasons for racial and ethnic differences remain unknown, factors such as differences in red cell survival, extracellular-intracellular glucose balance, and nonglycemic genetic determinants of hemoglobin glycation are being explored as contributors. Until the reasons for these differences are more clearly defined, reliance on HbA1c as the sole, or even preferred, criterion for the diagnosis of diabetes creates the potential for systematic error and misclassification. HbA1c must be used thoughtfully and in combination with traditional glucose criteria when screening for and diagnosing diabetes. In the late 1960s, hemoglobin A1 was first recognized as a glycated form of hemoglobin that was increased in patients with diabetes ( 1 ), and in 1976, hemoglobin A1c (HbA Continue reading >>
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Diabetes, Diet And Oral Medication
AOPA will be closed on March 21, 2018, due to inclement weather. Already a member? Please login below for an enhanced experience. Not a member? Join today Endocrine SystemDiabetes, Diet and Oral Medication For diabetes that is controlled by diet and exercise only, a medical certificate can be issued by the aviation medical examiner at the time of the examination and does NOT require a special issuance authorization. However, you will need to provide a current status letter from your treating physician and the results of an A1C hemoglobin determination within the past 90 days. If you have a diagnosis of Pre-Diabetes (Metabolic Syndrome, Impaired Fasting Glucose, Insulin Resistance, or Glucose Elevation/Intolerance) your aviation medical examiner may issue a certificate at the time of examination if you have an FAA Pre-Diabetes Worksheet completed by your treating physician. The FAA allows special issuance certification for diabetes mellitus controlled with oral medications. For special issuance consideration for diabetes mellitus on oral medications, you will need: A current diabetes evaluation from your treating physician that includes: A statement regarding the medication(s) being used, dosages, and frequency of use; The absence or presence of side effects and mention of any clinically significant hypoglycemic episodes; The results of an A1C hemoglobin determination within the past 30 days that confirms satisfactory control of the diabetes (item 2 below); Note must also be made of the presence of cardiovascular, neurological, renal, and/or ophthalmological disease. The presence of one or more of these associated diseases will not be, per se, disqualifying but the disease(s) must be carefully evaluated to determine any added risk to aviation safety. Laboratory Repor Continue reading >>
5 Simple Ways To Lower Your A1c This Week
The A1C blood test is a simple test that analyzes your glucose (blood sugar) levels by measuring the amount of glycated hemoglobin in your blood. Hemoglobin is a protein in your red blood cells; when glucose enters the blood, it attaches to the hemoglobin. The result is glycated hemoglobin. The more glucose in your blood, the higher your glycated hemoglobin. The A1C is a valuable indicator of how well your diabetes management plan is working. While your individual A1C goal will depend on factors including your age and your personal medical profile, most people with diabetes aim to keep their A1C below 7 percent. By keeping your A1C number within your target range, you can reduce the risk of diabetes complications. While it is important to develop a long-term diabetes management plan with your physician, there are several steps you can take right away to help reduce your A1C. Small changes add up, so consider trying some of these strategies to lower your A1C this week. 1. Try Short Sessions of High Intensity Exercise According to research presented at the American Heart Association's Scientific Sessions 2015, type 2 diabetes patients who did 10 minutes of exercise three times a day, five days a week at 85 percent of their target heart rate had a twofold improvement in A1C levels compared to patients who exercised for 30 minutes a day at 65 percent of their target heart rate. Be sure to check with your doctor before trying high intensity exercise, and wear a heart rate monitor so you don’t overdo it. 2. Shrink Your Dinner Plate Instead of a large dinner plate for your meals, use a smaller salad plate. This simple swap can trick your eyes and brain into thinking you’re eating more than you really are, and you’ll feel satisfied with less food. It’s especially helpfu Continue reading >>
10 Weeks Pregnant And Found Out A1c 8.9
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. Hi all. I am a Type 1 of 22 years and 35 years old. I have been without health insurance for quite sometime and recently was added to my husband's policy. Two weeks ago I went to the OB/GYN and saw my baby and heard the heartbeat for the first time! Today I got the call about my bloodwork. Everything fine except for the most important A1C 8.9 and low Vitamin D. I am so concerned for my baby. I have been testing since the at home preg test came back positive 10-15 times per day and have been in really good control. I do have some random highs but quickly correct those and have been diligent in all my care. I just need to hear positive stories from all of you. I am so scared and imagine the effects m sugars have had on my little one. I also was weighed in and since last year this exact time have put on FIFTY pounds. Wow Diabetes the ever changing green eyed goblin in the room! Thank-you all. And hope to connect with all of you who have/are going through same situation. You said you have been in really good control. do you mean just since you've found out you are prego? Or before? Just asking b/c u said your a1c is 8.9. Sounds like if you have been in control since the baby news then obviously that is great and I know you will continue to do that and hopefully lower that number, but I also hope you continue the good control after your baby is here so hopefully you wont have anymore 8.9's. We can all help to keep you motivated. You want to see your baby grow old and get married and all that so keeping in good control is the way to go! Keep it up and you should be just fine. I found out I was preg Continue reading >>
The A1c Results Are In!
Balancing Life While Living with Type One Diabetes Yesterday was a hectic day, but I did have the time to run to my Endocrinogist appointment, and I wasnt yelled at! Phew, that is always a good feeling that I am doing something right! (Well not right, but good enough). Our discussion went very well, and he said that he is going to work with me directly to get my blood sugars under better control. but I need to test, test and test some more! Of course he would say that, but it does make sence too. My last a1Cwas a 8.9 back in November of 2012. That was higher compared to the previous one, but not worse than I have ever been. He figured I would be running about the same a1C, so he just said to work on it especially if I plan on having kids! Woah, where did that come from?! Yes, my thoughts exactly! I guess I am at that point in my life (Im 24) where people are accepting of someone having a kid, and not really surprised if. oooppss it happens. Well he made it very clear to me that I need to continue on my BC pills, and be extremely careful of not having a kid right now. He also stated that I should get my a1Cdown to a 7 before I can think about it. Then he said one day, we will have the talk about your diabetes and getting pregnant. Phew, he isnt pushing me to get my a1C down just so I can have a kid. Im not ready for all of that right now anyway. Then he sent me on my merry little way to get my blood drawn. Ouch did it hurt! And I was all bruised up afterwards. (I hate hate hate getting blood drawn, and I certainly cant look or I will pass out!) Later last night I got an email from my doctor. He said just remember to test, and attached were my results! Woa, that was quick! My a1C is better, a 8.1, but still not good enough. It takes a lot of work to have, and maintain, t Continue reading >>
Interactive Diabetes Case 8: Discordant Values For A1c And Home Blood Glucose Values
CASE A 49-year-old, African-American man, a computer engineer, seeks a second opinion because his clinician tells him that his diabetes is uncontrolled, but the patient is sure that it is well controlled. Five years ago, he developed polyuria, polydipsia, nocturia, and lost 23 lbs over a four-month period. A random blood glucose level was 277 mg/dL (15.3 mmol/L). The glycated hemoglobin (A1C) was 10.8 percent. The patient was treated with medical nutrition therapy and metformin 1000 mg twice a day with meals. The patient adhered to his regimen. His symptoms resolved, and he regained 18 lbs. He states that he performs self-blood glucose monitoring once or twice a day. The fasting blood glucose values are in the 110 to 125 mg/dL (6.1 to 6.9 mmol/L) range. Values before supper are 115 to 140 mg/dL (6.3 to 7.8 mmol/L). With treatment, the A1C level improved to the 8.9 to 9.5 range; the most recent value, nine weeks ago, was 9.1 percent. The patient developed distal sensory neuropathy six months after the diagnosis of diabetes. He complains of tenderness in the bottoms of his feet. He feels that he is "walking on nerves," that he has "no fat in his feet," and that he is "walking on bone." His symptoms are alleviated by gabapentin but are still present. He has erectile dysfunction. He also has hypertension and gastroesophageal reflux disease. The patient's examination reveals a blood pressure of 120/70 in the right arm supine and 140/85 in the right arm upright. The heart rate is 60 regular. The weight is 207 lbs, height 5' 9", body mass index (BMI) 30.6 kg/m2. Peripheral pulses are intact in both lower extremities. Light touch is nearly absent to the knees. Vibration sense is mildly reduced at the great toes, slightly reduced at the medial malleoli, and intact at the tibial Continue reading >>
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Hba1c Is 8.6 Is This Bad?
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community My HBA1C is 8.5 how bad is this reading and how can I reduce it keeping my energy levels high. I work long hours in Saudi and preparing foods is sometimes hard and I seem to go for quick fixes like Alpen bars, peanut butter and jam sandwichs at night biscuits with my cuppa! I have other health issues which effect my sugar so how do I know if the Metformin is working along with the glicicide? I keep reading cut out all my current carbs keep with fats and protein how true is this? @Dadio carbs convert in our bodies to sugar, and as a T2D it is this sugar our bodies can no longer deal with efficiently. So, yes, if you and less fuel (sugar) to the fire, the fire (Blood Sugars) will die down a bit novorapidboi26 Type 1 Well-Known Member I would say the 8.9 is on the high end of the scale of "room for improvement"..... cutting carbs is the first line of defense until you build up a knowledge of your own personal carb tolerances... the metformin only compliments you own insulin response I think....so getting the carb down will help and then you can begin testing the foods you like to eat before deciding yay or nay.. Your HbA1c of 8.9 is equivalent to an average of 11.6mmol/l . This means your blood glucose is running high much of the time and may be causing you damage. The UK guidelines say we shouldn't go above 8.5mmol/l at any time, so you are well above that. You are also on Gliclazide, so your levels should be a lot lower than they are. It's your choice, but if you don't reduce your snacking and cut those carbs your levels won't come down. Instead of sandwiches for snacks, try cheese, boiled eggs, tomatoes, cold meats, nuts, salads. Do you test your own Continue reading >>
The A1c Test And Patients With Chronic Kidney Disease
Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician. In the United States, about 1 in 10 people have diabetes, a disease that affects the way the body produces or uses insulin. Insulin is a hormone that helps regulate glucose (sugar) in the blood. When blood sugar levels get too high, health problems can develop, including kidney problems. In fact, about half of all people diagnosed with diabetes will develop kidney disease. Persistently high sugar levels can damage the small blood vessels in the body. In the kidneys, diabetes can also cause damage to the tiny filters called glomeruli that filter the blood. The result is that your kidneys may begin to leak protein into the urine, and can become unable to properly eliminate the water, salt and waste products from your body. Another complication of diabetes is nerve damage, often causing burning and numbness in the feet. However, it can sometimes also lead to trouble emptying the bladder. Pressure from a full bladder that doesn’t empty properly can further damage the kidneys. What is the A1C test? The A1C, or hemoglobin A1C test, is used to measure long-term blood glucose levels. It is typically given every three to six months to people with diabetes. This laboratory test shows the person’s average blood glucose control for the previous two to three months. It differs from the finger stick blood test that is used daily to monitor current blood sugar levels. For someone with diabetes, the goal is to have an A1C reading of less than 7.0 percent. For someone who is not diabetic, a normal A1C level is 4.0 percent to 5.9 percent. Research has shown that when A1C levels are close to normal, the risk for complications of diabetes Continue reading >>
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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Getting Hemoglobin A1c Under Control After A Relapse
Getting hemoglobin A1c under control after a relapse Getting hemoglobin A1c under control after a relapse A patient with diabetes questions the necessity of starting a statin. A patient, aged 57 years, was diagnosed with type 2 diabetes 5 years ago when her blood sugar was found to be elevated at 300 mg/dL, with a hemoglobin A1c of 8.9%. She experienced extreme fatigue at that time. She was started on metformin, along with recommendations for diet, exercise, and weight loss. One year later with the addition of metformin and titration up to 1000 mg twice daily, as well as improved diet, exercise, and a 10% weight loss, her hemoglobin A1c (HbA1c) improved to 7.7%. With this elevation in HbA1c, it was recommended that she take glipizide 5 mg once daily in addition to metformin. It was also suggested that her blood glucose values be metered 2 to 3 times weekly at alternating times. Glipizide was later increased to 5 mg twice daily to improve control. Nine months ago, she was hospitalized for right knee surgery. Just prior to this admission, she stated that she had decided to stop taking glipizide and was continuing to work on eating a healthy diet. She denied hypoglycemia or other adverse effects on glipizide, and stated that she simply no longer wanted to take the medication. She was not currently exercising due to knee pain. Her HbA1c was found to be elevated at 7.4%. At time of discharge, it was recommended she continue with dietary modifications, exercise as tolerated, and resume glipizide 5 mg once daily, It was also recommended that she continue with metering blood glucose values 2 to 3 times weekly at alternating times, and take metformin again in an effort to improve control. She was seen 3 months later as an outpatient, and her HbA1c had improved to 6.7%. She admi Continue reading >>
Probiotics May Help Reduce Blood Sugar Levels
MORE NEW ORLEANS — The microbes that live in your gut may play a surprising role in your blood sugar levels, a small new study from Canada finds. The study involved people who were following the DASH diet, which is recommended for people with high blood pressure. The people on this diet who also consumed probiotics, which are considered "good" bacteria, had a decrease in several measures of blood sugar levels over a three-month period, according to the findings. People with consistently high blood sugar levels may or may not go on to be diagnosed with diabetes; a diagnosis can depend on the results of several tests. Although more research is needed, the findings suggest that adding probiotics to the DASH diet could be used in the future to help protect against diabetes, said Arjun Pandey, a researcher at the Cambridge Cardiac Care Centre in Ontario and the author of the study. [8 Tips to Be a Probiotic Pro] Pandey presented his findings here on Sunday (Nov. 13) at the American Heart Association's Scientific Sessions annual meeting. The findings have not been published in a peer-reviewed journal. In the study, 80 people with high blood pressure were placed on either the DASH diet or the DASH diet plus probiotic-rich foods. About 15 percent of the participants had prediabetes, Pandey noted, which means their blood sugar levels were elevated but were not considered high enough to warrant a diagnosis of diabetes. The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is one of the most effective non-drug-related methods for improving certain aspects of heart health, including lowering blood pressure, Pandey told Live Science. The people in the study who added the probiotics to their diet did so by replacing certain components of the DASH diet with probio 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 >>
What’s Normal Blood Sugar?
Thank you for dropping in! If you need help lowering your blood sugar level, check out my books at Amazon or Smashwords. If you’re outside of the U.S., Smashwords may be the best source. —Steve Parker, M.D * * * Physicians focus so much on disease that we sometimes lose sight of what’s healthy and normal. For instance, the American Diabetes Association defines “tight” control of diabetes to include sugar levels as high as 179 mg/dl (9.9 mmol/l) when measured two hours after a meal. In contrast, young adults without diabetes two hours after a meal are usually in the range of 90 to 110 mg/dl (5.0–6.1 mmol/l). What Is a Normal Blood Sugar Level? The following numbers refer to average blood sugar (glucose) levels in venous plasma, as measured in a lab. Portable home glucose meters measure sugar in capillary whole blood. Many, but not all, meters in 2011 are calibrated to compare directly to venous plasma levels. Fasting blood sugar after a night of sleep and before breakfast: 85 mg/dl (4.7 mmol/l) One hour after a meal: 110 mg/dl (6.1 mmol/l) Two hours after a meal: 95 mg/dl (5.3 mmol/l) Five hours after a meal: 85 mg/dl (4.7 mmol/l) (The aforementioned meal derives 50–55% of its energy from carbohydrate) ♦ ♦ ♦ Ranges of blood sugar for young healthy non-diabetic adults: Fasting blood sugar: 70–90 mg/dl (3.9–5.0 mmol/l) One hour after a typical meal: 90–125 mg/dl (5.00–6.9 mmol/l) Two hours after a typical meal: 90–110 mg/dl (5.00–6.1 mmol/l) Five hours after a typical meal: 70–90 mg/dl (3.9–5.00 mmol/l) Blood sugars tend to be a bit lower in pregnant women. ♦ ♦ ♦ What Level of Blood Sugar Defines Diabetes and Prediabetes? According to the 2007 guidelines issued by the American Association of Clinical Endocrinologists: Prediabetes: Continue reading >>
"i'm 30 Years Old. My Ac1 Is 9.8.": Diabetes Community - Support Group
Now that you have been diagnosed with diabetes, you just accept and start taking actions to get it back under control.. Since your doctor wants you to try to manage Blood sugar with diet and exercise, my recommendations - 1. Read and follow Dr. Dansinger's Diabetes reversal Blog - 2. Interval and strength training. You can search internet for good recommendations. These two are the key to improving your insulin sensitivity. 3. Test.. test and test.. I was testing 5-6 times a day and still test 4 times a day (last a1c 5.3).. I plan to reduce my testing.. but you should test blood sugar as you try to figure out how your body responds to various foods and exercise. My first a1c was 7.8 and I am 35 yrs old. yes.. and ate a lot of carbs (bread, rice..). After reading Dr Dansinger's blog and other other sites, I have significantly reduced carbs and eat a lot more vegetables (Raw, steamed, roasted), good fat (olive oil, nuts, avocado), egg whites, and low fat cheese. Of course there are many healthy meat options too. My point and recommendation is that there needs to be major changes in diet, exercise and life style.. oh and key is to be consistent.. More we think about it, harder in can get.. Key for me has been to look for other things in life that I enjoy and not think about food.. One thing that keeps me going is just seeing my 4 yr old daughter.. I want to be in her life for a long time so i need to keep working on my blood sugar. I have a friend (same age) and is managing diabetes with diet/exercise and many on this board do the same.. jimbobway replied to shank_us 's response: shank, thanx for the excellent tips. Good stuff. I will read all the stuff you posted and will definitely change my lifestyle...pretty tough but I gotta do it. Anon_20247, please call your doctor Continue reading >>
Ask The Diabetes Team
Question: From Findlay, Ohio, USA: On December 12, 2009, my five-year-old son was diagnosed with type 1 diabetes after urinating frequently and drinking more for a few days. His blood sugar was 780 mg/dl [43.3 mmol/L] and his A1c was 10%. The endocrinologist explained that the A1c meant his blood sugar average for the last 90 days was 275 mg/dl [15.3 mmol/L]. My son's A1c on January 14 was 7.2 after 30 days on insulin, a three point drop in the A1c! Is it possible that the A1c could drop that much in such a short time? As I was concerned about an H1N1 Vaccination on November 10, 2009, I was wondering if the majority of this high daily reading could have happened in the last 30 days. So, I put together a 90 day spreadsheet prior to the December 12 diagnosis and tried to put in normal theoretical daily blood sugar value of 100 or 110 mg/dl [5.6 or 6.1 mmol/L] for the first 60 days and then tried to ramp up the theoretical values for the last 30 days, (after the H1N1 vaccination), such that I could average a daily blood sugar value of 275 mg/dl [15.3 mmol/L]. While it is possible, theoretically, to have values that would make this possible, there is no way to adjust this 90 day sliding window, or any 90 day sliding window, with the new A1c test result on January 14 of 7.2% (which equates to an average daily blood sugar reading of 160 mg/dl [8.9 mmol/L]). No matter how you adjust the theoretical daily numbers, there just does not seem to be any way, one could go from a A1c of 10% (daily average of 275 mg/dl [15.3 mmol/L]) to an A1c of 7.2% (daily average of 160 mg/dl [8.9 mmol/L]) one month later if this A1c test is looking at blood glucose based on red blood cells living 90 days. I even tried redoing the spreadsheet for the original December 12 diagnosis and assuming 275 m Continue reading >>