JUDGING LONG TERM GLUCOSE CONTROL

Glycosylated Hemoglobin (HBA1c) Estimation
Sugar levels fluctuate from minute to minute, hour to hour, and day to day. Thus for hour to hour control, or day to day, we need a parameter which will give us an overall idea of the blood glucose control.

The hemoglobin A1c (HbA1c) test is a simple blood test that indicates how well your diabetes has been controlled over the past three months. Unlike daily blood glucose testing, which measures your blood glucose level at the moment you test, the HbA1c test provides a broader picture of your overall glucose control.

What exactly is Glycosylated hemoglobin?

In the blood stream, glucose molecules get attached to protein molecules which are present in the blood. Hemoglobin is a protein in red blood cells that carries oxygen. Hemoglobin picks up glucose from the bloodstream, becoming "glycated." As blood glucose rises, so does the level of glycated hemoglobin.

Thus, the presence of glycosylated hemoglobin is a normal occurrence and HBA1c is present even in those who do not have diabetes.

If more glucose molecules are present in the blood, as would occur in a person with raised levels of blood glucose, then the number of glucose molecules which would get attached to the proteins, such as hemoglobin would increase and this would be seen as raised levels of HBA1c.

Another way of looking at this is:

Once hemoglobin becomes glycated, it remains that way for the life of the red blood cell, which is three to four months. This means the HbA1c test can provide a picture of your glucose control over several months.

Test results reflect the percentage of glycated hemoglobin in your bloodstream. People without diabetes typically have an HbA1c level of 5%. Studies have shown that people with diabetes who are able to keep their levels at 7% or less reduce their risk for complications such as blindness, kidney disease and nerve damage.

It is also possible to get an idea of your average blood glucose levels by estimating the HBA1c levels.

You should have the test every three to four months. It is a simple test that requires only one sample of blood. There is no need to fast. The sample can be taken at any time of the day -- even right after a meal.

Serum Fructosamine Levels

• This estimation gives an average of the blood glucose levels over the previous two weeks.
• Especially useful in monitoring glycemic control in certain situations like pregnancy, etc., where intervals of 6-8 weeks as in GHb estimations may not be optimal.

OPTIMUM MONITORING
Presently, self monitoring of the blood glucose levels, along with 12 weekly HBA1c estimations would seem to be the ideal method to monitor blood glucose control in patients.

But this may not be feasible, or economically viable, for many patients.

Most importantly, you must realize that monitoring your blood glucose levels is not the same as mentoring your diabetes!

Besides glycemic control, optimal monitoring in diabetes, implies optimising the weight, blood pressure, lipid abnormalities, and importantly, the diagnosis of the presence of long term complications in their early, initial stages.

Your Feedback Please