What is hemoglobin A1c (HbA1c)? Hemoglobin is found in red blood cells and is commonly known as the element that carries oxygen. But it does something else: it combines with some of the sugar (glucose) circulating in the blood stream to become glycohemoglobin. The amount of glucose that combines with the hemoglobin is directly proportional to the total amount of glucose circulating. Since the average life span of a single red blood cell is three months, it stands to reason that measuring the amount of glycohemoglobin would give a good approximation of the average blood sugar level of the previous three months.
Persons without diabetes have been found to have HbA1c levels between 4 percent and 6 percent representing an average blood sugar level of less than 120. For this reason, the American Diabetic Association and the American Association of Clinical Endocrinologists recommend persons who do have diabetes maintain their HbA1c levels at least less than 7 percent, and hopefully less than 6.5 percent. There was a time when a “fasting” blood sugar of 125 was used to diagnose diabetes. Clearly, this number can no longer serve as the cut-off for diagnosis, nor can it serve as the goal or acceptable standard for the management of diabetes.
There also was a time when providers were content if diabetic patients could maintain blood sugar levels less than 150. When complications of diabetes developed such as kidney failure, blindness or heart attacks and strokes, the attitude was, “It’s simply the natural process of the disease.” This attitude no longer serves the patient well. Experts now agree that working toward tight control with HbA1c levels less than 7.0 (average blood glucose levels less than 120-125) leads to significantly less complications later on. Tight control is to be achieved as soon as possible after the diagnosis is made, even if it means beginning insulin shots. The treatment of diabetes has changed dramatically in the last few years with many new types of oral medicines available and many new types of insulin. Insulin shots no longer carry the stigma of a hopeless end to an unmanageable disease.
If you are diabetic, are you getting your hemoglobin A1c levels checked every three months? Is your provider intent on working with you to achieve the best control of your diabetes possible? You can’t change the fact that you have diabetes, but you certainly can make sure it doesn’t get the best of you.
• Agnes Oblas is an adult nurse practitioner with a private practice and residence in Ahwatukee Foothills. For questions, call (602) 405-6320 or email firstname.lastname@example.org. Her website is www.newpathshealth.com.