What is HbA1C test and why is it done on diabetics regularly?

Written by Dr harold Gunatillake-FRCS, FIACS (US), FICS (US), MBBS (Cey), AM (Sing).-Health writer

When you do a finger prick blood test on a strip inserted into your glucometer, you are assessing the blood sugar level at that moment. Most diabetics do a fasting level in the morning before breakfast and the reading is of no significance for the control of blood sugar. It is a very reliable test to diagnose diabetes and prediabetes. Beyond that the test is of no significance.

An A1C test measures how well the body is maintaining blood glucose levels for the past three months which is the most important test to assess the control of your diabetes.

The mechanism behind this test is that when you eat carbs- they are converted into sugar in your small gut by enzymes. The sugar that is absorbed as glucose gets into your blood stream. When glucose enters the blood, it binds (pastes) to a red cell protein called haemoglobin. You are aware that the red colour of your blood is due to the haemoglobin content in the red cells.
The higher the carb intake the higher the blood sugar level be and more of glucose get bound to the haemoglobin.

The life span of a red cell is approximately about 4 months. So A1C tests are done using blood obtained by a finger prick every 3-4 months interval. Practically, most doctors advise you to get the test done every six months.

Hb1AC test is the best reliable diagnostic test to check whether you are a diabetic. Initial A1C test helps the physician work out an individual’s baseline A1C level for later comparison.
Non- diabetics generally have a figure about 6 units. Diabetics Hb1AC should not be brought down to this figure through medication. Normally physicians are happy with a reading between 6.5 and 7.2 units. With lower readings you are more susceptible for low blood sugar attacks (Hypoglycaemia)

Further this is the most reliable test done to help reduce the risk or intensity of diabetic complications, such as cardiovascular complications and the small arteries and nerves in the body, including retinal blood vessels in your eyes. Uncontrolled diabetes affects your nerves and results in a condition we label as a ‘Neuropathy’ leading to weakness and paralysis of limbs.

There are many ways of controlling your A1C levels in your blood.

Exercising and gym workouts on a daily basis will bring down your sugar level. After all your muscles need glucose for energy and during exercise sugar is taken directly from your blood to supply energy required. Your physician will arrange a plan of medication if exercise alone does not lower the blood sugar. Early stages you’ll start on tablets and after about ten years you invariably need to switch on to insulin. In pre-diabetic state when detected (referred to as spring diabetes) exercise and dieting alone would be sufficient to control your blood sugar level.

Life style changes and a diabetic diet plan will help to control your blood sugar.

You need the cooperation of your loved ones at home, especially your wife, to control your blood sugar levels, by cooking the right meals and a bit of nagging.

Majority of the people do not adhere to a strict regimentation to control diabetes and complications do occur.

In my opinion, if I were to choose a chronic disease, my choice would be diabetes. This is the only debilitating disease you have full control and with strict discipline your health would be similar to that of a non-diabetic. Remember, you are the captain of the ship.

Your kidneys can get affected if your blood sugar is not controlled. Your doctor will do a series of tests annually to check on your kidney situation. Blood electrolytes, including urea and creatinine levels are assessed. Another important test done will be your eGFR which is related to your blood creatinine level. Normally when the eGFR drops below 60 units you are heading for chronic kidney disease and steps needs to be taken to control your blood sugar levels tightly. Another important test done on your urine is to check the protein leakage through the damaged kidneys (proteinuria).

Conclusions: Plan a low glycaemic diet with a low glycaemic load. Check your body weight regularly and keep it within a BMI range of 25-27. Exercise and take your medication regularly. On this regime you can’t go wrong.