What If My Hba1c Is Normal But My Glucose Is Above Optimized
Sleep deprivation
Theres evidence that poor sleep patterns impair glucose metabolism. People on restricted sleep demonstrate worsened insulin response to food, resulting in higher blood glucose spikes. In one study, sleep-deprived people had higher glucose and insulin levels after consuming breakfast compared to those who slept a healthy eight hours. Other studies confirm this findinginsulin resistance is more common in people deprived of sleep.
Stress
The body releases a steroid hormone called cortisol to activate our “flight-or-fight” responses to counteract acutely stressful situations. Cortisol stimulates the release of blood glucose by breaking down its storage form, glycogen. If youve experienced a stressful week, good chances are your blood sugars may be slightly higher than normal.
Food
Because glucose fluctuates after meals, we recommend fasting for a full 12 hours prior to getting a blood test for an accurate reading. This means water only, not even black coffee. People react differently to coffee so we suggest to err on the side of caution and stick to just water.
Sometimes The Test Isnt Accurate And Heres Why:
- If you are bleeding a lot, the protein in your red bold cells may be low, so it could say your A1C is lower than it actually is.
- If youve just had a blood transfusion or have other forms of hemolytic anemia, your A1C test results may be lower than it actually is.
- If you are low in iron in the blood, your A1C test results may be higher than it actually is.
- If you have a special hemoglobin . Most people have Hemoglobin A. With the variant, you can be falsely high or low. A lab test can be done to see which one you are and special lab tests can then give you an accurate A1C.
- A new lab can give different results as well. Keep this in mind if your results were sent away to a new facility. It could account for minor reading variations.
What Is A1c And Why Is It Used
A1c estimates a persons average blood sugar levels over a 2 to 3-month span. It is the best measure we have of how well blood glucose is controlled and an indicator of diabetes management.
Though A1c doesnt provide day-to-day information, keeping A1c low has been proven to lower the risk of microvascular complications like kidney disease , vision loss , and nerve damage . The relationship between A1c and macrovascular complications like heart disease is harder to show in clinical trials, but having high blood sugar is a major risk factor for heart disease.
A1c is usually measured in a lab with routine blood work, or with a countertop machine in a doctors office using a fingerstick.
A1c measures the quantity of glycated hemoglobin, which refers to sugar attached to a red blood cell protein called hemoglobin. The number is reported as a percentage of the total hemoglobin in the blood. If a person consistently has higher blood glucose levels over time, A1c levels go up because more red blood cells are coated with sugar. The test is representative of a 2 to 3-month average because once a red blood cell becomes coated with sugar, the link is irreversible. It is only when the red blood cell is “recycled” that the sugar coating disappears.
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How Often Should You Check Your Hemoglobin A1c Levels
The American Diabetes Association suggests that if people with diabetes want to reduce their hemoglobin A1c levels quickly, they should get their hemoglobin A1c levels checked every three months until they reach their treatment goals.
People with diabetes who are meeting treatment goals and have stable blood control are recommended to check their hemoglobin A1c every six months according to the ADA.
Tracking hemoglobin A1c levels allows an individual and their healthcare professional to determine how well the person is controlling their blood sugar levels over time. However, they are not a substitute for daily glucose monitoring.
Advantages Of Hba1c Over Other Blood Glucose Tests
- The HbA1c test can be taken at any time and does not require fasting .
- It is unaffected by physical activity or stress prior to testing .
- As a marker of long-term blood sugar levels, it is unaffected by short-term hormonal surges .
- As a test, HbA1c has a low variability, both when measured in a single individual, and among people .
- HbA1c is more stable than glucose at 37°C .
- Symptomatic patients can be tested immediately at the same visit, saving costs .
However, some health conditions that affect red blood cells and hemoglobin can falsely increase or decrease HbA1c levels .
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What Tools Are Available If An A1c Test Is Not Accurate Or Sufficient
Besides A1c tests, the most common measures of blood sugar are the oral glucose tolerance test , CGM, and self-monitored blood glucose tests.
The OGTT is a diagnostic tool diabetes and prediabetes, assessing a persons response to consuming a fixed amount of sugar. After taking the sugar drink, blood sugar levels are measured two hours later. Below 140 mg/dl is considered normal, between 140 mg/dl and 200 mg/dl points to prediabetes or impaired glucose tolerance, and above 200 mg/dl indicates diabetes. It is not useful for tracking diabetes management.
For those with established diabetes, CGM has the advantage of monitoring blood sugar levels consistently throughout the day , providing more detailed insight into time spent in-range, low blood sugars, and high blood sugars. Examples of CGM include:
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Senseonics implantable Eversense CGM
If CGM is not available, taking frequent fingersticks with a blood glucose meter when waking up, before and after meals, and before bed can also indicate when blood sugar levels are going low, high, and staying in range.
Hemoglobin A1c Not Reliable In Diagnosing Type 2 Diabetes
The test that doctors most often rely on to detect a persons risk for prediabetes and type 2 diabetesthe hemoglobin A1c blood testtoo often delivers a poor reading, thereby missing the diagnosis in nearly three out of four at-risk individuals,1 according to research presented at the Endocrine Society meeting in New Orleans, Louisiana.
The investigators compared the accuracy of the A1c test with the other screening method used to assess patients risk of diabetesthe oral glucose tolerance test to arrive at this startling conclusion.¹
The common use of the hemoglobin A1c test to screen for prediabetes and type 2 diabetes should be skipped in place of more reliable tests. Photo: 123rf
The A1c missed almost 73% of the people with diabetes in comparison to the oral glucose tolerance test, says Maria Mercedes Chang Villacreses, MD, a clinical endocrinology fellow at the City of Hope Diabetes and Metabolism Research Institute in Duarte, California, who introduced the findings at the annual meeting of the Endocrine Society but are considered preliminary until published in a peer-reviewed medical journal.
The A1c lab value represents a look back at average blood glucose levels over the previous three months. It has been commonly used to detect diabetes for the last decade. Unlike other tests, no fasting is needed before you have blood drawn to assess your A1c level, making it more convenient for people.²
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Blood Sugar Levels Chart
Below chart displays possible blood sugar levels . Units are expressed in mg/dL and mmol/L respectively. Additional topics: What is diabetes? How do you know if you have diabetes? How to test for diabetes? Why is it important to measure your blood sugar levels frequently? Diet for people with diabetes You can also download or print this chart by clicking here. Reference: American Diabetes Association, Additional topics: What is diabetes? How do you know if you have diabetes? How to test for diabetes? What is normal blood sugar level? Why is it important to measure your blood sugar levels frequently? Diet for people with diabetesContinue reading > >
What Do Your Fasting Blood Glucose And Hemoglobin A1c Levels Mean
Blood glucose serves as the primary energy source for our brain and body. Healthy blood glucose levels are therefore essential for maintaining overall health and longevity. Unfortunately, several factors including the Standard American Diet and a sedentary lifestyle can increase glucose beyond normal levels, and over time, result in prediabetes and type 2 diabetes. If undetected, consistently high glucose can lead to long-term health complications, including nerve damage, cardiovascular disease, and kidney failure. This article explains the two most common blood tests used to detect abnormal glucose levels and ways to properly regulate them.
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Why Doesn’t My Average Blood Glucose Match My A1c
So, you test your meter for accuracy and everything looks good. You take your average blood glucose and convert it to A1C using a table, calculator, or equation you find online. Then, you get your blood work done and learn that your actual A1C is not even close.
What is the deal? It turns out, the relationship between average BG and A1C isn’t as clear as most of us think.
After doing some research, I came across a couple of reasons why someone’s actual A1C may be higher or lower than expected.
Description Of Study Participants
In total, 16 studies fulfilled our inclusion criteria . The reviewed studies included 44,203 total participants and the follow-up interval averaged 5.6 years . Overall, the mean age among 15 studies reporting baseline age was 53.4 years . One study population was exclusively female and another was exclusively male other study populations were mixed and contained 69.0% female, on average. Mean baseline A1C and fasting plasma glucose among the studies were 5.2% and 5.4 mmol/l , respectively .
CHARM, the Candesartan in Heart Failure-Assessment of Reduction in Mortality and Morbidity FBG, fasting blood glucose F/U, follow-up FPG, fasting plasma glucose IGT, impaired glucose tolerance NR, not reported OGTT, oral glucose tolerant test per., percentile 2-h PG, 2-h plasma glucose.
Ten studies reported that A1C was measured by high-performance liquid chromatography, three used other methods, and three did not provide information about A1C measurement. A1C values in three studies were standardized by the NGSP, one by the International Federation of Clinical Chemists, and another by the Swedish MonoS Standard. The A1C values standardized by the Swedish MonoS Standard were very low and covered a very narrow range and we did not use data from this study for statistical modeling.
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Medications With A1c Of 55
Most doctors wont prescribe diabetes medication for someone with an A1c of 5.5. However, they may recommend lifestyle changes, particularly if other risk factors are present.
Already on medication to manage your diabetes? If so, congratulations on getting your blood sugar under control. We know its not easy.
Stay on target and keep an eye on your blood sugar by testing your blood sugar at home. There are a variety of affordable blood glucose monitors available.
Talk to your doctor about whether an A1c of 5.5 is the optimal level for you and if dosage or injection adjustments are necessary.
The Rate That Glucose Attaches To Hemoglobin Can Vary Significantly From Person To Person
For some people, glucose attaches to hemoglobin very quickly. So even if their average blood glucose is 154 mg/dL , their actual A1C may 8% or even higher.
For others, glucose attaches to hemoglobin very slowly, and for the same average glucose of 154 mg/dL, they may have an actual A1C value in the 6% range or lower.
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Study Selection And Data Abstraction
We searched for published, English language, prospective cohort studies that used A1C to predict the progression to diabetes among those aged â¥18 years. We included studies with any design that measured A1Câwhether using a cutoff point or categoriesâand incident diabetes. Titles and abstracts were screened for studies that potentially met inclusion criteria, and relevant full text articles were retrieved. X.Z. and W.T. reviewed each article for inclusion and abstracted, reviewed, and verified the data using a standardized abstraction template. If A1C measurement was standardized by the National Glycohemoglobin Standardization Program and both standardized and unstandardized A1C values were reported, standardized values were used in the analyses. A sensitivity analysis, however, was conducted using both standardized and unstandardized A1C values. Relative measures of diabetes incidence including relative risk, odds ratio, hazard ratio, likelihood ratio, and incidence ratio were examined and cumulative incidences were converted to annual incidences . In studies reporting no measure of relative incidence, the incidence ratio was estimated as the absolute incidence in each A1C category divided by the incidence in the lowest A1C category.
How To Lower Hba1c And Blood Glucose Levels
Adopt a more vegetarian diet, including beans & nuts
Vegetarian diets are inversely associated with the risk of developing type 2 diabetes. In a meta analysis comparing nine different experiments, researchers found that vegetarian diets consistently improved fasting blood glucose and HbA1c. Why? They generally emphasize a diet rich in whole grains, fruits, vegetables, beans, and nuts, and lower levels of saturated and trans fat. Plus, beans often replace meat in these diets by acting as a protein source. Thanks to their high fiber content and low glycemic index , beans stabilize blood glucose and insulin levels. So individuals with type 2 diabetes may notice significantly lower A1c levels if they increase their bean intake to at least one cup per day. Similar to beans, nuts are low glycemic and help regulate blood sugar levels. In a recent experiment, people who replaced some of their food with a serving of nuts saw improved glycemic control and HbA1c levels. On a grander scale, eating nuts has an inverse association with type 2 diabetesthat is, people who include nuts in their daily lives tend to have a lower risk of developing diabetes.
Exercise
Exercise is a crucial component in managing glucose and insulin levels. It directly improves blood glucose control, increases insulin sensitivity, and helps maintain a healthy weight. Exercise is a very effective tool in preventing the development of type 2 diabetes.
Practice mindfulness
Prep more meals at home
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How Often Do You Need The Test
Your doctor probably will have you take the A1c test as soon as youâre diagnosed with diabetes. Youâll also have the test if your doctor thinks you may get diabetes. The test will set a baseline level so you can see how well youâre controlling your blood sugar.
How often youâll need the test after that depends on several things, like:
- The type of diabetes you have
- Your blood sugar control
- Your treatment plan
Youâll probably get tested once a year if you have prediabetes, which means you have a strong chance of developing diabetes.
You may get tested twice each year if you have type 2 diabetes, you don’t use insulin, and your blood sugar level is usually in your target range.
You could get it three or four times each year if you have type 1 diabetes.
You may also need the test more often if your diabetes plan changes or if you start a new medicine.
Itâs not a fasting test. You can take it any time of day, before or after eating.
People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements, such as vitamins C and E, and high cholesterol levels. Kidney disease and liver disease may also affect the test.
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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 app’s dashboard. Glucose in mg/dL: A1c = / 28.7 Glucose in mmol/L: A1c = / 1.59 So, for example, if your average blood glucose level in the past 3 months is 130 mg/dL , your estimated A1c is 6.15%. There are also cheaper devices you can buy that will allow you to do the actual A1c tests yourself, like this one. If you need to do these tests more often, say every month, then it could save you money in the long run as lab tests could get expensive. It may not be as accurate as the lab tests, but my guess is it’s probably good enough.Continue reading > >
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Why The A1c Sucks
The A1c has been around for a zillion years and is supposed to give people with diabetes and their healthcare professionals an idea of what the average glucose value has been over the prior two to three months.
For example, an A1c of 7% would equate to an average glucose value of 154mg/dl .
The A1c has been an important test since most folks with diabetes cannot be pricking their fingers every five minutes, 24 hours a day for three months and then just take the average. They would need a blood transfusion on a weekly basis! I will come back to the role of CGM a little later.
Why does the A1c suck?
The A1c sucks because it does not tell you anything about the fluctuations in your glucose values throughout the day and night, which is extremely important. If your A1c is high, you know your glucose is on the higher side in general, but you still can have serious, unrecognized low values and would never know it. On the other hand, if your A1c is low, you are probably having a lot of lows but with no clue what time of day, and be fooled since you are at goal with an A1c below 7%.
You may also get spurious results if you are African American or pregnant . If you are anemic from kidney disease or other chronic illnesses, the A1c may be artificially low. Sometimes we just cannot figure out why the A1c does not match home or continuous glucose monitoring results.
This is my famous quote so pay attention:
And now we can do it with CGM devices .