Hba1c

Hba1c levels are the levels of glycosylated haemoglobin. This is a measure of the amount of glucose that has bound to haemoglobin ( the pigment that carries and releases oxygen from the red blood cells ).

Blood has a lifespan of about 120 days and hence the Hba1c gives a better overall picture of diabetic control compared to a spot check of glucose noted by a glucose monitor or a fasting/random glucose level.

We use these to assess the level of control of a diabetic.

The level is also now starting to be used officially to aid diagnosis since the World Health Organisation has recognised the potential.

We generally get this measured at least once a year in order to determine if the diabetes is well controlled or not or whether we have to go to the next level of treatment or alternatively whether a poor diet, missing oral medicines or having other problems e.g. injecting insulin into the same area or an area of scarring may  lead to problems with it working nd the sugars being high.

The hba1c is used to adjust dosing of oral tablets.

Use of insulin is much more dynamic and the glucose levels need to be measured. The doses may need to be adjusted according to the food types/quantities of a particular meal or measuring the blood sugars to ensure safety e.g. to allow the driving of heavy goods vehicles, or to check why one may feel unwell e.g. hypoglycaemia (too little ) or hyperglycaemia ( too much in the blood).

New units

Reference : http://dtb.bmj.com/site/about/HBA1C_chart_Feb_10.pdf

Hba1c New Units
% mmol/mol
5 31
5.5 37
6 42
6.5 48
7 53
7.5 59
8 64
8.5 70
9 75
9.5 81
10 86

The level of control is indicated by the colour.

Green is good.

“Yellow” not so.

Red, definitely not so good control.

If you are in the red level and only on tablets and you have looked after your diet, you are likely need insulin.

If you are in the red level, and you are on insulin then you should check that you are moving the injection sites ( no scarring is affecting the absorption of insulin) , monitor the bms and the relationship to the food taken in, exercise and amount of insulin and relationship to your health ( e.g. infections raise the bms) as do certain medicines ( e.g. steroids )

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