Why Hemoglobin A1c Is Not A Reliable Marker
i was recently tested for Hemoglobin A1c because i presented to an endocrinologist with extremely low blood glucose on lab test and some scary symptoms, not the ordinary hypoglycemia symptoms. My A1c was 4.7 which registered as low (L) on the lab print out–it was only slightly low. Does a low score on this suggest a possibility of short-lived RBCs? Does it have any relationship with extremely low blood glucose? my result at the lab, fasting, was 32mg/dL. Not long after that i got a home glucometer and i get the same kind of results on that as the lab got, in the 20s and 30s first thing in the morning, every day. did not know i had hypoglycemia until i had that lab test, though i had had one episode where i woke up with ataxia, i fell while walking to the bathroom first thing in the morning, i got up and immediately fell again. I soon found that i had very impaired coordination. i did not know why and i was very worried. Eventually i wanted to have breakfast but had great difficulty holding the measuring cup under the faucet, to get some water to heat, to make instant oatmeal, i lacked the coordination to get the water into the cup. I persisted and did make the instant oatmeal (pour hot water onto flakes and it’s done), and i got my lap top and was eating the oatmeal and i suddenly was aware that the symptoms were going away. Previously i had been unable to type. While eating the small amount of oatmeal, i realized i could type. That was about a month before the lab test. Since it only happened that once, i put it out of my mind. About 5 days after the lab test, i had the second episode, worse than the first, i woke falling out of bed to the floor, couldn’t use my arm to break the fall, i didn’t have the coordination. i sat on the floor, i could not get up and wa Continue reading >>
Why Doesn’t My Average Blood Glucose Match My A1c?!
So, you test your meter for accuracy and everything looks good. You take your average BG and convert it to A1C using a table, calculator, or equation you find online. Then, you get your blood work done and learn that your actual A1C is… Not even close! What’s the deal? As it turns out, the relationship between average BG and A1C isn’t as clear as most of us think. After doing some research, I came across a couple reasons why someone’s actual A1C may be higher or lower than expected… But before we get into that, let’s briefly go over why A1C is used to approximate average glucose over ~3 months: As glucose enters your blood, it attaches to a protein in your red blood cells called “hemoglobin.” Hemoglobin is the same protein that carries oxygen in your bloodstream, and it is what gives blood its red color A1C measures the total amount of glucose that has attached to your hemoglobin over the lifespan of your red blood cells (typically ~3 months). OK, now that we’ve got the science down, here’s why your average BG and lab-measured A1C values might not match up: 1. BG meter average does not usually reflect the average over a full 24 hours This reason is pretty obvious. If you are not on a CGM, it’s tough to get a full picture of your average blood glucose throughout the day. We generally test much more during the day than at night, and nighttime glucose values may be very different from daytime values. We also tend to test more often before eating (when glucose is typically lower), and less often after meals (when glucose is typically higher). So, for most people, BG meter average doesn’t accurately reflect average blood glucose over a full 24 hours. A1C, on the other hand, does. If you want your BG meter average to better reflect your A1C values, che Continue reading >>
- Mindfulness and Diabetes Management: A Perfect Match
- 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
- Type 2 diabetes: What is the average age of onset?
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 >>
For Diabetic Dialysis Patients, Low A1c Is Good, But Even Lower Isn’t
Two new studies show that when it comes to hemoglobin A1c in dialysis patients, Goldilocks had it right—the best level is not too high, but not too low either. Both studies show that the lowest mortality occurred in patients with intermediate levels, ranging between 6.5 percent and 9 percent, and that dropping below that was associated with worse patient outcomes. The guidelines for control of blood sugar in the Kidney Disease Outcomes Quality Initiative (KDOQI), dating to 2007, state that the target A1c level for people with diabetes “should be less than 7 percent, irrespective of the presence or absence of chronic kidney disease.” However, according to Kamyar Kalantar-Zadeh, MD, professor of medicine and pediatrics and epidemiology at the UCLA David Geffen School of Medicine in Los Angeles, “There is no consistent evidence to support these targets for dialysis patients.” Kalantar-Zadeh was lead investigator on one of the new studies. Previous large observational studies have come to different conclusions about the effect of A1c on mortality in dialysis patients. But these studies have generally been relatively short-term, he said. To determine the long-term effect of A1c, he and his colleagues examined outcomes in over 54,000 dialysis patients with diabetes over a seven-year period. They found that mortality from all causes followed a U-shaped curve in relation to time-averaged A1c. The lowest rate of mortality occurred when A1c was between 7 percent and 8 percent. In line with previous studies, it rose sharply above that, with the hazard ratio rising to approximately 1.4 when A1c was in the 9 percent to 10 percent range. Surprisingly, though, the hazard ratio also rose when A1c was below 7 percent, increasing gradually when the level was between 6 percent a Continue reading >>
- Is it possible to catch diabetes? It sounds absurd, but that's what a reputable new study suggests. And it may be that other 'lifestyle' diseases such as joint pain and even obesity are contagious, too
- Could going low-carb help you fight off diabetes? The usual advice for Type 2 is to eat plenty. But now a number of patients and doctors are leading a growing rebellion
- Can Diabetes Be Reversed? Study Claims Weight Loss And Cutting Calories Cure Condition, Even In Long-Term Patients
Your Most Important Blood Test
This week, the British Journal of Cancer published an incredibly important report that found a strong relationship between a simple blood test and the risk for various forms of cancer. The study found that the common blood test used by diabetics to measure their average blood sugar, A1c, was strongly predictive in terms of cancer development. For those of you who are not diabetic, you may not be familiar with this simple test that has profound health implications well beyond diabetes. Basically, the A1c test measures the amount of glycation that the protein hemoglobin has undergone. Glycation simply means that sugar has become bonded to a protein, in this case hemoglobin, and this is a relatively slow process. Hence, it’s a way to get a sense as to how high the blood sugar has been, in this case over a 3-4 month period of time, and this is why it’s so helpful for diabetics. But with this new report, we now understand that having elevated A1c translates to risk for cancer, and as I’ve explained in Grain Brain, it is also a powerful indicator of risk for developing dementia. If you look at the chart on page 117 of the book, reproduced below, you’ll note that A1c is also directly related to the rate at which the brain shrinks on an annual basis. Think of it, this one simple blood test can give you incredibly important information about cancer risk, risk for dementia, and even risk for shrinkage of your brain! Most commonly people are told that having an A1c of 5.6 – 5.8 should be considered normal, but when you look at the graph above, these levels already put you in the second highest category for brain shrinkage! I believe that, based on this information, we should strive to keep our A1c at 5.2 or even lower. The way to accomplish this is simply by reducing you Continue reading >>
Test Id: Hba1c Hemoglobin A1c, Blood
Evaluating the long-term control of blood glucose concentrations in diabetic patients Diagnosing diabetes Identifying patients at increased risk for diabetes (prediabetes) Diabetes mellitus is a chronic disorder associated with disturbances in carbohydrate, fat, and protein metabolism characterized by hyperglycemia. It is one of the most prevalent diseases, affecting approximately 24 million individuals in the United States. Long-term treatment of the disease emphasizes control of blood glucose levels to prevent the acute complications of ketosis and hyperglycemia. In addition, long-term complications such as retinopathy, neuropathy, nephropathy, and cardiovascular disease can be minimized if blood glucose levels are effectively controlled. Hemoglobin A1c (HbA1c) is a result of the nonenzymatic attachment of a hexose molecule to the N-terminal amino acid of the hemoglobin molecule. The attachment of the hexose molecule occurs continually over the entire life span of the erythrocyte and is dependent on blood glucose concentration and the duration of exposure of the erythrocyte to blood glucose. Therefore, the HbA1c level reflects the mean glucose concentration over the previous period (approximately 8-12 weeks, depending on the individual) and provides a much better indication of long-term glycemic control than blood and urinary glucose determinations. Diabetic patients with very high blood concentrations of glucose have from 2 to 3 times more HbA1c than normal individuals. Diagnosis of diabetes includes 1 of the following: -Fasting plasma glucose > or =126 mg/dL -Symptoms of hyperglycemia and random plasma glucose >or =200 mg/dL -Two-hour glucose > or =200 mg/dL during oral glucose tolerance test unless there is unequivocal hyperglycemia, confirmatory testing should be Continue reading >>
Could Your Hba1c Diabetes Test Be Wrong?
A glycated hemoglobin (HbA1c) is a preferred screening test for diabetes. Done easily with a fingerstick in your physician’s office, it eliminates the need for fasting (not eating) prior to the test. The diagnosis of diabetes is confirmed if two consecutive A1c levels are greater than or equal to 6.5. What is the HbA1c? Red blood cells are permeable to glucose (sugar)—so after they enter your circulation, glucose becomes attached to them. The degree to which your red cells become “sugar coated” depends on your blood glucose level. The A1c indicates the average blood sugar level over the lifespan of the red cell—and it lines up with average blood sugar over the previous 2 – 3 months. Take home message here: your HbA1c will not be affected if you had pizza the night before, unlike a random blood sugar test. But because the A1c is influenced by the total life cycle of your red cells, the levels can be inaccurate in some folks. Here are some times the HbA1c will not be helpful: A1c falsely elevated (HIGH) Your test may tell you that you have diabetes, but you don’t. Untreated anemia from iron deficiency or vitamin B12 and folate deficiency can result in a HbA1c value that is falsely high because your red cell turnover is low. Because you have more “older” red cells instead of making new ones (due to lack of iron, or other vitamins) your HbA1c will be higher than it should be. Kidney failure or chronic kidney disease. If you have abnormal kidney function your HbA1c may be falsely high. Very high triglycerides (over 1,750) may also cause a falsely elevated HbA1c. Splenectomy (spleen surgically removed) will give you a falsely elevated HbA1c, due to decreased red cell turnover. This is because the spleen can’t remove the red cells from the bloodstream—whi Continue reading >>
Going Beyond A1c – One Outcome Can’t Do It All
By Adam Brown, Lynn Kennedy, Ava Runge, and Kelly Close What does A1c miss and what can we do about it? The diaTribe Foundation presented at FDA! Check out the slides here. The Food and Drug Administration (FDA) hosted a landmark Public Workshop on August 29 – “Diabetes Outcome Measures Beyond Hemoglobin A1c (HbA1c)” – co-organized by The diaTribe Foundation, ADA, AACE, JDRF, and Scripps Translational Science Institute. For the FDA and many payers, A1c is currently the “gold standard” used to assess diabetes therapy – it reflects average blood glucose levels over a two-to-three-month period, and in turn, the long-term risk of complications from high blood sugar (hyperglycemia). An A1c of less than 6.5% or 7% is the goal for most people with diabetes. But A1c has limits: it cannot capture other critical outcomes that matter to patients on a daily basis. Low blood sugar (hypoglycemia) can be fatal, and yet, A1c tells us nothing about it. New therapies may dramatically improve quality of life, but those improvements won’t show up in an A1c value. Two people can have the exact same A1c value, but spend wildly different amounts of time at high and low blood glucose values. The diaTribe Foundation believes the review of new diabetes therapies should expand to reflect both the long-term and short-term risks that patients face, the daily tradeoffs that patients make, and the key barriers to better outcomes. This means going beyond A1c! Given recent improvements in glucose sensing devices and understanding of people living with diabetes, A1c can now be supplemented by other important tools. This article unpacks why going beyond A1c is important and shares other ways of measuring diabetes success. Click any of the points in the summary section immediately below fo Continue reading >>
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 >>
Diabetic Hemoglobin A1c Goals May Be Too Low For Older Patients
Diabetic hemoglobin A1C goals may be too low for older diabetics. Here is why and what some doctors think should change. Because the A1C is so new, doctors are still learning what number is the best goal for diabetes control. In 1986 the testing program was given to doctors to provide a clearer picture of blood sugar control in diabetics. They hoped to find that a lower number on the A1C improved diabetic complications. On the diabetic hemoglobin A1C, non-diabetics test in the 4% to 6% range. But a type 2 diabetic can test 10% or higher. Studies find that at levels higher than 8%, the complications multiply. The National Institute of Health says half of type 2 diabetics have poor blood sugar control in the U.S. So doctors hope the diabetic hemoglobin A1C will become a powerful tool for change. So far it seems to be working. But what is the perfect number for a diabetic? For a while they thought the perfect number for a diabetic was 7%. But diabetes doctors want to lower the goal to 6.5% or less. They say this will keep the heart, kidney, retinal and peripheral diseases from getting worse in type 1 and type 2 diabetes. There is no doubt that a lower diabetic hemoglobin A1C does equal fewer complications. A lower A1C means you have fewer AGEs, in your body. So you have less damage to your organs - your brain, heart, blood vessels and eyes. But the A1C cannot tell you how often you have those dangerous low blood sugars. Diabetic medications are a common cause of hypoglycemia as you attempt to lower the sugar in your blood by artificial means. Your endocrine system is a complex and sensitive organism. Medications cannot hope to duplicate it. Hormones regulate your blood sugar with tiny adjustments. If it dips too low your body releases epinephrine, making you feel nervous. Continue reading >>
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 >>
Low-carb Lab Testing – Part 1 – Blood Sugar Tests
Welcome to part 1 of our series on low-carb lab testing, where we’ll look at common blood sugar test options and how to interpret and track your results. In these posts we’ll dig into the most common lab tests one will encounter on their low-carb journey. Our goal is to educate you on what these tests mean so you can be better informed as you work to optimize your health. In this first post, we look at three tests that can be used to monitor your blood glucose levels. In subsequent posts, we’ll shift focus to insulin, lipids, thyroid and other markers that are important for patients to understand. Heads Up Health was designed to help you centralize and track all of your vital health data in one place, including important lab test results, so you can make informed and empowered decisions about your health. To get started, simply click on the button below to create your account. Or, read on for more information about common tests to help you monitor your blood sugar levels. Blood sugar, insulin and health Chronic, long term pathological elevations in blood glucose or insulin have been linked to type 2 diabetes, obesity, Alzheimer’s disease, kidney problems, deterioration of eyesight, neuropathy, poor prognosis in cancer, connective tissue irregularities, orthopedic injuries and more. Links and associations are not necessarily causal relationships, but the medical literature is robust with research detailing potential mechanisms by which chronically high blood glucose or insulin might be either directly causing or at the very least exacerbating these outcomes. With this in mind, if you’re concerned about your long term health and quality of life, keeping blood glucose and insulin within healthy ranges is one of the most important and effective things you can do. Continue reading >>
Hemoglobin (low And High Range Causes)
What is the hemoglobin A1c test? Hemoglobin A1c or glycosylated hemoglobin is a rough indication of blood sugar control in people with diabetes mellitus over the preceding 3 months. As more glucose (blood sugar) circulates in the blood on a daily basis, more glucose is bound to the circulating hemoglobin. Normal hemoglobin A1c levels range between 4% to 5.9%. As this number reaches 6% or greater, it signifies poorer diabetes control. A hemoglobin A1c of 6% roughly correlates with an average blood sugar level of 135 mg/dL (milligrams per deciliters) over the previous 3 months. Each 1% increase in hemoglobin A1c above 6% represents an average blood sugar of approximately 35 mg/dL over 135 mg/dL. For example, a hemoglobin A1c measurement of 7% corresponds to an average blood sugar level of 170 mg/dL in the previous 3 months. How can a person increase his or her hemoglobin level? There are a number of ways to increase hemoglobin levels. In general, low hemoglobin levels that need to be increased are caused by three circumstances: decreased red blood cell production (for example, altered bone marrow hemoglobin production, iron deficiency), increased red blood cell destruction (for example, liver disease), and by blood loss (for example, trauma from a gunshot or knife wound). Addressing these underlying causes of low hemoglobin levels initially determines what method to use to increase hemoglobin levels. Methods to increase hemoglobin levels are varied and their use depends on the underlying problems. Some of the ways to increase hemoglobin include: transfusing red blood cells receiving erythropoietin (a hormone used to stimulate red blood cell production in individuals with decreased red blood cell production or increased red cell destruction) taking iron supplements increas Continue reading >>
- Assessing how controlled is your diabetes: hba1c range
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
Artefactually Low Hemoglobin A1c In A Patient With Hemolytic Anemia
Hemoglobin A1C (HbA1C) is widely used for the monitoring and management of diabetes mellitus. Shortened red cell survival may result in artefactually low HbA1C values. In patients with hemoglobin variants or chemically-modified derivatives of hemoglobin, falsely decreased or increased HbA1C results may be found depending on the particular assay method. Although in most such cases, HbA1C can be reported if the appropriate methodology is selected. In diabetic patients with shortened red cell survival and in a small number of patients with certain hemoglobin variants, alternate approaches such as frequent glucose measurements and/or self glucose monitoring and fructosamine should be used to assess glycemic control. In diabetic patients with these conditions, HbA1C as the preferred diagnostic test for diabetes is not valid. Prekallikrein (Fletcher factor), a precursor of blood plasma kallikrein, is a glycoprotein consisting of 619 amino acid residues. Prekallikrein is synthesized in hepatocytes as a single polypeptide.1,2 Deficiencies of prekallikrein, factor XII (Hageman factor), high-molecular-weight (HMW) kininogen, and factor XI (plasma thromboplastin antecedent) affect the contact phase of coagulation. Despite abnormalities in coagulation tests including markedly prolonged activated partial thromboplastin time (aPTT), only factor XI deficiency is clinically relevant with a bleeding tendency, and a possible thrombophilia has been reported for factor XII deficiency.3–5 According to anecdotal reports, prekallikrein-deficient patients do not experience spontaneous or excessive injury-related bleeding; however, the marked prolongation of aPTT may be a diagnostic and management challenge for pathologists, hematologists, and surgeons with patients who undergo surgical proce Continue reading >>
A1c Level: What It Is And How To Lower It
If you are a diabetic, you are probably familiar with the concept of A1C tests. These are blood tests that are designed to check a person’s level of glucose (or blood sugar). This test has a purpose of checking to see if the patient has type 1 or 2 diabetes or prediabetes. Having high blood sugar is also called hyperglycemia, which may be caused by undiagnosed diabetes. It is important to continually get tested so that the syndrome can be caught and treated in its early stages. If it is addressed and treated quickly after being discovered, you may have a chance of reversing the disease. A patient’s diagnosis depends on what level of blood glucose is found in the blood. You are considered to be diabetes-free if the test shows levels that are below 5.7%. If you have blood glucose levels that are between 5.7 to 6.4%, it is likely that you have prediabetes. If the test comes back with levels greater than 6.5%, this indicates diabetes. In any case, a second test will be taken to confirm the diagnosis. Effects of High A1C levels If your A1C test has shown high levels of glucose in the blood, you are at risk for developing more serious complications. Some of these complications include heart attacks, strokes, kidney problems and circulation problems. If the issue goes untreated, it is also possible that you will start to suffer from damage to the eyes, cardiovascular disease, nerve damage, infections to the skin and gums, as well as problems with the joints. Symptoms of High A1C Prediabetes is difficult to spot, as it has no noticeable symptoms. People with type 1 diabetes may show many symptoms. You should get your blood glucose checked if you display signs of: extreme thirst, increased appetite, fatigue, weight loss and urination, blurry vision and/or fruity-smelling bre Continue reading >>
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- How to lower your A1C levels: A healthful guide
