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A1c Of 5

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 >>

Targets For Glycemic Control

Targets For Glycemic Control

Key Messages Optimal glycemic control is fundamental to the management of diabetes. Both fasting and postprandial plasma glucose levels correlate with the risk of complications and contribute to the measured glycated hemoglobin (A1C) value. Glycemic targets should be individualized based on the individual’s age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease and life expectancy. Highlights of Revisions New recommendation better defines the scenarios in which one can consider less stringent glycated hemoglobin (A1C) targets (7.1% to 8.5% in most cases). Figure 1 Recommended targets for glycemic control. Recommendations Glycemic targets should be individualized based on age, duration of diabetes, risk of severe hypoglycemia, presence or absence of cardiovascular disease, and life expectancy [Grade D, Consensus]. Therapy in most individuals with type 1 or type 2 diabetes should be targeted to achieve an A1C ≤7.0% in order to reduce the risk of microvascular [Grade A, Level 1A (1,2) ] and, if implemented early in the course of disease, macrovascular complications [Grade B, Level 3 (3,4)]. An A1C ≤6.5% may be targeted in some patients with type 2 diabetes to further lower the risk of nephropathy [Grade A, Level 1 (5) ] and retinopathy [Grade A, Level 1 (6) , but this must be balanced against the risk of hypoglycemia [Grade A, Level 1 (5)]. Less stringent A1C targets (7.1%–8.5% in most cases) may be appropriate in patients with type 1 or type 2 diabetes with any of the following [Grade D, Consensus]: c) Extensive coronary artery disease at high risk of ischemic events e) History of recurrent severe hypoglycemia g) Longstanding diabetes for whom it is difficult to achieve an A1C ≤7.0% despite effective doses of multip Continue reading >>

A1c Test

A1c Test

Print Overview The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you're managing your diabetes. The A1C test goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c. The A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications. Why it's done An international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation, recommend that the A1C test be the primary test used to diagnose prediabetes, type 1 diabetes and type 2 diabetes. After a diabetes diagnosis, the A1C test is used to monitor your diabetes treatment plan. Since the A1C test measures your average blood sugar level for the past two to three months instead of your blood sugar level at a specific point in time, it is a better reflection of how well your diabetes treatment plan is working overall. Your doctor will likely use the A1C test when you're first diagnosed with diabetes. This also helps establish a baseline A1C level. The test may then need to be repeated while you're learning to control your blood sugar. Later, how often you need the A1C test depends on the type of diabetes you have, your treatment plan and how well you're managing your blood sugar. For example, the A1C test may be recommended: Once every year if you have prediabetes, which indicates a high risk of developing diabetes Twice a year if Continue reading >>

A1c Basics

A1c Basics

On-target blood glucose control helps you feel your best and prevent or delay complications. The best measure of long-term average blood glucose control is a simple laboratory test called the A1C. What is A1C? An A1C (pronounced A-one-C) test reflects your average blood sugar or glucose level over the past two to three months. When you check your blood sugar with a meter after fasting and before or after meals, you won’t capture all the ups and downs. The A1C, also known as a glycosylated hemoglobin test or HbA1c, offers you an overview to compare with your blood sugar checks. The test requires a small blood sample—no fasting is necessary—for a lab analysis. How does it work? The test measures glycosylated hemoglobin, or the percentage of hemoglobin molecules in your red blood cells with glucose attached to them. (Hemoglobin is a protein in red blood cells that carries oxygen.) Glucose naturally sticks, or “glycosylates,” to some of the hemoglobin in red blood cells. When blood glucose is high, more hemoglobin molecules have glucose attached to them. The glucose stays there for the life of the red blood cell (about 120 days), which is why the test covers a three-month period. What are “good” A1C levels? For people without diabetes, about 4 to 6 percent of hemoglobin is glycosylated, so an A1C of 4 to 6 percent is considered normal. An A1C that’s 6.5 percent or higher is sufficient for the diagnosis of diabetes, according to the American Diabetes Association (ADA). The ADA states that an A1C 5.7 to 6.4 percent is diagnostic for prediabetes. For people with diabetes, maintaining an A1C of less than 7 percent over time can reduce the risk of the heart, eye, kidney and nerve damage associated with having diabetes for many years. Talk to your doctor about wha Continue reading >>

When Your “normal” Blood Sugar Isn’t Normal (part 1)

When Your “normal” Blood Sugar Isn’t Normal (part 1)

In the next two articles we’re going to discuss the concept of “normal” blood sugar. I say concept and put normal in quotation marks because what passes for normal in mainstream medicine turns out to be anything but normal if optimal health and function are what you’re interested in. Here’s the thing. We’ve confused normal with common. Just because something is common, doesn’t mean it’s normal. It’s now becoming common for kids to be overweight and diabetic because they eat nothing but refined flour, high-fructose corn syrup and industrial seed oils. Yet I don’t think anyone (even the ADA) would argue that being fat and metabolically deranged is even remotely close to normal for kids. Or adults, for that matter. In the same way, the guidelines the so-called authorities like the ADA have set for normal blood sugar may be common, but they’re certainly not normal. Unless you think it’s normal for people to develop diabetic complications like neuropathy, retinopathy and cardiovascular disease as they age, and spend the last several years of their lives in hospitals or assisted living facilities. Common, but not normal. In this article I’m going to introduce the three markers we use to measure blood sugar, and tell you what the conventional model thinks is normal for those markers. In the next article, I’m going to show you what the research says is normal for healthy people. And I’m also going to show you that so-called normal blood sugar, as dictated by the ADA, can double your risk of heart disease and lead to all kinds of complications down the road. The 3 ways blood sugar is measured Fasting blood glucose This is still the most common marker used in clinical settings, and is often the only one that gets tested. The fasting blood glucose Continue reading >>

What Is A Good Score On The A1c Diabetes Test?

What Is A Good Score On The A1c Diabetes Test?

Normal A1C level can range from 4.5 to 6 percent. Someone who's had uncontrolled diabetes for a long time can have an A1C level above 9 percent. A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate dates indicates diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which is high risk of developing diabetes. For most people who have previously diagnosed diabetes, an A1C level of 7 percent or less is a common treatment target. Higher targets may be chosen in some individuals. If your A1C level is above your target, your doctor may recommend a change in your diabetes treatment plan. Remember, the higher your A1C level, the higher your risk of diabetes complications. A good score on the A1C test depends on whether you’ve been diagnosed with diabetes. For those who do not have diabetes, a score of less than 5.7% is considered normal, while 5.7% to 6.4% indicates prediabetes and 6.5% or higher means you have diabetes. If you already have diabetes, a score of 7% or lower is desired. You and your doctor can decide what score is best for you. The A1C diabetes test is a way to get an average of how well your blood sugar has been controlled for the past three months. The standard A1C goal for most people with diabetes is less than 7%. However, the goal may be individualized or may be different for some people, especially older adults, people with heart disease or those who are prone to frequent low blood glucose. It's a good idea to find out what your A1C goal should be from your healthcare provider and then use that as a benchmark for your A1C results. No one quite agrees on where your A1C score should be, but we all agree on where it shouldn’t be. The scale does not look anything like the BGL numbers you are used Continue reading >>

Hemoglobin A1c Blood Test: Description & Optimal Ranges

Hemoglobin A1c Blood Test: Description & Optimal Ranges

The hemoglobin A1C blood test is a tool used to measure a person's blood sugar levels over the past few months. Learn about the A1C test and how it can help individuals manage their diabetes and blood sugar related disorders. Hemoglobin A1C Test You can tell a fair amount about a person's health by doing a routine physical exam. Findings from this type of exam provide a general overview of a person's state of health, but if you want to fully assess a person's risk of disease, you have to go below the surface. For this information, nothing beats a blood test. Blood tests are able to pick up on changes going on internally long before they manifest into external signs. For example, if you have concerns about high blood sugar or diabetes, you can get a good assessment of this condition by running a hemoglobin A1C blood test, also referred to as an A1C test, which is a blood test that shows the average blood sugar level over the last few months. In this lesson, you will learn how this test works and how it can help in the management of blood sugar disorders, like diabetes. How It Works To build your understanding of hemoglobin A1C, let's go inside a blood vessel. Here we find many substances floating around, but for this lesson, we will focus on just two: red blood cells and glucose. As you know, red blood cells contain hemoglobin, which is the protein that carries oxygen. You also know that the common name for glucose is blood sugar. If you have children, then you are well aware that sugar is sticky. This stickiness causes glucose molecules to stick to the hemoglobin in your red blood cells. This bonding of a protein and sugar molecule is called glycation. The resulting glycated hemoglobin is referred to as hemoglobin A1C, or simply A1C. Your red blood cells live for about Continue reading >>

Capsule Commentary On Radin, Pitfalls In Hemoglobin A1c Measurement: When Results May Be Misleading

Capsule Commentary On Radin, Pitfalls In Hemoglobin A1c Measurement: When Results May Be Misleading

The measurement of hemoglobin A1c (A1c) is the most common method used to determine glycemic control and is an important predictor of microvascular complications in patients with both type 1 and type 2 diabetes.1,2 Additionally, in 2010, the measurement of A1c was added as a criteria for the diagnosis of diabetes (A1c levels ≥ 6.5 % indicate diabetes).3 Because of the importance of this laboratory test in both the diagnosis and management of patients with diabetes, it is essential that health care providers recognize the factors that can lead to inaccurate and misleading results. In this issue, Radin discusses in detail the potential pitfalls of A1c measurements and also provides guidance on how the clinician can use alternative tests to determine glycemic control.4 The level of A1c is dependent on both the concentration of plasma glucose and the duration of exposure of hemoglobin to glucose.5 Thus, one major artifact of A1c measurements is changes in the half-life of red blood cells (RBC). Disorders that lead to an increased percentage of older RBCs, such as iron deficiency anemia, B12 or folate deficiency, or asplenia, artifactually elevate A1c levels. Conversely, disorders that shorten RBC life span, such as hemolytic anemia, blood loss, and splenomegaly, artifactually lower A1c levels. Patients with end-stage renal disease typically have falsely low A1c levels, due to a decrease in RBC lifespan. Similarly, during pregnancy, RBC lifespan is decreased leading to decreased A1c levels. Finally, hemoglobin variants can result in artifactually increased or decreased A1c levels, depending on the specific variant and the method used to measure A1c levels. In the article by Radin, more complete information on the variety of factors that can alter A1c measurements is provid Continue reading >>

A1c, Hba1c, A1c, Or Hb1c

A1c, Hba1c, A1c, Or Hb1c

What do all of the above have in common? Everything! They are the same thing called differently. People who have diabetes know exactly what their A1c value means for them, people without diabetes, less. However, this is an important figure that everyone in today’s society should at least find out some time or other, better sooner than later. It may tell you a lot more than you expected. Hb1Ac (as the Germans call it) is glycated hemoglobin. Wikepedia explains it as: a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic pathway by hemoglobin’s normal exposure to high plasma levels of glucose. Glycation of hemoglobin has been associated with cardiovascular disease, nephropathy and retinopathy in diabetes mellitus. Monitoring the HbA1c in diabetic patients may improve treatment. In the normal 120-day life span of the red blood cell, glucose molecules react with hemoglobin, forming glycated hemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycated hemoglobins are much higher than in healthy people. Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell therefore reflects the average level of glucose to which the cell has been exposed during its life cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months. Some researchers state that the major proportion of its value is related to a rather shorter period of two to four weeks. So long-winded explanation aside, that means that the value of your Hb1Ac w Continue reading >>

Is Hemoglobin A1c The Right Outcome For Studies Of Diabetes?

Is Hemoglobin A1c The Right Outcome For Studies Of Diabetes?

The goals of treatment of type 2 diabetes are to reduce the risk of diabetic complications and, as a result, improve the quality and, possibly, duration of life. For several decades, authoritative guidelines instructed clinicians to strictly control glucose levels of patients with diabetes to accomplish these goals. In addition, in the 1990s, the US Food and Drug Administration (FDA) began to approve drugs for the treatment of diabetes based on hemoglobin A1c (HbA1c) levels as the outcome. The prevailing concept was that risk reduction could be achieved by a clinical focus on reaching target values of HbA1c, agnostic to the strategies used. This concept, analogous to early notions about lipid lowering, persisted despite the failure of trials evaluating tight glycemic targets, as assessed by HbA1c levels, to reduce the risk of heart disease or improve survival.1 Continue reading >>

Add-on Combination Therapy

Add-on Combination Therapy

Warnings and Precautions Pancreatitis: There have been post-marketing reports of acute pancreatitis in patients taking saxagliptin, and in the SAVOR cardiovascular outcomes trial. Observe for pancreatitis. If pancreatitis is suspected, discontinue KOMBIGLYZE XR. Heart Failure: In the SAVOR cardiovascular outcomes trial, more patients treated with saxagliptin were hospitalized for heart failure compared to placebo. Patients with a prior history of heart failure or renal impairment had a higher risk for hospitalization for heart failure. Consider the risks and benefits of KOMBIGLYZE XR in patients who have known risk factors for heart failure. Monitor for signs and symptoms. If heart failure develops, consider discontinuation of KOMBIGLYZE XR. Vitamin B12 Deficiency: Metformin may lower vitamin B12 levels. Measure hematological parameters annually. Hypoglycemia: When saxagliptin was used in combination with a sulfonylurea or with insulin, the incidence of confirmed hypoglycemia was increased over that of placebo. Consider lowering the dose of these agents when coadministered with KOMBIGLYZE XR. Hypoglycemia could occur when caloric intake is deficient, strenuous exercise is not compensated by caloric supplementation, or when KOMBIGLYZE XR is used with other glucose-lowering agents or ethanol. Hypersensitivity: Serious reactions have been reported in patients treated with saxagliptin, including anaphylaxis, angioedema, and exfoliative skin conditions. Onset of these reactions occurred within the first 3 months after initiation of treatment with saxagliptin, with some reports occurring after the first dose. If a serious hypersensitivity reaction is suspected, discontinue KOMBIGLYZE XR. Use caution in patients with a history of angioedema to another DPP-4 inhibitor. Severe a Continue reading >>

Red Cell Transfusion Decreases Hemoglobin A1c In Patients With Diabetes

Red Cell Transfusion Decreases Hemoglobin A1c In Patients With Diabetes

Hemoglobin A1c (Hb A1c)1 is a mainstay of diabetes diagnosis and management that allows clinicians to estimate the recent mean blood glucose concentration of a patient. Glycation of hemoglobin is an irreversible, nonenzymatic process that depends on the glucose concentration in red blood cells (RBCs), and Hb A1c represents the integrated glucose concentration in RBCs over their life span. RBC transfusion can complicate the interpretation of Hb A1c values in diabetic patients because it introduces hemoglobin molecules exposed to glucose concentrations that may have been different from the glucose concentrations in the diabetic transfusion recipient. The potential effect of transfusion on Hb A1c has been recognized for some time, but opinions on the direction of the effect are contradictory. Data from the older literature (1–3) suggest that the high concentration of glucose in RBC storage medium promotes glycation and causes Hb A1c values to increase over time, which would predict that Hb A1c might increase in transfused patients. This concept has been stated in a recent review article (4) and on consumer Web sites, such as Lab Tests Online (however, a recent case in which a pathology resident was contacted to explain a patient's Hb A1c value decreasing from 7.4% to 5.4% in 3 days after the patient received 3 units of RBCs suggested that transfusion may lower Hb A1c values in diabetic patients. Indeed, the majority of blood donors are not diabetic, and donor RBCs would dilute the increased Hb A1c value (>6.5%) in a diabetic patient. To our knowledge, no study has used contemporary Hb A1c methods to examine the effect of RBC storage conditions on Hb A1c or the overall effect of RBC transfusion on Hb A1c in patients. To investigate these questions, we used an immunoassay Continue reading >>

Abby: Trick To Setting A1c Goal For Diabetes Treatment

Abby: Trick To Setting A1c Goal For Diabetes Treatment

Dear Dr. Roach: My elderly sister, 73, has Type 2 diabetes, and is taking 500 mg of metformin twice a day. After two years on metformin, her fasting glucose level is only 125 mg/dl and A1C only 6.8 percent. If she continues taking medication, will her fasting glucose level ever get to around 85 mg/dl and her A1C get to 5 percent? She wants to be in the normal ranges. In your opinion, is the goal of drug therapy, like metformin, only the control of diabetes? If so, then what can she do to reach her goals of 85 mg/dl and A1C of 5 percent? R.I. Dear R.I.: Type 2 diabetes mellitus is a common disorder of unknown exact cause, but which generally is caused by resistance to the action of insulin and by a gradual decrease in the amount of insulin the pancreas is able to put out. There are many types of treatment for diabetes, but the most important are a healthy diet and regular exercise (a registered dietician nutritionist is a valuable source of information). In people who need medication, metformin is a very good first choice for many, especially people who are overweight. The goal of treatment is the control of symptoms, but also to reduce the risk of complications of diabetes, especially blood vessel disease. Small blood vessel disease leads to kidney failure, nerve damage and vision changes. Large blood vessel disease leads to heart attack, stroke and peripheral vascular disease, which sometimes can mean amputations. There remains debate about the optimal blood sugar goal. For older people and those at high risk for (or who already have) large blood vessel disease, treating people with a goal A1C level of 5 percent actually has more risk than a goal of around 7 percent. However, for younger people, most diabetes experts recommend an A1C level in the “normal” range, su Continue reading >>

Feline Diabetes And A1c

Feline Diabetes And A1c

A Dried Blood Spot mail-in A1C (glycohemoglobin) test for canines and felines. Sold in 5 packs with everything you need to do the test. Including, prepaid postage on the 5 return envelopes. Purchase of the 5 pack also includes test results emailed, faxed or mailed via USPS depending on your preference. STEP 3: Once blood is dry, mail the test using the supplied pre-paid business reply envelope – typical delivery time is 3-5 business days. Tests may also be expedited via a third party shipping service (at veterinary’s expense). Samples are tested Monday through Friday from 9:00 AM – 5:00 PM (EST). Results are emailed or faxed to the contact information that was listed on the test form. For questions related to the status of a result, please email the code located on the bottom of the test to [email protected] About A1C (glycohemoglobin) Many pets have clinical and subclinical/transitional diabetes only identified by A1C. It is also called glycated hemoglobin or glycohemoglobin. Glycation is a non-enzymatic reaction between the carbonyl group and the N-terminal of lysine amino acid. This process leads to a Amadori compounds which undergo a series of oxidation, dehydration and fragmentation reactions which generates advanced glycation end products. This universal reaction occurs 24 hours a day 7 days a week in mammals and is the foundation for why A1C is an accurate and reliable test from people to mice and including cats and dogs. Since hemoglobins life span in felines is 70 days. You get a very accurate average glucose levels for this time due to the predictable and repeatable process of glycation. The same is true for canines. Except their red blood cells (hemoglobin) life span is 110 days giving an average glucose level via glycation (A1C) for this time p Continue reading >>

5 Ways To Lower Your A1c

5 Ways To Lower Your A1c

For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>

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