Dr Aidin Rawshani

What is blood sugar and HbA1c (A1c)?

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Blood sugar (glucose) and HbA1c (long-term sugar, long-term blood sugar)

What is blood sugar, glucose and blood glucose?

Dear child has many names, which also applies to sugar. In the human body, it is glucose we call sugar. Glucose is a sugar species and it is the only sugars that the cells of the body can use to produce energy. When we say blood sugar, blood glucose, or sugar in the blood, we mean the concentration of glucose in the blood. The concentration is most often indicated by the unit mmol/L (millimoles/litre). All people with diabetes have abnormally high blood sugar, which is the very definition of diabetes.

Everyone with diabetes has high blood sugar

In diabetes, it is important to treat high blood sugar to reduce the risk of future complications. This is achieved primarily through improved diets, increased physical activity and adherence to drug therapy. The medications available are either insulin or various tablets. The higher the blood sugar you have, the greater the risk of complications (sequelae) to diabetes.

High blood sugar mainly increases the risk of kidney disease (nephropathy), damage to the retina (retinopathy, leads to impaired vision), and damage to nerve pathways (neuropathy). High blood sugar also increases the risk of serious cardiovascular diseases. Read more about complications of diabetes here.

What is HbA1c

Hemoglobin A1c (HbA1c) or glycaemic hemoglobin is a measure of average blood sugar in the last 2-3 months. In the red blood cells, there is hemoglobin that binds to the oxygen, which can then be hemoglobin from the lungs to all tissue of the body. When the hemoglobin hits glucose, the sugar binds to the hemoglobin, it is said that hemoglobin has been “glycosylated” and it is called HbA1c. The red blood cells are formed in the bone marrow and break down after about 120 days of constant circulation in the body.

What is measured in HbA1c sampling is the proportion (either as a percentage or per mille) of glycolised hemoglobin. HbA1c thus indicates the proportion of hemoglobin, as a percentage or per mille, that has glucose bound to it. If you have high blood sugar levels in the blood, a greater proportion of the hemoglobin will be glycolised and HbA1c levels will be higher. Blood glucose levels over the past 30 days determine 50% of the value of HbA1c.

In the clinic, the number of annual controls of HbA1c should be adjusted for each individual, it is recommended that HbA1c be checked between 2-4 times a year. There are quite a few sources of error in measuring HbA1c that one should be aware of, usually falsely low HbA1c values, i.e. that the individual actually has higher levels. Several blood diseases leading to malformed constituents of proteins in the blood and different blood cells affect HbA1c levels.

Recommendations for HbA1c
Diabetes typeOptimalAcceptableUnsatisfactory
Type 1 diabetes≤ 52  52-62≥ 62
Type 2 diabetes≤ 4242-52≥ 62

The relationship between HbA1c and small vessel disease (microvascular complications) is well affected, the levels of small vascular disease of the fundus (retinopathy) are already seen at HbA1c 48 mmol/mol in individuals with type 1 diabetes. HbA1c less than 48 mmol/mol is recommended to reduce the risk of severe eye, kidney and nerve damage, fasting plasma glucose should be less than 6-8 mmol/l and less than 10 mmol/l during the daytime. The risk of complications is further reduced if one does not smoke and at the same time has good blood pressure.

Some individuals have swinging blood sugar that is difficult to regulate and causes frequent sensations and recoil in blood sugar levels as blood sugar usually rises rapidly if it becomes too low. Achieving an HbA1c below 60 mmol/mol for an individual with type 1 diabetes requires a well-structured life with frequent blood glucose measurements, knowledge of the disease and treatment.

Glycemic hemoglobin (HbA1c) Plasma Glucos

Glycemic hemoglobin (HbA1cPlasma-glucose
406-7
507-9
609-10
7010-12
8012-13
9013-15
10015-17
11016-18
12017-20

Diabetic complications and HbA1c

In Sweden, several population studies have been conducted to investigate the relationship between HbA1c and macrovascular complications. {TanCredi:2015BC, Lind:2011ct, Lind:2014dd} In these studies, it has been observed that even at normal blood sugar levels, i. e. HbA1c 53 mmol/mol for individuals with type 1 diabetes and type 2 diabetes, so there is an increased risk of cardiovascular complications and premature death compared to the general population.

These epidemiological studies show that normal blood sugar levels continue to increase 2-4 times the risk of complications. Individuals with diabetes appear to be at the highest risk of developing heart failure compared to individuals without diabetes. However, these studies always show that people with diabetes and low or normal HbA1c levels have a lower risk of cardiovascular disease and death.

The risk increases further if the person has high blood pressure, high blood lipids or smokes.

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