The HbA1C Blood Glucose Test for Type 2 Diabetes

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As a personal trainer in London for over 20 years, I’ve had many clients with type 2 diabetes.

Many of my clients monitor their own blood sugar levels using a finger-prick test, or one of the more hi-tech methods such as the Freestyle Libre 2 sensor or the Dexcom G7 sensor. A healthy range is 4 – 6 mmol/L between meals (or 4 – 7 mmol/L within 2 hours after a meal). A score above 7 (or 8.5 within 2 hours after a meal) is classed as hyperglaecemic. A score of 11 mmol/L or above indicates untreated type 2 diabetes.

This self-test gives a snapshot of your blood sugar levels at the moment of testing.

There is a seperate test that cannot be done by the patient, it requires a blood sample to be sent to the lab. This is the HbA1C test, which gives an average blood sugar reading over the last 3 months. Hb stands for haemoglobin, which is a protein in the blood which contains iron and transports oxygen around the bloodstream to all the cells of the body. A1C means ‘glycated’ or ‘sugar-coated’. The HbA1C test indicates what percentage of your haemoglobin is sugar-coated.

A healthy range of HbA1C is under 5.6%. Pre-diabetes is a reading of 6% – 6.5%. A reading of 6.5% and above indicates full-blown type 2 diabetes. If your Hb A1C levels are between 7% – 8% your risk of diabetes complications rises by around 25% to 30%. If your reading is between 8% – 9%, your risk of complications rises by 50% – 60%. If your HbA1C levels are between 10% – 11% you have a near 100% risk of diabetes complications.

What are diabetes complications? They include diabetic retinopathy, diabetic neuropathy (peripheral nerve damage, mainly to the sensory nerves), diabetic foot ulcers (and in extreme cases the need for amputation of toes or the whole foot), kidney damage, liver damage, an increased risk of heart disease, and an increased risk of stroke.

To add to the complexity of diabetes readings, the percentage readings can also be expressed in mmol/mol (millimoles per mole). For example, a reading of 6% equates to 42mmol/mol, and a reading of 6.5% equates to 48mmol/mol, which is the level that type 2 diabetics should aim to stay below.

In his excellent YouTube video, leading diabetes expert Dr V. Mohan (chair of the Dr Mohan Diabetes Specialities Centre, based in India), explains that the HbA1C test gives a broader perspective of blood glucose levels than the snapshot of a blood glucose self-test. He explains that the sugar-coating of haemoglobin is a slow process, like rusting metal, and that the HbA1C test gives an accurate picture of the process over the last 3 months. He recommends that people with type 2 diabetes get this test done every 3 months, in addition to regular self-testing to ensure that blood sugar levels are under control.

(Dominic Londesborough is a personal trainer in London and an online nutrition coach)

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