
February 19, 2005
A1c (Glycohemoglobin, HgbA1c)
Question from Calgary, Alberta, Canada:
My eight year son has had two separate A1c readings above 0.9 over a six month period. What is the normal expected A1c range for a type 1 diabetic? Also, what is the recommended change in his diabetic care that should be done?
Answer:
I suspect you mean A1c levels over 9% not 0.9. The normal range is about 4 to 6%. Exact definitions of control are not uniformly defined, but here would be my approximations:
Excellent control: A1c less than 7%
Good control: 7 to 7.9%
Fair control: 8 to 8.9%
Poor control: greater than 9%
Remember, also, that even when average blood glucose values, as expressed by the A1c, are within your target range, there can still be large swings on a day-to-day basis that are also related to long term complications. And, as good as current therapy is with insulin analogs, multi-dose insulin regimens, basal-bolus treatment and insulin pumps, we still only approximate what the normal pancreas used to do.
Usually, when control is off and A1c levels are too high, there is a miss-match between food, timing, portions and insulin. Many times, there needs to be more monitoring for detective work and problem solving. The best advice, if you cannot figure this out at home, would be to contact your diabetes team and ask them to help with the problem solving. Looking at graphs of downloaded data can be very useful as can color coding logbooks looking for patterns and then adjusting what activity, food and/or insulin needs to be changed.
SB