What is HbA1c?

The hemoglobin A1c test is a simple lab test that shows the average amount of sugar in your blood over the last two to three months. It’s the best way to find out if your blood sugar is under control. All people with type 2 diabetes should have a hemoglobin A1c test at least twice a year. If your treatment changes or if your blood sugar level stays too high, you should get a hemoglobin A1c test at least every three months until your blood sugar level improves. Regular testing will help you and your doctor to track your blood sugar levels over time and plan long-term treatment options to reach your target level of control.

The ABCs of Hemoglobin A1c Testing . . .

The Best Test of Blood Sugar Control for People with Diabetes

By Rick Mendosa - From Veterans Health Administration Diabetes Program

What is the hemoglobin A1c test?
The hemoglobin A1c test (also called H-b-A-one-c) is a simple lab test that shows the average amount of sugar (also called glucose) that has been in a person's blood over the last 3 months. The hemoglobin A1c test shows if a person's blood sugar is close to normal or too high. It is the best test for a health care provider to tell if a person's blood sugar is under control.

What does this test measure?
Sugar in the bloodstream can become attached to the hemoglobin (the part of the cell that carries oxygen) in red blood cells. This process is called glycosylation (pronounced gli-kos-a-lay'-shen). Once the sugar is attached, it stays there for the life of the red blood cell, which is about 120 days. The higher the level of blood sugar, the more sugar attaches to red blood cells. The hemoglobin A1c test measures the amount of sugar sticking to the hemoglobin in the red blood cells. Results are given in percentages.

Why do more people need to know about this test?
The findings of a major diabetes study, the Diabetes Control and Complications Trial (DCCT), have shown just how important the hemoglobin A1c test is. The study showed that lowering the hemoglobin A1c number can delay or prevent the development of serious eye, kidney, and nerve disease in people with diabetes. The study also showed that lowering hemoglobin A1c levels by any amount improves a person's chances of staying healthy.

When should this test be done?
All people with diabetes should have a hemoglobin A1c test at least twice a year. People with diabetes should get the test more often if their blood sugar stays too high or if their health care provider makes any change in their treatment plan.

How is the hemoglobin A1c test done?
This test is usually done in a health care provider's office. To do the test, a small sample of blood is taken. The blood sample is sent to a laboratory for testing, and the laboratory sends the results to the patient's health care provider.

Where does self-monitoring of blood glucose fit in?
Self-monitoring of blood glucose is also very important. A finger-stick test using a blood glucose meter measures the actual level of sugar in the blood at the time of the test. The meter reading is reported in milligrams per deciliter (mg/dl). Self-monitoring of blood glucose helps people with diabetes see how food, physical activity, and diabetes medicine affect their blood sugar. The readings from these tests can help people with diabetes manage their disease day by day or even hour by hour. The readings can also tell them when their blood sugar is too low or too high, so they can work with their health care provider to change their treatment plan. All people with diabetes need regular hemoglobin A1c tests. Most people with diabetes also need to self-monitor their blood glucose to get a complete picture of blood sugar control. Self-monitoring blood glucose gives a snapshot of control at the time of the test, while the hemoglobin A1c test gives the big picture of control over the past 3 months. Together, these tests tell a patient and his or her health care provider whether the patient's blood sugar is under control.

What does a hemoglobin A1c test result mean?
The hemoglobin A1c goal for people with diabetes is less than 7 percent. The DCCT findings showed that people with diabetes who keep their hemoglobin A1c levels close to 7 percent have a much better chance of delaying or preventing diabetes problems that affect the eyes, kidneys, and nerves than people with hemoglobin A1c levels 8 percent or higher. A change in treatment is almost always needed if a person's hemoglobin A1c is over 8 percent. But, if people with diabetes can lower their hemoglobin A1c number by any amount, they will improve their chances of staying healthy.

How does the hemoglobin A1c relate to readings from self-monitoring of blood glucose?
People with high daily blood sugar readings most of the time will usually have a high hemoglobin A1c test result. To maintain a hemoglobin A1c level less than 7 percent means that the blood sugar should rarely go above 150 mg/dl on any self-monitoring blood glucose test performed before meals during the previous 3 months. The blood sugar also should not drop below 60-70 mg/dl, or low blood sugar occurs.

How can people with diabetes keep their hemoglobin A1c at less than 7 percent?
Staying in control of diabetes over a prolonged period of time requires following a recommended meal plan, sticking to a physical activity program, taking prescribed diabetes medicines, self-monitoring of blood glucose if recommended, and consulting a health care provider often. When a patient has a high hemoglobin A1c test result, a health care provider can work with the patient to identify what is causing high blood sugar by examining the patient's record of self-monitoring blood glucose. Common causes of high blood sugar include eating too much food or eating the wrong foods, lack of physical activity, stress, a need to change medicines, and infection or illness. By finding the source of the problem, a health care provider can decide if and how to change a patient's treatment plan to meet the hemoglobin A1c goal of less than 7 percent.

How can people with diabetes use their hemoglobin A1c test results?
When people with diabetes know the results from their hemoglobin A1c test, they can take an active role in their diabetes management. A high hemoglobin A1c is one that is greater than 8 percent. People with diabetes who have a test result that is greater than 8 percent need to work with their health care provider to change their treatment plan.
A hemoglobin A1c test result that is close to normal is one that is less than 7 percent. When people with diabetes have a test result that is less than 7 percent, their treatment plan is probably working and it is likely that their blood sugar is under good control.

Plan Your Diet With a Diet Diary!
Are you obese? Over-weight? Want to lose weight? Keen on getting in shape? Tired of going on crash diets and fitness regimes? Just can’t keep you motivated? Don’t know what to do? Here is an answer to all your worries – plan your diet with a diet diary!

Why should I prefer a diet diary?
A crash diet reduces your metabolism, causes vitamin and mineral deficiencies, and may lead to serious health problems. To add insult to injury, when you quit your diet, you tend to gain more weight than you lost. As a result, you weigh more, with poorer metabolism. If you are looking for a long-term solution to weight loss, you have to make a permanent change to your lifestyle. This change is easier than you might think. Thus simply put, a diet diary is an easier and permanent solution for weight-loss and it should be used as a tool to make good, healthy decisions about food and exercise!

On which aspects will the diary specifically help?
There are certain aspects on which only a diet diary can help you. Few of such aspects are mentioned below-

• The most mundane purpose of a diet diary is showing you what and how much you eat. A lack of consciousness can be the biggest enemy of your success in weight loss.

• By writing down your actions and feelings, you force yourself to consciously realize them and also get the opportunity to transform automatic eating behavior into a conscious choice.

• It helps you keep your weight loss efforts on track.

• You could also use it to record your visits to the gym, so you can keep a check of how much, or how little, you're doing.

• When you maintain a diet diary, you're basically undertaking a project in which the only purpose is to understand yourself better.

• It will also give you a better understanding of your relationship with food and how it affects your body and your emotions.

Online diet diaries and their additional facilities
You can go for a simple personal diary but also available these days and that too free of cost are some online diet diaries.

An online food diary is easy to use. One simply has to search the food database of various items and select the food items one consumes.  This information is taken by the online analysts who then give you suggestions about how to improve your diet and how to stay within your calorie goals. You also have the services of an online calorie counter..
Also provided are motivational charts & reports customized to the individual needs. 
The best part of an online diet diary is that one can view ones progress over time, receive personal tips, and even see what he/she would weigh in 3 months if every day were like today. Online or offline, a diet diary will always be of great help and if you are willing to use it, be ready to be surprised by the results.

The basics
Up until a few years ago, health professionals believed that if a food was composed of complex carbohydrates (starches), it must break down into sugar more slowly in your body than food composed of simple carbohydrates (sugars). Through research, we have learned more about how foods affect blood glucose levels. When you eat a slice of bread, the flour from the bread breaks down into sugar (glucose) in your body to provide you with energy. The same thing happens when you eat a piece of fruit, drink a glass of milk or eat a chocolate bar. Each of these foods contain a different kind of sugar. Fructose is a sugar in fruit, lactose is found in milk and sucrose is found in the chocolate bar. All of these sugars are broken down during digestion and provide you with energy. The speed at which a food is able to increase a person's blood glucose levels is called the glycemic response. The glycemic response is influenced by many factors. Some factors may be the amount of food you eat, how the food is processed or the way the food is prepared. For example, pasta cooked 'al dente' (firm) is absorbed more slowly than pasta that is overcooked.

The glycemic index
The ranking of different foods based on their glycemic response was first studied by Dr. David Jenkins and colleagues at St. Michael's Hospital (Toronto). The research team conducted several experiments looking at the speed at which different foods affect blood glucose levels and compared the numbers to a slice of white bread. White bread is given the glycemic index value of 100. Foods that have a value less than 100 are converted into sugar more slowly than white bread. Foods that have a glycemic index value greater than 100 turn into sugar more quickly than white bread. Other researchers have used glucose as the reference food, so glucose would have a value of 100. Today either glucose or white bread may be used as the reference food (if white bread = 100, then glucose = 140). Current values listed in this article should be divided by 1.4 to obtain the Glycemic Index(GI) of a food for which glucose = 100. What the researchers found surprised them. Foods such as milk and fruit tend to have a lower glycemic index value than common starchy foods such as bread, rice, potatoes and breakfast cereals. Even sugar (sucrose) had a glycemic index of 83, lower than some starchy foods. The good news is foods that were previously avoided by people with diabetes can now be added to their diet in moderation.

Strategic eating
Selecting foods with a low glycemic index may help to manage your diabetes (see accompanying chart). Increasing the number of low glycemic index foods such as legumes, barley, pasta and whole grains (e.g., cracked wheat) in your meal plan may have real benefit in controlling blood glucose levels. Most low glycemic index foods offer more fibre and are low in fat, both of which are recommended in Health Canada's Guidelines for Healthy Eating, as well as the Canadian Diabetes Association's nutrition guidelines . High fibre foods also help lower your risk of heart disease. In fact, the Canadian Diabetes Association's Guidelines for the Nutritional Management of Diabetes in the New Millenium state that for every 10 gram increase in cereal fibre daily, the risk of heart disease decreases by 30 percent. By simply including a high fibre cereal such as 1-1/2 cups of oatmeal in your meal plan, you will have added an extra 10 grams of fibre. As well as incorporating oatmeal or other high fibre cereals into your meal plan more often, here are a few more low glycemia index tips for healthy eating:

• Prepare dishes with beans such as chili, soups, and salad.

• Eat whole grain, pumpernickel and oat bran bread more often than white bread.

• Eat fresh fruit. Fruits have a low glycemic index, so they break down into sugar slowly in your body. Canada's Food Guide recommends five to ten servings of fruits and vegetables every day. Enjoy a variety!

• Eat parboiled, brown or white rice more often than instant rice.

• Eat pasta, rice, yams, lima beans or baked potatoes more often than mashed, boiled or instant potatoes.

You should also remember that table sugar can produce a slower rise in blood glucose levels than potatoes, but it lacks the vitamins, minerals and fibre provided by the potato. Decisions on foods must be made on the basis of overall nutrition, as well as the impact on blood sugar.
Also, don't forget about the roles that fat and protein will play. Protein and fat with our meals can also slow down the absorption of carbohydrates, which are converted into sugars during digestion. Add fats in moderation to your foods and choose heart healthy fats such as non-hydrogenated margarine and vegetable oils.

The glycemic index is an average of the glycemic responses of many individuals. This index is fairly accurate and it is useful to determine your own blood glucose response to different foods and meal combinations. Regular self monitoring of blood glucose and good note-taking can help you determine your individual glycemic response to food.