Thank you for your post. Sometimes, the result of the HbA1c tests can go wrong. Because you have more “older” red cells instead of making new ones (due to lack of iron, or other vitamins) your HbA1c will be higher than it … For more on why post-meal blood sugar is a superior marker, read  When Your Normal Blood Sugar Isn’t Normal (Part 2). Clinical Practice Diabetes Care 2010 Apr; 33(4): 817-819. The reticulocyte count inversely correlated with erythrocyte life span (r = −0.77, P < 0.01).". Any variation in the RBC (or erythrocyte) or hemoglobin may cause hba1c errors. Pre-diabetes can check A1C once per year to track the progression of type 2 diabetes. 5.2) indicates the percentage of hemoglobin that has become glycated (stuck to sugar). A1C levels can often be lowered through weight loss, exercise, medication, and more. Before you presume the A1c and the doc were wrong, make it a fair test. On the other hand, if someone is diabetic, their red blood cells live shorter lives than non-diabetics. Sugar has a tendency to stick to stuff. Be systematic. Summary: HbA1c is a marker that reflects your average blood sugar levels in the previous 3 months. Another condition that affects hemoglobin A1c levels is anemia. A1c forms naturally when glucose is present in the blood. Fructosamine is a compound that results from a reaction between fructose and ammonia or an amine. The A1c goes by several different names, such as Hemoglobin A1C, HbA1C, Hb1C, A1C, glycated hemoglobin, glycohemoglobin and estimated glucose average. Over the last few years doctors are increasingly relying on a test called hemoglobin A1c to screen for insulin resistance and diabetes. HbA1c can be lower in the second trimester of pregnancy . 2,4 Hiroshi Nose 1 and colleagues induced dehydration in 10 subjects by exercise and checked haemoglobin (Hb), haematocrit (Hct), Na, K+, Cl, and plasma osmolality at 0 minutes, 30 minutes and 60 minutes after exercise. The A1C is a test that monitors long-term blood sugar levels and indicates the risk of complications. The main problem is that there is actually a wide variation in how long red blood cells survive in different people. "An A1c of 8% can correspond to an average blood sugar of 140 mg/dl in one person, while in another it could be 220 mg/dl." A1C can be increases or decreases by various factors; they are: A little doubt saves many a mistake. Untreated anemia from iron deficiency or vitamin B12 and folate deficiency can result in a HbA1c value that is falsely high because your red cell turnover is low. This will drive up the A1c test result – but it doesn’t mean that person had too much sugar in their blood. We … Erythropoietin deficiency - due to kidney diseases, Uremia (BUN more than 85 mg/dl), and Severe nephropathy. It may mean you can come off your medication, or stop checking 4 times a day, but you still have diabetes. The results revealed that the HbA1c test can lead to similar results for people having quite widely divergent blood sugar levels. This is just basic science. 10 causes of Normal A1c and High Blood Sugar in the blood test results. Hemoglobin C trait affects approximately 3% of African Americans. It just means their hemoglobin lived longer and thus accumulated more sugar. Additional studies need to be done to confirm a result. Founder of the Kresser Institute. People who are anemic have short-lived red blood cells, so like diabetics, they will test with falsely low A1c levels. The percentage of A1c increases in proportion to the average blood glucose level over the previous 2 to 3 months -- a reflection of the average lifespan of red blood cells. Can hba1c be wrong? Hemoglobin A1C, also known as HbA1C, is widely touted as the "diabetic truth detector". Because your A1C changes over months, checking it more often than quarterly is of limited or no use. Quite disappointed about it. For looking at an individual’s glucose values, CGM is a better tool for measuring average sugar levels, time-in-range, and hypoglycemia. Some medications, such as drugs used for chemotherapy, chloramphenicol, hydantoins, and quinidine. For someone who has both diabetes and chronic kidney disease (CKD), it can be more difficult to rely upon A1C … If your once-controlled A1c has spun out of control despite your best efforts, it’s possible you don’t have type 2 diabetes at all. The assumption is that they live for four months (120 days). , This information should be sent to every doctor maybe then they’ll figure out that they’re not right I am a diabetic that has been arguing with them for 40 years thank you, The ADAPT Health Coach Training Program is an Approved Health and Wellness Coach Training & Education Program by the National Board for Health and Wellness Coaching (NBHWC), Kresser Institute, a division of Chris Kresser LLC, a Nevada LLC
 But before we get into that, let's briefly go over why A1Cis used to approximate average glucose over ~3 months: 1. Nutritional deficiencies, iron, copper, folate, and vitamin B6 & B12 can affect the result. Hemoglobin Variants and Derivatives: Genetic variants (e.g. Always seek the advice of a Doctor or other Health Care Profession regarding any question you have about your health conditions, diagnosis, and treatments. No, type 2 diabetes is not reversible, but it can be controlled and that is what everyone should aim for. As I learned in my teens, the HbA1c test shines a light on things I was trying to hide. Once you recognize the A1C interferences, then choosing an alternative form of test. The A1C test is a simple blood test. Three, the assumption is not that RBC's live for three months. HbA1c can be lower in chronic liver disease . What is HbA1c? I’ve tried apple cider vinegar, green apples, proteins no snack before bedtime, but have not achieved any consistency, My last A1C was 7.5 but in the past has been as low as 6.1, Not sure how to deal with the “Dawn” syndrome which seems to be my biggest obstacle. I had a normal A1C and high fasting serum glucose so just reading around out of curiosity. My doctor would love to put me on meds but for the past 10 years I’ve chosen diet and exercise. But instead of measuring the previous 12 weeks like A1c, fructosamine measures the previous 2-3 weeks. This is a serious problem, because fasting blood glucose and hemoglobin A1c are almost always the only tests doctors run to screen for diabetes and blood sugar issues. Overall, It’s not good at getting to the details of blood sugars, but when used with other pieces of information it can draw attention to (sometimes unseen) problem areas in our diabetes management, and that’s a good thing. Fructosamine is especially useful in people who are anemic, or during pregnancy, when hormonal changes cause greater short-term fluctuations in blood glucose levels. And we already know that fasting blood glucose is the least sensitive marker for predicting future diabetes and heart disease. If you are already diabetic, necessary steps to better manage the condition can be taken. Anemia, Thalassemia or hemolytic anemia, and liver disease. Help!! Limitations of the Test. A1C can be increases or decreases by various factors; they are: Decrease or increase in erythrocyte (RBC) makes your A1C lower or increase, respectively. It can be done anytime during the day, before or after a meal, and still give an accurate result. During the A1C test, a member of your health care team takes a sample of blood by inserting a needle into a vein in your arm or pricking the tip of your finger with a small, pointed lancet. Researchers found that the lifetime of hemoglobin cells of diabetics turned over in as few as 81 days, while they lived as long as 146 days in non-diabetics. This proves that the assumption that everyone’s red blood cells live for three months is false, and that hemoglobin A1c can’t be relied upon as a blood sugar marker. An A1c test of 5.6 percent or below is reflective of normal blood sugar levels -- or a daily average below 115. As someone else mentioned, may be the A1C result was wrong by lab? While this sounds good in theory, the reality is not so black and white. Years ago, before i started exercising regularly, my fasting sugar was higher (low 100s), and at that time my A1C was around 5.6 – so both stats were consistent to show a slight elevation. An A1C of 6.4 or even a 5.5 shows control and is something to be very proud of. The theory behind the A1c test is that our red blood cells live an average of three months, so if we measure the amount of sugar stuck to these cells (which is what the hemoglobin A1c test does), it will give us an idea of how much sugar has been in the blood over the previous three months. Chronic alcohol abuse produces a false high. Measuring it can give you an idea of your blood sugar levels over time. The A1C is a blood test that gives us an estimated average of what your blood sugar has been over the past 2-3 months. Elders, black with an iron-deficient and genetic predisposition to high glycation are prone to over-diagnose. 1810 E. Sahara Ave, Suite 402 Las Vegas, NV 89104 USA | 702.850.2599, All photos on this page are courtesy of ThinkStockPhotos.com or iStockPhoto.com unless otherwise marked. Hemoglobin A1C is created when sugar sticks to your red blood cells. Hemorrhage or bleeding - heavy menstrual periods in women and stomach ulcers. Vitamin C & E ingestion interfere with some assay methods and decrease result. The main problem is that there is actually a wide variation in how long red blood cells survive in different people. Blood HbA1c test levels are reflective of how well diabetes is controlled. But hemoglobin A1c (HbA1c) test results can be misleading and don’t tell the full story. This study, for example, shows that red blood cells live longer than average at normal blood sugars. To put the most accurate picture together, I like to have all four: fasting blood glucose, A1c, post-meal glucose and fructosamine. Even drinking a … Posted 06/04/2016. A1C increases or decreases due to problems relating to RBC, hemoglobin, bilirubin, and supplement use. Hemoglobin A1C (HbA1c) is an invaluable tool for monitoring long-term glycemic control in diabetic patients. 2. What causes A1C error? Type 1 diabetes should check their A1C quarterly. Hemoglobin Variants - Hemoglobin S-trait affects about 8% of African Americans. First, one study does not prove anything. The result is that people with normal blood sugar often test with unexpectedly high A1c levels. As I learned in my teens, the HbA1c test shines a light on things I was trying to hide. Testing accurately for blood sugar is like putting pieces of a puzzle together. Untreated anemia (due to iron deficiency or B-12 deficiency) can lead to a higher HbA1c level; Aspleenia (decreased spleen function) can lead to higher HbA1c levels; blood loss or recent transfusion can lead to a lowered HbA1c level; cirrhosis of the liver will lead to a lowered HbA1c level; the genetic blood disorders Haemoglobinopathy and Thalassemia will lead to either increased or decreased HbA1c values; … Overall, It's not good at getting to the details of blood sugars, but when used with other pieces of information it can draw attention to (sometimes unseen) problem areas in our diabetes management, and that's a good thing. Patients with end-stage renal disease generally have falsely low A1c values. Once corrected for red blood cell age, however, the error rate was reduced to one in 10 patients. The incidence is significantly higher for those under 35 years of age: About 25 percent of people in that age group have LADA.In a 201… A1C measures the total amount of glucose that has attached to your hemoglobin over the lifespan of your r… Type 2 diabetes with high blood sugar and undergoing treatment modification should have an A1C test every three months until BS stabilizes. An A1C level of 6.5 % or higher on two separate instances states you have diabetes. ANSWER People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. In a person with normal blood sugar, hemoglobin will be around for a lot longer, which means it will accumulate more sugar. But post-meal blood glucose testing is by far the most reliable and accurate way to determine what’s happening with blood sugar, and the most sensitive way of predicting future diabetic complications and heart disease. However, fasting is not necessary for an HbA1c. Anyone that has cooked with sugar can tell you that. Hypertriglyceridemia interfered with some assay methods and increases result. carbamylated Hb in patients with renal failure, acetylated Hb in patients taking large amounts of aspirin) can affect the accuracy of HbA1c … Conditions such as acute and chronic blood loss, hemolytic anemia, and splenomegaly can all cause falsely lowered A1c results. Another condition that affects hemoglobin A1c levels is anemia. Medical conditions lead to low RBC count include cancer, rheumatoid arthritis, HIV/AIDS. It's more practical (and significantly cheaper) than post-meal glucose testing, and it's less likely to be skewed by day-to-day changes than fasting blood glucose. Any variation in the RBC (or erythrocyte) or hemoglobin may cause hba1c errors. All you can say from this study, subject to validation from other studies, which you do not cite but I found, is that (a) the measurement of HbA1c is dependent upon the person's average life of his/her RBC's and (b) HbA1c test would be more accurate if it took into account the average life span of the person's RBC's. Normal HbA1c Range But the test relies on having an average turnover time of your red blood cells and this can lead to an incorrect diagnosis if certain conditions are not taken into account. Many doctors are now using the hba1c on its own to diagnose type two diabetes. Another useful – but underused – blood sugar marker is fructosamine. High bilirubin interferes with some assay methods and increases result. People who are anemic have short-lived red blood cells, so like diabetics, they will test with falsely low A1c levels. We must remove misconceptions about Hemoglobin A1c test with other blood sugar tests. This confused me early in my practice. If you’ve had high blood sugar levels in the past month or so, your HbA1c levels will be higher too. Even so, A1C is still used to monitor pregnant women with diabetes. What you can expect. You don't need to fast for the A1C test, so you can eat and drink normally before the test. Learn more about what hemoglobin A1c is, normal A1c levels, and view our helpful A1c chart. ~ Albanian Proverb. Zhuzhu584. Healthy non-diabetic has an A1C of less than 5.7%. A1C test for diabetes diagnosis might lead to over or miss the diagnosis. Hemoglobin Variants - Hemoglobin S-trait affects about 8% of African Americans. While this sounds good in theory, the reality is not so black and white. It’s also called glycated hemoglobin, hemoglobin A1c or just A1c. I hope you don't get any surprises. Type 2 diabetics should take the A1C test at least twice per year if your blood sugar is in a healthy range and stable. It helps assess glycemia better. That means the percentage of hemoglobin A1C in your bloodstream will be lower, too. These tests are glycated serum protein testing (fructosamine or glycated albumin). However, many clinicians managing diabetics have encountered the problem of HbA1c values that do not agree with fingerstick glucose logs. As glucose enters your blood, it attaches to a protein in your red blood cells called "hemoglobin." A1C levels can often be lowered through weight loss, exercise, medication, and more. But if I only had to choose one, it would definitely be post-meal glucose. The number reported in the A1c test result (i.e. Splenectomy is a surgical procedure (partial or complete removal of the spleen); this raises A1C. Like A1c, it’s a measure of average blood sugar concentrations. 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