BY AMY CAMPBELL, MS, RD, LDN, CDCES | AUGUST 23, 2022
Numbers play a big role in managing diabetes. For example, monitoring blood sugars, either with a meter or a CGM (continuous glucose monitor), gives you information on where your blood sugars stand at a particular point (or points) in time. Getting your cholesterol measured and having your blood pressure checked at your regular provider visits let you and your provider know the status of your heart health. There’s another number to know about, and that’s your A1C. As part of “knowing your numbers,” make sure you know what your A1C level is, what it means, and what to do if it’s not at target.
Introducing the A1C
Making sense of your blood sugars and your overall level of diabetes control is where the A1C comes in. This number may go by other names, such as:
- Hemoglobin A1C
- HbA1c
- Glycated hemoglobin
- Glycosylated hemoglobin
- Glycohemoglobin A1C
What is this number all about? Simply put, the A1C test is a blood test and it reflects your average blood glucose (sugar) levels over the past three months.
Don’t get confused by the word “hemoglobin,” by the way. Hemoglobin is a protein found in red blood cells that carries oxygen from your lungs to the rest of the body. Your health care provider may order a hemoglobin test as part of a complete blood count (CBC) to help detect anemia, sickle cell anemia, low iron intake, infection, or blood loss. And the “A” in hemoglobin A stands for “adult,” and it’s the most common form of hemoglobin, accounting for over 97% of total red blood cell hemoglobin.
However, hemoglobin A1C is measuring how much glucose, or sugar, is attached to your hemoglobin. Glucose in the blood sticks to hemoglobin in red blood cells and remains stuck. Everyone has some glucose attached to their hemoglobin, but the higher your blood sugar levels are over three months, the higher your A1C will be. And in case you’re wondering why this test is often done every three months, it’s because three months is typically how long a red blood cell lives.
If you have diabetes, your provider or diabetes educator may prompt you periodically to get your A1C checked. This may be every three months or even every six months, depending on the type of diabetes you have, as well as your level of diabetes control. (You may not need an A1C test done as often as three months if your glucose levels have mostly been staying within your target range). The higher the A1C result, the higher the risk of developing long-term diabetes complications, such as heart disease, kidney disease, and nerve and eye problems.
How the A1C test is used
The A1C test can be used for a number of reasons. For example, an A1C test may be used as a tool to diagnose prediabetes or diabetes.
Prediabetes
Prediabetes is when your blood sugar is higher than normal, but not high enough yet to be considered type 2 diabetes. The CDC (Centers for Disease Control and Prevention) lists the following as risk factors for prediabetes:
- Being overweight
- Being age 45 or older
- Having a parent, brother, or sister with type 2 diabetes
- Being physically active less than three times a week
- Having had gestational diabetes or having had a baby weighing more than 9 pounds
- Being African American, Hispanic or Latino, American Indian, or Alaska Native, as well as Pacific Islander and Asian American
Type 2 diabetes
Type 2 diabetes is when your blood sugars are higher than normal and your body can’t make enough insulin or the cells in the body don’t respond normally to the insulin that you make. Risk factors for type 2 diabetes are:
- Having prediabetes
- Being overweight
- Being age 45 or older
- Having a parent, brother, or sister with type 2 diabetes
- Being physically active less than three times a week
- Having had gestational diabetes or having had a baby weighing more than 9 pounds
- Being African American, Hispanic or Latino, American Indian, or Alaska Native, as well as Pacific Islander and Asian American
- Having non-alcoholic fatty liver disease (NAFLD)
Type 1 diabetes
Type 1 diabetes is when your pancreas stops making insulin or stops making enough insulin. It’s considered to be caused by an immune reaction. Type 1 diabetes is less common than type 2 diabetes, and requires the person to take insulin daily by injection, an insulin pump, or using an inhalable form of insulin. Risk factors include:
- Having a parent, brother, or sister with type 1 diabetes
- Being a child, teen, or young adult, although type 1 diabetes can occur in people of any age
- Injury to the pancreas
- Presence of autoantibodies
- Physical stress
- Exposure to illnesses caused by viruses
An A1C test is also helpful in determining how well your diabetes is managed and if any changes are needed to your treatment plan to help prevent long-term complications. This is why getting your A1C level checked every three months, or as recommended by your health care provider, is so important.
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