What is an A1c and why does my doctor care about it so much?
An A1c gives you and your doctor a pretty accurate estimate of what your average blood glucose level was over the last 2-3 months.
Think of your A1c like your final grade in your high school math class, which is made up of daily quizzes over the course of the entire semester. Your quiz scores can vary from day to day, but your final grade tells of your overall success.
Much like your blood sugar scores that vary from day to day, your final A1c “grade” tells how you did, on average, over the last 3 months. Your A1c results gives you an idea of how well your diabetes treatment plan is working.
How Does The A1c Test Work?
Hemoglobin is a protein found in your red blood cells, whose job is to bring oxygen to all the cells of your body. When glucose enters your red blood cells, some of it links to the hemoglobin, making it permanent glycated. The more glucose there is, the more glycated hemoglobins are formed.
The A1c is essentially a percentage of how many hemoglobins have glucose attached to them. The American Diabetes Association recommends to have your A1c checked at least twice a year. I’d recommend every three months- so four times per year.
So what is a good A1c reading?
A normal A1c is below 5.7. Pre-diabetes is considered 5.7-6.4. Diabetes is when your A1c is above 6.5.
|Normal||below 5.7 percent|
|Prediabetes||5.7 to 6.4 percent|
|Diabetes||6.5 percent or above|
What is an eAG?
eAG stands for estimated average glucose. It is measured in the same units as your daily blood glucose with your glucometer. Since you’re used to seeing your blood glucose (aka blood sugar) readings on a daily basis, the eAG is a familiar way to see what your A1c is actually telling you. For example, an A1c of 7% means your estimated average glucose is 156mg/dL. An A1c of 10 means your eAG is 240.
What if I get a bad A1c reading?
The good news is, your body is making new red blood cells every day. So when you go in to get your next A1c reading in 3 months, you will have all new hemoglobin. One bad reading does not mean you are doomed. The fact that you’re still alive means you have another chance for the next A1c reading to be good.
What if I had a huge improvement in my A1c?
If you have a personal success story of dramatically decreasing your A1c in 3 months, please contact us to be featured on an upcoming Feature Me Friday.
OK, the blog post is over now.
But if you want to get technical, here’s a super in depth description of what an A1c reading means:
Everyone has blood coursing through their veins to keep them alive. Blood is made up of blood cells and plasma. The three types of blood cells are the red blood cells, white blood cells, and platelets. We care about the red blood cells for your A1c.
Red blood cells are made in the bone marrow and have an average life span of 100-120 days. Red blood cells contain a special protein called hemoglobin, which contains iron, whose main job is to carry oxygen throughout the body.
Hemoglobin (abbreviated Hb) has three different subtypes, HbA, HbA2, and HbF. Hemoglobin A makes up over 95% of all the Hemoglobin. Hemoglobin A is made up of three genes, HbA1, HbA2, and HbBB.
Meanwhile, everyone eats food (aka nutrients) to keep them alive. Any nutrient can be categorized as either a MACROnutrient or a MICROnutrient. The three main types of macronutrients are carbohydrates, proteins, and fats.
Carbohydrates can be classified as either simple (monosaccharides and disaccharides) or complex (oligosaccharides and polysaccharides). The three types of monosaccharides are glucose, fructose, and galactose. Glucose (aka sugar) circulates the body in the plasma.
Back to Hb A…
Remember Hemoglobin A? Well, glucose can attach to the HbA1 molecule, and once it does, it is permanently attached. This is called a “glycated hemoglobin,” which is denoted HbA1c. The more glucose that’s floating around in the plasma, the more likely it will attach to a hemoglobin, creating more and more HbA1c molecules.
The ratio of HbA1c molecules versus total hemoglobin molecules results in a percentage, known as your A1c level, usually ranging between 4-6%. So an A1c of 5 means that 5% of all bodily hemoglobin has a sugar attached to it. Using a fancy formula, it can be determined what the average blood glucose level was during the last 3 months. For the example of 5% HbA1c, the average blood glucose level during those three months was 97.
Since red blood cells are constantly dying and created in the body, and have an average lifespan of 100-120 days, the HbA1c is a really good indicator of your average blood glucose level over the past 3 months. This is why your doctor wants you to come to their office four times a year (every 3 months) to check your HbA1c level.
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