Diabetes India
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Glucose regulation and A1c

precisionnutrition.com/bloo...

First, folks with healthy blood sugar levels may have longer-lived red blood cells than those with poor glucose regulation.

The better you regulate and manage glucose, the longer your red blood cells can survive. The longer your red blood cells live, the higher your circulating hemoglobin. And if circulating hemoglobin is high, that will probably show up in the A1c blood panel.

In other words, it’s possible for your hemoglobin A1c to appear a bit high, even — or maybe especially — if your blood sugar regulation is excellent.

And the opposite can also be true.

Poor glycemic control may kill off red blood cells prematurely. This can result in less circulating hemoglobin and a lower hemoglobin A1c measurement — even if your actual glucose levels are actually on the higher side. How ironic!

If you’re feeling confused, no wonder. This is one of those situations where being especially healthy can actually interfere with accurate assessment. It’s also why scientists are looking for better tests.

How long do your red blood cells live?

If longer-lived red blood cells can lead to higher hemoglobin A1c levels, despite healthy glucose levels, maybe doctors should be evaluating the lifespan and turnover of red blood cells in their patients.

Here’s a calculation for doing that. It’s just an estimation, as blood chemistry calculations aren’t perfect. Still, it may give a bit of insight into your personal red blood cell lifespan and it offers food for thought.

To do this calculation, you’ll need to know your reticulocyte count and your hematocrit.

Reticulocytes are early red blood cells. Produced in the bone marrow, they’re released into circulation as reticulocytes, and in a few days transform into fully mature red blood cells.

Reticulocytes can be used as a marker of red blood cell production.

For example, in someone who is losing blood (for example, from a bleeding ulcer or heavy menstruation) or in someone with short-lived red blood cells, the reticulocyte count may be higher. This is because the body will attempt to increase blood cell production to make up for the loss.

On the other hand, a low reticulocyte count can indicate that the body is generally happy with the amount of red blood cells or their lifespan, and doesn’t need to pump out as many reticulocytes.

The equation for determining how long your red blood cells are surviving is:

Red blood cell survival (days) = 100/[reticulocytes (percent)/reticulocyte life span (days)]

Here is an example:

Let’s say your reticulocyte count is 0.8% and your hematocrit is 45. Pulling from corrected reticulocyte count tables, the number for the reticulocyte life span (RLS) number would be 1.0.

Thus your equation would look like this:

100/[0.8/1] = 125 days

If your hemoglobin A1c number is a little higher than you’d expect given your current diet and lifestyle, and your red cell survival is longer than 120 days, your longer-lived red blood cells may be the reason.

23 Replies
oldestnewest

Is there any test for Reticulocyte %?

And as mentioned above, if HbA1c may be higher when glucose levels are maintained at optimal level and If HbA1c may be lower when glucose levels are higher.....how reliable can be this test afterall?

CONFUSED A LOT!

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pathdoor.com/book/blood-tes...

this is available with thyrocare costing just Rs.180/-

Feeling happy and cheerful in life is most reliable marker :P

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Honestly, health and all the tests done for diagnosis not reliable in all conditions or say different conditions or even different individuals. It's all too complicated. Better to just eat and enjoy!:-)

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I saw on thyrocare website where i do online booking...there this test is not included in hemogram.

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Lot of other factors also affect Hba1c.

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how about cheerful happy life???...does that reduces Hba1c?? shrisamarth

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Will help up to certain extent.

cheerful happy life

Definition will change from person to person. :)

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And most importantly, what about this mentioned in above link you posted?

1."In other words, the amount and type of fat you eat can influence hemoglobin A1c levels, creating falsely elevated levels that might not reflect your actual glucose management."

2."Vitamin C, vitamin E, or coenzyme Q10 may decrease hemoglobin A1c levels."

3."On the one hand, anything that leads to a shorter red blood cell lifespan theoretically could reduce a person’s A1c levels. So, folks with untreated B12, folic acid, hemolytic, or iron deficiency anemia might show artificially lowered A1c levels, despite their glucose levels.

On the other hand, iron deficiency anemia, in particular, can actually lead to higher levels of hemoglobin A1c. That’s because of a compound called malondialdehyde, which increases glycation."

Summary of possible interfering factors with Hemoglobin A1c levels

In the end, here’s a summary chart of the main factors that could impact A1c levels and create confusing and erroneous test results.

Potential causePossible impact on A1c

High protein dietElevated serum ureaIncreased

Healthy glucose levelsLonger lived red blood cellsIncreased

Iron deficiency anemiaIncreased glycation due to elevated malondialdehydeIncreased

High saturated fat intakeObservationIncreased

Vitamin C, vitamin E, and/or CoQ10 supplementationDecreases glycationDecreased

Excess red blood cell breakdownShorter-lived red blood cellsDecreased

PLEASE START STUDYING MEDICINE IN DETAIL FOR SUPER SPECIALIZATION BECAUSE EVEN OUR DOCTOR AND ENDOCRINOLOGIST MIGHT NOT BE KNOWING THIS AND EVEN IF THEY KNOW, IT IS ALL TOO COMPLICATED TO MANAGE DIABETES THROUGH DIAGNOSIS BASED ON HBA1c WHICH IS CONSIDERED MOST RELIABLE OF ALL.

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Fructose glycosylates haemoglobin seven times more than glucose, with both of them raising HbA1c.

You are correct that too much protein can also elevate urea, but where is the evidence that saturated fat increases glycation? Combined with mono-unsaturated fat, the outcome is cardiovascular health. I eat plenty of natural fat, and have zero calcification.

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Ashka9

Vow. That's great. But this reminds me an adage " if you can't convince, confuse." Well. This shows that doctors and researchers are very much confused about the control of D. more parameters means more confusion. All these tests will add to your health cost with no benefits.

I think more attention should be paid to diet control. Diet diet and diet is the first treatment. The attempts should be to find out how to decide if one can take 100g carbs or 50 g or less or more. Also how much protein and fats - good quality to be taken. At present in my opinion knowing one's bcf IR and a1c should decide that. All the other reports are to know the damage done to the organs by D.

Healthy natural food and no junk food is the best strategy.

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Hidden

Jason Fung may use bad langauge but he is better that ADA Drs as he advocated fasting for controlling diabetes & reducing insulin or pills

But the ADA Drs advocate more carbs & hence more pills so they can earn more kickbacks

And we have people like you supporting these bodies

Are you really a diabetic... ? I doubt...

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yes.... Shashikantiyengar most of LCHF followers proudly posts medical reports online and in forum.... cause they really feel proud of achievement ...

But we really don't know status of Hidden is he really diabetic??? is he medical professional???

and why he is so much supportive of ADA...

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No idea

They only post opinions & never reveal their status

They will oppose any diet which is against ADA diet

As if ADA is their creation...

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or they are creation of ADA???? :O

when they talk they should provide medical reports in support to their stand...

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Anup

i have posted many things on my fb page. Many have liked my posts and few have asked me questions too.

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Hidden

I'm not sure if only 7% rbcs are glycosylated. All the rbcs get glycosylated and the glycosylation is permanent.

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Hidden I guess it is " If you cannot convince ..try to confuse.. confuse....or corrupt ";)

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Hidden

You are confusing reticulocyte count to glycosylated hb. Yes. Glycosylation of hb occurs on way of formation of rbcs. That's why it gives 3 months average.

Yes. At present doctors themselves are confused about the management of D. That's why so much research on a parameter 🐒🐒🐒🐒. There is only one definite treatment and that is diet. Investigations of prime importance are fasting insulin value, fbs, ppbs and a1c as far as D control is concerned. Most other investigations are done to know the organ damage.

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Hidden

😝😝😝😝😝😝😝😝😝😝😝😝😝😝😝😝😝

I always like your responses.

Never knew IIT is giving degree of medicine. Thanks for sharing your knowledge.

"

1)glycosylation continues for the entire life span of the erythrocyte.

2)it is proportional to both concentration of glucose and period of exposure." Agreed. So what is the controversy?

"

Reticulocyte counting is a recent technique using radio active labeling and is only an instrument, pointer for further knowledge ..". I don't think reticulocyte counting is a recent technique and requires radio labeling. Reticulocytes are nucleated form of rbcs. They are premature or early form of rbcs. Ultimately they lose nucleuii to become rbcs. Rbcs are the only cells in the body which do not nucleii. Reticulocyte count has long been used to see the rbc turnover. In case where there is bood / rbc loss our body need to produce more rbcs rapidly. So these premature form of rbcs - reticulocytes are pushed into the circulation from bone marrow and reticulocyte counts increase in peripheral blood. It's counted by looking into microscope and now a days there are machines which give the count and other rbc related parameters.

But sir thanks for making me laugh 😝😝

"A man is known by his company, " i'm enjoying your company too @indiacratus

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Anup

there is a doctor in US who has mastered both IT and medicine. I read v....ery long back.

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Anup

you are absolutely right.

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Hi all learned participants of this post,

I read the post and all the 50 responses one by one from top to bottom in this one sitting.

Before that I was under the impression that HbA1c=5% means that 5 out of 100 of all the Hb-s are glycosylated and 95 out of 100 are not. I was understanding it as a binary state. By this what I mean is analogous to the states of an ORDINARY electrical switch - either on or off (SPST), or to the bits of a computer representing either zero(0) or one(1) at any time.

Filtering out the venting of ego clashes, the residue makes me, in my incompetence & ignorance, think that all Hb-s of a body are glycosylated, with the difference that the extent of glycosylation is different.

If all Hb-s are glycosylated to different extents, how, in my case, the result 5% for HbA1c is arrived at? Does it not mean that even though each Hb is glycosylated to a different extent, the average extent of glycosylation of each Hb is 5%?

There are some more related doubts. Shall ask later; it is 0130hrs & feeling sleepy. Good day everyone :-)

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