hello guys today we are going to talk
about
a1c so what is a1c this commonly asked
question and today i'm specifically
answering barbara williamson's question
where she asked in our what is normal
blood sugar video and i think i
mentioned a1c in that video and she's
asking what is really avon c and
everybody asking the same question so
let's talk about it
i am dr ahmed ergin i am the founder of
sugaramds.com
again our primary purpose is to serve
you remotely so we can take care of your
diabetes
using technology
not that you have to be tech savvy but
we will make it easy for you where you
don't have to leave your home
and you can still see us and make sure
your diabetes under control and reduce
the number of medications
now let's move on to the topic so why we
measure a1c right so a1c is a test
that's commonly used is a standardized
test so but most people have trouble
understanding what the a1c is
so why do we call it
a1c or hemoglobin a1c in a better term
because we are measuring the glucose
within your hemoglobin now hemoglobin is
a protein in your blood that is
subject to carry your oxygen
from
a to b so your your hemoglobin is
getting oxygenated in your lungs and
carrying that oxygen to the rest of the
body
now the same hemoglobin is permeable
which means that
it is open to
the transfusion of glucose into itself
so it opens its arms to
the glucose so as a result
the more glucose you have in your system
the more glucose will be
in your hemoglobin
so that's what we are measuring now why
do we measure that every three months
that's the next question right so that
is because your hemoglobin lives for
three months so as a result assuming
that your hemoglobins are living three
months
the glucose they accumulate in three
months
will be
tested
and then we can tell exactly how much
your blood sugars are running based on
how much glucose is in the hemoglobin
there is a percentage it's reported as a
percentage
and every percentage corresponds to an
average blood sugar it is a perfect test
barely but we'll talk about the
advantages and disadvantages of this
test now
so before we dive into details let's
talk about
what do the results mean so sometimes i
tell people okay your a1c is seven
percent or they'll tell that their a1c
is six percent eight percent ten percent
whatever when i ask my patients okay
what does that mean to you
and they say oh i think it's supposed to
be less than seven let's suppose 6.5 but
they don't they don't really know what
it means right so as an educated patient
which is the best patient right so if
you know what a1c is at the end of this
video you're going to be an a1c pro
you're going to be able to teach
everybody about a1c
but the bottom line at least you should
understand if nothing else from this
video
that every percentage of naivan c
corresponds to an average blood sugar so
six percent is on average 120 right
so seven percent is 150. so every one
percent increase or decrease in your
blood sugars corresponds to a 30
milligram per deciliter change in your
in your overall blood sugars so if
you're going from six percent to seven
percent that means that your average
blood sugars are rising by 30 milligram
per deciliter on average so
six percent is 120
7 is 150
8 is 180 and then it goes on so
if you go to like uh for example i want
to calculate i'm gonna cheat here so if
you go look 12 percent that's that's
around three three hundred so but you
can make an easy calculation about that
so
i hope that's easy to understand and
we'll move on to the next topic now
a lot of people are also confused about
their avon seagull right there's a lot
of things said and done about this a1c
now of course uh clinicians actually
determine the a1c goal the universal
goal is less than seven percent and the
reason there's a universal goal is
because they use avon c in studies to
determine the risk reduction so for
example if your a1c goes down
one percent
your actually overall risk of diabetic
complications can go down by 30 percent
so as a result
they determined that if you stay below
seven percent overall for the entire
population that is a good target to keep
patients with diabetes under control
now of course
the lower the sugar the better
um so
we want to keep actually young diabetics
who
just got diagnosed in the first five
eight years of diabetes or even 10 years
we want to keep them as low as possible
less than 6.5 down to 6 percent that's
all okay i have a lot of patients with
a1c down to 5.7 5.5 not even in the
diabetic range because of the approaches
we have and they almost live their life
almost free of diabetes right so that is
possible so what i say to my patients
with the a1c goal is as low as
reasonably achievable
what does it mean
to bring the a1c you have to bring your
average blood sugars down right so to do
that
you have to use sometimes strong
medications and some medications can
cause very low blood sugars i don't know
if you ever had a low blood sugar but
it's not a pleasant experience it is
very very difficult to go through that
experience now if you're having low
blood sugars frequently yes your a1c
will go down right why because your
average blood sugar will go down because
you're if you're running low frequently
your average will be low as well but
that's not what we want that's one of
the downside of a1c
is that just because your a1c is down
doesn't mean that you are doing great
you may still be having a lot of
fluctuations it doesn't tell you again
a1c does not tell you anything about
fluctuations it only tells you
what is your average so we want to avoid
low blood sugars
but still want to keep the a1c down that
is the key that differentiates a good
diabetes doctor
from a bad one
that differentiates a good
endocrinologist from a bad one so
if if you're on medications that cause a
lot of low blood sugars and you're
suffering from this and your doctor
don't care about that that is a problem
right so
do you need to you need to give them
hypoglycemia the low blood sugar see how
they how it feels you know
so anyways
uh so that's the goal as low as
reasonably achievable that if you're
going down to six percent and you're
having a lot of low blood sugars and we
don't have any way of improving that
because you have to be on these
medications for some reason then i tell
them look it's okay to be a 6.5 or it's
okay to be seven percent rather than
having so many low blood sugars correct
so i hope we agree on that uh some
people are extremely obsessed about
their blood sugars they they're they
they're they're stuck in the a1c or my
a1c has to be six percent or whatever
however they came up with these ideas uh
they don't even know sometimes what the
a1c is but they want to see that number
down to six it's a psychological thing
uh but i try to educate them look it's
it's not just about uh the number it's
about your health right so the reason we
want to bring the a1c down we want to
avoid complications
uh but 6.5
also will not give you complications
seven percent less than seven percent
will probably not gonna give you
complications so
it is
better to be safe than trying to pull
the numbers too low sometimes there are
actually studies where when they tried
every medication it's called a court
study if you want to look it up uh it's
a major study a super large study
so what they did they tried to bring a1c
down as much as possible and they
realized that more people actually died
and they attribute that due to too many
low blood sugars
causing the death so as a result we want
to avoid that problem
so the problem with a1c as you can
imagine so since you're having low blood
sugars and you're having
a1c down
so that is one of the problems you
really you know when you start using a
dexcom g6 or freestyle library for
example that
tells you all the fluctuations because
it's a continuous glucose measurement
devices that tell you everything
happening with your blood sugars you'll
be so surprised how much your blood
sugars are actually fluctuating so as a
result we want to make sure that does
not happen so i'll give you an example
so you may have a seven percent a1c
right with blood sugars ranging between
130 and 180
that's not actually bad if you're waking
up with 180 and your highest during the
day is 180 you can still have a seven
percent and that's a healthy number
because you're not really fluctuating
too much
but you can achieve the same number
again seven percent is what 150 on
average right so 130 180
you know put them together divided by
two
that is seven percent
now if you are having a blood sugar of
50 and 250 every time let's say you're
51 time 250 next time 51 times 250 next
time and keeps going
so you're actually having a lot of very
high blood sugars but because of the low
blood sugars it negates it out as a
result you slept seven percent a1c so
just because you go to your primary care
doctor and you're able to see some
person and they say oh you're good that
doesn't necessarily mean you're good you
may still be having a lot of
fluctuations and that still needs to be
addressed so as a result at sugar mds we
monitor you and we track you remotely so
if you are fluctuating that much we
don't wait three months uh we don't just
check your a1c we look at your real
numbers we try to get you continuous
glucose monitoring devices we uh you
know if you cannot get those we at least
monitor your finger sticks remotely so
if you are using our app i can see
what's going on on my screen
without you even knowing so that is the
beauty of it so we can intervene and fix
those problems before it turns into
bigger problems
another quick tip for you to know
a1c may be different from lab to lab so
if you're checking your events in
doctor's office and then you go to um
to another lab you may actually end up
having like let's say one time you check
is 6.8 next time it can be 7.1
and you'll be like oh well it went up
actually it's just a variation in the
labs so i recommend to stick with the
same lab because a1c basically helps us
the most to see the trend so if you're
going down from nine percent down to
eight percent seven percent that's a
good sign although again it doesn't tell
you the whole story but it's still
pretty good sign okay
uh now what are the disadvantages now
sometimes actually not appropriate so
again remember we rely on your
hemoglobin so if you have anemia which
is a hemoglobin problem right so if you
have iron deficiency b12 deficiency
or you have chronic kidney disease and
they are giving you erythropoietin
anything that that messes with your
hemoglobins you may be having
transfusion you know you may be having
bleedings you may be having iron
infusions
anything that tries to manipulate your
anemia your
your hemoglobin cells can definitely
distort the overall result because you
are basically adding when you are
transfusing you're adding fresh cells
you're you know diluting the pool
uh or if you have an anemia your your
hemoglobins may uh actually die faster
so as a result it doesn't really reflect
every three months so some in some
diseases they actually live longer
and it does
you know you can over reflect so if
there is a hemoglobin problem if you
have thalassemia if you have sickle cell
disease uh then the hemoglobin a1c is
really not very reliable so that's
something that you should
know about so what do we do if we cannot
use hemoglobin a1c number one we can use
continuous glucose monitoring systems
and they are the best so even if you
don't have a
personal cgm
like a dexcom g6 or freestyle libre
we can do a professional one we can put
one on you for a week or two to see how
your sugars are really running instead
of just a1c
also we have other testing such as
fructosamine
again that lines the glucose
so we rely on the fructosamine's ability
to bind the glucose which gives us a
shorter duration around two to three
weeks time frame of half your blood
sugars on average running so that can we
can use that
we can use glycomark if you're not on
giardians farsigh or in mercana that
certain medications that actually
makes you urinate to blood sugar
glycomark is a test that relies on the
kidneys ability to
reabsorb glucose and so forth so we can
use glycomark as an alternative test so
we have other ways to find out how your
sugars are running and most importantly
if you have nothing else to do you have
your finger sticks you can do blood
sugar checks and if you are checking
frequent enough that can give you a
almost like a good enough uh
uh understanding of how your blood
sugars are running as well
sometimes uh pregnant women
women with gestational diabetes also are
curious if they can just rely on an
uh it is it is still used however
remember when you are pregnant your
blood volume goes up your hemoglobin
changes so it may be a little falsely
low but if you know that it's falsely
low and you can you can you still have
to check your finger sticks you should
still be okay you can still look at the
hemoglobin as a
way of
controlling diabetes during pregnancy
but again just you have to be careful
because the results are not exactly
the same as if when you are not pregnant
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