Hb-What? What Your HbA1C Actually Means

HbA1c, that dreaded alphanumeric abbreviation. When living with type 1 diabetes, testing your HbA1c can sometimes make you feel a little down if that little score wasn’t what your diabetes healthcare team were hoping for. However, understanding the importance of monitoring your HbA1c and your options for managing it may help you to feel more positive and in control over those pesky alpha-numerals.

Monitoring Your Blood Glucose Levels

There are a few methods of checking how your blood glucose (BG) levels are going. Depending on what suits your lifestyle and on the advice of your diabetes healthcare team, you may be using one or a combination.

1. The finger prick: a single snapshot of your BG levels at that moment in time.

2. Continuous glucose monitoring (CGM): an ongoing picture of your levels across the day, enabling you to see patterns.

3. Time in range (TIR): TIR is a relatively new metric used particularly in those using a CGM device. It indicates the percentage of time your BG sits between a certain range (3.9-10.0mmol/L, or 70-180mg/dL) over a specified period of time.

4. HbA1c testing: a longer-term picture of how well you’re managing your diabetes.

HbA1c is a kind of chemical 'footprint' that shows how much glucose has been in your bloodstream over the past 60 to 90 days (the average lifespan of a red blood cell). Although your diabetes healthcare team will be able to give you a more individualised HbA1c target, in general, people living with diabetes are advised to aim for a HbA1c of 6.5% (48mmol/mol) or under. This helps to minimise your risk of diabetes-related complications.¹ It's important to have your HbA1c levels tested at least every three months so you can get a fuller picture of how well you're doing and make the necessary treatment and lifestyle adjustments to do even better.

Tell Those Alpha-Numerals Who’s Boss! 7 Steps To Manage Your HbA1c

To keep your HbA1c in the target range and to reduce the risk of complications, accurate doses of insulin need to be delivered to the body. There are a few different ways to administer your insulin, including conventional therapy, multiple daily injections, or the most convenient way - using an insulin pump. Whichever insulin delivery method suits you the best, improving your blood glucose management and HbA1c can significantly increase your quality of life² and enjoyment of your favourite activities.

Here are seven tips that will help you gain greater control of your diabetes management and HbA1c levels:

1. Monitor your BG levels and HbA1c.

It’s difficult to know what adjustments you may need to make to your treatment if you don’t know what your readings are!

2. Watch out for hypoglycaemia.

If you can establish a familiar routine for treating a hypo it may help you quickly spring into action without panicking. This may involve having glucose tablets, juice, or hard lollies always on hand. Having a routine can also help you to avoid overcompensating and ending up with elevated BG levels.

3. Be aware of hyperglycaemic episodes.

Just as BG can drop low, it can also swing high. It’s possible you may encounter hyperglycaemia due to underestimating your carbohydrate intake, insufficient insulin intake, or loss of insulin potency. The goal of treating hyperglycaemia is to prevent diabetic ketoacidosis and delay or prevent diabetes complications due to high BG over an extended period of time.

4. Take a sick day if you need it.

Illness and infection put extra stress on the body and often raise BG levels.³ An insulin pump allows you to make adjustments quickly in response to illness and infection. When feeling unwell, you may also want to increase the frequency of measuring your BG levels and check your urine for ketones.

5. Pay close attention to nutrition and carbohydrates.

Understanding how your carbohydrate intake affects your BG levels can help you to better meal plan and ultimately manage your HbA1c. Familiarise yourself with the amount of carbohydrates in the foods you love and work with your diabetes healthcare team to find a way to both keep your carbohydrate count low and your enjoyment of food high!

6. Exercise.

Different exercises can impact your BG levels in different ways so keep a close eye on your readings every time you try a new type of activity and be prepared just in case of a hypo.

7. Manage your infusion sites.

If you are using an automated insulin delivery system such as an insulin pump, it is important to be proactive about keeping your infusion site healthy and your insulin, reservoir, and infusion set fresh. Some principles to consider include regularly changing your infusion site, frequently inspecting the site, making sure you use appropriate sites, and keeping adequate supplies on hand.

Final Thoughts

Testing your HbA1c levels needn’t be a cause of anxiety. By working directly with your diabetes healthcare team to formulate an individualised management plan, you can take strong steps to keep those alpha-numerals under your thumb.

References

1. Diabetes.co.uk. Guide to HbA1c. https://www.diabetes.co.uk/. Available at: https://www.diabetes.co.uk/what-is-hba1c.html. (Accessed March 2022).
2. Herman W, Braffett B, Kuo S, Lee J, Brandle M, Jacobson A, Prosser L, Lachin J.What are the clinical, quality-of-life, and cost consequences of 30 years of excellent vs. poor glycaemic control in type 1 diabetes? J Diab Comp. 2018; 32(10):911-915.
3. Diabetes.co.uk. Stress and Blood Glucose Levels. https://www.diabetes.org.uk/. 2019. Available at: https://www.diabetes.co.uk/stress-and-blood-glucose-levels.html. (Accessed March 2022).

* Editor’s note: This article has been adapted and reproduced from a post published on Medtronic Diabetes Australia.