You do not need to be fasting to have an Hbg A1c blood test done. It can also be known as HbA1c, hemoglobin A1c, A1c, glycosylated hemoglobin, glycohemoglobin or glycated hemoglobin.
Let's compare A1c to candy apples. Imagine your red blood cells are like candy apples in a zooped up candy factory - maybe Willy Wonka's - where the apples get soaked in syrup for 3 months! The more sugar in the syrup, the sweeter the apple. Well, the more sugar in your blood, the sweeter the red blood cell. Blood sugar sticks to the hemoglobin in red blood cells - and the red blood cells live for 3 months while floating around in your blood. There you have it - candy coated hemoglobin.
The medical profession calls it glycosylated hemoglobin. (Any protein with sugar attached to it is called "glycosylated").
Home or Disposable A1c Kits:
There are some home Hbg A1c blood test kits available. "Choice A1c" or "Choice DM A1c" is a kit that provides results within minutes at your own home. Please do an internet search for "home A1c kit". I cannot comment on which brand is more reliable or still available.
There are also mail in A1c kits. All can usually be purchased over the counter for a reasonable price - ask your pharmacist for details. You provide a small sample of your blood (eg. wiped on a test card/strip) and mail it in to the company. However...
I must tell you that there have been complaints about sending in kits, not receiving a response and not being able to contact the company afterward. You may wish to call the company prior to purchasing their kits to be sure they are still in business. You may wish to consider researching the company thru the Better Business Bureau prior to committing to anything (boy, that seems like a lot of work doesn't it??). Also talk with your pharmacist about the reputable mail-in options or deal through a large company that may offer refunds (eg. be sure to check the policies on Amazon if you order through them as you would hope they wouldn't be selling mail-in kits that could no longer be serviced). All of a sudden it sounds like it might just be easier to go to the lab.
PLEASE NOTE: The A1c blood test does not match the readings you get on your blood glucose meter at home. For conversions of A1c versus blood sugar values that you see on your home meter, please see hgb A1c conversions to home meter readings.
What is a "good" result for Hbg A1c blood test?
The Hgb A1c blood test can have different normals depending on the lab methods used. However, most labs in North America have 6% ( 0.060) or less as the normal hgb A1c for people without diabetes.
For people with diabetes, guidelines for the A1c test are typically 7% ( 0.070) or less. In Canada, a target of under 6% is recommended if it is safe to do so without frequent or severe hypoglycemia (see here for the definition of hypoglycemia). Since target levels for the Hbg A1c blood test can be individualized, be sure to check with your doctor.
Why should I have the Hgb A1c blood test?
. . . Because it tells you your risk of getting diabetes complications to eyes, kidneys, nerves (impotence included) and heart.
Much of the damage caused by diabetes happens because of glycosylation (sugar coating) of proteins in the body. Measuring the amount of sugar stuck to part of the hemoglobin (a1c blood test) is a good indicator of what might be happening in other tissues. Particularly if the A1c stays high.
The DCCT and UKPDS are excellent landmark studies for type 1 and type 2 diabetes. They clearly show the higher the A1c over a period of a few years, the more complications arise. But the reverse is also true: Lowering A1c levels greatly reduces the risk of complications.
How much can you lower your risk of complications?
•In type 2 diabetes, every 1% drop in A1c lowers the risk of complications by 37% !
•In type 1 diabetes, lowering the A1c from 9% to 7% reduced complications by 34-76%! The continuation of DCCT - the EDIC study - also showed that lower A1c values also reduced the risk for heart disease by whopping 50%!
Doesn't this make you want to learn your A1c so you can work to lower it if it's high? So you can see your progress? So you can work with your diabetes team and doctor to get it down even just a smidge? Remember, dropping from 9% down to 8% could reduce your risk of complications by 37%!!
How often should I have the Hbg A1c blood test ?
Guidelines vary slightly between countries. Canada recommends the A1c every 3 months. The U. S. suggests every 3 months but every 6 months may be acceptable if your blood sugars are stable and in target with the guidelines blood sugar levels. Please check with your doctor.
Make life easier . . . ask for a "standing order" for the Hbg A1c blood test from your family doctor. Then you can go directly to the lab every 3 months without getting a requisition from your doctor every time.
Why should I follow the trends in my A1c blood test results?
. . .Because, diabetes changes. To be proactive and protect your health, diabetes educator's tell you to follow the trend of your A1c to give you more information about your diabetes.
For example, if your A1c blood test is in target at 6.5% but the next one is 7.0% this tells you your glucose levels have been rising somewhere in the day. You might do more blood sugar testing at home to see where you are getting those slightly higher numbers. Then work to lower them. You don't want to wait for that A1c to rise above 7% if that is your target.
IF your A1c has dropped from 10% down to 8%, then you have reason to celebrate. This is a great reduction. You might wait until the next A1c test to see if it comes down further. However, keep your eye on your home glucose tests to be sure things are moving in the right direction. You'd hate to wait 3 months just to find out, - oops - you are at 9%.
If your Hgb A1c blood test is significantly high or refusing to drop significantly then you may need to meet with your doctor and diabetes team to discuss methods to help you lower the A1c.
Remember: The Hgb A1c blood test only tells you if you've been in target most of the time or not. It does not tell you where in the day your sugars might be high or low. Also, it does not tell you about recent changes to your blood sugars. Very often we'll see or hear from patients because their sugars have been high for the past month even though their last A1c was great. These are very proactive people who want to fix the high numbers they see on their meters BEFORE their A1c blood tests rise.
So . . . Using blood sugar monitors at home is important! These numbers tell you where in the day you are in target or not in target compared to guidelines blood sugar levels.
How do I lower the A1c . . .
For reducing A1c, you need to know what times of the day your blood glucose levels are the highest or are out of target. Diabetes educators specialize in fine-tuning advice to fit into people's lives, priorities and their problem times of the day. Some of the tips you will get you'll find below. Please work with your doctor or educator.
•Tips to lower fasting blood sugars.
•Tips to lower lunch blood sugars.
•How to lower supper glucose readings.
•How to lower bedtime glucose levels.
•How to lower 2 hr post prandial sugars
There are a number of people who insist that their Hgb A1c blood test should be lower because their fasting blood sugars are great. But the A1c rarely lies. Unfortunately, if these folks aren't testing their sugars at other times of the day, they simply won't find those high blood sugars that are pushing up the A1c. That means, numbers that are pushing up their risk of getting damage to eyes, kidneys, nerves as well as heart attack and stroke.
Can the Hgb A1c Blood Tests give false reading?
The A1c test can read lower than it really is if you are anemic (have low levels of hemoglobin). The more anemic you are, the more the Hgb A1c blood test is falsely lowered.
If you frequently have blood sugars that meet the definition of hypoglycemia, then your A1c blood test could be in target even though you might have high blood sugars often. The highs and lows seem to average out. Don't fool yourself into believing all is well. The highs can still do damage despite all the low sugars (which can also be unsafe).
If you have great blood sugar readings at home (for all times of the day including after meals) but your Hgb A1c blood test is high, your meter might be inaccurate. Check for diabetes test strips accuracy problems.
If your glycated hemoglobin is high but your before meal tests are in target, then please consider doing post prandial or "after meal" blood sugar tests. These too can affect your chance of getting complications.
The Hgb A1c blood test can be higher than it really is if you have unusual hemoglobin. For example, a very small population of people (particularly of African descent) have some fetal hemoglobin which can falsely elevate the A1c reading.
Hgb A1c Conversion to Blood Sugars
The Hgb A1c blood test (or glycated hemoglobin) done in people with diabetes does not equal the values you see on your home blood glucose monitor. For example, an A1c of 8% does not mean your blood sugars for the past 3 months have been about 8 mmol/L. See below.
There are different references for converting glycated hemoglobin to meter readings. They do differ, so what your educator says may differ from what you see here. I have chosen the information from the American Diabetes Association Standards of Medical Care in Diabetes.
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