What’s all the hype about the HbA1c? It’s all the consultants seem to go on about, but are they that important?
First of all, some basics and facts!
- HbA1c means the glycated haemoglobin in the blood. So, the amount of glucose stuck to haemoglobin accumulated through having high blood sugars. (The higher, the more glucose gets stuck)
- The glucose ‘falls off’ after around 3 months which is why that’s how frequently you have your A1c measured.
- The target A1c was 7.5% but has been lowered to 6.5% because studies showed that the average A1c across the country was 0.5% above the target.
- They are using 2 units of measurement % and mmol/ls so if your A1c 7.0% it is 53mmol/ls.
Here is a link to a page with a lot more details on the subject if you’d like to know more about what an HbA1c is and means – http://www.diabetes.co.uk/what-is-hba1c.html
All that is very well, having a high A1c can lead to complications, you should aim to lower your A1c and it is an incredibly important measurement, of course. But what does an HbA1c actually mean to the diabetic?
Not much. When I was younger at least.
Until I was about 10/11 it was just a number. I didn’t care what it was really. I realised that everyone in the room was happy if it was in the 7s and there was surprised congratulations if it was in the 6s. And that was it.
Of course as I grew older I understood more and more about complications. Words like neuropathy and retinopathy were thrown around in conversations and they would crop up on my timeline. However I didn’t directly ever link it with your A1c, that was a number and those were long term consequences of high blood sugars – two separate things.
I wasn’t stupid believe me, I knew both were important and so a year into high school I started really thinking about it all. Suddenly my A1c had to be below 7. If it wasn’t it meant I was a ‘bad diabetic’. I wasn’t too harsh on myself – but it was a personal challenge.
Now? What does an HbA1c actually mean to the diabetic at 16 years old?
I don’t think “Oh my gosh! My A1c will go up!” every time I get a reading over 9 mmol/l. I also don’t think about complications every time I have a high blood sugar. But it means a lot more than it did.
If I have a few bad weeks of blood sugars, or a few months I begin to dread what the number will be. Little seeds of doubt plant themselves in the back of my mind.
What if my A1c had gone up by over 0.5%?
What if I’m making it a habit?
What if I can’t get it back down into the 6s?
Will I start seeing complications?
But mostly, what I’m thinking is actually….
What will my mum say when she sees it? What will my doctor say? I’m such a bad diabetic. (Well I say that, I’ve never been scolded before for my A1c!)
Because there’s so much pressure to have a good A1c, it’s all anyone seems to worry about with diabetes long term! Everyone in the know judges you if you mention your A1c and it’s a little higher than it could be. I know this because I’m guilty of it myself sometimes!
It’s just a shame because NHS England does things by numbers and the A1c is the only measurement for diabetes control so we’re stuck with people talking about it constantly.
Yes a diabetic’s HbA1c is very important. Yes it should be a low number for their future and I have my insulin pump and CGM that’s helping me achieve this.
But I’m more concerned about other equally as important aspects!
Nighttime hypos, long term effects of hypos, eventually pregnancy (because yeah! I do think about that already and how impossible it sounds for a diabetic!) food and weight and last but not least the emotional side and coping with living with T1 day in day out.
Yes my A1c is important to me, but that’s not the only thing I think about.
Here’s an interesting graph I was once shown that helped me understand my A1c and a conversions able of the old % to the new mmol/l. The graph is potentially a little scary but it’s actually relative risk on the y axis and it put things into perspective for me.