Lab Test Knowledge: HbA1C

What is HbA1C?

HbA1c is also known as glycosylated hemoglobin. Hemoglobin is a component of red blood cells that carries oxygen. When hemoglobin binds with glucose in the blood, HbA1c is formed. The higher the glucose concentration in blood, the higher the levels of HbA1c.

Red blood cells can survive for 8 to 12 weeks in our body. That's why the levels of HbA1c are not influenced by daily fluctuations in the blood glucose concentration, but reflect the average glucose levels over the last 6 to 8 weeks. Because HbA1c can be used to tell how well the blood glucose level has been controlled in the past, it's an important tool to track the progress of any diabetes management plan.

How to interpret the values?

a diabetes control card

• In non diabetic patients the normal HbA1c level is less than 7%. HbA1c levels over 6% is sufficient to identify people who are at an increased risk for diabetes.
• In people with diabetes, a HbA1c levels below 6.5% shows good diabetes control.
• For people who are at risk for getting hypoglycemia, a level of 7.5% is an acceptable target.

How often should you repeat measurement?  

If your diabetes is in good control, repeat HbA1c measurement every 6 month. If you are trying to improve control or if you are making changes in your treatment plan, repeat the test after 3 months. Repeating HbA1c test sooner than 6 weeks after the last measurement provides little or no information and is not cost effective.

What are the limitations of HbA1c?

Although HbA1c test is an important tool that tells how well you're doing over the past months, it can't replace daily blood glucose monitoring for those who need it. HbA1c levels can't be used to adjust insulin dosage, nor can it detects the presence of hyperglycemia or hypoglycemia.

In people with kidney disease, chronic excessive alcohol intake, and hypertriglyceridemia, HbA1c levels may be falsely increased. Blood loss either acute or chronic and several diseases of the red blood cells like thalassemia and sickle cell disease may falsely decreased HbA1c levels.

Learning Glycemic Index for Diabetes Control

The glycemic index (GI) measures how quickly blood sugar levels rise after eating a type of food. Foods with carbohydrate that break down quickly release glucose more rapidly into the blood. These high GI food is suitable for energy recovery after exercise or for a person with hypoglycemia. Low GI foods will release glucose slower and more steadily, blunting the peak of glucose rise after meal and improving long term glucose control.

Having knowledge on Glycemic Index can help you improve control on your blood glucose level. A low GI diet also provides other health benefits like reducing weight, improving cholesterol levels and even prevent certain cancers.

Glucose has a glycemic index of 100. A food is generally considered to have a high GI if it scores above 70. Foods with a GI of 55 or less are considered low GI foods and should be the main choices for people who are looking to lower their blood glucose.

Listed below are examples of different types of foods along with their GI score.

Low GI Foods (55 or less)
Roasted and salted peanuts	14
Low-fat yoghurt with sweetener	14
Cherries	22
Grapefruit	25
Pearl barley	25
Red lentils	26
Whole milk	27
Dried apricots	31
Butter beans	31
Fettucine pasta	32
Skimmed milk	32
Low-fat fruit yoghurt	33
Wholemeal spaghetti	37
Apples	38
Pears	38
Tomato soup, canned	38
Apple juice, unsweetened	40
Noodles	40
White spaghetti	41
All Bran	42
Chick peas, canned	42
Peaches	42
Porridge made with water	42
Lentil soup	44
Oranges	44
Macaroni	45
Green grapes	46
Orange juice	46
Peas	48
Baked beans in tomato sauce	48
Carrots, boiled	49
Milk chocolate	49
Kiwi fruit	52
Stoneground wholemeal bread	53
Crisps	54
Special K	54
Banana	55
Raw oatbran	55

Moderate GI Foods (56 to 69)
Muesli, non toasted	56
Boiled potatoes	56
Sultanas	56
Pitta bread	57
Basmati Rice	58
Honey	58
Digestive biscuit	59
Cheese and tomato pizza	60
Ice cream	61
New potatoes	62
Coca cola	63
Apricots, canned in syrup	64
Raisins	64
Shortbread biscuit	64
Couscous	64
Rye bread	65
Pineapple, fresh	66
Cantaloupe melon	67
Croissant	67
Shredded wheat	67
Mars bar	68
Ryvita	69
Crumpet, toasted	69
Weetabix	69
Wholemeal bread	69

High GI Foods (70 and above)
Mashed potato	70
White bread	70
Watermelon	72
Swede	72
Bagel	72
Branflakes	74
Cheerios	74
French fries	75
Coco Pops	77
Jelly beans	80
Rice cakes	82
Rice Krispies	82
Cornflakes	84
Jacket potato	85
Puffed wheat	89
Baguette	95
Parsnips, boiled	97
White rice, steamed	98
Mashed potato	70
White bread	70
Watermelon	72
Swede	72
Bagel	72
Branflakes	74
Cheerios	74

The DASH (Dietary Approach to Stop Hypertension) Eating Plan

What is the DASH eating plan?

The DASH (Dietary Approaches to Stop Hypertension) eating plan was originally designed to lower blood pressure, but it turns to be beneficial for other conditions like diabetes, stroke, and even several types of cancer.


Within two weeks of starting the DASH diet your blood pressure may drop from 8 to 14 points. Best response came from people with prehypertension and people whose blood pressure was only moderately high. Even though the DASH diet is not intended for weight-loss, you may lose unwanted pounds because it guides you toward a healthier eating habit.

The components of the DASH diet includes:

• Reduced sodium intake. The standard DASH diet recommends up to 2300 mg (1 teaspoon) of sodium per day, while the lower sodium DASH diet recommends up to 1500 mg (2/3 teaspoon) per day. The lower sodium version is especially helpful in lowering blood pressure for middle aged or older adults, for African-Americans and for those who already have high blood pressure.
  

  

  An apple a day keeps the doctor away? Try four or five.

• Fruits and vegetables. In a 2000 calories per day basis, DASH recommends 4-5 servings or fruit and another 4-5 servings of vegetables per day.One serving of vegetable includes 1 cup raw leafy or 1/2 cup of cooked vegetables. One serving of fruit includes 1 medium fruit or 1/2 cup fresh, frozen or canned fruit. Most fruits are low in fat except for coconut and avodacoes.
• Grains. In a 2000 calories per day basis, DASH recommends 6-8 servings or grain products such as bread, cereal, rice and pasta. One serving of grains includes 1 slice whole-wheat bread, 1 ounce of dry cereal, or 1/2 cup cooked cereal, rice or pasta. Whole grains are better choices because they have more fiber and nutrients than do refined grains
• Low or non fat diary products. In a 2000 calories per day basis, DASH recommends 2-3 servings or diary products such as milk, yogurt, and cheese. One serving includes 1 cup of skim or 1% milk, 1 cup of yogurt or 1.5 ounces of cheese.
• Lean meat, poultry, and fish.  In a 2000 calories per day basis, DASH recommends up to 6 servings. One serving includes 1 ounces of cooked skinless lean meat, poultry, or fish or 1 egg. Even lean varieties of meat my contain extra fat and cholesterol. So go easy on them.
• Seeds and nuts. DASH recommends 4-5 servings per week of seeds and nuts such as almonds, sunflower seeds, kidney beans, peas, and lentils. Serving sizes are small and are intended to be consumed weekly because these foods are high in calories. One serving includes 1/3 cup of nuts, 2 tablespoons seeds or 1/2 cup cooked beans or peas.
• Lower total fat with higher portion of unsaturated fat. In a 2000 calories per day basis, DASH recommends only 2-3 servings of fat. One serving includes 1 teaspoon of soft margarine, 1 tablespoon of low-fat mayonnaise or 2 tablespoons light salad dressing. Saturated fat and trans fat raises your blood cholesterol, especially the bad LDL cholesterol. Meat, butter, whole milk, cream, eggs, palm and coconut oils are high in saturated fat. Therefore, you would want to avoid them. 
• Reduce sweets and added sugars consumption. DASH recommends no more than 5 servings of sweets per week. One serving includes 1 tablespoon of sugar, jelly or jam or 1/2 cup of sorbet. 
• Limiting alcohol. DASH recommends that men limit alcohol to 2 or fewer drinks a day and women 1 or less.

To sum it all, the DASH eating plan emphasizes on a balanced diet, heavy on fruits and vegetables, with the right amount of protein, but lower in sodium and total fat. 

Managing Diabetes

Diabetes management aims to keep your blood sugar in control through various measures, from diet and lifestyle changes to medications and insulin injection. When it comes to diabetes, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life. But do you know what makes your blood sugar level rise and fall?

Dietary Habit

By now you're probably getting bored of me stating the obvious, but healthy eating is the most important part of any diabetes management plan. It's not just about the quality and quantity of the foods you eat, the meal schedule matters too.

Blood sugar level peaks around two hours after meal then begins to fall after that. If you keep to a regular schedule by eating at the same time every day and dividing your total daily calories into several small meals at regular times, you can control the fluctuation of your blood sugar level.

Stick to the DASH (Dietary Approach to Stop Hypertension) eating plan because it's also the best diet for diabetes. It's well balanced, have the right mix of carbohydrate, fruits, vegetable, and lower fat. Always remember to coordinate your meals and your medication, especially if you're using insulin to avoid low blood sugar (hypoglycemia).

Physical Activity

Staying physically active improves your body's response to insulin.

Regular exercise is another important part of your diabetes management plan. Regular physical activity improves your body's response to insulin. This is especially important in people with type 2 diabetes. When you exercise, your muscles take up the excess glucose and turn them into energy.

Pick the type of exercise that is appropriate with your condition. If you have a heart problem or sores in your feet, consult your physician first. Pay attention to your blood sugar levels before, during, and after exercise and recognize the signs of low blood sugar such as hunger, weakness, lightheadedness, anxiety, and fatigue. Bring an emergency snack or glucose pill with you when you're exercising. Drink plenty of water or isotonic fluids to prevent dehydration that can affect blood sugar levels.

Medication

Diabetes medications and insulin are used only when diet and exercise are not enough to control your blood sugar. If you have type 1 diabetes, then insulin must be included in your treatment plan. If you have type 2 diabetes, you may take either oral anti-diabetic medication (as a single drug or in combination) and/or insulin in combination.

pre-filled insulin pen to deliver insulin

Insulin works by increasing glucose uptake into your cells. There are many types of insulin which differ in how they act and how long they stay in your body. Oral anti-diabetic agents may either increase the amount of insulin secreted by the pancreas, increase the sensitivity of your organs to insulin, or decrease the absorption of glucose from the gastrointestinal tract.

Anti-diabetic drugs, like other type of pharmacological agents, may interact with other medications such as anti-hypertensive agents and birth control pills. Always consult your doctor to find the right medications for you and minimize drug interactions and side effects.

Stress

Psychological stress increases the production of stress hormones in body. These hormones may prevent insulin from working properly and increase your blood sugar level. Learn to manage your stress by relaxation techniques, learning coping strategies, setting limits and prioritizing tasks.

Illness, menstruation, pregnancy, and menopause may also put your body under extra stress. Anticipate to take extra measures to control your blood sugar during any of these conditions.

Metabolic Syndrome and Related Conditions

What is metabolic syndrome?

Metabolic syndrome (also known as metabolic syndrome X, syndrome X, cardiometabolic syndrome, and insulin resistance syndrome) is a combination of risk factors that raises the risk for cardiovascular disease and other health disorders like stroke and diabetes. Studies indicated that almost as high as 25% of the United States people suffers from metabolic syndrome and this number increases to around 35% as the population ages.

The term 'metabolic' is used to describe alterations in the normal biochemical processes in the body that occurs with these multiple condition. Metabolic syndrome occurs when a person has three or more of the following: 

• 

  abdominal obesity or apple shaped belly

  Abdominal obesity
• Triglyceride level ≥150 mg/dL
• HDL cholesterol <40 mg/dL in men or <50 mg/dL in women
• Systolic blood pressure ≥130 mm Hg
• Diastolic blood pressure ≥85 mm H
• Fasting glucose ≥100 mg/dL
• Insulin resistance or glucose intolerance

Having only one of these conditions doesn't mean you have metabolic syndrome, but having one increases your odds for getting another one.

"Standalone, each one of the conditions that made up metabolic syndrome is already a serious health problem. Combined, the risk of contracting a serious disease increases even more."

Although metabolic syndrome is a serious condition, with aggressive lifestyle changes, you can delay or even prevent the development of serious health problems. Weight reduction, physical activity, healthy diet, and regular monitoring of blood glucose, blood cholesterol, and blood pressure are beneficial to people with metabolic syndrome.
 
Risk factors of getting metabolic syndrome are increasing age, racial background (Hispanics and Asian are at a greater risk), obesity, family history of diabetes and other diseases like hypertension or polycystic ovary syndrome in women.

Basic Knowledge About Diabetes

What is diabetes?

Diabetes is a chronic disease in which blood sugar levels are above normal. An organ in our body called the pancreas produces a hormone called insulin. Insulin helps control the sugar level in your blood and help glucose to get into the cells of our bodies. Glucose is the main energy source for our cells. Even though you have high levels of it in your blood, your body cannot make use of it without insulin. In short, your cells are starving even though you have abundant energy source.

diabetes is having too much sugar in your blood

When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugar to build up in your blood. Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. In 2009, diabetes was the sixth leading cause of death in the United States.

What are the types of diabetes?

There are two types of diabetes. Type 1 diabetes, previously known as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, account for about 5% of all diabetes cases. In this type of diabetes, the cells of the pancreas can no longer make insulin because the body's immune system has destroyed them. Type 2 diabetes, previously known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, account for about 90% to 95% of all diabetes cases. This type of diabetes usually begins with insulin resistance in which the body can not properly use insulin. Over time the pancreas loses the ability to secrete enough insulin in response to meals.

What are the risk factors for diabetes? 

• Being overweight or obese.
• Having a parent, brother, or sister with diabetes.
• Being African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage.
• Having a prior history of diabetes in pregnancy or birth of at least one baby weighing more than 9 pounds.
• Having high blood pressure measuring 140/90 or higher.
• Having abnormal cholesterol with HDL ("good") cholesterol is 35 or lower, or triglyceride level is 250 or higher.
• Being physically inactive—exercising fewer than three times a week.

blood sugar monitor

When should I be tested for diabetes?

 

Anyone aged 45 years or older should consider getting tested for diabetes, especially if you are overweight. If you are younger than 45, but are overweight and have one or more additional risk factor, you should consider getting tested.

What are the symptom of diabetes?

Many people have no signs or symptoms of diabetes. The symptoms can also be very vague that you might not notice them until you have suffered the complications. Initial signs of diabetes are

• increased thirst
• increased hunger
• fatigue
• increased urination, especially at night

Over time, you may also develop weight loss, blurred vision, slow healing sores. More serious findings are kidney problems, heart problems, or loss of consciousness.

What is the treatment for diabetes?

Type 1 diabetes is treated by healthy eating, exercise, and insulin injections. For type 2 diabetes, the treatment consists of healthy eating, exercise, routine blood glucose testing. In addition, people with type 2 diabetes often requires oral medication, insulin, or both to control their blood sugar levels.

People living with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.