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December 7, 2006

A1c (Glycohemoglobin, HgbA1c), Daily Care

Question from United Kingdom:

I have had diabetes for five years. I eat well, take my insulin and test my blood sugar four times a day. Ever since I have had diabetes, my A1c has been around 11.0 and 12.0. I have been trying my best to get it down and haven't succeeded. Just once, I would like to have a good trip to the hospital and not one were they tell me what will happen to me if I don't start "taking better care of myself." What should I do?


I am pleased to hear that you check glucose levels four times daily and that you take your insulin, and that you “eat well.” What is your activity level? And, what are the glucose readings that you dutifully check?

If the home glucose readings are high, then the high A1c values are likely genuinely reflecting that there is an imbalance in your food-to-insulin-to-activity interactions. Your diabetes team will be the best ones to help you make ongoing adjustments. For instance, perhaps you are on an insulin plan that it not intensive enough and they need to promote you to a more intensive plan.

On the other hand, if the home glucose readings look good (and I’m talking 100 mg/dl [5.6 mmol/L] to 180 mg/dL [10.0 mmol/L] here), and the high A1c values are surprisingly elevated and seem discordant to the home glucose readings, then perhaps there is something interfering with optimal measurement of the A1c.

The A1c is the “hemoglobin A1c.” The values certainly depend upon the blood concentration of glucose over the preceding 8 to 12 weeks, but also depends on the quantity and quality of hemoglobin. Some hemoglobin variants have a different “stickiness” for glucose and/or have a longer period of time before being metabolized. This can cause false elevations of the A1c. This commonly can be screened for by doing a special test to assess for the potential variety of hemoglobins in your blood. (A common test is a hemoglobin electrophoresis). These variant hemoglobins can occur in ANYONE, but are more often seen in persons of African and Mediterranean descent.

Another screening method is to measure the “total glycosylated hemoglobin” and not simply the A1c.

These are discussions that are best held with you and your Diabetes Specialists after careful review of your home glucose readings and your basic diabetes meal-activity-insulin regimen.