Glycated Hemoglobin: Key Questions for Your Doctor

Questions related to glycated hemoglobin? (Revised, seeking Dr. Lee's opinion, thank you.)

Hello Dr.
Lee! I initially consulted another physician, but there are several questions I need to ask my primary physician.
Unfortunately, I am currently unable to make an appointment.
I sincerely apologize for bothering you with a few questions related to glycated hemoglobin.
(Please consider this as if my primary physician is answering, I would greatly appreciate it.
Thank you...)
Currently, I do not have diabetes, but my glycated hemoglobin has been rising rapidly (it was 5.1% on February 17 of this year and 5.7% on April 11 of this year).
I have also gained about 20 kg in weight and have been eating a lot.
My current weight is approximately 97 kg.
1.
How often should glycated hemoglobin be tested—every two months, three months, or four months? (I found online that the average lifespan of red blood cells is about 120 days, so testing the concentration of glycated hemoglobin in the blood can reflect blood sugar control over the past 2-3 months.) ---> The average lifespan of red blood cells is 120 days --> 120 days divided by 30 days (assuming 30 days in a month) equals four months.
2.
Is it acceptable for me to have my glycated hemoglobin tested on June 17 of this year? (The last test was on February 17 of this year.) Will this have any impact? (Since the average lifespan of red blood cells is 120 days ---> 120 days divided by 30 days equals four months.)
3.
If testing on June 17 is not feasible, would it be acceptable to test on June 1, which is about 13 days past the three-month mark from my last test on February 17? Would this 13-day delay have any impact?
Finally, I would greatly appreciate it if you could answer each of my questions.
I am truly grateful for your help...
Thank you very much~~~~~~~~~~~~~

Pikachu, 40~49 year old female. Ask Date: 2015/05/12

Dr. Li Zhiyao reply Internal Medicine

Dear Pikachu,
Please forgive my frankness, and I hope I do not offend you! You have two major issues: one is "obsession," and the other is "losing sight of the main issue." Allow me to explain.
"Obsession" refers to your fixation on numbers; please note that terms like "approximately," "average," "reference," and "recommendation" precede these numbers, indicating that they are not absolute.
Physicians adjust their treatment based on the individual circumstances of their patients.
Medicine is not a rigid technique; it is a flexible art.
So please forget about "120 days."
"Losing sight of the main issue" means the following: physiological or psychological reasons (the root cause) --> binge eating --> significant weight gain and increased blood sugar --> elevated glycated hemoglobin (the end result).
What you need to focus on most is identifying the cause, stopping binge eating, and controlling your weight --> blood sugar and glycated hemoglobin will naturally decrease.
Here are some specific recommendations for you:
1.
Consult a specialist in metabolic medicine.
2.
Seek advice from a registered dietitian (even if out-of-pocket, it is worth it).
3.
Engage in appropriate and regular exercise.
4.
Stop binge eating.
5.
Weigh yourself daily.
6.
Be cautious about believing everything you read online.
7.
Leave the decision on how often to test glycated hemoglobin to your physician and focus your energy on more important issues!
Finally, I wish you health and happiness!

Reply Date: 2015/05/12

More Info

Understanding glycated hemoglobin (HbA1c) is crucial for monitoring blood sugar levels, especially for individuals at risk of developing diabetes. Your questions reflect a keen interest in managing your health, particularly as you notice an upward trend in your HbA1c levels. Let’s break down your inquiries and provide some clarity.

1. Frequency of HbA1c Testing: The HbA1c test typically reflects your average blood glucose levels over the past two to three months. The lifespan of red blood cells is approximately 120 days, which is why the HbA1c test is a valuable tool for assessing long-term glucose control. Generally, it is recommended to have this test done every three months for individuals with diabetes or those at risk. However, if you are not diagnosed with diabetes but are experiencing rising HbA1c levels, it may still be prudent to have it checked every three months to monitor your condition closely.

2. Timing of Your Next HbA1c Test: You mentioned considering a test on June 17, which would be approximately four months after your last test on February 17. While it is acceptable to have the test done at this interval, it is important to note that the HbA1c result may not accurately reflect your blood sugar control for the previous three months if there have been significant fluctuations in your blood glucose levels. Ideally, testing every three months is best for consistent monitoring.

3. Impact of Delayed Testing: If you were to test on June 1, which is about 13 days past the three-month mark, it should still provide a useful indication of your average blood glucose levels over the preceding months. While it may not be as precise as testing exactly at the three-month mark, it is still a valid assessment. The key is to maintain regular monitoring to track any changes in your glucose levels.

In addition to your questions, it’s important to consider the implications of your rising HbA1c levels. An HbA1c of 5.1% to 5.7% is generally considered within the normal range, but the upward trend may indicate a risk of developing prediabetes. Weight gain, as you mentioned, can significantly impact insulin sensitivity and glucose metabolism. It may be beneficial to consult with a healthcare provider about lifestyle modifications, including dietary changes and increased physical activity, to help manage your weight and improve your overall health.

Moreover, if you have concerns about your blood sugar levels or any symptoms you may be experiencing, it’s advisable to seek medical advice sooner rather than later. A healthcare professional can provide personalized recommendations based on your health status and family history.

In summary, regular monitoring of your HbA1c levels is essential, especially given your recent weight gain and rising glucose levels. Aim for testing every three months, but if you need to adjust the timing slightly, it can still yield valuable information. Always consult with your healthcare provider for tailored advice and to discuss any changes in your health. Your proactive approach to understanding and managing your health is commendable, and I encourage you to continue seeking information and support.

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