What Are Some Alternatives To Hba1c Measurement
Just like hemoglobin, many other proteins also can attach to glucose. This glucose interaction and attachment can lead to a similar interpretation and can be used to estimate glucose control. Generally, there is a good correlation between A1c values and fructosamine. However, there are some problems with the use of fructosamine as well. For example, because the turnover of serum albumin is more rapid than hemoglobin, fructosamine values reflect average glucose values in a much shorter time. This time is typically 1 to 2 weeks.
If patients have albumin problems such as protein-losing kidney disease or liver disease, fructosamine values may be incorrect.
1,5-anhydroglucitol is a polyol that comes in the diet. In normal individuals, this is completely reabsorbed by the kidneys after the filtration. As a result, serum concentrations are typically stable in normal individuals. When glucose levels go up, the kidney reabsorption of the substance is inhibited. As a result, 1,5-anhydroglucitol levels will go down as glucose levels go up.
3.Continuous glucose monitoring systems
Continuous glucose monitoring systems such as Dexcom, freestyle libre, or Medtronic guardian systems can also give you continuous blood glucose readings that can have a corresponding A1c. Since it is average blood sugar, if your average blood sugars on CGM as 150, you can safely assume that your A1c is at 7%.
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How To Calculate Your A1c
The Hemoglobin A1c test is a blood test used to measure the average blood glucose concentration in your body in the past 1-3 months. For diabetics, this is the standard way of determining how well the diabetes is controlled. An A1c of less than 7% is considered good.
Getting the test every 3 months is usually enough. But sometimes you may want to just estimate your A1c level based on the data from your regular self-tests. The formula below could help in this case.
Accuracy, of course, could vary depending on how often and when you check your blood sugar. I found it pretty accurate last time I used it. My calculation was off only by 0.1%. This is the same formula GlucoseTracker uses in the apps dashboard.
Glucose in mg/dL:
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Misalignment Between Current Target Levels Of Mean Glycemia And Target Blood Glucose Levels
This reanalysis of ADAG data has demonstrated that current blood glucose target levels are not properly aligned with target levels of mean glycemia as defined by normal or near-normal levels of A1C. The fasting target BG levels are too low for the four major organizations guidelines of glycemic targets and the postprandial target BG levels are also too low for 3 of these 4 guidelines.12–15
Many patients are encouraged to get their BG levels down low enough to attain a normal A1C level of 5.6-6.49%, which is the bin containing the lowest range of A1C levels studied in this ADAG article. The fasting blood glucose levels attained by the subjects with these levels of mean glycemia tended to be higher than the maximum levels that were recommended in most guidelines. The ADAG subjects whose A1C levels were in this range were found to have mean fasting blood glucose levels of 122 mg/dl for both type 1 and type 2 patients. This mean value is above the top of the target range established by the American Association of Clinical Endocrinologists in 2011, above the top of target range established for type 1 diabetes by the International Diabetes Federation European Region in 1998, above the top of the target range established for type 2 diabetes by the IDF in 2012, and toward the high end of the target range established by the American Diabetes Association as of this year.12–15
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How To Check Your Own Blood Sugar Level
One way to check ones own sugar level is by pricking a finger with a lancet and placing the blood that comes out onto a test strip, then inserting the strip into a glucose monitor. A meter can tell you what your levels are in about 5 seconds. Another option is by taking an oral glucose tolerance test , which takes longer but may also provide more accurate results. A persons individual level will depend on many factors including how old they are, their ethnicity, their weight and height, and the activity theyve performed recently. Blood sugar levels can be checked by pricking a finger to get a drop of blood and putting it on a glucose meter.
Identify The Main Pain Points
Whether you are self-managing your diabetes or work closely with your medical team, the first step should always be to try to identify the main pain points or reasons why your A1c is higher than youd like. The only real way of doing this is by tracking your blood sugars very closely.
If you wear a Continuous Glucose Monitor, you can look at your 7-day, 30-day, and 90-day data to see if you can spot any trends. For example, you might find that you are running high from 1-5 AM every night, every morning or every day after meals. Or perhaps you always go low after exercise. We all have different blood sugar patterns.
Its also very possible that you simply are running your blood sugar a little too high all the time and could benefit from adjusting your diabetes medication. Identifying patterns like that makes it possible to pinpoint areas of potential improvement so you can start making a plan for how to limit your high and low blood sugars.
If you rely on manual blood sugar testing, its a little trickier since most people dont test every five minutes. What I would recommend is increasing how often you test for a while, and maybe even test during the night if you wake up anyway. Most meters allow you to download data to your computer, or you can upload the data to app-based platforms like One Drop or mySugr. This can help you see the data in a more cohesive way so you can start looking for trends.
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The Original Adag Study
An International Expert Committee with members appointed by the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation was convened in 2008 to consider the current and future means of diagnosing diabetes in nonpregnant individuals.2 The group concluded that the A1C assay provides a reliable measure of chronic glycemia and correlates well with the risk of long-term diabetes complications. The same year an international multicenter study by the ADAG Study Group reported the relationship between average glucose and A1C levels to estimate the relationship between the two metrics.3 This group derived a mathematical relationship using a combination of continuous glucose monitoring and frequent fingerstick capillary blood glucose testing.
Can This Test Be Used During Pregnancy
Although the A1c test can be useful in the early pregnancy to diagnose if improvement has diabetes before pregnancy, A1c testing is typically not very correct during the pregnancy due to changes in hemoglobin and expansion and blood volume. Typically your endocrinologist will use glucose tolerance test and follow you with glucose testing with fingersticks or continuous glucose monitoring systems.
The bottom line
Endocrinologists and primary care doctors, commonly use this test to diagnose and treat and monitor diabetes. It reflects average blood sugars within the last 3 months. This is because the test relies on hemoglobin turnover that is typically 3 months. If there are problems in your red blood cells or hemoglobin due to a variety of situations we have discussed above, the test may not be reliable. There are also many caveats that diabetes specialists, as well as diabetic patients, should be mindful of when interpreting test results.
About the author: Dr. Ergin operates a large diabetes practice mostly in West Palm Beach, FL, and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him to track patient progress and be available at all times. Soon to be available in NY and NJ.
2260 Palm Beach Lakes Blvd
Ste 212 unit 7
West Palm Beach, FL
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Whats The Recommended A1c For People With Diabetes
The American Diabetes Association recommends an A1C goal of < 7% in most adults . Some healthcare providers may recommend an A1C of < 6.5%, if they can maintain it without adverse effects or events, such as frequent hypoglycemia.2
An A1C of < 8% is also thought to be appropriate for people:
- with a history of hypoglycemia
- limited life expectancy
- or other complexities of life.2
We recommend that you discuss your personal target goals with your care team.
Normal Blood Sugar Levels Chart
Every substance present in our body has an optimum level. Above or below that specific range, that particular substance is harmful to our health. And so is sugar. There is a certain range of blood sugar which is considered as standard for almost all age. However, there might be some changes in the level considering different factors like age and other co-morbidities. Lets look at the chart:
|2 hours after the meal
|< 140 mg/dl
Sometimes, random blood is also taken. In this case, the glucose level of 200 mg/dl is considered a diabetic condition.
Going through the chart you will notice certain terms regarding blood sugar which you need to understand in order to evaluate your own glucose level. So, I will just give a small brief regarding those:
- Fasting blood glucose: Here, blood sugar is tested after abstaining from food and drink for at least 8 hours.
- Postprandial blood sugar:In this case, blood sugar is tested 2 hours after a meal to access if its at the optimum level after having a meal or not.
- Random blood glucose: Blood is tested at any time of the day.
- HbA1c: It refers to a blood test which is done to evaluate the average level of blood glucose over the past 3 months. HbA1c is also known as glycosylated haemoglobin or A1C. Moreover, fasting is not required before carrying out the test.
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A1c Calculator For Average Blood Sugar Level
The HbA1c tool calculates your average blood glucose level in units. The glycated Hemoglobin A1C test shows your average blood sugar level over the past 2 to 3 months. If youd like to know your average blood sugar level over that time frame, just enter your most recent HbA1c results into the A1c calculator below, then hit enter. Furthermore, you can calculate your A1c level simply by entering your average blood sugar level into that field, hit enter for your result. . So basically, when people ask Can I calculate my A1C at home?, the answer is yes. Reference the A1C chart with your result value. A helpful tool for diabetics with t1d or t2d diabetes!
How Does Age Affect A1c
A1c is a measure of diabetes management, so your A1c wont naturally shift as you get older. However, as you age your diabetes management strategies and A1c goals may change for example, younger people may be more focused on reducing long-term health complications, while older people may concentrate on avoiding severe lows. Talk with your healthcare professional if youre curious about how your age may affect your A1c levels.
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Why Your A1c Matters
In a nutshell: your A1c is one of the clearest indicators of your risk for developing diabetes complications like neuropathy , retinopathy , nephropathy , and severe infection in any part of your body that requires healing.
For instance, a small cut on your toe could become infected due to high blood sugars, struggle to heal, and become severe enough that the infection could lead to an amputation.
The general guidelines from the American Diabetes Association recommend an A1c at or below 7.0 percent for the best prevention of diabetes complications. Your risk of developing a diabetes complication continues to drop as your A1c drops closer to 6 percent.
Some people with diabetes aim for A1c levels in the 5s and lower especially those who follow strict low-carb diets like the ketogenic diet and the Bernstein diet. However, this hasnt been proven in research as especially necessary, nor is it reasonably achievable for the larger population of people with diabetes.
Its also important to remember that your blood sugar levels and your A1c are just information that tells you whether your body needs more or less of factors like insulin, other diabetes medications, changes in your nutrition, and changes in your exercise.
If you dont like the number youre seeing on your glucose meter or your A1c results, use that number as motivation to make changes in how you safely manage your diabetes in order to get different results.
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How To Reduce A1c Levels
People want to know how to lower a1c in a week. When managing the a1c levels, it is important to know that this is a slow and gradual process. Therefore, you cant expect to lower the values overnight.
What you can do, instead, is talk to your doctor and find the best ways to manage the problem. The options below can help.
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What Are The Disadvantages Of Using A1c
Like any other testing in medicine, that may be technical errors in interpreting A1c levels. These errors can lead to misleading results or assumptions. The lifespan of hemoglobin can influence the test results. The test result will be falsely high when the red blood cell turnover is lower. A1c levels will be falsely low when the red blood cell turnover is slow such as in untreated anemia. So, let us review possible problems with the the test.
Racial differences can also play a role in the ability of the test to estimate average blood sugars. For example, A1c levels are typically higher in African-American Hispanic in Asian populations compared to Caucasians. Thankfully racial differences do not lead to significant A1c problems as some other issues we discussed above.
What Are The Risks Of Chronic High Blood Glucose Level
Increase your physical activity. You donât have to train to be an Olympic athlete, but you should strive to include a few short walks in your daily routine. Every step is crucial!
- Attempt to reach and maintain a healthy BMI .
- The BMI is the most fundamental indicator, but you should also consider your waist-hip ratio. A large amount of visceral fat has been related to an increased risk of diabetes and heart disease.
- Maintain a healthy, well-balanced diet. If youâre overweight, donât go over your daily calorie restriction, and attempt to eat even less. Say goodbye to processed meals and sweets.
- If you follow those recommendations, your hemoglobin A1C levels will almost certainly improve.
- A higher risk of cardiovascular disease, such as myocardial infarction or stroke.
- Thereâs a chance youâll get chronic renal disease or perhaps kidney failure.
- Nerve injury and paresthesia are more likely.
- There is a high risk of retinopathy and vision loss.
- Infections, including as skin infections and mycoses, are common.
- Difficulties with conceiving,
- Diabetic foot, which could cause amputation!
They may diagnose you with diabetes if your A1C result is equal to or higher than 6.5 percent. If this is the case, make an appointment with your doctor away!
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Why Was My Hba1c Result Higher/lower Than The Result Given By The Calculator
In addition to the reasons given just above, there are some other practical reasons which may explain difference between the calculators estimate and your lab results. We will look at a few of the more common reasons for differences.
If you take a relatively high proportion of your blood glucose tests at the same time of day, eg upon waking, the HbA1c result the calculator gives will give a decent reflection of your early morning results but may not so well represent your blood glucose levels at other timers in the day.
Similarly, if you take more before meal, rather than after meal, readings, the HbA1c result given by the calculator will give a better reflection of your before meal results than after meal ones.
Typically, most peoples after meal results are higher than their before meal results, so if you take significantly more before meal results than after meal readings, you may find that the calculator gives you a lower result than your lab test result will.
Determining The Right A1c Goal For You
Just because a normal blood sugar range of 70 to 130 mg/dL is considered the healthiest doesnt necessarily mean thats the appropriate goal range for you especially if you have type 1 diabetes, or take insulin as a person with type 2 diabetes.
The reason this may not be the right goal for you is that extremely tight blood sugar management in people taking insulin can potentially lead to frequent low blood sugars which can be dangerous.
Achieving extremely tight blood sugar management, like a range of 70 to 130 mg/dL, also often requires a strict nutrition plan, more frequent than usual blood sugar monitoring, precise medication management, and most importantly, years of experience studying your own blood sugar levels.
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