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I am betting/hoping some people here can explain A1C testing better than my doctor…
I understand that A1C is a measurement of how much glucose is attached to hemoglobin. It’s a percentage. So if the score is 7, does that mean that 7% of the hemoglobin has glucose? That doesn’t seem so bad..if the vast majority, 93% doesn’t!
And my understanding is that once glucose sticks to hemoglobin, it stays until the hemoglobin cell dies, in approximately 90 days. So, it seems like if you gave a spike just one time in three months, you will have a high A1C because that glucose is still there.i have been trying to exercise after eating, to bring down BS, but is futile if that glucose is there and not going to go away?
A hemoglobin A1c (aka HbA1c or A1c) level of 5 is considered optimal. An A1c of 5.0 means that 5% of the hemoglobin in your blood is saturated with sugar. A1c levels between 4 and 5.6 percent indicate good blood glucose control over the last 2-3 months.
intense exercise drives up my sugar levels .
i can wake up. at 140 .. run 3-1/2 miles and be 160-170 .
same from my weightlifting but not as high .
the body dumps a lot of glycogen with intense exercise in to the blood .
walking will bring me lower but not any intense exercise, which has the opposite effect on me.
i am on trulicity 4.5 mg , one shot a week.
a1c is higher then i had when on old school glympride but my endocrinologist who is head of endocrinology at one of new yorks top tier hospitals says the medical profession is accepting higher a1c numbers on the new GLP -1 drugs .
they are very protecting of the organs diabetes like to attack . so 6.7 , 6.8 is like the old 6.1
you also can’t go to low with the new shots like with the older drugs like metformin or glympride
Last edited by mathjak107; 04-26-2024 at 06:46 AM..
Hb of course is found in RBCs, and those live for about 3 months before being cleared out by your spleen....As those cells float around your circulation they bump into glucose molcules that stick to the Hb. The more glucose they encounter, the more that sticks and the higher the measurement.....HbA1c of 6% correlates with an average BS level of less than 120mg%, while 7% correlates with an average BS of about 160mg%.....
I like to give an analogy of hanging a sweater in the middle of the room and seeing how much lint has collected on it after three months.....But you're right about variable BS levels-- If our sweater has collected X lb of lint in 90 days, we assume it collected X/90 lb every day....but it might have collected all X lb in one big dust storm on just one day.....
For most people, BS are consistent enough from day to day to make HbA1c levels useful...A well controlled diabetic who caves in and eats a 5lb box of Fannie May's in one day is not going to appreciably change his A1c ....That's why I always told pts (and so many OCD readers here) not to obsess over elevated post prandial BSs-- it's just not that important and doesn't affect the HbA1c to any great degree...
Plenty of research shows that complications of DM (MI, CRF, stroke) are improved when HbA1c is held to 7%, but no further benefit is seen in the literature with lower levels (risk of Diabetic retinopathy may be improved with lower levels).
Because those RBCs last 90 days there's no sense in repeating A1c levels any more than once in three months...Doing one in less than 90 days means you're just over-lapping the periods so you can't properly evaluate change.
You aren't seeing the dynamic aspects of glucose going up and down and old red blood cells dying and new ones that haven't been exposed to high glucose levels being created every day.
Adults can have different types of hemoglobin starting off with hemoglobin F in babies which changes as they grow to hemoglobin A1 and A2. The A1 comprises about 97% of the hemoglobin content and the rest A2. People can have genetic mutations of hemoglobin that can alter the percentage and mess up the A1C which is glycosylated hemoglobin. The percentage of A1 hemoglobin of any given individual is one variable.
The second variable is the dynamic red blood cell mass that is supported by the 120 day average survival of individual red blood cells. That obviously impacts a "90 day" average. Think of red blood cells like individual trees with each having tree rings based on daily rainfall. The older the tree the more yearly rings one will see. The more rings mean the tree is older and older red blood cells will proportionately have higher glycosylated hemoglobin content. Older red blood cells like older trees are also more fragile and get destroyed more readily. Hemolytic anemias will drastically erroneously alter the A1C percentage invalidating the A1C reading because older cells die off quicker.
One speaks of the 90-day average that A1C is based on but in reality, it isn't that simple as it is really skewed slightly more towards the last month than the previous 90 days. The last month is comprised of younger red blood cells.
The correlation between A1C levels and disease was established by trying to detect early complications of diabetes with that being retinopathy. It was an epidemiological clinical cutoff setting. That value also varies based on genetics and may differ among different ethnic groups with some having a lower value and others having a higher value of A1C before complications are seen. Recent studies also questioned whether retinopathy was an appropriate indicator of renal damage or other symptoms. That is when urine microalbumin testing came about.
People can't relate to A1C numbers which is true in your case and so Average Daily Glucose was thrown out there for people to be able to relate to.
A hemoglobin A1c (aka HbA1c or A1c) level of 5 is considered optimal. An A1c of 5.0 means that 5% of the hemoglobin in your blood is saturated with sugar. A1c levels between 4 and 5.6 percent indicate good blood glucose control over the last 2-3 months.
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Jeez, I just got an A1C reading of 5.8 and my doc wants to put me on meds -- and she is a DO. And 5.6 is normal!? I've asked for a 6 month reprieve to bring it down on my own. There's no baseline reading so I don't know if I'm trending in the right or wrong direction. Guess I'll have to eliminate everything tasty until after Thanksgiving. Fun.
Jeez, I just got an A1C reading of 5.8 and my doc wants to put me on meds -- and she is a DO. And 5.6 is normal!? I've asked for a 6 month reprieve to bring it down on my own. There's no baseline reading so I don't know if I'm trending in the right or wrong direction. Guess I'll have to eliminate everything tasty until after Thanksgiving. Fun.
Hb of course is found in RBCs, and those live for about 3 months before being cleared out by your spleen....As those cells float around your circulation they bump into glucose molcules that stick to the Hb. The more glucose they encounter, the more that sticks and the higher the measurement.....HbA1c of 6% correlates with an average BS level of less than 120mg%, while 7% correlates with an average BS of about 160mg%.....
I like to give an analogy of hanging a sweater in the middle of the room and seeing how much lint has collected on it after three months.....But you're right about variable BS levels-- If our sweater has collected X lb of lint in 90 days, we assume it collected X/90 lb every day....but it might have collected all X lb in one big dust storm on just one day.....
For most people, BS are consistent enough from day to day to make HbA1c levels useful...A well controlled diabetic who caves in and eats a 5lb box of Fannie May's in one day is not going to appreciably change his A1c ....That's why I always told pts (and so many OCD readers here) not to obsess over elevated post prandial BSs-- it's just not that important and doesn't affect the HbA1c to any great degree...
Plenty of research shows that complications of DM (MI, CRF, stroke) are improved when HbA1c is held to 7%, but no further benefit is seen in the literature with lower levels (risk of Diabetic retinopathy may be improved with lower levels).
Because those RBCs last 90 days there's no sense in repeating A1c levels any more than once in three months...Doing one in less than 90 days means you're just over-lapping the periods so you can't properly evaluate change.
Just to the bold part. After having a Libre 3 for 17 months I highly disagree. If you only do it once in the 3 months before your blood test then yes I agree. From personal experience just one bad meal or a 2 donut breakfast once a week will make a difference. Now if you still only have 2 or 3 bad meals/treats per week it will significantly raise you A1c level in my personal experience.
As a real example my A1c was 6.4 two tests ago. Last test was up to 6.9 from just 1 or 2 bad meals per week. It takes days of being slightly below normal to make up for a huge few hour spike from a bad meal, silly snack, or even a single soda.
If you are on meds it could be different for you. I have to be crazy strict to get a A1c of 6.4 since I am not on any meds.
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