Glycated hemoglobin (HbA1c) is a form of hemoglobin which bonds slowly and spontaneously with sugar. Because of this combination non-enzymatic and irreversible, Glycated hemoglobin (HbA1c) has good stability and is not affected by the occasional increase or decrease in blood sugar. Since life span of a red blood cell is about four month (individual red blood cells have varying lifespans), the percentage of hemoglobin bound to sugar in the blood to the total hemoglobin reflects patient’s average blood sugar level in the past three months. Therefore, the measurement of HbA1c could be used for diabetes diagnostic or evaluating the control of glucose of diabetes patients.
What is normal HbA1c for diabetics?
Glycated hemoglobin is not affected by daily blood sugar fluctuations, exercise or food, and is one of the main indicators reflecting the level of long-term blood sugar control. Generally, the normal reference range of glycated hemoglobin (HbA1c) is 4% to 6.5%. For diabetes patients, an ideal HbA1c level is 7% or below, but individual difference should also be taken into consideration. If HbA1c maintains at 7% to 8%, that means blood glucose control is normal, 8% to 9% indicates that the control is not satisfactory, in that situation, patients should pay more attention to diet and exercise, or adjust treatment plan under the guidance of the doctor. If Glycated hemoglobin > 9%, there may be a risk factor for the development of chronic complications.
- HbA1c<7%: Suitable for most adults with type 2 diabetes (except pregnant women).
- HbA1c<6.5%: Suitable for young, uncomplicated, and long life expectancy patients with type 2 diabetes.
- HbA1c<8.0%: Suitable for diabetic patients with a history of severe hypoglycemia, short life expectancy, significant microvascular or macrovascular complications, or severe comorbidities and a long course of diabetes.
At what HbA1c diabetes is diagnosed？
HbA1c can be taken as one of the diagnostic criteria for diabetes, but it’s only aimed at type 2 diabetes. There are two kinds of diabetes, namely type 1 diabetes and type 2 diabetes.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a disease of the immune system. Abnormal immune behavior will attack the insulin-producing beta cells in the body, resulting in insufficient insulin to control blood sugar levels.
This disease usually occurs in childhood or adolescence. However, it could also happen to all ages throughout our life, especially menopause. The onset is generally rapid, with symptoms such as thirst, polydipsia, polyuria, polyphagia, fatigue and weight loss, and rapid weight loss. Some patients have ketoacidosis at the first episode. And type 1 diabetes will eventually be treated with insulin without exception, that why we called it insulin-dependent diabetes.
Most of patients are disturbed by type 2 diabetes, which develops usually after the age of 35-40. They may not lose completely the ability to produce insulin, some patients even have too much insulin. However, the effect of insulin is poor, it is in a state of relatively insufficient. Obesity and overweight may cause type 2 diabetes. Because body fat affects the blood sugar-lowering function of insulin, causing increase of body’s blood sugar, which can lead to illness. The early symptoms of such patients are not obvious, with only mild fatigue and thirst. However, some dangerous macrovascular and microvascular complications may occur. Diet therapy and oral hypoglycemic drugs are more effective. Some patients may still need insulin therapy in the later stage.
Limitation of HbA1c
- All children and young people
- Patients of any age suspected of having type 1 diabetes
- Patients with symptoms of diabetes for less than 2 months
- High-risk patients with acute illness (e.g. patients requiring hospitalization)
- The patient takes drugs that may cause a rapid rise in blood sugar, such as steroids, antipsychotic drugs, etc.
- Patients with acute pancreatic injury, including pancreatic surgery
- During pregnancy
- There are genetic, blood, and disease-related factors that affect HbA1c and its measurement
Besides, test of Glycated hemoglobin (HbA1c) is affected by many factors. For example, all the factors which influence life span of red blood cell will also impact test result. At the meantime, the HbA1c test results may have a “delay effect” on the evaluation of adjusted treatment and the diagnosis of new-onset diabetes patients. Besides, it cannot accurately reflect the risk of hypoglycemia in patients, nor can it reflect the characteristics of blood glucose fluctuations.
How can I lower my HbA1c quickly?
First of all, we should know that HbA1c reflects the blood sugar level in a long-term, about three months. Therefore, we couldn’t lower it immediately. High level of glycosylated hemoglobin is very harmful to the body. The most obvious harm is the rapid increase in blood sugar, and even in an imbalanced state, there is a very high possibility of suffering from diabetes or hyperinsulinemia. These diseases complications are quite numerous, and some of them are fatal. Therefore, you should try to lower the blood sugar as soon as possible by taking the hypoglycemic drugs. At the meantime, you can change adjust your diet and lifestyle.
Some people with high glycated hemoglobin may have normal blood glucose. At this time, you don’t need to control the intake of staple foods. Your own blood sugar regulation can restore glycated hemoglobin to normal values. However when the high glycated hemoglobin occurs, you’d better drinking plenty of water every day and stopping smoking and drinking.
For all the diabetics, they should strictly control the intake of sugar foods, and remember not to eat too much food with too high sugar content, which will make their blood sugar rise rapidly. And then, appropriate exercise is helpful for them to avoid obesity and to control blood sugar level. What is also important, it’s to monitor blood sugar level in the daily life and use oral hypoglycemic drugs or insulin under the guidance of a doctor for hypoglycemic therapy.
What fruit should diabetics avoid?
The fruits that diabetics can’t eat are those with particularly high sugar content, including lychees, longans, custard apples and some tropical fruits, such as durian, mango, and pineapple. Although these fruits are very nutritious, they have too much sugar that the blood sugar of diabetics may arise quickly. With good control of blood sugar and kidney function, diabetics can consume low-sugar fruits between meals. Pitaya contains high dietary fiber, low sugar and calories, and is suitable for diabetic patients with high blood fat and high uric acid. The pectin in apples can prevent hyperlipidemia, and high dietary fiber can prevent large fluctuations in blood sugar after a meal. Oranges contain less sugar and have a lower glycemic index, which can prevent diabetes complications. No matter what kind of fruit it is, it should be eaten scientifically. The daily nutritional intake is based on the daily nutritional ratio. Most fruits can be eaten by diabetics.
What is a good breakfast for a prediabetic?
Prediabetic refers to those who are suffering from hyperglycemia and hypoglycemia and those who have a problem in glucose metabolism, but it does not meet the diagnostic criteria for type II diabetes. Some patients may think skipping breakfast can prevent blood sugar from rising, but in fact, it’s totally wrong.
For the breakfast, eat more whole grains as a staple food is helpful for stabilizing glucose, like whole wheat bread, oats, millet, corn and other cereals. It is recommended that prediabetic eat about 120 grams of whole grains a day. The rich dietary fiber can delay the absorption of glucose and make blood sugar more stable after a meal. High-quality protein foods such as chicken breast, fish and shrimp, eggs, and milk could extend digestion time, but don’t eat too much. It can effectively prevent the occurrence of hypoglycemia between meals. Besides, according to perspective of balanced nutrition, breakfast needs to be paired with vegetables. Because vegetables are rich in dietary fiber and nutrients needed by the human body. Eating about 100 grams of green leafy vegetables for breakfast will make the nutrition more balanced and make blood sugar more stable.
Appropriate breakfast will play an important role in the daily life for the management of glucose.
Diabetes is not a single disease, it may cause a series of complications, such as retinopathy, nephropathy, cardiovascular disease, neuropathy, etc. Therefore, we should pay more attention to value of glycated hemoglobin (HbA1c) which is gold standard of diabetics diagnosis. Nowadays, there are convenient equipment which are ponit-of-care products (POCT), with their help, we are able to obtain HbA1c testing result within minutes, and to monitor easily situations of patients in the last three months.
References
[1] World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2 ed. Geneva, World Health Organization, 1999 Available from: https://www.who.int/diabetes/publications/report-hba1c_2011.pdf
[2] Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016;11:95-104. Published 2016 Jul 3. doi:10.4137/BMI.S38440. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933534/