Doing all the right things but your HbA1c too high?
Do you ever get that sinking feeling when your doctor sends you off for an HbA1c test? You know you've been doing all the right things, but still, there's a nagging doubt that the results will come back higher than you expect.
It doesn't seem fair. But there might be an interesting reason the results are high. The results could reflect your 'post-prandial spikes'.
Post-prandial blood glucose levels
Post-prandial means 'after eating', and high blood glucose levels that occur after you've eaten are known as 'post-prandial hyperglycaemia. It's normal for blood glucose levels to go up after eating, and they usually peak about an hour later.
The interesting thing is that research done by the American Diabetes Association1 has found that high post-prandial blood glucose levels are the leading contributors to high HbA1c results.
You can see if post-prandial spikes are a common problem by checking your blood glucose before and after meals. If you test just before eating and about 2 hours after your meal, you'll quickly see the difference before and after eating. And you'll also see which meals are causing the biggest spikes.
It's important to observe the difference before and after eating. That way, you've got a starting point, and you can see how high your blood glucose rises based on what you eat.
Get the info with Accu-Chek Insight
To help you get a better picture of post-prandial rises in your blood glucose, ask your doctor for the Accu-Chek Insight programme. This is a clever little tool that takes you through an intensive 3 day check which will identify any post-prandial peaks. Once you've completed the three day programme, you and your doctor will have really specific information to work with, and that will help you find a way to manage these peaks.
Here's what else you can do to manage post-prandial blood glucose levels:
- Do some exercise. Muscles use up glucose from the blood.
- Choose the right carbs. Carbohydrates directly effect your blood sugar directly, so the amount and type of carbohydrate make a difference. Avoid foods with 'empty carbs', those with high sugar content.
- Stick to your medication. Whether you take tablets or insulin, following your doctor's medication plan is a key part in reducing those after-meal peaks.
- Share your results. Keep track of your blood glucose results with a log book or a device like the Accu-Chek Smart Pix and take these to your doctor so he or she can fine-tune your medication plan.
- Test more often. Make the effort to test before and approximately 2 hours after meals. That way, you'll know what food has a greater or lesser impact on your blood glucose levels. And don't forget, ask your doctor about the 3 day Accu-Chek Insight programme for an intensive look at how food and exercise are affecting those levels.
What does your doctor see in your HbA1c lab test?
Every few months it's likely that your doctor sends you off to the lab for a blood test known as the HbA1c test. As people in our recent focus groups agreed, most people know that the HbA1c test shows what's been going on with your blood glucose levels over the past few months.
Interestingly, a number of people commented that they worry that the HbA1c only provides an 'average', and therefore evens out the peaks and troughs. Of course, that's where your own blood glucose monitoring comes in as it can show more detail on a daily basis. However the HbA1c is an important test. What is it exactly, and how does it work?
What is HbA1c?
Your HbA1c test measures your average blood glucose levels over a three-month period by taking a sample of haemoglobin (red blood cells) A1c molecules-a specific component of your red blood cells.
Some blood glucose naturally attaches itself to these HbA1c molecules as they move through your bloodstream. When this happens, the molecule is considered "glycated." The more glucose in your blood, the higher the percentage of glycated HbA1c molecules you'll have.
Once a cell has been glycated, it stays that way. And since each HbA1c molecule has a lifespan of about four months, your HbA1c sample will include cells that are a few days, a few weeks and a few months old. That's how the test result covers a span of about three months.
Of course, without regular self-testing to provide day-to-day insights, an HbA1c result can be misleading.1 Because it gives a long-term view, a person with frequent highs and lows could have an average HbA1c that looks quite healthy.2 The best way to get a complete picture of your blood glucose control is by reviewing your daily log along with your regular HbA1c tests, and working closely with your healthcare team to interpret the results.
Why the HbA1c test matters
As with your own blood glucose monitoring, the HbA1C test is all part of good diabetes management.
The key is to keep an eye on your blood glucose levels, with the aim of keeping them as close to your target goals as possible. That matters because, according to the United Kingdom Prospective Diabetes Study (UKPDS), keeping your HbA1c levels as close to normal as possible reduces your risk of long-term diabetes complications such as nerve damage, eye disease, and kidney and cardiovascular problems. Even if you already have some complications from diabetes, lowering your HbA1c may help reduce the symptoms and slow the progress of these complications.3
1 American Diabetes Association, "A1C Test." Available at http://www.diabetes.org/type-1-diabetes/a1c-test.jsp.
2 Medscape Today. "How Should Hemoglobin A1c (HbA1c) Results Be Interpreted in Your Patients with Diabetes?"
3 UK Prospective Diabetes Study. Available at http://www.dtu.ox.ac.uk/index.php?maindoc=/ukpds/.
