Who is popular today?

Dr Maxwell Adeyemi

People with diabetes used to depend on daily finger pricks to measure their blood sugar levels. These tests are accurate, but only in the moment. They are actually very limited as an overall measurement of blood sugar control.
This is because your blood sugar can vary wildly depending on the time of day, your activity levels, and even hormonal changes. Some people may have high blood sugar at 3 am and be totally unaware of it. The A1C test measures the amount of haemoglobin in the blood that has glucose attached to it. The test is used to monitor blood sugar levels, as well as for diagnosis and screening of pre-diabetes and diabetes.
Haemoglobin A1C tests became available in the 1980s and quickly became an important tool in monitoring diabetes control. Haemoglobin A1C tests measure average blood glucose over the past two to three months, so even if you have a high fasting blood sugar, your overall blood sugar may be normal, or vice versa. A normal fasting blood sugar may not eliminate the possibility of type 2 diabetes.
This is why haemoglobin A1C tests are now being used for the diagnosis and screening of pre-diabetes and diabetes. Because it does not require fasting, the test can be given at any time as part of an overall blood screening.
A1C test measure measures the amount of haemoglobin in the blood that has glucose attached to it. Haemoglobin is a protein found inside red blood cells that carries oxygen to the body. Haemoglobin cells are constantly dying and regenerating. Their lifespan is approximately three months. Glucose attaches (glycates) to haemoglobin, so the record of how much glucose is attached to your haemoglobin also lasts for about three months. If there’s too much glucose attached to the haemoglobin cells, you will have a high A1C. If the amount of glucose is normal, your A1C will be normal.

Haemoglobin A1C levels

Someone without diabetes will have about five per cent of their haemoglobin glycated. A normal A1C level is 5.6 per cent or below. A level of 5.7 to 6.4 per cent indicates pre-diabetes. People with diabetes have an A1C level of 6.5 per cent or above. There is a calculator that shows how A1C levels correlate to glucose levels. To monitor overall glucose control, people with diabetes should have an A1C test at least twice a year.

More frequent measurements like every three months should be taken if:

· you have type 1 diabetes
· your treatment is being adjusted
· you and your doctor are setting certain blood sugar targets
· you are pregnant

How an A1C test works

The test is effective because of the lifespan of the haemoglobin cells. If your blood glucose was high last week or last month, but it’s normal now, your haemoglobin will carry a “record” of last week’s high blood glucose in the form of more A1C in your blood. The glucose that was attached to the haemoglobin during the past three months will still be recorded by the test, since the cells live for approximately three months. The A1C test provides an average of your blood sugar readings for the past three months. It is not accurate for any given day, but it gives a good idea of how effective your blood sugar control has been over time.

Factors that affect your A1C results

Anyone who’s had diabetes for any length of time knows that A1C tests have not been reliable until recently. In the past, many different types of A1C tests gave different results depending on the lab that analysed them. But the Standardisation Programmes has helped improve the accuracy of these tests. But accuracy is relative when it comes to A1C or even blood glucose tests. The A1C test result can be up to half a per cent higher or lower than the actual percentage. That means if your A1C is six, it might indicate a range from 5.5 to 6.5.
Some people may have a blood glucose test that indicates diabetes but their A1C is normal, or vice versa. Before confirming a diagnosis of diabetes, the doctor should repeat the test that was abnormal on a different day. This isn’t necessary in the presence of unequivocal symptoms of diabetes such as increased thirst, urination, and weight loss and a random sugar over 200 mg/dl. Factors that affect HbA1c results include: kidney failure, liver disease and severe anaemia. Ethnicity can also affect HbA1c results as people of African, Mediterranean, or South-east Asian descent may have a less common type of haemoglobin that can interfere with some A1C tests such as sickle cell and thalassemia. Certain medications like aspirin, opiate analgesics and HIV medications, and supplements such as vitamin E, vitamin C and B12, as well as severe blood loss, blood transfusion, early or late pregnancy, high cholesterol especially high triglyceride, alcoholism, and rheumatoid arthritis are other factors that affect HbA1c results.

Who should get an A1C test

Adults over the age of 45 should take an A1C test to get a baseline reading. People under 45 years old should get the test if they’re overweight or have the following risk factors:
. a past diagnosis of gestational diabetes
· a diagnosis of pre-diabetes
· a diabetes diagnosis

Dealing with high HbA1c

High A1C levels are indicative of uncontrolled diabetes, which has been linked to an increased risk of the following conditions:
· cardiovascular diseases, like stroke and heart attack
· kidney disease
· nerve damage
· eye damage that may result in blindness
· numbness, tingling, and lack of sensation in the feet due to nerve damage
· slower wound healing and infection

If you’re in the early stages of type 2 diabetes, small changes in lifestyle can make a big difference and even put your diabetes in remission. Starting an exercise programme can help. Type 1 diabetes needs insulin treatment as soon as it’s diagnosed. For those who have had pre-diabetes or diabetes for a long time, higher A1C results may be a sign that you need to start on medication or change what you’re already taking. Pre-diabetes can progress to diabetes. You may also need to make other lifestyle changes and monitor your daily blood glucose more closely. People with diabetes should take an A1C test at least twice a year and more frequently in some cases.

Contact Dr Maxwell on 363-1807 or 757-5411.
The post Understanding haemoglobin A1C appeared first on Trinidad and Tobago Newsday.