Doctors rely on a number of tools to help you manage your diabetes to prevent or delay the complications of your disease. These tools include finger stick blood sugars, serum HbA1c levels, and assays for urine microalbumin levels.

The major complications of Diabetes Mellitus include:

• kidney damage and failure
• heart attack
• stroke
• blindness
• nerve damage in your feet
• blood vessel damage, more common in the legs and sometimes resulting in gangrene and amputation
• erectile dysfunction

With this information firmly in mind, let’s go on to discuss the tools used to help you manage your diabetes.

About HbA1c testing…

Of these tools, testing for Hemoglobin A1c (glycosylated hemoglobin) provides a number that gives your doctor a pretty good idea of what your “average blood sugar” has been over a 60 to 90 day period.

Hemoglobin is the oxygen carrying iron component of your red blood cells. Most red blood cells have a life span of 100 to 120 days, before your spleen removes and disposes of them. During that 110 plus days, excessive blood sugar (glucose) can bind irreversibly to hemoglobin forming HbA1c (glycosylated hemoglobin). The higher the level of blood glucose, the higher the concentration of HbA1c will be.

HbA1c tests are standardized to reflect the level of glucose to which your hemoglobin has been exposed during that 120 days. Values are reported in terms of percentages from 4 to 14 percent, representing 4 to 12 week average blood sugars of 60 to 360 mg%.

HbA1c levels of 5.9 or less are usually consider normal. Levels above 10 indicate a person’s diabetes is not under good control.

Here are HbA1c levels for you to compare and learn to discuss with your family doctor or endocrinologist.

HbA1c %                 Average blood glucose mg%

4                                60

5                                90

6                                120

7                                150

8                                180

9                                210

10                            240

11                            270

12                            300

13                            330

14                            360

 

It’s easy to see as the concentration of glucose in your bloodstream increases, your HbA1c increases more than proportionately.

I think it’s important you remember that while HbA1c levels provide your doctor an idea of what your blood sugar has been running over the span of 4 to 12 weeks, your daily or every other day blood sugars are more useful when deciding about medication changes. This is particularly true with insulin changes.

There are several conditions that may cause changes in your anticipated HbA1c readings.

Things that can increase HbA1c:

Vitamin B12 deficiency

Folic acid (folate) deficiency

Things that may decrease HbA1c:

Sickle Cell Disease

G6PDH enzyme deficiency

 

Things that could increase or decrease HbA1c:

Mononucleosis (your spleen will breakdown red blood cells faster or slower)

About the other tools…

Finger Stick Blood Sugar

Doing daily or every other day finger stick blood sugars (FSBS) gives you and your doctor an idea of how your blood sugar is running on a day-to-day basis. Looking at these numbers and the time of day they are obtained allows your doctor to help you with your diet and medications. The American Diabetes Association advises you try to keep your blood sugar in the 140 mg% range. Endocrinologists currently advise you strive toward a FSBS of 100 to 120 mg%. Either way, your doctor will want to see a written log of your sugars to help make decisions about how often you need to check FSBS and changes in your therapy.

Urine microalbumin testing

Urine testing for a protein called “microalbumin” helps your doctor detect early damage to your kidneys, coronary arteries (heart) and the small blood vessels elsewhere in your body. With prolonged exposure to elevated blood sugar levels, fluid secreting parts of your kidneys “leak” microalbumin as cells are damaged and can’t maintain “tight seals” In addition, the endothelial cells lining all of your blood vessels suffer damage and start to thicken and develop premature calcium and cholesterol plaques.

By testing your urine microalbumin at least twice a year, your doctor can make changes to your medications, habits, lifestyle and medications that may delay further damage for many years. Normal values for microalbumin are 29 mg% or less. When your values are between 30 and 300 mg% on two different occasions, you will have “microalbuminuria”.

At that point your doctor will schedule 24-hour urine tests to determine how much microalbumin you are “spilling” and what your albumin/creatinine ratio is.

What is the significance of all of this?

Our goal in treating Diabetes is to help you delay or avoid these complications by keeping your blood sugar as normal as possible. Doing so will hopefully also help you live a longer, more active life without major disability.

With the above information, you should be able to thoroughly discuss your diabetes with your doctor on your next visit. Doing so will help you better understand how to manage your disease and will be a tremendous investment in your future health.

Dr. Frank

Reference: American Diabetes Association: Diabetes Care: “Standards of medical care in diabetes-2007”