 Hey guys, this is Dr. Ahmed Ergin. I'm an endocrinologist and a diabetes education specialist. Today I am talking about A1C or hemoglobin A1C. I have been getting a lot of questions about what is a good A1C. There's a lot of debate going on. If you read the conversation or the messages that comes out of the videos, there's a lot of definitely debate out there that you can definitely get involved. But let's clarify the clouds. Let's get started. Before we dive into this video guys, please watch the entire video. Please write a comment, give a like because these are the important information. I know sometimes attention spend is not that great. You may want to cut it off short or watch its entirety. And also try to not skip the ads. That will also help us to pay for the production costs. Let's go. Okay guys, so most of you know what an A1C is. But the reason we call this hemoglobin is because, you know, hemoglobin is readily permeable to glucose. So it's one of those cells that will just welcome any glucose coming in. And they also stick to the protein structure in the hemoglobin. The hemoglobin is the cell that carries oxygen in your blood that a hemoglobin is essential. If you're having a low hemoglobin, then you're called anemic. Ironically, when you're anemic, your hemoglobin A1C may not be right. If you have a transfusion, hemoglobin A1C may not be right. We are relying on a healthy hemoglobin cell that is not modified or treated or etc. So if you're on iron, for example, or if you have on medications that try to increase your hemoglobin or improve your anemia, your hemoglobin A1C may not be correct just so you know. But having said that, we rely on the hemoglobin to see how much glucose is stuck on it. Now, the reason we check it every two to three months is because your hemoglobin survives two to three months. And then we look at the whole entire pool and based on the previous studies and correlations of blood sugars, we know that every A1C corresponds to a certain average blood sugar. Now, when we say, for example, you have a 7% A1C or hemoglobin A1C, we are saying that basically your average blood sugar is 150. That includes your all your ups and downs, etc. That's the average. So 6% is, for example, 120. So every 1% A1C signifies the 30 milligram per deciliter glucose difference on average. Again, by no means A1C is the best thing to measure. It gives us an idea, but it doesn't really tell us about the highs and lows. So for example, you can be down to 50 at breakfast and up to 250 at lunch, and down to 50 again at dinner, up to 250 before bedtime, your average A1C will be seven. That that's not good. That doesn't mean that you're doing very good. So what is important is to keep the A1C down without low blood sugar. So that's why we always say stay away from insulin if you can, stay away from cell phone urea if you can, unless you have to. These drugs you can discuss with your doctor what are the alternative drugs to insulin and cell phone urea such as glupazide, glumaparide. Sometimes we use it, but just from economical reasons, because some people cannot afford anything else or their insurance doesn't cover anything else. But typically, those drugs are not the best. Back to hemoglobin A1C. So what is a good hemoglobin A1C? Well, that depends on where you are at your life right now. So if you're watching this video and you don't want to become diabetic or you have family members with diabetes and you are wondering if you have diabetes or not, well, you can get an A1C check, especially if you're over 45. If you're overweight, you definitely need to get your A1C checked because you're not going to know, you're not going to have symptoms until your blood sugar is really jacked up to 300s, 400s. That's why it's very important to catch it early. And unfortunately, like up to 30% of people have already complications by the time of diagnosis, which is 6.5% A1C. So if you have 6.5% or more A1C, we call you diabetic. But the problem is, let's say I diagnosed you at A1C of 7.5, and you have had an A1C of 7 to 7.5 for like already five years, you may have complications. And if you're genetically prone to it, and that's another topic we can talk about. And not everybody is very prone to complications. And you don't know what is in your genes. There's really no gene testing for that. But there are some type one diabetics we know their blood sugars are in the 200, 300 all the time, and they never get complications. So how do you explain that? We think there's some genetic predisposition to have complications. And there are some diabetics out there that A1C is only 7.2, 7.3. They already have eye disease and kidney disease. We're like, what's going on here? You know, it's a genetic predisposition is a huge factor. If you had family members with diabetes, if they had complications from diabetes, you probably will do as well. Hopefully, you need to be way more aggressive. So but if you had the family members, you know, they're all diabetic and you know, they're all healthy. They didn't really have any problems. It may be a little relief for you not to say that you can let your blood sugar go high. But again, 6.5% or more is just a draw line to say, oh, you're diabetic or not. But insulin resistance actually starts at 5.7% A1C. So if you're 5.7% A1C or more, up to 6.5, we call you insulin resistance, resistant. And your blood sugar is already like shifting. We call this actually more like a pre diabetes, I would say your insulin resistant and pre diabetic. Now, can you become insulin resistant even before 5.7% A1C? Yes, you can. Because insulin resistance basically tells you that your body needs more insulin than some normal people. Now, if you're genetically strong in terms of insulin making capacity, let's say you come from a family who inherited millions of dollars, you don't have to worry too much about working every day busting your butt off like I do. But basically, you don't have to worry about too much if you have a huge inheritance. So same thing with the pancreas. If you have a lot of insulin production capacity, you may not become diabetic, but you will live as an insulin resistant person if you have the risk factors for insulin resistance. Well, how do you know you're insulin resistant? If you have a big abdominal circumference, if you have a low HDL, you know below 40 for men, below 54 women, triglycerides more than 150, sometimes high blood pressure, etc. are the ways you know that you're insulin resistant. Another way to know insulin resistant is like you're dieting and exercising, but you're not able to lose weight quickly, or you're always hungry, etc. Or you're on a high carb diet, more than likely you're insulin resistant. Your A1C may still be at 5.2, 5.3. That doesn't mean that you're very healthy. So again, your body is not just composed of single molecules. We don't rely on one single test to tell you how healthy you are. That's why A1C is in an important measurement, but it's not everything. So people will say, oh, my A1C is like 5.2. I'm good to go. You know, I can do whatever I want. And no, you still have to be careful about keeping a healthy weight, eating right, intermittent fasting, keeping a low carb diet is still going to help you to prevent future complications of, if not diabetes, but insulin resistance. So I hope that's clear. Now, let's talk about the complications that happens with A1C. So anytime you go more than 6%, that's why if you can achieve A1C of 6% without causing significant side effects from the medications, or if you can do that with lifestyle changes, especially in early diabetes, it is very easy to kind of change your diet and start exercising more. But if you can achieve A1C less than 6%, it's best because after 6%, any 1% increase in your A1C will increase your risk of complications by 30%. So instead of having a 6% A1C, if you're having an A1C of 7%, 8%, 9%, 9% A1C gives you a 90% increased risk of complication from diabetes. And you know, up to 80% of people within 15 years will develop eye disease and kidney disease. So when you think about these statistics, you have to act on bringing your A1C down. Now, bringing A1C down at every expense is not the key. There are some studies out there. One of the studies is called Accord. That study showed that if you just throw anything on patients to just try to bring the blood sugar down, they sometimes actually end up having more problems, more complications, or even death from very aggressive treatment. Now, in my practice, I always use medications that cause less risk for low blood sugars. And we use aggressive lifestyle intervention. And of course, we go with whatever the patient can do. We do not alienate people. Now, sometimes I see comments saying that, oh, just stop eating carbs, you pigs, you know, don't do that, because come on, you may be a guy who is very strong willed and, you know, you may be doing great with your diet, but do not put shame on people who cannot do the same thing like you. So you have to be a little sensitive in your comments when you're trying to advise people. Don't be so harsh. Even there are some insults coming to me or to our audience. Look, this is a democratic country. We do and say whatever we want. Everybody is free. We give the advice. People take their advice the way they want to take it. But again, we have to work with people. That's the essence of good care. So I hope this helps, guys, but I want you to write comments and questions. Again, listen to the video. Sometimes I get questions about what I have already said in the video. So watch the video in its entirety. You can watch it again. There's no harm to that. And make sure that you guys give a thumbs up. Make sure you share this video and we'll see you in the next one, guys.