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Hba1c Matters HbA1c Matters What is HbA1c? The HbA1c reading reveals your average blood sugar level over the past three months. When blood sugar levels are high, sugar attaches to the red blood cells. The HbA1c monitors how much sugar is attached to the red blood cells, which have a lifespan of about 3 months. The HbA1c reading is therefore able to show what your average blood sugar levels have been in the last 3 months. The units we report HbA1c in are changing, and in the future you will see it reported as a whole number rather than a percentage. Both units are given below. Why does it matter? HbA1c levels are linked with risk of diabetes complications, with higher readings increasing the chance of problems. This is illustrated in the graph below. 15 13 Retinopathy 11 Nephropathy Relative 9 Risk 7 Neuropathy 5 Microalbuminuria 3 1 6 7 8 9 10 11 12 Previous method % 42 53 64 75 86 97 108 New IFCC method HbA1c The graph shows the risk of complications associated with diabetes including retinopathy (eye damage that can lead to blindness), nephropathy (kidney damage that can lead to kidney failure and a need for dialysis), neuropathy (damage to the nerves) and microalbuminuria (protein in the urine which is associated with kidney damage). When HbA1c levels are below 7.5% or 58 mmol/mol, the risk of each of these complications is very low – approximately equivalent to people who do not have diabetes. The risk of each complication rises increasingly steeply as HbA1c levels rise above 7.5% or 58 mmol/mol. For example the risk of developing retinopathy is 15 times higher when the HbA1c is 12% or 108 mmol/mol. HbA1c goals The recommended target for HbA1c is less than 7.5% or 58 mmol/mol. This reflects studies that show levels below this significantly reduce the risk of developing complications associated with diabetes. HbA1c Matters Owner; Victoria Franklin Date of Issue: 8/7/2010 Version: 1 Date of Review: July 2011 Page: 1 of 2 HbA1c Matters Blood sugar goals The goal of treatment for people with Type 1 diabetes is to keep blood sugar values within a target range, because this is associated with a lower HbA1c, which will reduce the chance of diabetes complications. Time of blood test Blood sugar target range Before breakfast 5.5 - 7.7 mmol/l Before lunch and evening meal 4.5 – 7.7 mmol/l Before bed 6.5 – 8 mmol/l Achieving Blood Sugar Goals Think of each blood sugar reading as a challenge – not a ‘good’ one or a ‘bad’ one. React to each sugar reading. If it is in the normal range, you are on ‘target’. Children and Young People on two or three injections daily If you notice that you are having a run of high blood sugars at the same time of day you probably need to adjust your regular insulin dose. We usually suggest you adjust your insulin by 10% of the dose at a time. Children and Young People on Basal Bolus Therapy: If you have blood sugar readings above the target range, consider; • Your last insulin bolus – Consider its timing - ideally all boluses should be before your meal or snack. • Your last meal or snack – Could the carbohydrate content have been under-estimated or the insulin forgotten? • If you find that post meal blood sugars are regularly high – you may need more insulin for this meal, or if carbohydrate counting more insulin for every 10 grams of carbohydrate. • Your basal insulin dose - If your blood sugars are high throughout day, especially before breakfast, you may need more basal insulin. Management of diabetes is much more than a 3 monthly visit to the clinic. The day-to-day care of diabetes is very much the responsibility of the young person and family. This involves: • Frequent blood sugar monitoring – before each meal and before bed. • Adjusting each Novorapid dose according to pre-meal blood sugar and the size of your meal if you are on basal bolus therapy. This may include carbohydrate counting. • Adjusting your regular insulin if you are on 2-3 injections a day if you regularly get high readings. The diabetes team is available 9am - 5pm on week days to help with any difficulties you may be experiencing in keeping blood sugars in the target range. We really want to hear about any problems you are having before your next clinic visit, so we can provide advice and work together to achieve our common goal – a happy healthy childhood and a future free of complications associated with diabetes. HbA1c Matters Owner; Victoria Franklin Date of Issue: 8/7/2010 Version: 1 Date of Review: July 2011 Page: 2 of 2 .
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