Before we talk about your A1c, let's talk about donuts.  I know I'm odd, but I don't really like them.  They smell great, but the taste never measures up to the smell for me.  Lest you think I'm one of those people who just doesn't like sweets, rest assured that there are days when I'd drive 20 miles for a chocolate bar!

What I do like about donuts is using them to explain hemoglobin A1c, and that's what I'm going to do now.

Diabetes and hemoglobin A1c

Hemoglobin is the medical word for "red blood cells."  The "A1c" means "glycated", or covered in sugar.  To put it simply, the hemoglobin A1c test measures the percentage of your red blood cells that are sugar-coated.

Every day, your body makes new red blood cells, and every day, old blood cells outlive their usefulness and get destroyed.  The lifetime of a red blood cell inside your body is about 3 months.

Your red blood cells are donut-shaped.  Think of them as plain, unglazed donuts.  If you have a healthy amount of sugar in your bloodstream, just a few of your red blood cells will become glazed with sugar.

As your blood sugar rises, more and more of your red blood cells will become glycated, that is, more and more of your "donuts" will become "glazed."

Think about a box filled with a dozen donuts.  Imagine that a person with well-managed diabetes has only one glazed donut in her box, while another person with poorly controlled diabetes might have 2 or 3 glazed donuts in his box.

Why do I need to control my A1c?

Those glazed donuts, or sugar-coated red blood cells, damage the tiniest of blood vessels in your body, the ones in your eyes, your kidneys, and your hands and feet — all the places where people with diabetes have complications.

What's a normal hemoglobin A1c?

A person without diabetes will have an A1c of 5.6% or less.  The prediabetic range is 5.7-6.4%, and a level of 6.5% or more is high enough to diagnose diabetes.  For people with diabetes, the American Diabetes Association's recommended goal is to keep the A1c under 7%.  This helps prevent long-term damage to the eyes, kidneys, and other tissues.

How often should my doctor check my A1c?

Getting a new A1c test every couple of weeks isn't useful, because most of the same red blood cells are still floating around in your bloodstream, and once they become sugar-coated, they stay that way.   Remember when we said that each red blood cell lives in your body for about 3 months?  That's why your doctor doesn't run this test more often than every 3-6 months.  If you have diabetes and your A1c is good, your doctor will probably wait 6 months or more in between tests.

How can I lower my A1c?

The best way to lower your A1c is to lower your daily blood sugar readings.  If your daily blood sugar levels are good, your A1c will be good, too.  (You'll only have too many glazed donuts in your box if you have too much sugar in your bloodstream most of the time.)  So, you can't change your A1c today, but you can start to change your blood sugar today.