Wednesday, June 3, 2015

Wisdom Wednesday: A1C Test

The A1C is a common blood test used to diagnose type 1 and type 2 diabetes and then to gauge how well you’re managing your diabetes. The A1C test goes by many other names, including glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C and HbA1c.

The test result reflects your average blood sugar level for the past two months. Specifically, the A1C test measures what percentage of your hemoglobin – a protein in red blood cells that carries oxygen – is coat with coated with sugar (glycated). The higher the A1C level, the poorer the blood sugar control and the higher the risk of diabetes complications. Because red blood cells (RBCs) live approximately 120 days, the half life of an RBC is 60 days. So the test measures the saturation of sugar into RBCs over that 60 day average.

Recently an international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that the A1C test be the primary test used to diagnose prediabetes, type 1 and type 2 diabetes. Previously, the fasting glucose was the gold standard. However, in many cases the A1C elevates years prior to the fasting glucose. It is estimated that there are 35 million undiagnosed cases of type 2 diabetes in the United States alone.

The medical norm for the A1C test is less than 5.7%. That corresponds to an average blood sugar level, in milligram per deciliter (mg/dL) of 117. Research reveals anything above that level causes damage to the kidneys, small blood vessels, nerves and the eyes. A test result of 6.5%, the threshold for diabetes, reflects an average blood sugar level of 140.

A1C levels above 5.7 but below 6.5 are considered pre-diabetes. This is where many of my patients land, if they are not yet true diabetics. This is also where early treatment in the form of dietary improvements, regular exercise, and supplementation will easily reduce the A1C below 5.7% and allow patients to avoid Type 2 diabetes.

When I check a patient for inflammation (I check every patient, every visit for inflammation), I test the prostaglandin pathways. Please review one of my early blogs “Inflammation – Part 1” posted on March 19, 2014. This is the most common active inflammatory pathway for musculoskeletal issues. Omega 3 fatty acids in the form of fish oil and/or flax seed oil are usually the most effective anti-inflammatory supplements for this pathway. However, if I find the need for sesame seed oil, I suspect that the patient has some aspects of metabolic syndrome and very often their A1C will be elevated.

Unfortunately, I am finding evidence of metabolic syndrome and elevated A1C on more and more patients at younger and younger ages. These patients typically are in their early 30s, are not overweight and claim to eat well and exercise on a regular basis. They don’t look prediabetic, but they are.
The “sesame seed test” is so accurate, that about 90% of patients showing a need for this oil will have an elevated A1C clinically. The other 10% have some other aspect of metabolic syndrome – hypothyroidism, central obesity, high blood pressure, and/or high serum lipids.

The last two are just tests results and central obesity is obvious to the casual observer. Hypothyroidism is rare in men but almost universal in women over the age of 40. It too, can be diagnosed by a simple blood test.

Bottom Line – Please have your A1C tested. It is a simple, non-fasting blood test that costs about $35. If you are a female, have a TSH (thyroid stimulating hormone) run as well. These two tests could save your life and a lifetime of suffering.

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