Blood glucose levels (also called blood sugar levels) reflect how well diabetes is being managed and how well the plan of care (healthy eating, exercise, and medication) is working. If the blood glucose levels are consistently under control (with levels near normal), diabetes complications may be reduced or even prevented.
HBA1C ( GLYCOSYLATED or GLYCATED HAEMOGLOBIN)
What is HbA1c testing?
The HbA1c test is a laboratory blood test that gives an indication of longer-term blood glucose control over the last 2-3 months. The test is used to diagnose diabetes and as a monitoring tool for those who have been diagnosed with diabetes.
The HbA1c measures how much glucose has become stuck to the red blood cells. Red blood cells have a lifespan of about 120 days and so the test gives a good indication of what the overall blood glucose levels have been throughout that time.
How useful is the test?
Getting blood glucose and HbA1c levels down into the optimal ranges means working with your doctor or diabetes nurse on implementing a plan for healthy eating, weight control, getting active and exercising and, when prescribed, using medications that help to control the way your body uses glucose.
What are healthy HbA1c levels?
Target HbA1c levels will vary from person to person. Your doctor or nurse will work out a safe target HbA1c with you. Targets will take your age and any other medical conditions into consideration.
Below is a general range of HBA1c levels for people with diabetes – please check with your doctor about what the expected range is for you. Target ranges may vary according to age, or medical conditions or if you are taking medication.
|HbA1c value (mmol/mol)|
|Less than 50||Excellent control|
|50-54||Very good control|
|55-64||May be appropriate and acceptable in many individuals but higher than ideal from clinical trial evidence. Microvascular complication risk increases above around 55 mmol/mol|
|65-79||Not good glycaemic control.|
|80-99||Poor glycaemic control|
|100 or more||Very poor glycaemic control. Immediate action is required|
BLOOD GLUCOSE TESTING AT HOME (SMBG self-monitoring of blood glucose)
If you are on tablets for your diabetes, your doctor may ask you to test your blood glucose at home. If you are prescribed insulin you will test your blood glucose levels up to several times a day.
Blood glucose targets vary depending on a person’s age and circumstances. Your doctor and nurse will guide you on your personal target levels for glucose tests (SMBG) and HbA1c, and set them in partnership with you.
As a general guide
A fasting blood glucose test measures blood glucose levels after you've gone without food for at least eight hours. In the early morning hours, hormonal changes in our body may naturally cause blood glucose to rise. For people who don't have diabetes, the increase in blood glucose is offset by increased insulin production. For people with diabetes, medication may be needed.
- Aim for fasting early morning blood glucose values less than 6mmol/L (but greater than 4.2 mmol/L for those on glucose lowering medication)
- Otherwise the general target is 4.2 - 7. 8 mmol/L
- After a meal, levels should, where possible, be less than around 8.5 mmol/L
Many people have difficulty maintaining their blood glucose levels in these ranges. Your healthcare professional will help you to set realistic goals. Your health status, age, other medical conditions will be taken into consideration.
|TIPS FOR GLUCOSE SELF TESTING
Three keys to success in monitoring your blood glucose anywhere -
- Keeping your meter and supplies with you at all times so that you always have them when you need them.
- Making it a habit to check your blood glucose level by building it into your routine.
- Checking your blood glucose meter's accuracy when you visit your pharmacy or doctor by comparing your results with your HbA1c test results.
When should you check?
A regular schedule, such as before and after one meal each day, helps you see how your blood glucose changes. Compare those numbers to the target range your healthcare team sets for you. Share your findings with them.
You may also want to vary the times you check your blood glucose to learn more about your numbers at other times of the day. In addition to a regular monitoring schedule, also consider checking your blood glucose anytime you -
- Change your insulin or diabetes medication
- Change your meal plan
- Think your blood glucose level is too high or too low
- Are sick or under stress
- Drink alcohol
- Drive a vehicle
- Exercise more or less than usual
Talk with your healthcare team to determine the best schedule for you.
What to do with the results (creating a blood glucose profile)
Checking glucose levels shouldn't be viewed as an annoying task, but instead as a tool to figure out what the next step is in treating the diabetes. Think of monitoring as a compass: when you figure out what your glucose is at different times of the day and look at the patterns, it will be much easier to determine what direction to head in.
Determine what causes blood glucose changes. Do you sometimes miscalculate how much carbohydrate is in a particular food, and then find that your blood glucose is either too high or too low? Log these observations and try to remember them so you'll have an easier time in the future.
Knowing your blood glucose level helps you treat low or high blood glucose before it becomes an emergency. It also helps you know how to exercise and how food affects your blood glucose, and how much insulin (if you take insulin) to take. Most importantly, it helps you feel more in control as you manage life with diabetes.
Remember to take the records of your glucose tests with you when you see your doctor or nurse so you can discuss them.
Blood Glucose Meters
If you need a meter, your doctor will provide a prescription for blood testing equipment. You can also see information by PHARMAC www.pharmac.govt.nz