Goals in Diabetes Care: A1c
By Dr. Kelsey E. Simmons
This is the third in a series of columns about managing diabetes as part of November as Diabetes Awareness Month.
What is an A1c anyway? Besides being something that your doctor checks at most office visits, A1c is literally the amount of glucose attached to the red blood cells in your body. The more glucose in your blood, the more red blood cells have glucose attached to them. The A1c value is the percentage of red blood cells in your body that have glucose attached to them.
What does that information tell us? A lot of things. First, it gives us an idea of what your average blood sugar has been over the last few months. People without diabetes often have an average blood sugar less than 100. People who are at increased risk of diabetes, or have prediabetes, have an A1c value of 5.7 to 6.4. This means people with prediabetes have an average blood sugar of 126 to 140. People who have diabetes have an A1c value of 6.5 or higher. This means people who have diabetes often have a blood sugar greater than 140. The higher your A1c, the higher your average blood sugar. If your A1c is 9.0, your average blood sugar is 212. If your A1c is 10, your average blood sugar is 240. Having an A1c of 9.0 or higher means that on average, your blood sugar is almost twice as high as people who don’t have diabetes.
Why does it matter? Over time, diabetes causes a lot of problems in your body. The longer your blood sugar is above what is considered normal, the higher your risk of developing permanent, irreversible damage from diabetes. Uncontrolled diabetes can lead to skin infections, blindness, glaucoma, cataracts, nerve damage and loss of sensation in the feet, as well as kidney damage which may lead to dialysis. When uncontrolled diabetes is present with high blood pressure and high cholesterol, the risk of heart attack and stroke also increases. All of these problems can be avoided with keeping blood sugar as close to normal as possible.
How else does A1c help us? For one thing, it helps us determine if the treatment we put you on is working. Every time a medication is added, we should expect to see some level of improvement in the A1c. If we are trying lots of different medications and your A1c isn’t changing, it could be the medications. Testing the A1c helps us determine if your treatment plan is right for you. It also helps us determine if your blood sugar meter is correct. If you are checking your blood sugar at home and getting lots of low numbers or lots of normal numbers but your A1c is very high, it may be time to purchase a new meter.
What should my A1c be? Your target is your own. You are unique and your goal A1c is as unique as you are. Work with your doctor to understand your health and develop a goal A1c that is safe for you.
Call 1-844-735-8864 for assistance with managing your diabetes with the help of a SeHealth primary care provider who can refer to an endocrinologist or diabetes educator if needed.
Kelsey Simmons, D.O., is a family medicine physician who completed a fellowship in diabetes at Duke/Southern Regional AHEC in Fayetteville, NC. She provides care at Southeastern Health’s Southeastern Medical Clinic Gray’s Creek.