HbA1c Normal Range for a Diabetic – Most Reliable Test

HbA1c or Glycated Hemoglobin is most reliable test for confirming diabetes. HbA1c measurement has a central role in management of diabetes. HbA1c levels can be directly related to the risk of development of diabetic complications.

What is HbA1c (Glycosylated Hemoglobin) ?

Hemoglobin in blood reacts spontaneously with glucose to form glycated  derivatives in a non enzymatic manner. The process occurs slowly, with the extent of glycation determined by the concentration of glucose in the blood. Human hemoglobin A undergoes such glycation to form HbA1c from a reaction between the Beta chain of  hemoglobin A0 and glucose. Other compounds result from similar reactions on the alpha and beta chains of hemoglobin and these can be measured as the total glycated hemoglobin.

Which conditions affect HbA1c levels ?

Glycated hemoglobin can be affected by the presence of hemoglobin variants and uremia. Vitamin C, Hemolytic and Iron deficiency anaemia can also give abnormal results. Other conditions in which there is a rapid turnover of red blood cells ( e.g. polycythemia, anaemia or blood transfusion) can also give inaccurate results.

Why HbA1c (Glycated Hemoglobin) is most reliable test for Diabetes ?

HbA1c (Glycated Hb) serves as a retrospective indicator of the average glucose concentration over the previous 6-8 weeks. Approximately 50% of the variance in HbA1c is determined by the average blood glucose concentration over the previous month. 25% by the concentration over 30-60 days, and the remaining 25% by the concentration from 60 -120 days ( Red blood cells have lifespan of around 120 days).

  • HbA1c offers a potentially easier, non -fasting and therefore more acceptable test.
  • There is less intra individual variation with HbA1c than glucose testing. ( Fasting blood sugar test can vary in intra individual depending on hours of fasting, quantity and quality of food consumed )

HbA1c

How HbA1c is interpreted ?

Results of HbA1c can be interpreted for diagnosis of diabetes as :-

5.6 % and below = Normal

5.7 – 6.4% = Pre-diabetes

6.5% and Above = Diabetes 

At the time of diagnosis if you have HbA1c of less than 5.7 % that means you do not have diabetes (excluding conditions affecting HbA1c readings mentioned above). If your reading is between 5.7% -6.4 % then you are in Pre-diabetes stage i.e. you have risk of developing diabetes. At this stage diabetes can be reversed to normal with diet, exercise (weight loss) and certain medication which enhances insulin sensitivity. 6.5% And above HbA1c indicates established diabetes. If your blood sugars are in Pre-diabetes range or established diabetes range then consult diabetes specialist immediately.

In already established diabetic person HbA1c monitoring helps diabetologist to check the control of blood sugar in preceding 3 months and can titre medication according to it.

According to ADA guidelines HbA1c of < 7 % is the goal for diabetes management. In younger patients tight control (HbA1c of 6.5%) is even better in minimizing the complications of diabetes.

It has been proven by DCCT & UKPDS trials ( Type 1 & 2 diabetes patient study) that reduction in HbA1c even by 1 % reduces majority of microvascular complications ( retinopathy, neuropathy, nephropathy) & macrovascular complications ( peripheral vascular disease, amputations, heart failures).

HbA1c is also used for monitoring sugar control progress during pregnancy.

That was all about HbA1c (Glycated Hemoglobin) and its use.

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Ref : page no.399,400,401 Textbook of Diabetes 4th edition wiley-blackwell

Dr. Nikhil Prabhu ( Diabetes Specialist )

Dr Nikhil Prabhu is a consultant Diabetologist from mumbai. he has been practicing for more than 10 years and currently over 7000 patients are under his treatment for diabetes and thyroid disorder from mumbai and navi mumbai area. | you can book his appointment for tele-consultation on 9082523295 | follow us on YouTube for more diabetes & health related tips

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6 Ways to Treat Constipation in Diabetes at Home

Majority of diabetic people suffer from constipation, irregular bowel movements, abdominal cramps, dyspepsia, etc. Uncontrolled diabetes or Hyperglycemia affects nerves that supplies gastro-intestinal tract and hampers peristalsis. This leads to stagnancy of food in gastrointestinal tract. Diabetes also affects the nerves which supplies pyloric sphincter, causing disturbances in its relaxation, which ultimately leads to delayed gastric emptying. Nerves supplying to antrum of stomach are also affected leading to improper crushing of food and accommodation of food in stomach. This finally leads to dyspepsia & constipation. Normally, food we eat reaches rectum in around 36 to 48 hrs. In diabetic person due to imbalance in gastric motility this time span gets further delayed.

CONSTIPATION IN DIABETES
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6 ways to treat constipation in Diabetes at home

You can treat constipation in diabetes with following six ways :

  1. Increase Fibre in diet – There are two types of fibre in diet (insoluble & soluble). High fibre diet helps to form bulk of stool, also increases water content of stool, makes it soften so it can easily pass through gastro-intestinal tract. Cereals, whole grains, beans are reach in fibre content. Green leafy vegetables, Fruits like apples, pearsberries etc are good for diabetic people. Breakfast with oats helps to get good amount of fibre at the start of the day.
  2. Drink lots of water – If you do not drink good amount of water, body ultimately tries to take water from food you eat & making stools harder. If you are increasing fibre in diet then increase water consumption as well. Drink atleast 1.5 litre of water daily.
  3. Regular Exercise – Regular exercise is necessary for all diabetics. It not only helps in controlling blood sugars but also helps to pass food further in gastro-intestinal tract. Even a moderate amount of exercise in the form of brisk walking or cycling helps to prevent constipation.
  4. Natural Probiotics – Daily a cup of yoghurt or a glass of Chass helps to keep healthy intestinal bacterial flora leading to good digestion of food and preventing constipation.
  5. Laxatives – Laxatives can be of different types like bulk forming, Osmotic, Stool softeners, bowel stimulatory. etc. Isbgol Powder and castor oil are commonly used home made laxatives. It is advisable to consult your diabetes doctor before starting any laxatives.
  6. Last but not the least Excellent Blood Sugar control with diet, exercise and regular timely medication plays and important role in treating constipation in diabetes. Cause of constipation can vary from Nerve damage of GI tract due to long term poor management of diabetes to just simple lack of fibre in diet.

Extreme cases of constipation like Fecal impaction more commonly affecting elderly and disabled bed ridden individuals requires enema or manual evacuation of hard stools by inserting one or two gloved fingers in anus.

Those were the Natural ways of treating constipation in diabetes at home.

If you like my article please share it with your friends and family.

Awareness is prevention !

Dr. Nikhil Prabhu ( Diabetes Specialist )

Dr Nikhil Prabhu is a consultant Diabetologist from mumbai. he has been practicing for more than 10 years and currently over 7000 patients are under his treatment for diabetes and thyroid disorder from mumbai and navi mumbai area. | you can book his appointment for tele-consultation on 9082523295 | follow us on YouTube for more diabetes & health related tips

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Top 10 Myths & Facts About Diabetes

Diabetes is a global disease and it is predicted that it will be affecting over 80 million individuals by 2025 in India and over 300 millions around the world. Compared to the disease progression, its awareness is very low among Indian population. Even though diabetes is common, many people don’t know much about it – this includes people who are at greatest risk.

Here are 10 myths and facts about diabetes.

diabetes myths and facts

Myth 1 : Diabetes is caused by eating too much of sugar

Fact 1 – Diabetes is not caused by eating too much of sugar. There are 2 types of diabetes i.e Type 1 diabetes and Type 2 diabetes. In Type 1 diabetes (Juvenile Diabetes), body doesn’t produce hormone, called insulin, which manages blood sugar levels. The exact cause of Type 1 diabetes is unknown. But it is believed that autoimmunity, genetics and environmental factors like certain viral infections plays an important role in its etiology.

In Type 2 diabetes body produces insulin hormone, but either it is less in quantity or its action is impaired (insulin resistance) and not able to maintain blood sugar level at normal levels. Abdominal obesity (tummy fat) is believed to be culprit for insulin resistance, in Indian population.

Other causes of diabetes includes excessive alcohol consumption which lead to repeated pancreatitis and ultimately beta cell destruction of pancreas leading to insulin shortage and diabetes. Certain pancreatic surgeries like surgery for cancer of pancreas involving tail part or removing entire pancreas lead to insulin deprivation and diabetes.

Myth 2 : Diabetic person should not eat chocolates, sweets, etc

Fact 2 –  Diabetic people can eat chocolates, sweets etc BUT they have to limit the quantity at each serving. Diabetes management is an art of balancing blood sugar level. Foods with low glycemic index raises blood sugar level but to a lower extent whereas those with high glycemic index raises blood sugar level rapidly. Mild to moderate exercise like walking, cycling etc helps to lower blood sugar level. No food is absolutely forbidden if you can maintain the consumption of proper portion size.

Myth 3 : If you are overweight or obese then you will get diabetes for sure.

Fact 3 – Every overweight or obese individual may not get diabetes. There are several other factors such as family history, etc. which are also contributory. But ofcourse, obesity (especially abdominal obesity) is an important risk factor for insulin resistance and diabetes. You can see all other risk factors for diabetes in my previous article.

Myth 4 : Once insulin started it will remain life long.

Fact 4 –  No, not always. Insulin can be of best choice in certain conditions like prior to operation or surgeries, in acute infections or stress, certain conditions where oral intake of food is limited etc. Insulin can be given temporary in these conditions as insulin helps in wound healing. It has very less chance of interaction with other medicines.

Diabetes is progressive disease. Almost 50% of beta cells are dead when diabetes detected for first time. Over the years beta cells keep on decreasing with use of sulfonylurea drugs. Eventually a stage comes, after around 7-10 years, when there is very less beta cell reserve to produce insulin. At this stage patient requires external insulin injections. Around 25% of Type 2 diabetes patients reach beta cell exhaustion stage & require insulin.

Myth 5 : Diabetes is curable.

Fact 5 –  No. There is no cure for diabetes till now. Diabetes can be well controlled with diet, exercise and timely proper medications.

In case of pre-diabetic stage, diabetes can be reversed or delayed. This can achieved by maintaining proper diet, and exercise to induce weight loss. Certain insulin sensitizers like metformin can also be used. But once you have established diabetes, it is not curable.

Myth 6 : Herbal supplements can reverse or cure diabetes.

Fact 6 – Once diabetes is confirmed, it is not curable with any herbal supplements and medicines. HbA1c (Glycated Hemoglobin) is most reliable blood test to confirm diabetes.

Myth 7 – Diabetes is contagious

Fact 7 – Diabetes is not contagious and not transmitted from person to person.

Myth 8 : Insulin injections are very painful

Fact 8 – No, insulin injections are not painful as the needle is very small and very thin compared to normal blood collection needles. Nowadays insulin flex pens are available for insulin injections, they are designed in such a way that patient can himself take insulin shot without any pain.

Myth 9 : Type 2 diabetes is only seen in adults

Fact 9 –  Nowadays, Type 2 diabetes has also been observed in children as well. Type 2 diabetes has been detected in a 5 year old child. Faulty lifestyle, poor food habits and childhood obesity are the culprits for this.

Myth 10 :  People with diabetes can’t live active healthy life

Fact 10 –  No. Exercise, in the form of brisk walking or even cycling, lead to increase glucose uptake by muscles. Exercise also increases insulin sensitivity. Thus an active life along with exercise is very helpful for diabetes patient. Diabetic patients on insulin or certain drugs which increase insulin production from pancreas need to take special precautions like having a carbohydrate rich snack before exercise to prevent hypoglycemia.

Those were the top 10 myths and facts about diabetes. If you like my article please share it with your friends and family.

Awareness is prevention !

Dr. Nikhil Prabhu ( Diabetes Specialist )

Dr Nikhil Prabhu is a consultant Diabetologist from mumbai. he has been practicing for more than 10 years and currently over 7000 patients are under his treatment for diabetes and thyroid disorder from mumbai and navi mumbai area. | you can book his appointment for tele-consultation on 9082523295 | follow us on YouTube for more diabetes & health related tips

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Which Anti-Diabetes Medicines can Cause Low Blood Sugars or Hypoglycemia?

What is Hypoglycemia ?

When blood glucose level falls below 70mg/dl, person feels dizziness, headaches, sweating, confusion, anxiety symptoms, which relieve immediately after restoring blood glucose level to normal is known as Hypoglycemia.

Hypoglycemia
Credits: Oliveviewim.org

Common Symptoms of Hypoglycemia includes :

  1. Adrenergic Symptoms of hypoglycemia :

    • Hunger
    • Faintness
    • Weakness
    • Sweating
    • Palpitations
    • Tremors
    • Tingling
    • Nervousness
    • Numbness around mouth

     

  2. Neuro-glycopenic Symptoms : may require help or assistance from another person.

    • Headache
    • Double Vision
    • Lack of co-ordination
    • Inappropriate behavior
    • Confusion
    • seizures
    • Coma
    • Permanent Brain Damage & Death

Which Anti-Diabetes Medicines can cause Low blood Sugars or Hypoglycemia?

Most common is Insulin. Any type of insulin or its analogues can cause hypoglycemia.

Most commonly used insulin includes Premixes like Mixtard 30/70, Huminsulin 30/70, Novomix 3o, Humalog 25/75, regular insulin like Human Actrapid, Huminsulin R. etc or Fast acting analogues like Novorapid, Apidra, Humalog etc

Long & intermediate acting insulin & analogues like Glargine (Lantus), Detemir ( Levemir) Degludec (Tresiba), NPH, Huminsulin N etc.

In case of oral medication, those oral anti-diabetes tablets which increases insulin secretion (insulin secretagogues) from pancreas can cause hypoglycemia.

Most commonly used Insulin secretagogues includes:

  1. Sulphonyureas:

    • Glibenclamide – Daonil, Glucored, Semi daonil, etc.
    • Glimeperide – Amaryl, Zoryl, Glimestar, Glimy, Azulix, Euglim, Glimiprex, Glucoryl, etc.
    • Gliclazide – Reclide, meclazide, diamicron, Glizid, Diabend, Dianorm, Glycinorm, etc.
    • Glipizide – Glynase, Semi-glynase, Lipi, etc.
  2. Glinides:

  • Repaglinide – Eurepa, Novonorm, Repa, Regan, etc.
  • Nateglinide – Glinate, Natiz, etc.

Other anti diabetic medicines like metformin (Glyciphage, Cetapin, Metsmall, etc.), Pioglitazone (Pioz, piopar, etc.), Alfa – glucosidase inhibitors like voglibose ( PPG, Volibo, Advog, Prandial,Volix, etc.), Acarbose (Glucobay, etc.),  DPP4 inhibitors including sitagliptin ( Zita, Istavel, Januvia, etc), Viladgliptin ( Galvus, Zomelis, etc) , Saxagliptin ( Onglyza), Linagliptin ( Trajenta) , Teneligliptin (zetaplus, tenglyn, dynaglipt) even newer addition to the list SGLT2 Inhibitors like Empagliflozin (jardiance, gibtulio), Dapagliflozin (forxiga, oxra, glidepa), canagliflozin (sulisent, invokana) or remogliflozin (remo, remozen, zucator, reniva) , DO NOT Cause Hypoglycemia when given alone or in monotherapy but can cause hypoglycemia when given in combination with insulin secretagogues or with insulin.

If you found this article useful, please share it with your friends & family. I appreciate the feedback and encouragement.

Awareness is Prevention.

Dr. Nikhil Prabhu ( Diabetes Specialist )

Dr Nikhil Prabhu is a consultant Diabetologist from mumbai. he has been practicing for more than 10 years and currently over 7000 patients are under his treatment for diabetes and thyroid disorder from mumbai and navi mumbai area. | you can book his appointment for tele-consultation on 9082523295 | follow us on YouTube for more diabetes & health related tips

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