and Pitfalls of A1c Test
The A1c test a useful blood test that
indicates the average of blood glucose levels during the
preceding 80 to 100 days. It measures the percentage of a
blood protein that becomes "sticky" due to sugar attached to
it. The test value rises with the rising levels of blood
In healthy people, 5 to 5.5 percent of hemoglobin is
sticky with sugar (glycated hemoglobin is the scientific
term for it). A value of 6.5* or higher on more than two
occasions is accepted as a valid criterion for diabetic
diagnosis. The red blood cells have a life span of about 120
days and that explains the value of the A1c test in
assessing blood glucose levsls over a period of 80-100 days.
The Value and Pitfalls of A1c
In general, the A1c test is useful for monitoring the
success of diabetes treatment A value of 5.6% or less is
considered optimal. The American Diabetes Association (ADA)
recommends that every diabetic should have an A1C test done
a minimum of twice a year, with more frequent testing for
those with poor control or changes in treatment. I use this
test more often.
It is a mistake to rely on the A1c test to exclude the
diagnosis of diabetes in the initial screening. There are
simply far too many errors made in such testing. I
illustrate my point with a case study.
A Case Study
Just yesterday, I saw well-informed man in his late
sixties. His fasting blood sugar was in the normal lab range
and A1 test was 5.1%. Based on these values, none of his
ologists had any reason to suspect diabetes. In my view,
fasting blood sugar should be banned for screening for
diabetes. The real test is insulin. His thee-hour insulin
profile revealed insulin toxicity (with peak value almost
seven times as high as the optimal value of 25 units).His
blood sugar values were above 200 in two of the four blood
samples and established the diagnosis of diabetes using the
criteria of the American Diabetes Association. He was
startled when I told him he had diabetes.
"But I have been seeing my doctors regularly for years
and my A1c and fasting blood sugar tests have been perfect.
How can I be suddenly diabetic?" he asked.
"No, you didnít suddenly become diabetic," I replied.
"No?" he frowned.
"No. If some had done a three-hour insulin test for you
three years ago, almost certainly they would have diagnosed
"Then why didnít they do the test?"
"Doctors rarely do an insulin test."
"Because that is not the prevailing standard."
"Why isnít it so?"
"Because the American Diabetes Association does not say
it should be."
"Why is that so?"
"Can you guess?" I asked.
"Could it be that there is no money in it? The Diabetic
Association gets its money from companies that sell diabetes
"Your guess is as good as mine," I replied.
Being One's Own primary
American Ology and Ologists
The A1c Test
and Pitfalls of A1c Test