HbA1c: Meaning, causes and symptoms of increase, management & Ayurveda Understanding

Understanding and managing blood sugar levels is crucial for maintaining overall health, especially for individuals with diabetes. The haemoglobin A1C (HbA1C) test plays a pivotal role in this process, offering valuable insights into one’s average blood sugar levels over the span of two to three months.

Glucose, derived from the foods we consume, serves as a primary energy source for our cells. Facilitated by insulin, glucose is transported into cells to fuel various bodily functions. However, in individuals with diabetes, either insufficient insulin production or ineffective utilization by cells leads to elevated blood sugar levels.

Glycated Haemoglobin

A fascinating aspect of blood sugar regulation is its interaction with haemoglobin, a protein present in red blood cells. As blood glucose levels rise, glucose molecules bind to haemoglobin, forming a complex known as glycosylated haemoglobin. The HbA1C test quantifies the percentage of red blood cells coated with glucose-bound haemoglobin, providing a reliable measure of average blood sugar levels over the preceding months.

The longevity of red blood cells, which circulate for approximately three months before being replaced, enables the HbA1C test to offer a retrospective view of glucose control.

Elevated HbA1C levels indicate sustained high blood glucose levels, highlighting potential risks associated with diabetes, such as heart disease, kidney disease, and nerve damage.

However, the significance of HbA1C extends beyond mere diagnosis. By monitoring and managing HbA1C levels through appropriate treatment and lifestyle modifications, individuals with diabetes can mitigate the risk of complications and regain control over their blood glucose levels. In essence, the HbA1C test serves as a valuable tool in diabetes management, empowering individuals to make informed decisions about their health and well-being.

Alternative names

–        Glycohemoglobin
–        Glycated haemoglobin
–        Glycosylated haemoglobin

HbA1c tests

Indications of HbA1C

HbA1C test is used for the screening or to diagnose –

Type 2 diabetes – In case of type 2 diabetes, Blood sugar level gets too high because the body doesn’t make enough insulin to move blood sugar from bloodstream to cells or because cells in the body might have stopped responding to insulin.

Prediabetes – It is a condition where blood sugar levels are increased above the normal limits but aren’t that high enough to be diagnosed as diabetes.

If someone has diabetes or prediabetes, a Hb1AC test will help to monitor the condition, to see how well the patient diagnosed is able to control the blood sugar levels

Who needs to test for HbA1C?

–        If you’re over 45 years old, normal test results mean you should undergo the test again every three years.
–        Should prediabetes be indicated by your results, you’ll typically need testing every 1 to 2 years; consult your provider for frequent guidance and strategies to mitigate diabetes risk.
–        If your results indicate diabetes, ensure you have an A1C test at least twice annually to monitor your condition and treatment progress.

Individuals under 45 are at higher risk of developing diabetes if they –

–        Have prediabetes.
–        Are overweight or obese.
–        Have a family history of type 2 diabetes.
–        Experience high blood pressure or elevated cholesterol levels.
–        Have a history of heart disease or stroke.
–        Engage in physical activity less than three times a week.
–        Previously had gestational diabetes or gave birth to a baby over 9 pounds.
–        Belong to demographic groups with increased diabetes risk, including African American, Hispanic or Latino, American Indian, Alaska Native, some Pacific Islander, and Asian American populations.
–        Have polycystic ovarian syndrome (PCOS).

Symptoms of diabetes which may warrant an A1C test are

–        Excessive thirst.
–        Frequent urination.
–        Unexplained weight loss.
–        Persistent hunger.
–        Blurry vision.
–        Numbness or tingling in extremities.
–        Fatigue.
–        Dry skin.
–        Slow-healing sores.
–        Increased susceptibility to infections.

Does this test require any preparation?

No, there is no special preparation required for the HbA1C test. A person can take the test at any time and there is no requirement to fast before taking the test.

How is the test performed?

A healthcare professional will extract a blood sample from a vein in the arm utilizing a small needle. Following needle insertion, a minute quantity of blood will be gathered into a test tube or vial. Sensations of mild discomfort, often described as a brief sting, may be experienced during needle insertion or removal. Typically, this procedure requires less than five minutes to complete.

Are there any risks involved?

Having a blood test poses minimal risk, with potential for slight discomfort or bruising at the needle insertion site. However, these symptoms typically resolve promptly.

How are results interpreted?

A1C test results are presented as a percentage and indicate the amount of haemoglobin bound to glucose in the blood.

–        Normal A1C – Below 5.7%
–        Prediabetes A1C range – 5.7–6.4%
–        Diabetes A1C – 6.5% or higher

A single A1C test does not confirm diabetes diagnosis; variability exists.

A reading of 6.8% could actually vary between 6.4–7.2%.

If A1C is elevated, a doctor may assess current blood sugar levels.

Diabetes diagnosis may occur if blood sugar levels exceed 200 mg/dl.

Tests will be repeated if A1C or glucose scores suggest diabetes.

Prediabetes may be diagnosed with A1C results between 5.7–6.4%.

What is the meaning of eAG?

Average glucose or eAG is another way of expressing the results from the standard HbA1C test. The eAG score gives an idea of the average glucose levels in a person’s blood over a period of two to three months. The following table shows the comparison between the two scores which is based on a calculation from the American Diabetes Association.

What can affect results of HbA1C test?

Factors causing inaccurate A1C results include:

–        Kidney problems
–        Liver disease
–        Severe anaemia
–        Blood loss or blood transfusions
–        Early or late pregnancy
–        Medications like opioids and some HIV medications
–        Low iron levels
–        Illness
–        Stress

Certain individuals may possess less common haemoglobin types, affecting test results –

–        African, Mediterranean, or Southeast Asian descent
–        Blood disorders such as sickle cell anaemia or thalassemia

In such cases, alternative or additional tests may be recommended by a doctor.

What is the significance of Managing Blood Sugar and A1C Levels?

  – Managing blood sugar and A1C levels is crucial due to their association with health complications, even in individuals without diabetes.
– Elevated A1C levels pose a significant risk factor for cardiovascular diseases and stroke, particularly in individuals susceptible to diabetes.

Risk Progression and Complication

  – As A1C percentages increase, the risk of prediabetes progressing to type 2 diabetes escalates, alongside complications in diagnosed diabetes cases.

  – Research indicates a fourfold increase in the likelihood of developing type 2 diabetes for each percentage-unit rise in HbA1C, as demonstrated in a notable 2018 study.

Preventing Complications with A1C Management

  – Managing blood sugar levels is essential for diabetes patients to mitigate the risk of complications, particularly affecting small blood vessels like those in the eyes and kidneys, as well as the coronary arteries.
– Maintaining an A1C of 7% or lower significantly reduces the risks associated with diabetes-related complications.

Individualized Targets

Tailoring blood sugar and A1C targets with healthcare professionals is essential, recognizing individual differences in managing diabetes.

A1C Testing During Pregnancy

–        A1C testing at the onset of pregnancy can identify high-risk individuals for diabetes.
–        Gestational diabetes screening during pregnancy and post-delivery may involve alternative methods due to pregnancy’s impact on A1C test results.

Test Frequency Recommendations

–        The American Diabetes Association (ADA) recommends regular A1C testing for diabetes management.
–        For individuals without diabetes, baseline A1C testing is recommended at age 45 or earlier for those with risk factors such as obesity, with subsequent testing based on baseline results.
–        Individuals with a history of gestational diabetes should undergo screening every three years.

Tips to reduce HbA1C levels

Lifestyle Tips

Physical activity

– Follow current guidelines recommending a minimum of 150 minutes of moderate exercise per week.
– Consult a doctor for personalized exercise plans, especially for those using insulin or with special considerations.

Routine activities

  – Incorporate housework, gardening, and other daily tasks to maintain movement.

Monitoring blood glucose

  – Essential for meeting targets and making necessary adjustments.

Following the treatment plan

  – Adhere to prescribed medications and lifestyle therapies.

Weight management

  – Work with healthcare professionals to set achievable weight loss goals.

Tracking progress

  – Maintain self-motivation, monitor changes, and identify effective strategies.

Getting others involved

  – Engage others for support and accountability in adopting lifestyle changes.

Dietary Tips

General Guidelines

– Emphasize a healthful diet rich in fresh fruits, vegetables, and whole foods, while minimizing sugar, salt, and fat intake.
– Monitor carbohydrate intake for better glucose management.
– Mind portion sizes and eat regularly every 3–5 hours.
– Plan meals ahead, keep a food journal, and spread carbohydrate-rich foods throughout the day.
– Prefer less processed or whole foods like whole grains, fruits, vegetables, legumes, and nuts.
– Aim for a balanced diet comprising healthy proteins, fats, and carbohydrates.
– Seek guidance from a registered dietitian for personalized dietary advice, including carb intake based on individual factors such as exercise levels and treatment plan.

Nutrition

– Meal Planning
– Create a meal plan or consult with a dietitian to manage blood sugar effectively.
– Consider adopting the ADA’s Diabetes Plate Method as a guideline.

Key Trends to be incorporated into diet plan

– Ensure sufficient intake of fruits and vegetables.
– Choose lean protein sources and foods with less added sugar.
– Limit trans fats and reduce consumption of processed foods.

Raised HbA1c: Ayurveda Understanding

Prameha is a condition which is compared to diabetes mellitus. This disease is mainly caused due to abnormal vitiation of kapha. From the Ayurveda perspective, abnormally increased kapha in the bloodstream can be considered as raised HbA1c. This kapha contributes to excessive sweetness in the blood, since kapha is sweet in nature (quality).

Similarly, an abnormal buildup of meda – fat tissue in the bloodstream or contamination of fat carrying channels will contribute to the increased sweetness in the blood. This is because meda is one of the tissues which is an abode of kapha.

Abnormal increase of Rasa Dhatu should also be considered. Kapha is the excreta of rasa tissue. If rasa is formed in excess, kapha too is produced in excess, which might contribute towards manifestation of prameha.

Agnimandya – deficit digestion fire / capacity and ama – intermediate products of sluggish digestion which are toxic for the tissues should also be considered and also atisantarpana – over nutrition.

All these conditions can lead to excessive sweetness in the blood and cause raised levels of HbA1c.

Treatment for raised HbA1c includes timely administration of shodhana – cleansing therapies and tarpana – nourishing treatments (for vata predominant prameha). Medicines, therapies, dietetic protocols and lifestyle changes as suitable in and as prescribed for prameha, medoroga – diseases caused due to errors of fat metabolism, sthoulya – obesity, medo vriddhi – overweight conditions or abnormal rise of fat in the body, medovaha sroto dushti – contamination of channels responsible for fat formation and conveyance in the body, managing increased kapha, medas and ama, management of agnimandya are ideal.

Related Reading – ‘HbA1c – Glycated Haemoglobin – Ayurveda Understanding’