 Hello guys, today we are going to talk about A1C. So what is A1C? This commonly asked question and today I'm specifically answering Barbara Williamson's question where she asked in our what is normal blood sugar video and I think I mentioned A1C in that video and She's asking what is really A1C and everybody has in the same question. So let's talk about it. I am Dr. Ahmed Ergin. I am the founder of SugarMDs.com. Again, our primary purpose is to serve you remotely so we can take care of your diabetes using technology. Not that you have to be tech savvy, but we will make it easy for you where you don't have to leave your home and you can still see us and make sure your diabetes under control and reduce the number of medications. Now, let's move on to the topic. So why we measure A1C, right? So A1C is a test that's commonly used is a standardized test. So, but most people have trouble understanding what the A1C is. So why do we call it A1C or hemoglobin A1C in a better term? Because we are measuring the glucose within your hemoglobin. Now, hemoglobin is a protein in your blood that is subject to carry your oxygen from A to B. So your hemoglobin is getting oxygenated in your lungs and carrying that oxygen to the rest of the body. Now, the same hemoglobin is permeable, which means that it is open to the transfusion of glucose into itself. So it opens its arms to the glucose. So as a result the more glucose you have in your system, the more glucose will be in your hemoglobin. So that's what we are measuring. Now, why do we measure that every three months? That's the next question, right? So that is because your hemoglobin lives for three months. So as a result, assuming that your hemoglobins are living three months, the glucose they accumulate in three months will be tested and then we can tell exactly how much your blood sugars are running based on how much glucose is in the hemoglobin. There is a percentage supported as a percentage and every percentage corresponds to an average blood sugar. Is this a perfect test? Barely, but we'll talk about the advantages and disadvantages of this test now. So before we dive into details, let's talk about what do the results mean. So sometimes I tell people, okay, your A1c is 7% or they'll tell that their A1c is 6%, 8%, 10%, whatever. When I ask my patients, okay, what does that mean to you? And they say, oh, I think it's supposed to be less than 7%, it's supposed to be less than 6.5%. They don't really know what it means, right? So as an educated patient, which is the best patient, so if you know what A1c is, at the end of this video, you're going to be an A1c pro. You're going to be able to teach everybody about A1c. But the bottom line, at least you should understand, if nothing else from this video, that every percentage in A1c corresponds to an average blood sugar. So 6% is on average 120, right? So 7% is 150. So every 1% increase or decrease in your blood sugars corresponds to a 30 milligram per deciliter change in your overall blood sugars. So if you're going from 6% to 7%, that means that your average blood sugars are rising by 30 milligram per deciliter on average. So 6% is 120, 7% is 150, 8% is 180, and then it goes on. So if you go to like, for example, I don't want to calculate, I'm going to cheat here. So if you go like 12%, that's around 300. So but you can make an easy calculation about that. So I hope that's easy to understand and we'll move on to the next topic now. A lot of people are also confused about their A1c goal, right? There's a lot of things said and done about this A1c. Now, of course, clinicians actually determine the A1c goal. The universal goal is less than 7%. And the reason there's a universal goal is because they use A1c in studies to determine the risk reduction. So for example, if your A1c goes down 1%, your actually overall risk of diabetic complications can go down by 30%. So as a result, they determined that if you use table of 7% overall for the entire population, that is a good target to keep patients with diabetes under control. Now, of course, the lower the sugar, the better. So we want to keep actually young diabetics who just got diagnosed in the first five, eight years of diabetes, or even 10 years. We want to keep them as low as possible less than 6.5 down to 6%. That's all okay. I have a lot of patients with A1c down to 5.7, 5.5, not even in the diabetic range because of the approaches we have. And they almost live their life almost free of diabetes, right? So that is possible. So what I say to my patients with the A1c goal is as low as reasonably achievable. What does it mean? To bring the A1c, you have to bring your average blood sugars down, right? So to do that, you have to use sometimes strong medications. And some medications can cause very low blood sugars. I don't know if you ever had a low blood sugar, but it's not a pleasant experience. It is very, very difficult to go through that experience. Now, if you're having low blood sugars frequently, yes, your A1c will go down, right? Why? Because your average blood sugar will go down because if you're running low frequently, your average will be low as well. But that's not what we want. That's one of the downside of A1c is that just because your A1c is down doesn't mean that you are doing great. You may still be having a lot of fluctuations. It doesn't tell you, again, A1c does not tell you anything about fluctuations. It only tells you what is your average. So we want to avoid low blood sugars, but still want to keep the A1c down. That is the key. That differentiates a good diabetes doctor from a bad one. That differentiates a good endocrinologist from a bad one. So if you're on medications that cause a lot of low blood sugars and you're suffering from this and your doctor don't care about that, that is a problem, right? So you need to give them hypoglycemia, the low blood sugar, see how it feels, you know? So anyways, so that's the goal. As low as reasonably achievable, that if you're going down to 6% and you're having a lot of low blood sugars and we don't have any way of improving that because you have to be on these medications for some reason, then I tell them, look, it's okay to be a 6.5 or it's okay to be 7% rather than having so many low blood sugars, correct? So I hope we agree on that. Some people are extremely obsessed about their blood sugars. They are stuck in the A1C or my A1C has to be 6% or whatever, however they came up with these ideas. They don't even know sometimes what the A1C is, but they want to see that number down to 6. It's a psychological thing, but I try to educate them. Look, it's not just about the number, it's about your health, right? So the reason we want to bring the A1C down, we want to avoid complications, but 6.5% also will not give you complications, 7%, less than 7% will probably not give you complications. So it is better to be safe than trying to pull the numbers too low sometimes. There are actually studies where when they tried every medication, it's called a court study. If you want to look it up, it's a major study, a super large study. So what they did, they tried to bring A1C down as much as possible and they realized that more people actually died and they attribute that due to too many low blood sugars causing the death. So as a result, we want to avoid that problem. So the problem with A1C, as you can imagine, so since you're having low blood sugars and you're having A1C down, so that is one of the problems. You really, you know, when you start using a DEXCOM G6 or Freestyle Libre, for example, that tells you all the fluctuations because it's a continuous glucose measurement devices that tell you everything happening with your blood sugars, you'll be so surprised how much your blood sugars are actually fluctuating. So as a result, we want to make sure that does not happen. So I'll give you an example. So you may have a 7% A1C, right, with blood sugars ranging between 130 and 180. That's not actually bad. If you're waking up with 180 and your highest during the day is 180, you can still have a 7% and that's a healthy number because you're not really fluctuating too much. But you can achieve the same number. Again, 7% is what, 150 on average, right? So 130, 180, you know, put them together divided by 2, that is 7%. Now, if you are having a blood sugar of 50 and 250 every time, let's say you're 51 time, 250 next time, 51 time, 250 next time and keeps going. So you're actually having a lot of very high blood sugars, but because of the low blood sugars, it negates it out as a result, you still have 7% A1C. So just because you go to your primary care doctor and your A1C is 7% and they say, oh, you're good, that doesn't necessarily mean you're good, you may still be having a lot of fluctuations and that still needs to be addressed. So as a result, it's sugar MDs. We monitor you and we track you remotely. So if you are fluctuating that much, we don't wait three months. If you don't just check your A1C, we look at your real numbers. We try to get you continuous glucose monitoring devices. If you cannot get those, we at least monitor your finger sticks remotely. So if you are using our app, I can see what's going on on my screen without you even knowing. So that is a video of it so we can intervene and fix those problems before it turns into bigger problems. Another quick tip for you to know, A1C may be different from lab to lab. So if you're checking your A1C in doctor's office and then you go to another lab, you may actually end up having like, let's say one time you check is 6.8 and next time it can be 7.1 and you will be like, oh, well, it went up. Actually, it's just a variation in the labs. So I would recommend to stick with the same lab because A1C basically helps us the most to see the trend. So if you're going down from 9% down to 8%, 7%, that's a good sign. Although again, it doesn't tell you the whole story, but it's still a pretty good sign. Okay. Now, what are the disadvantages? Now, sometimes actually not appropriate. So again, remember, we rely on your hemoglobin. So if you have anemia, which is a hemoglobin problem, so if you have iron deficiency, B12 deficiency, or you have chronic kidney disease and they are giving you erythropoietin, anything that messes with your hemoglobins, you may be having transfusion, you may be having bleeding, you may be having iron infusions, anything that tries to manipulate your anemia, your hemoglobin cells can definitely distort the overall result because you are basically adding when you're transfusing, you're adding fresh cells, you're diluting the pool, or if you have an anemia, your hemoglobins may actually die faster. So as a result, it doesn't really reflect the three months. So in some diseases, they actually live longer and it does, you know, you can overreflect. So if there is a hemoglobin problem, if you have talosemia, if you have sickle cell disease, then the hemoglobin A1c is really not very reliable, so that is something that you should know about. So what do we do if we cannot use hemoglobin A1c? Number one, we can use continuous glucose monitoring systems and they are the best. So even if you don't have a personal CGM, like a Dexcom G6 or Freestyle Libre, we can do a professional one. We can put one on you for a week or two to see how your sugars are really running instead of just A1c. Also, we have other testing such as fructosamine, again, that relines the glucose. So we rely on the fructosamine's ability to bind the glucose, which gives us a shorter duration, around two to three weeks time frame of how your blood sugar is on average running. So that we can use that. We can use glycomarc if you're not on Jardines, Farsig, or Inmocona, that certain medications that actually makes you urinate the blood sugar. Glycomarc is a test that relies on the kidney's ability to reabsorb glucose and so forth. So we can use glycomarc as an alternative test. So we have other ways to find out how your sugars are running. And most importantly, if you have nothing else to do, you have your finger sticks, you can do blood sugar checks. And if you are checking frequent enough, that can give you a good enough understanding of how your blood sugars are running as well. Sometimes pregnant women, women with gestational diabetes also are curious if they can just rely on A1c. It is still used. However, remember when you're pregnant, your blood volume goes up, your hemoglobin changes. So it may be a little falsely low. But if you know that it's falsely low and you still have to check your finger sticks, you should still be okay. You can still look at the hemoglobin as a way of controlling diabetes during pregnancy. But again, just you have to be careful because the results are not exactly the same as if when you are not pregnant. Again, guys, thank you for watching. If you like it, please give it a thumbs up and subscribe to the channel. 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