A better way to check your diabetes : Written by Dr harold Gunatillake FRCS-Health writer

Most Sri Lankans do ignore a simple test to check for diabetes when required after the age of 40, as they do not realise the serious issues of the disease and the ability to control better when detected early. Those who have a family history of diabetes do check to find out whether they have got high blood sugar levels.

To check for fasting blood sugar finger prick test would do. If you have your own glucose testing monitor, you could check it at home when required. In a normal non-diabetic person the reading would be about 90mg/dl. (6 mmol/l). When it reaches 126mg/dl (6.9mmol/l) you would be considered a pre-diabetic. The complications with pre-diabetes and full blown diabetes are similar. So, it is important at the pre-diabetes stage to nip in the bud by eating low GI foods and exercise daily.

There are other tests recommended like ‘Glucose tolerance tests’ among others to diagnose and confirm diabetes.

Today there is a better test to control blood sugar levels and reduce the long term risks of heart attacks, stroke, blindness and kidney failure associated with diabetes.

One such test is the HbA1c or in short A1c test. This term refers to glycated haemoglobin a protein within each red cell that carries oxygen throughout the body. The glucose that enters your blood stream joins with the oxygen in the haemoglobin to become glycated.

By measuring glycated haemoglobin (HbA1c) doctors are able to get an overall picture of what your average blood sugar levels have been over a period of about three months. This period of three months is estimated because life span of red cells is about three months.

If you have diabetes the HbA1c is much higher than those without diabetes. The greater the rise there is more chance of developing complications like micro-vascular changes, kidney failure, heart attacks and so on.

Normal HbA1c level is below 6.0%, prediabetes 6-6.4% and mature type 2 diabetes is 6.5% or over.

Further simple explanation of the difference between the daily or weekly testing of blood sugar level with a gluco-meter is that such testing gives the level of the blood sugar at the time of testing alone, because blood glucose levels fluctuate constantly, literally on a minute by minute basis. That test does not indicate previous hour results or earlier. HbA1c test gives you an assessment of the average amount of glucose in your haemoglobin for a period of three months, which gives a better assessment of the diabetic situation in your blood. Sometimes doctors call this a memory test.

Rather than performing other blood tests to check on diabetes, it is much better to offer an HbA1c test at least once a year. Good control over HbA1c means that you are lowering the risk of complications.

Most people having diabetes record HbA1c results on an average as 7% (53 mmol/mol on an average. This means the average blood sugar level has been 8 mmol/L. If your HbA1c reading is 6% gives you 7 mmol/L of glucose in your blood.

Today, it is considered that HbA1c test is used to diagnose diabetes. It also identifies people with prediabetes and provides insight into how well blood sugar is controlled for a period of three months.

Doctors can assess and control your blood sugar better knowing the result three months before.

Today, for millions of people worldwide, the HbA1c test forms the basis of their treatment Dr John Higgins, associate professor of systems biology at Harvard Medical School in Boston says that errors are significant with this test, but another specialist, Dr Joel Zonszein, director of clinical diabetes at Albert Einstein College of Medicine’s University Hospital, New York City states that diabetes can be properly monitored and treated with this test.
In Sri Lanka, today there are many people having diabetes having not had HbA1c test to check their diabetic situation. May be it is more costly than the finger prick strip test. Testing strips are also expensive- 3 strips cost as much as a packet of rice.

WE recommend that you have an HbA1c test every six months to keep your blood sugar level within the normal range.

You may forget fasting blood sugar tests frequently as most do and get worried when it’s on the high range. It is a test of no importance when you are diagnosed as a diabetic subject. Random blood sugar tests have a place in the assessment of your sugar control.

Dr Gunatillake-Health editor is a member of the Academy of Medicine, Singapore. Member of the Australian Association of Cosmetic Surgery. Fellow of the Royal College of Surgeons (UK), Corresponding Fellow of the American Academy of Cosmetic Surgery, Member of the International Societies of Cosmetic surgery, Fellow of the International College of Surgery (US), Australian diplomat for the International Society of Plastic, Aesthetic & Reconstructive Surgery, Board member of the International Society of Aesthetic Surgery, Member of the American Academy of Aesthetic & restorative Surgery, Life Member of the College of Surgeons, Sri Lanka, Batchelor of Medicine & Surgery (Cey). Government scholar to UK for higher studies and fellowship.