“I just had my AC1, no, AC something….oh, what’s it called”. It’s that 3 month test that does not lie; I think it needs to be below 7. I don’t know what that means, but I am concerned because my doctor says it was high. Can you help me?”
…said one of my patients to me in exasperation. He was more confused at the end of his explanation than he began and he is not alone. People living with diabetes are constantly tracking their numbers and aiming for moving targets. Things get confusing and complicated, making it tempting to throw in the proverbial towel and give up any attempt at managing diabetes. Let us take a closer look at “the test that does not lie”.
So what is the A1C test? Here are some fast facts:
The A1C test is sometimes called the glycohemoglobin or hemoglobin A1C test. Glyco refers to sugar and hemoglobin is the oxygen carrying protein in red blood cells. It is an important tool which, along with your (finger-stick) blood sugar results, helps you and your health care provider monitor your progress over a 3-4 month window. Doctors use the A1C test to determine your risk factor for developing serious complications such as heart disease, eye disease, and foot infections which may result in amputation.
The A1C test does not fluctuate do to immediate changes in diet, exercise, or medications. Conversely, finger-stick test you perform at home is a snapshot of your blood sugar at that exact moment. The A1C is like a long-exposure photograph. Everyday blood sugars vary at different times of the day; eating, exercise, and medications cause your blood sugar levels to fluctuate throughout the day.
The A1C test indicates the percentage of hemoglobin that is glycated (coated with sugar). On average 4-6% of hemoglobin are coated with sugar, the higher the blood sugar the thicker the sugar glaze. Red blood cells have a lifespan of 3-4 months. Older, glycated, cells are replaced by fresh red blood cells that are not glycated. This is why the A1C test is often called the test that does not lie: it focuses on your blood sugar levels for the entirety of the past 3 to 4 months.
What should your A1C be?
Health care providers are taking a more patient-centered approach when they look at targets such as A1C, blood pressure, and other lab values. Previously an A1C below 7% was the target for most people with diabetes. However, studies over the past 3-4 decades show targets should not be uniform, one-size-fits-all. Factors like age and life expectancy now play a major role in determining targets. Younger people with a long history of diabetic complications would benefit from a more aggressive treatment and strict targets than an older individual newly diagnosed with diabetes. Studies also show strict control in seniors increases their risk for hypoglycemia (low blood sugar).
The American Diabetes Association states A1C results between 4-5.6% indicate normal blood sugars; 5.7-6.4% indicate pre-diabetes and A1C results over 6.5% indicate diabetes.
So take charge today; get to know your A1C like you know your home address and get on the road to better health and better blood sugar control.