Glycosylated hemoglobin, physical examination and diabetic patients, why should they all be examined?

What is glycosylated hemoglobin? Glycosylated hemoglobin, abbreviated as HbA 1c in English, refers to glucosylated hemoglobin by name. In fact, glycosylated hemoglobin is the combination of glucose in blood and hemoglobin in red blood cells to form glycosylated hemoglobin. Glycosylated hemoglobin has a characteristic that once glucose and hemoglobin are combined, it is not easy to separate until red blood cells die, and the more glucose in the blood, the higher the proportion of glycosylated hemoglobin. The average life span of red blood cells is about 120 days, so glycosylated hemoglobin can exist for about 2-3 months, which means that glycosylated hemoglobin can reflect the average blood sugar of human body for 2-3 months.

So let's look at the situation of sugar friends. His glycosylated hemoglobin is 7. 1%, which shows that his blood sugar level is relatively high in three months. Even if his fasting blood sugar does not exceed the standard, we need to pay attention to it, otherwise it will increase his risk of complications. In fact, this explains another problem related to glycosylated hemoglobin, that is, glycosylated hemoglobin cannot replace daily blood glucose monitoring.

Glycosylated hemoglobin cannot replace daily blood glucose measurement. Although glycosylated hemoglobin represents the average blood sugar of human body for 2-3 months, if we only look at glycosylated hemoglobin, we can't see the blood sugar changes of sugar friends. We all know that the blood sugar fluctuation of diabetic patients is generally larger than that of normal people, but we can know the degree of blood sugar control of patients by recording the blood sugar fluctuation of patients, so glycosylated hemoglobin can not replace the daily blood sugar test.

Let's give an example. If you have two sugar friends, the glycosylated hemoglobin level is about 6%, which belongs to the normal range, but one of them has a higher blood sugar after meals, which indicates that his blood sugar fluctuates greatly. If he continuously monitors his blood sugar, he may see the fluctuation chart of blood sugar, which is very dangerous, because the greater the fluctuation of blood sugar, the greater the risk of complications, especially acute complications, such as cardiovascular diseases. Therefore, glycosylated hemoglobin can not fully represent the daily blood sugar situation of patients, and daily blood sugar monitoring is as important as glycosylated hemoglobin.

Especially sugar lovers, if they want to know their improvement or influence on blood sugar through diet, exercise, drugs and living habits, they should not only look at the index of glycosylated hemoglobin, but also add daily blood sugar monitoring, and can compare blood sugar with glycosylated hemoglobin. If the two values are close, it shows that glycosylated hemoglobin is more effective and can also reflect the daily blood sugar situation of sugar lovers, so they can judge the future sugar control methods or set corresponding goals according to this value.

What is the standard value of glycosylated hemoglobin and what value should it be controlled to? Since glycosylated hemoglobin is the average blood sugar for 2-3 months, what value should it be controlled to? Let's start with normal people. Generally speaking, the glycosylated hemoglobin value of normal people without diabetes is generally between 4% and 5.6%. If it exceeds 5.6%, the patient's blood sugar is abnormal. However, if it is lower than 6.4%, it is generally considered to be in a pre-diabetic state and cannot be counted as diabetes. However, if glycosylated hemoglobin exceeds 6.5%, it can basically be considered as diabetes. Of course, the value of glycosylated hemoglobin has not been used in the diagnosis of diabetes in China, but it has been paid more and more attention at present, because glycosylated hemoglobin is regarded as the gold index of diabetes control. Generally speaking, the lower the glycosylated hemoglobin value, the lower the probability of complications.

Studies have shown that for every reduction of glycosylated hemoglobin 1%, the mortality caused by diabetes can be reduced by 2 1%, the complications of small blood vessels can be reduced by 37%, and the amputation or death caused by peripheral blood vessels can be reduced by 43%. Reducing this value from 9% to 7% can reduce the probability of diabetic microangiopathy by 50-70%. Therefore, sugar friends should control glycosylated hemoglobin below 7%.

Of course, if someone goes to the hospital for monitoring and finds that their glycosylated hemoglobin is between 5.7% and 6.4%, don't worry too much at this time, which means that you are not diabetic, but belong to pre-diabetes. You can reverse the current state and return to normal through good diet and exercise habits, but you can't be too careless, because 50% of people will enter the stage of diabetes within 3 years without corresponding sugar control treatment in pre-diabetes, so glycosylated hemoglobin can also be used.

What is the relationship between glycosylated hemoglobin and blood sugar? We can calculate the average blood sugar of sugar friends by glycosylating hemoglobin, and there is a calculation formula:

Average blood glucose (mmol/l) = 1.59x glycosylated hemoglobin (HbA 1c)-2.59.

For example, if glycosylated hemoglobin is 4%, then the average blood sugar is 3.77 mmol/L.

We can directly check the average blood sugar according to the picture below.

From the above formula or picture, we know that when glycosylated hemoglobin is 7%, the average blood sugar is already 8.6mmol/L, which is already very high.

Why is the blood sugar value sometimes inconsistent with glycosylated hemoglobin? Glycosylated hemoglobin is higher than average blood sugar.

Sometimes sugar friends usually measure fasting or postprandial blood sugar, and find that blood sugar is basically concentrated between 4-7.8mmol/L, but glycosylated hemoglobin is above 7%, even reaching 8%. Why? This shows that the sugar friend's method of measuring blood sugar may be wrong. On the one hand, we should check whether the blood glucose meter is accurate, on the other hand, we should pay attention to monitoring postprandial hyperglycemia, so as to determine where the problem lies. If the blood sugar is too high after a meal, discuss with your doctor how to control your blood sugar. The sugar friend mentioned at the beginning of the article, his blood sugar belongs to this category. Through understanding, it is found that he usually tests fasting blood glucose and ignores postprandial blood glucose, especially his postprandial 1 hour blood glucose is very high, so he needs to adjust his medication immediately to make his blood glucose fluctuate.

Glycosylated hemoglobin is lower than the average blood sugar.

If the sugar friend's normal blood sugar value is between 6.7- 10mmol/L, but the glycosylated hemoglobin is below 6%, there are two situations. One possibility is the influence of some diseases, such as hemoglobin problem, abnormal red blood cell metabolic rate, abnormal renal function and so on. , which may lead to a low reading of glycosylated hemoglobin. On the other hand, it may be that sugar friends have had hypoglycemia, just measuring the time.

Although we said earlier that glycosylated hemoglobin is the golden indicator of sugar control, it does not mean that it is absolute, because there are many situations that will lead to errors in glycosylated hemoglobin, so sugar lovers can not only measure glycosylated hemoglobin every three months to understand the average blood sugar, but also need to monitor blood sugar every day to understand the fluctuation of blood sugar in a short period of time.

The glycosylated hemoglobin value that each sugar lover needs to control is different. Although controlling glycosylated hemoglobin below 7% can reduce the occurrence of complications, the target value of blood sugar monitoring needs to be determined according to the situation of sugar lovers themselves, such as whether there have been many hypoglycemia? Any complications? How old is the patient? How is the patient's medication? ..... and so on, so this 7% value is not everyone's goal.

Sugar friends should communicate with doctors more, so that doctors can better understand their own situation and set the corresponding target value of glycosylated hemoglobin. You can also refer to the following table to see if it is suitable for those sugar friends, and then further monitor and control your own blood sugar.

How to reduce glycosylated hemoglobin? Daily blood sugar management should be done well. Because glycosylated hemoglobin reflects the average blood sugar value in the past three months, it is suggested that if you want to reduce your glycosylated hemoglobin, you should first start with your daily diet, then work and rest regularly, don't stay up late, and then do regular exercise step by step. The amount of exercise can be gradually increased. Of course, the most important thing is not to forget to take medicine or inject insulin. Don't feel fine just because your blood sugar drops a little, which will increase your health risks and make you prone to various acute and chronic diseases.