How The Test Works
The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.
Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.
If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.
Can The A1c Test Result In A Different Diagnosis Than The Blood Glucose Tests
Yes. In some people, a blood glucose test may show diabetes when an A1C test does not. The reverse can also occuran A1C test may indicate diabetes even though a blood glucose test does not. Because of these differences in test results, health care professionals repeat tests before making a diagnosis.
People with differing test results may be in an early stage of the disease, when blood glucose levels have not risen high enough to show up on every test. In this case, health care professionals may choose to follow the person closely and repeat the test in several months.
Facts And Definition Of Hemoglobin A1c
- Hemoglobin A1c, often abbreviated HbA1c, is a form of hemoglobin that is bound to glucose.
- The blood test for HbA1c level is routinely performed in people with type 1 and type 2 diabetes mellitus.
- Blood HbA1c levels are reflective of how well diabetes is controlled.
- The normal range for level for hemoglobin A1c is less than 6%.
- HbA1c also is known as glycosylated, or glycated hemoglobin.
- HbA1c levels are reflective of blood glucose levels over the past six to eight weeks and do not reflect daily ups and downs of blood glucose.
- High HbA1c levels indicate poorer control of diabetes than levels in the normal range.
- HbA1c is typically measured to determine how well a type 1 or type 2 diabetes treatment plan is working.
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Oral Glucose Tolerance Test
The OGTT is a two-hour test that checks your blood sugar levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
- Diabetes is diagnosed at 2 hour blood sugar of greater than or equal to 200 mg/dl
Oral Glucose Tolerance Test
|140 mg/dl to 199 mg/dl
|200 mg/dl or higher
You Have Hemoglobin Type C D Or E
Did you know there were various variants of hemoglobin? Itâs not common to know your type, but if youâre wondering whatâs leading to elevated A1C levels, you may want to check. The most common is Hemoglobin A.
According to research by the government in British Columbia, Canada, there are 350 varieties. Type C, for example, doesnât carry oxygen very well, which can affect A1C levels. Then thereâs Type E, an inherited blood disorder most common among people of Southeast Asian descent. It can also record false high levels of A1C in your system. To find out what types you have, itâs a good idea to take a blood test called the hemoglobin electrophoresis test.
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Check Your Blood Sugar Levels As Your Doctor Has Directed
Work with your doctor to determine if, and how often, you should check your blood sugar. You may be tempted to pick up an A1C home testing kit, but Dowdell does not recommend doing that. As he mentions, day-to-day fluctuations in your blood sugar can be masked by an A1C result that is at your goal level. Instead, if you have a personal continuous glucose monitor, such as a Dexcom G6 or a Freestyle Libre , Dowdell recommends checking your time in range to see if you are at the optimal level. For many people that is 70 to 180 milligrams per decilter , according to ADA guidelines. Having your A1C checked by your healthcare provider every three to six months is sufficient, he adds.
Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C levels or what they mean, dont hesitate to ask your doctor.
Time In Range For Diabetes Management
Glycemic control, the process of properly managing your blood glucose, is a very important aspect of living with any form of diabetes. Hyperglycemia and hypoglycemia are two of the main challenges for people with diabetes, and controlling these fluctuations is crucial to reducing your risk for long-term complications like peripheral neuropathy, chronic kidney disease, fatty liver disease, high cholesterol, high blood pressure, and Alzheimers disease.
Most doctors use a standard measure called the hemoglobin A1c to measure your blood average over a 90-120 day period.
The A1c measures the percentage of hemoglobin in your blood that has been glycosylated. This provides doctors with an indicator of how much glucose has attached to hemoglobin over the course of the lifetime of hemoglobin molecules .
The higher the percentage, the more glucose has attached to hemoglobin, and the higher your average blood glucose.
The A1c test can also be used to diagnose diabetes, based on the following guidelines:
Image courtesy of the American Diabetes Association: https://www.diabetes.org/a1c
- If your A1c level is below 5.7%, you are considered at the lowest risk for prediabetes and type 2 diabetes.
- If your A1c level is between 5.7% and less than 6.4%, you may be diagnosed with prediabetes.
- If your A1c level is 6.5% or higher, you may be diagnosed with type 2 diabetes.
Monitoring your time in range allows you to determine a few key things that the A1c measurement does not directly measure:
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Reasons Your A1c Might Be High When Youre Not Diabetic
Are you worried youâre at risk of diabetes because of high blood sugar levels on your A1C test? Does your blood sugar spike even when youâre eating healthy foods like apples and pears?
While high blood sugar is a common sign of diabetes, itâs not exclusive to those with the health condition. In fact, people often encounter high levels even if they donât have a history of diabetes.
Stick To A Regular Schedule So You Can More Easily Follow Your Healthy Diet And Lifestyle
Skipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much, the ADA points out. This is especially true if you are taking insulin or certain diabetes drugs. Your doctor can help you determine the best meal schedule for your lifestyle.
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What Does A1c Stand For
Hemoglobin A1C , commonly called A1C, stands for glycosylated hemoglobin. An A1C test provides information on how well-controlled a persons diabetes is. It does this by measuring the percentage of red blood cell hemoglobin protein that has sugar stuck to it and provides a three-month average of your blood glucose levels, explains , MD, a board-certified endocrinologist at the Center for Endocrinology at Mercy Medical in Baltimore. The higher blood sugar levels are, the more glucose attaches to hemoglobin. The results provide patients and their healthcare providers with information on how well their treatment, diet, and medication is working and whether adjustments are necessary.
There are a few reasons a doctor might suggest an A1C test:
- To make a diagnosis of Type 2 diabetes
- To test for prediabetes
- To monitor blood sugar levels
- To determine if treatment adjustments are needed
The A1C blood test is not for diagnosing Type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases .
Setting The A1c Standard
A friend suggested that I contact the people who run the standardization program for A1C testing. This organization affiliated with the University of Missouri is the NGSP. Those initials used to stand for the National Glycohemoglobin Standardization Program. But now that the NGSP is international, they changed the name.
So I called Curt Rohlfing, the NGSP data manager and technical writer/research analyst at the University of Missouri. And finally hit pay dirt in my quest for learning what a normal A1C is.
Curt told me that every three or four years his lab at the university studies a group of people who don’t have diabetes to scientifically determine what a normal A1C level is. The results from one study to the next are always close, Curt told me. In their most recent study they tested 29 people who lived nearby in central Missouri.
I asked how they knew if the people they tested didn’t have diabetes. “Because we did fasting glucose tests on them, they had no prior history of diabetes, and none of them were obese,” Curt replied.
So what were their levels? They ranged from 4.5 to 6, Curt replied. That’s at plus or minus 3 standard deviations. I am certainly no statistician. But Curt tells me that it includes about 99 percent of the values.
The range is narrower — 4.7 to 5.7 — at plus or minus 2 standard deviations. This includes about 95 percent of the values.
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What Are Normal Blood Sugar Levels
Normal blood sugar levels vary based on when you last ate. For example, if you just ate a meal, your blood sugar levels will be higher than if you haven’t eaten in a while.
The normal blood glucose range is 70-99 mg/dL before meals, and less than 140 mg/dL two hours after eating. If you are fasting , your blood sugar should be below 95 mg/dL.
You Have High Triglyceride Levels
Your triglycerides are a type of fat in your blood, serving as an energy source for your body. Your body can convert energy it doesnât need to burn right away into triglycerides. It then uses them as an energy source between meals.
The NIH has found that A1C levels can be an indicator of your triglyceride count. If one is high, the other most likely is as well. This is especially true if your diet is high in added sugars.
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Start An Exercise Plan You Enjoy And Do It Regularly
Find something you enjoy doing that gets your body moving take your dog for a walk, play a sport with a friend, or ride a stationary bike indoors or a regular bike outdoors.
A good goal is to get 150 minutes of moderate exercise per week, recommends Jordana Turkel, a registered dietitian and certified diabetes educator at Park Avenue Endocrinology and Nutrition in New York City. This is also what the ADA recommends. Different types of exercise can lower your A1C by making the body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising, and to aim for two days of strength training.
Be sure to check with your healthcare provider before embarking on an exercise plan, though. He or she can come up with an individualized plan for you.
And if you monitor your blood sugar daily, check it before and after exercise. As the Joslin Diabetes Center at Harvard Medical School explains, exercise can cause your blood sugar to rise, as more is released from the liver, and blood sugar to fall, due to increase insulin sensitivity. Fluctuations in your blood sugar levels can result if you arent careful. This is particularly important if you are on insulin or another diabetes medication that causes insulin secretion, such as include sulfonylureas, such as Amaryl , and glinides, such as Prandin and Starlix .
What Are Normal Blood Glucose Levels In Healthy Individuals
Blood sugar levels can either be normal, high, or low, depending on how much glucose someone has in their bloodstream. Glucose is a simple sugar thats present in the bloodstream at all times. Normal blood glucose levels can be measured when someone fasts, eats, or after theyve eaten. A normal blood glucose level for adults, without diabetes, who havent eaten for at least eight hours is less than 100 mg/dL. A normal blood glucose level for adults, without diabetes, two hours after eating is 90 to 110 mg/dL.
Many factors affect blood sugar levels throughout the day:
- Type of food consumed, how much, and when
- Physical activity
- Menstrual periods
An ideal blood sugar level for anyone without diabetes or prediabetes, regardless of age, in the morning should be less than 100 mg/dL. Remember, blood sugar levels can fluctuate throughout the day as a result of the factors previously mentioned.
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How Is The A1c Test Used To Diagnose Type 2 Diabetes And Prediabetes
Health care professionals can use the A1C test alone or in combination with other diabetes tests to diagnose type 2 diabetes and prediabetes. You dont have to fast before having your blood drawn for an A1C test, which means that blood can be drawn for the test at any time of the day.
If you dont have symptoms but the A1C test shows you have diabetes or prediabetes, you should have a repeat test on a different day using the A1C test or one of the other diabetes tests to confirm the diagnosis.2
Who Should Get An A1c Test And When
Testing for diabetes or prediabetes:Get a baseline A1C test if youre an adult over age 45or if youre under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:
- If your result is normal but youre over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.
- If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
- If you dont have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.
- If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.
Managing diabetes:If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.
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Now That Youre Checking Your Blood Glucose What Do The Numbers Mean
Depending on your diabetes treatment plan, your doctor or diabetes educator may advise you to check once a week, once a day or up to 10 times a day . But what does it mean when you see a 67, 101 or 350 on your meter? And what is a normal blood sugar, anyway? Great questions! After all, if you dont know what the numbers on your meter mean, its hard to know how youre doing.
The American Diabetes Association provides guidelines for blood glucose goals for people with diabetes, and the goals vary depending on when youre checking your glucose:
Fasting and before meals: 80130 mg/dl
Postprandial : Less than 180 mg/dl
By the way, these guidelines are for non-pregnant adults with type 1 or type 2 diabetes. Children, adolescents and pregnant women may have different goals.
Your blood glucose goals may be different, however. If youre younger, have had diabetes for a shorter amount of time or are not taking any medicine for your diabetes, your glucose goals might be a little tighter, or lower. Likewise, your blood glucose goals may be higher than what ADA recommends if youre older, have diabetes complications, or dont get symptoms when your blood glucose is low.
Bottom line: talk with your health-care provider about the following:
When to check your blood glucose How often to check your blood glucose What your blood glucose goals are
What Is The Most Recent Ada Guidelines
There is a new guideline comprising an elevated A1c which can go up to 8.5 or even 9 for adult seniors 65 years of age.Whats the Big Deal with Higher Normal A1c Target?- Incorrect Diagnosis Can Lead to Complex SymptomsFor Diabetes, higher A1c target is a relaxing guideline. Because accomplishing 8 or 8.5-9ish is easier than achieving < 7%. < 7% needs more stringent glycemic control, and higher medication requirement. Using more than adequate medicines when not necessary may cause dangerous low sugar situation. In essence senior patients can be easily misdiagnosed and over treatment harm the body rather than improving. Realizing your normal A1c target range as a senior can help you mitigating the risks.
A1c Number Represents a Reliable and Offers Accurate Diagnosis of Diabetes:
1. They are repeatable2. It is convenient as it doesnt need fasting before the blood sample is withdrawn
American Diabetes Association offers < 7% A1c as the normal target for adults without diabetes.Aging Related A1c Increase With Non-Diabetes
Age in Years. A1c Mmol. Mg/ dL20-39. 6.0%. 42.1 12660 years. 6.5%. 47.5. 160
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A1c/average Blood Sugar Chart
A1c test results come out as percentages. According to the NIH, normal A1c levels are at or below 5.7%. An A1c level between 5.7% and 6.4% may indicate prediabetes, and an A1c level of 6.5% or higher may indicate diabetes. For example, if hemoglobin A1c 5.9% is your percentage, your doctor may diagnose you with prediabetes.
The NIH adds that your A1c level should be kept below 7% if you have diabetes. Your doctor will work closely with you to reduce your A1c to normal levels if they are too high and may recommend eating healthier foods and exercising regularly to help regulate your blood sugar.