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Diabetes and Hemoglobin A1C
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Diabetes and Hemoglobin A1C

Hemoglobin A1C (HbA1C or A1C) is a simple blood test that measures the average blood sugar levels over the past 2- 3 months. Because it is an average over several months, you do not have to be fasting when you get you blood drawn to check it.  It is one of the commonly used tests to diagnose prediabetes (sometimes called insulin resistance), as well as type 1, and type 2 diabetes. It is also the main test used to help manage diabetes. If you have diabetes or prediabetes, your healthcare provider will likely order this test every three to six months depending on how your blood sugar is doing. 

What is an A1C? When sugar enters the bloodstream, it attaches to hemoglobin — the protein in red blood cells that carries oxygen. Everyone has some sugar attached to the hemoglobin (called glycosylated hemoglobin); however, people with higher blood sugar levels have more. The A1C test measures the percentage of the hemoglobin that is coated with sugar. The more hemoglobin that is coated with sugar, the higher the A1C will be. The higher the A1C, the more dangerous the blood sugar becomes. Controlling your blood sugar lowers the A1C and lessens the danger.    

 A normal A1C level is at or below 5.6 %. A level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing diabetes. Higher A1C levels are linked to diabetes complications including vision troubles or blindness, kidney problems and failure, heart attacks and circulation problems, and nerve problems including numbness of the toes and feet.   The goal for most people with diabetes is an A1C of 7% or less. However, your personal goal will depend on many things such as your age and other medical conditions. Ask your healthcare provider to help you set a personal goal. 

There are several factors that can falsely increase or decrease A1C results: 1) kidney and liver disease as well as severe anemia, 2) certain medications, including opioids and some HIV medications, 3) blood loss or blood transfusion, and 4) early or late pregnancy. 

The American Diabetes Association (ADA) recommends that everyone 45 years of age and older have the A1C test as a method for screening for blood sugar problems. If results are normal, the A1C can be repeated every three years. If results are suggestive of prediabetes, the A1C should be checked at least annually. For those who were diagnosed with diabetes during pregnancy (called gestational diabetes) that resolved after the baby was born, there is a recommendation to be tested every three years thereafter to make sure you do not develop diabetes in the future. . 

For those who are overweight or obese and have one or more of the risk factors for developing type 2 diabetes, the recommendation is to have the A1C tested as part of an annual medical exam. Typical risk factors include: a parent or sibling with diabetes, being physically inactive, having high blood pressure, having high triglycerides or a low HDL, having a history of heart disease, or being a member of a high-risk ethnicity, including Native American, African American, Latino, or Asian American. 

Ask your healthcare provider if you should be screened for blood sugar problems. Early treatment will postpone or even eliminate potential complications from having a high blood sugar. 

Zuzana Fletcher, is a Nurse Practitioner Specialist at the Pocatello Health West Clinic.  She graduated with honors in 2013 and has more than 6 years of diverse experience in her field. 

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