Why The A1C (Glycated Hemoglobin) Test For Diabetics Does NOT Give Us The Whole Picture

Why The A1C (Glycated Hemoglobin) Test For Diabetics Does NOT Give Us The Whole Picture

Diabetics are familiar with the A1C test.  It is performed to assess roughly a 90 day period of sugar that is attached to your hemoglobin.  It is supposed to tell us if we are taking good care of ourselves.  The test is performed every 3 months because the average life of a red blood cell is 90 days.

Diabetics are told that the A1C is the ‘holy grail’ of knowing if you are in good health or not.  It’s the aim of most every diabetic to get that number lower!  I’ve been diabetic for over 35 years and it’s great to learn new things.  What have I learned?  I now know that the A1C, although a great test to determine the ‘average’ blood sugar reading over 3 months, does really nothing more than that.  It does NOT accurately tell us all we need to know about our diabetic health.

The A1C for a non-diabetic person is about 5.7%.  A ‘well-controlled’ diabetic will have an A1C at 6.5% or lower.  If someone’s A1C is 8.0% or higher, then they are generally in trouble!  Long-term high blood sugar levels lead to high levels of oxidative stress (free radical damage).  This damage is mostly what is responsible for killing diabetics.  Afterall, 65% of diabetics will die from heart disease/stroke and this damage is caused by, you guessed it, poor blood sugar control.

Diabetics get A1Cs to determine long term health...is it really giving us that data?

Diabetics get A1Cs to determine long term health…is it really giving us that data?

The formula for determining your A1C is as follows:

  1.  Take an average of your blood sugars over a period of time.  The longer the time, the better.  When you get blood work done, they are using a decent quantity of blood and again, can read the amount of glucose attached to the hemoglobin in your blood (over about 90 days)…this gives a result that is far more accurate than you can determine at home…but for the sake of this blog, follow along.
  2. Add the number 46.7 to your final average that  you have determined.
  3. Now divide the resultant number by 28.7
  4. This gives you your A1C percentage and you can determine where you stand in regards to your A1C.

Before we continue, we need to understand that, as mentioned above, oxidative stress kills.  There are over 153,000 studies on the topic of oxidative stress on pubmed.org.  For diabetics, keeping tight blood sugar levels is vital…literally. The oxidative stress that is created with large changes in blood sugars day to day, week to week, month to month, etc…create significant, cumulative damage inside the body of a diabetic.  Ultimately, it’s the allostatic load (cumulative damage) that does the diabetic in.  I already cited the heart disease and stroke likelihood, but I should also mention that diabetics are at a much higher risk of certain cancers and neurodegenerative diseases.  The bottom line is that blood sugar fluctuations kill and this leads me to ask: what is the utility of the A1C anyway, being every endocrinologist relies so heavily on it?

I’ve had an interesting voyage as of late.  I have a history of excellent A1Cs but I do have decent blood sugar fluctuations. Sometimes, they can be quite extreme.  I have always looked for ways to lower the amount of damage to my body that my diabetes causes.  I believe in supplementation to minimize the effects of free radical damage (something we all have but diabetics have a lot more).  However, supplementation should only be used if you are already starting with an optimally healthy body…meaning, you must FIRST get your body in optimal shape before supplementation is worth it.  My point is that it doesn’t make much sense for an obese and otherwise unhealthy person to take a lot of pills if their lifestyle is horrible.  No amount of pills will overcome the deleterious effects of lifestyle.

Although I am already what ‘numbers’ consider to be ‘healthy’, I decided to began a system to get me to even healthier.  I remain on that system to this day.  I dropped about 20 pounds, cut my short acting insulin (Novalog) from 16 units to 0-5 per day, and got superfit.  I love how I feel as I’ve never felt better. I’m faster, fitter, stronger, lighter, etc…now for the big test….what was my A1C going to look like?  It should, after all, go down…right?

I usually score in the low to mid 6’s with my A1C.  Although this number looks good, I used to have a huge variance in blood sugar readings on a daily basis. We cannot forget that a 60 blood sugar reading and a 220 blood sugar reading average out to 140…and that is about a 6.5 A1C number…an ‘excellent result’.  But, those fluctuations…they are certainly creating a lot of damage in the body.  Should I believe that since the number is 6.5 that I am doing well?  Heck no…that picture is entirely incomplete.

The problem is that the A1C is not taking into account daily fluctuations, which is what kills the diabetic. There is no measure of this as endocrinologists do not tend to measure oxidative stress…and they should.  Only this way could they see what is going on inside the body due to free radical damage before a disease state sets in…or more simply put, before the diabetic dies.

I just got my results back from my A1C I just had taken…and guess what?  My cholesterol was awesome (my HDL was 88), my body is more alkaline than ever (this alone is amazing), and about that A1C…the number was about the same…6.5.  I was in amazement as I thought it’d be lower but then I remembered something: I have minimal blood sugar fluctuations now as compared to before.  I am lighter, stronger, fitter, faster, have lower levels of oxidative stress (I use a Raman Spectrometer to validate this) and still, I have the same number.

This means only one thing and the conclusion is simple: the A1C does not tell the entire story of the health of a diabetic.  We can all agree that it tells us the average blood sugar over a period of time, and we want to keep that number low, but it doesn’t tell us much more as it misses out on the most important aspect of diabetic health: blood sugar fluctuations.  In essence, the A1C can be totally fooled by rather lousy control.  I know how I was and how I am now…it’s a tremendous difference.  Although my A1C is the same, my health is vastly improved.  This is what matters most!

I hope this blog can be used to help diabetics find a dietary system that minimizes blood sugar fluctuations.  When you find one, stay on that system! Yes, we will all have bounces but the less we have, the better our health will be.  No matter if you use an insulin pump, have a CBGM, or anything else, if you have a lot of blood sugar fluctuations, you are not healthy…not one bit! Don’t think your A1C level is telling you the whole picture as it is not.  There are things that can be done and we should never stop looking to improve our lives so that we can live a longer and healthier life.

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