Recently I interpreted for a very sweet patient with a 20+ year history of diabetes. When the doctor asked him about his hemoglobin A1c value, he was confused, as if the doctor had asked him for the winning numbers for the lotto. As a diabetic patient, though, you need to know the value of your hemoglobin A1c just like you know your own phone number.
“Well, what is it this hemo-something?” asked the patient curiously. The doctor gave him an explanation that I’d like to share.
Hemoglobin A1c is a test that is also known as HbA1c, glycated hemoglobin, or glycosylated hemoglobin. This test provides information about a person’s average levels of blood glucose, also called blood sugar, and we use it for diagnosing and monitoring diabetes in diabetic patients.
Hemoglobin is a protein inside red blood cells that carry oxygen to your body. Typically, these red blood cells live for about 3 months, so this test gives us the info about how your blood sugar levels have been for the past 3 months.
Hemoglobin A1c is then formed in blood when glucose attaches to hemoglobin. It looks like a donut with sprinkles where the donut is the hemoglobin and the sprinkles are the glucose attached to it.
This test is used to monitor how well a diabetic is taking care of his glucose levels since it reflects how elevated the values of blood glucose have been over the past 2-3 months. So, if you have been good and have been taking your medication, eating healthy, and exercising, your “donuts” will have “few sprinkles”. On the other hand, if you have not been taking care of yourself, your “donuts” will have “a lot of sprinkles”. This means that your hemoglobin is covered by many glucose molecules.
Depending on the type of diabetes that a person has, how well that person’s diabetes is controlled, and on the healthcare provider’s recommendations, the A1c test may be measured 2 to 4 times each year. The American Diabetes Association recommends A1c testing for diabetics at least twice a year if they are meeting their treatment goals and if their glycemic control is stable. When someone is first diagnosed with diabetes or they do not have their diabetes under control, their doctor may order A1c test quarterly.
In healthy people, the HbA1c level is less than 6%. As a diabetic you have to keep your A1c below 7%. Studies have demonstrated that the complications of diabetes can be delayed or prevented if the HbA1c level can be kept below 7%, therefore, seven is the magic number. If your HbA1c is above 7%, then we have to adjust your medication and work on your lifestyle to prevent long-term diabetes-related complications, like kidney disease, nerve disease, and blindness. But this test only reflects how your diabetes has behaved in the past 2-3 months; it will not show if you were good last week or this morning, for example.
If this bit of information left you “craving for more” check the references below. Hopefully this description gave you a better understanding of this now basic test and come to the rescue when a provider explains it to your patient!