Ha1C has become a standard blood test to look at the body’s sugar regulation. But what is it? Imagine a red blood cell with little antennas (called glycoproteins) sticking out of it. As the cell travels through the bloodstream, these antennas attach to sugar that passes by. Since the lifespan of a red blood cell is approximately 120 days and the sugar-sticking-on process is irreversible, these red blood cells can be examined to see how much glucose is in the bloodstream over 120 days. (In technical terms, glucose combines with hemoglobin to produce glycosylated hemoglobin.)
Healthy HA1C values should be between 4.9 and 5.6 since most of the sugar should be taken into the cells rather than stay in the bloodstream. With elevated blood sugar levels, the amount of glycosylated hemoglobin increases. Lower values, on the other hand, mean that the body may have had problems with either the supply of or the processing of sugar.
Are there things that affect this reading?
I have found that even those folks with “normal” HA1C levels still report symptoms related to blood sugar issues. This is why it is important to look at signs and symptoms as well as the test data—then you’ll get the whole picture. Since HA1C just gives you an average value over a period of time, during some of those periods you may be high while other times you’re low, causing you to experience symptoms of both while averaging a “normal” value.
Also, the HA1C test is based on the fact that your blood cells live for 120 days. In a study published in the 2004 Diabetics Journal, researchers found that the lifetime of hemoglobin cells of diabetics could be as little as 81 days, while in non-diabetics, they survived longer—up to 146 days. Therefore, a person with normal blood sugar has their hemoglobin in the bloodstream for longer period of time, which may allow more sugar to accumulate. The result? Higher HA1C levels.
Another condition which may affect hemoglobin HA1C values is oxygenation issues. Just like diabetics, folks with certain types of anemias may have short-lived red blood cells, which may have falsely effect HA1C levels. For example, a client tested for very high HA1C. His doctor told him to quit eating sugar. Now, this guy eats better than anyone I know, exercises on a daily basis, and laughs frequently…sugar consumption for him is not the issue. Turns out he carries genes which cause him to have a high amount of very small red blood cells. Just for fun, he tested his blood sugars for a full week and saw no dysregulation that would relate to high HA1C.
According to the Mayo Clinic, the following may also affect HA1C readings:
- If you experience heavy or chronic bleeding, your hemoglobin stores may be depleted. This may make your HA1C test results falsely low.
- If you have iron-deficiency anemia, your HA1C test results may be falsely high. A substance called malondialdehyde enhances the glycation of hemoglobin.
- Most people have only one type of hemoglobin, called hemoglobin A. If you have an uncommon form of hemoglobin, your HA1C test result may be falsely high or low.
- If you have had a recent blood transfusion or have other forms of hemolytic anemia, test results may be falsely low.
Dr. Ron Grisanti, DC, found that a major cause of unregulated glycosylated hemoglobin is an unrecognized B6 and zinc deficiency. Additionally, according to the NPR article, “The A1C Blood Sugar Test May Be Less Accurate In African-Americans,” African-Americans may have misleading A1C levels: “About 4 percent of the people in the study who carried the sickle cell trait were diagnosed with diabetes, but they expect a test corrected for bias would have identified about 7 percent—nearly twice as many people.”
Are there any other tests?
Therefore, it is important to look at glucose, HA1C, fasting insulin, lipid markers, etc. to get a good idea of how your body is handling blood sugar.
Another useful blood sugar test is called fructosamine. It is a compound that results from a reaction between fructose and ammonia. Fructosamine measures blood sugar levels during the previous 2 to 3 weeks and is not affected by the length of a red blood cell lifespan.
According to Johns Hopkins, “Consider [monitoring glycated albumin] in patients with patient visits less than one month apart. Because the half-life of albumin and other serum proteins is shorter than that of hemoglobin, concentrations of fructosamine and glycated albumin will change more rapidly than HbA1c and can serve as an index of intermediate-term glycemic control.”
Finally, some practitioners use glycated insulin or Glycomark due to its short half-life.