What is the hba1c test?
The HbA1c test is the hemoglobin A1c test, or glycated haemoglobin test. What that means is it’s a test of your red blood cells that have chemically combined with sugar (glucose). In other words, the build up of glucose in your system has attached itself to a red blood cell, and glycated it. So the more sugar in your system, the more glycated red blood cells you carry, and in turn, the higher your HbA1c result will be.
So the test reflects on your blood sugar over the last 2-3 months, with the last month or so having more dominance over your result, because you’re red blood cells regenerate. It’s basically a quality control test for diabetes to assess a diabetics control over their blood sugar levels from the previous 2-3 months. Because blood glucose levels fluctuate from minute to minute, hour to hour, and day to day, this is the best method doctors have for assessing control.
Everyone, whether non-diabetic, pre-diabetic, type 1 diabetic, or type 2 diabetic has some degree of sugar in their blood.
What is a normal HbA1c?
That chart is from Diabetes UK. Along with this more visual one:
Any HbA1c result of over 6.5%, ie, a diabetic, is automatically at risk of several health complications. The NHS website states that ‘Even a mildly raised glucose level that doesn’t cause any symptoms can have damaging effects in the long term.’
This means, in short, as a diabetic you are up to five times more likely to develop heart disease or have a stroke. High blood glucose levels can also damage the tiny blood vessels of your nerves, which causes a tingling or burning pain that spreads from your fingers and toes up through your limbs. The nerves in your digestive system may also be affected, causing vomitting, diarrhoea or constipation. Retinopathy is also damaged, which may damage your vision. The blood vessels in your kidneys may become blocked, causing your kidneys to work less efficiently, and in severe cases can lead to kidney failure. There are also a lot of foot problems with diabetics, as damage to the nerves can means that small cuts aren’t noticed, which can lead to a foot ulcer developing, and about 1 in 10 diabetics get a foot ulcer. Sexual dysfunction is another problem caused by high blood glucose levels, as is miscarriage and stillbirth. Still with me? Good.
So why are diabetics encouraged to have a HbA1c of at least 6.5%? This is was Dr. Bernstein discovered:
‘From different doctors, I’ve gotten the same answers. They’ll say ‘Look, my specialty is diabetes. I treat maybe 3,000 patients. If all of these patients were to either die young, go blind, develop painful neoroptahy in their feet, if they wer to lose their ability to copulate or reproduce, or if they lost their legs…these are all natural consequences of diabetes’, these dotors tell me, ‘but if one patient out of my 3,000 dies of hypoglycaemia I get sued. So I’m gonna make sure that there’s not the remotest possibility of any of my patients dying of hypoglycaemia. I’m gonna keep their blood sugars so high so it’s not a possiblity.’ That’s the story. That’s the true story. ‘ (1. Dr. Richard Bernstein)
None of these diabetic complications have to be a part of a diabetics future. None of them. They only occur when blood glucose levels are elevated for a prolonged period of time. This is why it’s so important that blood glucose levels being aimed for are as near to normal as possible, ie, in the range of a person who does not have diabetes.
4-5.5mmol/l before meals, and less than 8mmol/l, postprandial (two hours after meals).
When I was diagnosed with Type 1 diabetes in September 2014, I had a HbA1c of 12.5%, which equates to an average blood glucose level of 17.3 mmol/L for the previous 2-3 months. I was already showing signs of nerve damage, my fingers and toes would tingle regularly, and I didn’t know why. I thought maybe just poor circulation. But no, it was high blood sugar. Had I ignored my symptoms and suspicions, I’d have ended up in a coma in hospital before I could’ve hoped to have being diagnosed. Otherwise, death would have soon followed.
Since diagnosis, I’ve had 3 HbA1c results. I ignored the diabetes target – instead, I take every day as it comes and try to have tight control over my diabetes. As a result, my HbA1c result came back at 4.8%. I have a HbA1c result that would match a non-diabetic. If I had another medical examination now for a visa, I wouldn’t even flag up as being medically unsound in any way. I would pass with flying colours. So for any diabetic out there who wants to achieve a normal HbA1c, it’s completely achievable, and should not be discouraged. I have been told that my HBA1c is too low for a diabetic, and that I should aim for 6.5-8.2%. However…
if a normal, non-diabetic HbA1c result is achievable for me, as a diabetic, then why don’t I deserve a normal level, free from the risk of diabetic complications?
1. Dr. Richard Bernstein in ‘Note 2. An HbA1c of 6.5% – Dr Bernstein’s Diabetes University