Hemoglobin A1c (HbA1c) Test for Diabetes

What is a Hemoglobin A1c (Average Blood Sugar) Test?

The Hemoglobin A1C Test  is also called HbA1c, glycated hemoglobin test, or glycoslated hemoglobin test is a common blood test used to diagnose type 1 and type 2 diabetes to determine how well your diabetes is being controlled. 

According to American Diabetes Association, the test result of A1c reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of your hemoglobin (a protein in red blood cells that carries oxygen) is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications. 

Why Hemoglobin A1c Test  is Done?

Based on the international committee of experts from the European Association for the Study of Diabetes, American Diabetes Association, and International Diabetes Federation stated that they recommends the A1C test as the primary test used to diagnose prediabetes, type 1 diabetes and type 2 diabetes.

A1C test can help you manage your diabetes:

• to determine if your treatment plan is working properly
• to confirm self-testing results or blood test results by the doctor.
• to show you how healthy choices can make a difference in diabetes.

How to Prepare A1c Test?

A1c Test is a quite simple blood test. You just eat and drink normally before the test.

Expect your the A1c test

During the test, the health care team practitioner simply takes a sample of blood by inserting a needle into a vein in your arm or pricking the tip of your finger with a small, pointed lancet. The blood sample is sent to a lab for analysis. You can return to your usual activities immediately.

The Results

After the blood analysis, the results conclude for someone who doesn't have diabetes, a normal A1C level can range from 4.5 to 6 percent. Someone who's had uncontrolled diabetes for a long time might have an A1C level above 8 percent.

When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes.

For most people who have previously diagnosed diabetes, an A1C level of 7 percent or less is a common treatment target. Higher targets may be chosen in some individuals. If your A1C level is above your target, your doctor may recommend a change in your diabetes treatment plan. Remember, the higher your A1C level, the higher your risk of diabetes complications.

Here's how A1C level corresponds to average blood sugar level, in milligrams per deciliter (mg/dL) and millimoles per liter (mmol/L):

A1C level        Estimated average blood sugar level
5 percent        97 mg/dL (5.4 mmol/L)
6 percent        126 mg/dL (7 mmol/L)
7 percent        154 mg/dL (8.5 mmol/L)
8 percent        183 mg/dL (10.2 mmol/L)
9 percent        212 mg/dL (11.8 mmol/L)
10 percent        240 mg/dL (13.3 mmol/L)
11 percent        269 mg/dL (14.9 mmol/L)
12 percent        298 mg/dL (16.5 mmol/L)
13 percent        326 mg/dL (18.1 mmol/L)
14 percent        355 mg/dL (19.7 mmol/L)

What are the limitations?

Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose for those who need it. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log of results are so important to staying in effective control.

Source & References:

1. A1c Test - mayoclinic.com Retrieved last March 3, 2013
2. Living with Diabetes  - diabetes.org. Retrieved last March 3, 2013 
3. The Hemoglobin A1c (HbA1c) Test for Diabetes - webmd.com . Retrieved last March 3, 2013 
4. Image source: http://www.dlife.com/diabetes/export/pics/dLife_Images/A1C_Levels_p1.jpg. Retrieved last March 3, 2013

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Oral Glucose Tolerance Test (OGTT)

What is Oral Glucose Tolerance Test?

The oral glucose tolerance test (OGTT), also known as the glucose tolerance test, is a lab test to how your the body’s ability to metabolize glucose, or clear it out of the bloodstream. In this procedure the The patient is asked to take a glucose drink and their blood glucose level is measured before and at intervals after the sugary drink is taken. The test can be used to diagnose diabetes, gestational diabetes  or prediabetes.

The test is a more substantial indicator of diabetes than finger prick testing

Why OGTT is Done?

According to webmd.com the Oral Glucose Tolerance Test is done to:

• Check pregnant women for gestational diabetes. You have an increased chance of developing gestational diabetes if you:
• Have had gestational diabetes during a previous pregnancy.
• Have previously given birth to a baby who weighed more than 9 lb (4.1 kg).
• Are younger than age 25 and were overweight before getting pregnant.
• Diagnose prediabetes.
• Diagnose Insulin resistance, and
• Reactive hypoglycemia

How to Prepare the Test?

For those who taking the test to diagnose diabetes or prediabetes, you must need first to prepare before performing the diagnostic test:

• You must eat a balanced diet that contains at least 150 grams (g) of carbohydrate per day for 3 days before the test. Fruits, breads, cereals, grains, rice, crackers, and starchy vegetables such as potatoes, beans, and corn are good sources of carbohydrate.
• Fasting at least 8 to 12 hours before your first blood sample is taken. Do not eat, drink, smoke, or exercise strenuously during the fasting.
• Must tell your doctor about all prescription and nonprescription medicines you are taking, because it will affect the test results. You may be instructed to stop taking certain medicines before the test.

How is Done?

After the preparation, on the day of testing, the following steps will be done:

• A blood sample will be collected when you arrive. This is your first blood taken to measure your blood sugar (glucose) level before the test. 
• The next stage is to take a very sweet tasting, glucose drink. It is best to drink the liquid quickly. For the standard glucose tolerance test, you will drink 75 grams or 100 grams. Pregnant women drink 75 grams of glucose.
• Further blood samples will then be taken either at regular intervals of say 30 or 60 minutes or a single test after 2 hours. The test could take up to 3 hours.Since activity can interfere with test results, you will be asked to sit quietly during the entire test. Do not eat during the test. You may drink only water during this time.

The Blood Test

The health professional taking a sample of your blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Apply a gauze pad or cotton ball over the needle site as the needle is removed.
• Apply pressure to the site and then a bandage.

What Should the Test Result be?

For people without diabetes:

• Fasting value (before the test): under 6 mmol/L
• At 2 hours: under 7.8 mmol/L

For people with impaired glucose tolerance (IGT)

• Fasting value (before the test): under 6.0 to 7.0 mmol/L
• At 2 hours: under 7.9 to 11.0 mmol/L

For diabetic levels

• Fasting value (before the test): under 7.0 mmol/L
• At 2 hours: over 11.0 mmol/L

What do these OGT Test Results mean?

If you fall in the range within the impaired glucose tolerance, you will likely be advised to make lifestyle changes. In some cases, blood glucose lowering medication may be advised.

If you fall within the diabetic range, it is quite likely that blood glucose medication will be prescribed to help your body keep your blood glucose levels down.

National Institutes of Health (NIH) stated, that the OGTT it is better able to diagnose high blood glucose after a glucose challenge than the fasting blood glucose test. A doctor may recommend it if he or she suspects diabetes in cases where a patient’s fasting blood glucose level is normal. However, the test is more time-consuming and complicated than the fasting blood glucose test.

Source & References:

1. Glucose Tolerance Test - diabetes.co.uk Retrieved last February 26, 2013
2. Oral Glucose Tolerance Test  - Webmd.com. Retrieved last February 26, 2013 
3. Glucose Tolerance Test - nlm.nih.gov . Retrieved last February 27, 2013 
4. Image source: http://www.diabetesinfo.org.au/webdata/images/Glucose%20Tolerance%20Test.jpg. Retrieved last February 26, 2013

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Type 2 Diabetes

Overview

Type 2 diabetes mellitus, (formerly noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes), according to World Health Organization (WHO) Type 2 diabetes is the most common form of diabetes, comprises 90% of people with diabetes around the world, and is largely the result of excess body weight and physical inactivity. Until recently, this type of diabetes was seen only in adults but it is now also occurring in children.

In this article, you'll learn the basics about type 2 diabetes, including symptoms, causes and prevention.

What is Type 2 Diabetes?

In type 2 and other types of diabetes, you have too much glucose, also called sugar, in your blood. People with diabetes have problems converting food to energy. After a meal, food is broken down into glucose, which is carried by your blood to cells throughout your body. With the help of the hormone insulin, cells absorb glucose from your blood and use it for energy. Insulin is made in the pancreas, an organ located behind the stomach.

The type 2 diabetes is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. This is in contrast to diabetes mellitus type 1, in which there is an absolute insulin deficiency due to destruction of islet cells in the pancreas.

People with type 2 diabetes produce insulin; however, either their pancreas does not produce enough insulin or the body cannot use the insulin adequately. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include:

• Damage to the body. Over time, the high glucose levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke.
• Dehydration. The buildup of sugar in the blood can cause an increase in urination. When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration.
• Diabetic Coma (Hyperosmolar nonketotic diabetic coma). When a person with type 2 diabetes becomes very ill or severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication.

Causes of Type 2 Diabetes?

People can develop type 2 diabetes at any age, even during childhood, however, those at highest risk for the disease are those who:

• Are over 45 of age
• Are obese or overweight
• Have had gestational diabetes 
• Have family members who have type 2 diabetes
• Have prediabetes
• Are inactive
• Have low HDL cholesterol or high triglycerides levels
• Have high blood pressure
• Are members of certain racial or ethnic groups

Signs and Symptoms of Type 2 Diabetes

People with type 2 diabetes may not have symptoms for years or decades, but as the disease progresses and blood sugar levels rise, symptoms develop. Here is the list of signs and symptoms for people with type 2 diabetes :

• Blurred sight
• Dry, itchy skin
• Increased thirst 
• Increased hunger (especially after eating)
• Frequent need to urinate
• Decreased sensation or numbness in the hands and feet
• Frequent bladder and vaginal infections
• Male impotence (erectile dysfunction)
• Slow healing of cuts or sores
• Tiredness
• Leg cramps

Preventing of Type 2 Diabetes

Many people with type 2 diabetes go undiagnosed for several years and are not diagnosed until they go to the doctor with complications of diabetes. But up to 60% of type 2 diabetes can be prevented. People at risk of type 2 diabetes can delay and even prevent this disease by following a healthy lifestyle. This includes:

• Maintaining a healthy weight
• Regular physical activity
• Making healthy food choices
• Managing blood pressure
• Managing cholesterol levels
• Not smoking.

References

1. "Diabetes" Retrieved January 05, 2013
2. "Am I at Risk for Type 2 Diabetes?" Retrieved February 01, 2013
3. "Type 2 Diabetes" Retrieved February 01, 2013

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