Diabetes is a very common clinical condition caused by the deficiency of insulin.When the pancreas fail to produce enough insulin, the glucose molecules cannot be utilised by the cell for its activities and there is starvation of cell in the midst of plenty.Thus diabetes patients experience more hunger and if not controlled properly, they will eat more food and increase the blood glucose level.If this situation continues, there would be continuous presence of glucose in blood and sometimes at high levels, but no visible symptoms will be seen.This will lead to complications in different internal organs like kidney and when remained unchecked it may prove fatal.Thus diabetes is rightly called silent killer.
There are many treatments available for diabetic patients.Now insulin therapy is becoming popular and is replacing medicines.But whatever be the treatment, control of intake of food is highly recommended.It is the prime and best treatment to tackle diabetes.But how many of the diabetic patients are aware of it?.Do they control diabetes and take appropriate measures to keep the glucose level normal?.To find out this, every one goes for a very common test, which is to check the blood glucose level in fasting and postprandial.They confirm their glucose level and if it is in normal limits, they conclude their response as good.But there is a big disadvantage to this method.We all know that the test records the blood sugar of the day we went for the test.Now what about the other days?.There are people who would go for this test and once they know that their blood sugar is under normal limits, they will start to eat more food and if someone ask them why they are eating so much sugar, they will show the report and prove their stand.There are still other people who would not control sugar a bit, but before the day of the test they will starve or decrease food intake.So the next day when the test is conducted the report will show normal.In short, that test is a failure when you want to know how you control diabetes.It only shows what your blood glucose was on that particular time.With that test we can never conclude the effectiveness of the measure we take to control diabetes.But now that is an old story.A new laboratory Investigation technique is available which can find out how you have controlled diabetes and what your average blood sugar was for the last 3 months!.Yes.It is called Glycated Hemoglobin test or Average Blood Glucose Test.So next time you go to lab technician, do ask for this test.Now lets see in detail about it.
Glycated Hemoglobin Test
Principle
When there is excess of glucose in blood(hyperglycemia), the protein in the RBC will undergo a process called gycation.Gycation means glucose molecules will get attached to the protein molecule without the help of an enzyme.In blood when amount of glucose molecules increases, it will attach to the amino acid of the globin protein of the hemoglobin in RBC and that glucose molecule cannot be removed.Therefore it remains in the RBC throughout the its life span which is 120 days.These glycated hemoglobin are together called HbA1 fraction.Out of this 80% molecules are HbA1c where glucose is attached to the N-terminal valine(amino acid) of the beta chain of glucose.Here all you need to understand is that according to the amount of glucose in blood, more and more glucose molecule get attached to the globin in RBC which remain bonded there until the death of RBC which is 120 days.So by calculating the amount of these glycated RBC in blood we can find out the average blood sugar of an individual.
Interpretation of the test
In the laboratory,one of the technology used to find out the HbA1c value is called, Bidirectional Interfaced Fully Automated Turbidometry by Roche.The values are expressed in percentage.The normal level of HbA1c is about 4-7%.But in diabetic patients, the value increases to 8-15%.Precisely speaking a value below 6% is normal.The value between 6-7% is said to be in good control; 7-8% is fair control and 8-10% is unsatisfactory control.When the value is above 10%, it is poor control.So by referring to this value and comparing to the turbidometry value of your own, you can understand how well the diabetes is controlled.Here we have to understand that an elevated glyco hemoglobin indicate poor control of diabetes and the risk of renal complication (kidney problems) and retinopathy proportionately increases.Like that if there is a reduction in 1% of glyco hemoglobin, there will be a decrease in long term complication to an extent of 30%.
Along with the test a report on Average blood glucose level will also be present which is derived from the HbA1c values.The unit here is mg/dl which is same as the value we get in normal test of fasting and postprandial.It reference range is as follows: 90-120 mg/dl is excellent control; 121-150mg/dl is good control; 151-180mg/dl is average control.If the range is 181-210mg/dl, action is suggested and if the value is above 211mg/dl it time for you to be panic!.Here you must understand clearly what this value implies.Its never a real value, but a average value for last 3 months (almost 120 days).It doesn’t mean that your blood is having that much amount of sugar at any time, but the term here is average.Suppose you have eaten food which cause 10 unit to rise above the normal level for 1 week and later in the next week if you have eaten less food so that value drop to 10 units below normal, the net effect when you take the average value will be normal.
So by doing this test in every 3 months, you can clearly understand how you respond to the treatment or how you control your diabetes.There is no use in doing this test before next 3 months because the previous glycoHb will be present at that time which will give an inaccurate result.I believe every diabetic patient has to undergo this test and understand your diabetic control and based on that you can consult a doctor and get appropriate treatment method for your present situation.If properly controlled there is nothing to worry about diabetes and a normal life is possible.