What is hemoglobin A_1C?

Hemoglobin A_1C is a blood test that measures the average blood sugar level in the blood over the past two or three months. Specifically, this test measures the amount of sugar that permanently attaches to hemoglobin, a protein in red blood cells. Because red blood cells live for about three months, this test shows the average blood sugar level during that time. This test gives some of the information that you could get if you measured your blood sugar every day continuously throughout the day and night.

Why is hemoglobin A_1C important?

We know high blood sugar damages blood vessels and may cause blindness, kidney failure, nerve damage, amputation, heart attack, stroke, and premature death. Managing blood sugar dramatically reduces the risk of these complications. The hemoglobin A_1C test helps to determine whether your blood sugar control has been adequate to minimize damage from diabetes.

Do I need both hemoglobin A_1C and standard blood sugar testing?

Yes. Each test gives different information about blood sugar control. For example, your fasting blood sugar may be normal, but if your hemoglobin A_1C is high, then you know there are times in the day that the blood sugars are too high and you are still at risk of having complications from diabetes. On the other hand, if your hemoglobin A_1C is high, you need spot checks of the blood sugar level to know specifically what part of the day in which you may need to manage differently.

How do results from hemoglobin A_1C compare with blood sugar levels?

The hemoglobin A_1C test measures the percent of hemoglobin that is chemically bound to sugar. The normal range of hemoglobin A_1C is 4-6%, which corresponds to an average blood sugar level of 60-120 mg/dl. Your doctor will help determine what level is best for you, but generally a hemoglobin A_1C greater than 7% (average blood sugar equal to 140 mg/dl) means that measures must be taken to achieve better management.

The hemoglobin A_1C  test results may be inaccurate in certain conditions. The test results may be falsely low in the following situations: the use of dapsone, certain types of anemia, mechanical heart valves, recent blood transfusion, enlarged spleen, treatment with erythropoietin, severely elevated triglycerides, high-dose vitamin C or E.

Conversely, test results may be falsely elevated in the following situations: untreated hypothyroidism, after surgical removal of the spleen, Iron deficiency, vitamin B12 deficiency, reduced red blood cell production by the bone marrow, chronic alcoholism, chronic kidney disease.

If there is a question about the reliability of the test results, other means of testing may be considered, such as the fructosamine test.

Hemoglobin A1c	Blood Sugar
A1c	(mg/dL)
4%	60
5%	90
6%	120
7%	150
8%	180
9%	210
10%	240
11%	270
12%	300
13%	330

What can I do if my hemoglobin A_1C results are high?

While it is important to keep blood sugar levels from being too high, it is also important not to risk frequent or severe episodes of dangerously low blood sugar levels. You and your doctor will evaluate your situation to determine which of the following factors may be playing a role:

• Too little exercise
• Inadequate medication type or dosing
• Too much food
• Wrong types of food
• Increased stress
• Infection

The hemoglobin A_1C test provides you with more information to maintain good management of your diabetes. Better control means a longer, healthier life. And any positive change in your care, no matter how small, makes a difference. For example, each 1% decrease in the hemoglobin A_1C reduces the risk of eye and kidney damage by 37% and reduces the risk of diabetes-related death by 21%. The more you are involved with your health care, the greater the likelihood of living a longer and healthier life.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.

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