Glucose regulation and A1c

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.


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43 Replies

  • 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 reliable can be this test afterall?



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

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

  • 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!:-)

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

  • Lot of other factors also affect Hba1c.

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

  • Will help up to certain extent.

    cheerful happy life

    Definition will change from person to person. :)

  • 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


  • 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.

  • Anemia lowers A1C and not increases it:

  • 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.

  • I spend most on testing strips and focus more on keeping blood sugar levels in non diabetic range. Annual tests, I postponed for three years now. Will do on sixth anniversary of me being a diabetic.

    Yes, diabetes self management starts with carbs control. Covering up high carbs with high fiber just for slowing down spikes is counter productive.

  • Is there anything called KIDNEY DOCTOR? Are you a doctor?

    It's "Nephrologist" for your information, and Nephrologist is better equipped to talk about diabetes managements than someone with a certificate course on mushroom, grapes or wheat cultivation.

    Oh Jason Fung has become a well respected person as he does not indulge in just making OPINIONS and he backs it with science and data. That's why he will never say that some special quality of wheat can have some SU like chemical or works like DPP4 inhibitor. That's why there are doctors in India who follow him and have adopted his teachings in their medical practice. He has data to prove and back his view point, just like we have when we say let's talk medical reports.

    At the end of the day, it's the MEDICAL REPORT that COUNTS and I am not sure why you prefer never to include the medical reports data in your discourse. Anything that reduces DRUGS and improves Medical reports is SCIENCE.

    Can you please educate us why you always IGNORE the SCIENCE of medical reports? That's science and men of science should always talk about it. Talking about "groups" etc is more of a politician's way of thinking.

    Now ADA's FB page is also having diabetics who do not follow ADA's diet:

    And, ADA isn't unhappy about diabetics posting about non ADA diet and even about Dr Bernstein on their wall. I even posted the link to the Indian forum that is dedicated to LC** on their FB page, something that has helped 1000+ Indian diabetics that I know of.

  • indiacratus

    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...

  • Watch the ADA's Facebook page. Almost everyone there is against ADA's burgers that they post. All talking Dr Bernstein, Jenny Ruhl, Keto Diet, LCHF diet.

    Dr Jason Fung is a hero for us, just like Jenny Ruhl, Dr Bernstein, Dre Peter Attia, Dr Eric Westman et al. Jason Fung's language is great.

    I have started posting on ADA's Facebook page, against their dietary recommendations.

  • 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 indiacratus is he really diabetic??? is he medical professional???

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

  • 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...

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

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

  • Let's post on Facebook page of ADA against their High Carb diet, like most of the posts by users are. All talk about Bernstein, Jenny Ruhl, Low Carb, Ketogenic diet there. And, thankfully they don't get bullied there for talking against ADA right on their FB account.

  • Anup

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

  • Great suramo Many of us have decided to start posting on ADA's official FB page.

    Spread the word and convince them instead of following the easy path of confusing them. WE are growing every day, despite the attempts by a few to insult us with failed opinions.

  • I have been asking him for SCIENCE of 60% carbs.

    I have been asking him on how 100 gms carbs is nutritional torture (his favorite opinion) and what nutrients we are lacking and where's the data to back his OPINION.

    He has no answers. I am looking for data and not statements from ADA or Mayo. WE don't care about what ADA says and have been proving it day in and day out, through medical reports, that ADA recommendation is BROKEN. But just as Pakistan lives/ is living in denial, many so called bodies also live in denial.

  • indiacratus

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

  • This is how a real doctor talks. To the point and no padding around because if one knows the subject, no padding is needed. Those who don't know start discussing astronomy, and grapes cultivation as part of answer.

    Since you follow a LC diet, you are not on the right side of those who do lot of padding.

  • They never answer to the point. Strictly unmathematical.

    I have failed to get any scientific answer for two of my queries based on your often repeated statements/opinions. Repeating them again:

    (1) Show us some science behind 60% CARBS. Don't quote ADA/Mayo OPINIONS. We don't care what they say. Diabetes has grown 4 times in last 35 years following their's and USDA recommendations.

    (2) What nutrients, micro-nutrients one lacks on 100 grams carbs diet? Specifics please and not some ADA/Mayo statement.

    Waiting for "to the point" answer.

    We answer with data and with mathematics. See one example:

    People boast about their numbers on ADA's Facebook page by not following what ADA/Mayo et al talk. Visit their page. ADA never calls them names.

    As schopenhauer said :the official philosopher. Reject such company. They have no work.

    Preach and let the students decide. That's what I do and gained one more follower on my profile here, since y'day. Count stands at 206 now.

  • The ant and the elephant, is the size difference with the ADA, WHO, EASD AND these people.

    Any idea what happens when an ant gets up the trunk of an elephant?

    I don't think by insulting diabetics here who have been successful by ditching ada/mayo or all such elephant's guidelines will ever strengthen any argument because they are proudly defending what they do based on their medical reports.isn't it great that ants are performing better than elephants? scientifically it is great. elephants need some wake up call, stop taking money from drug and food industry and learn science from the intelligence of ants.

    every time u try and insult fellow diabetics here you lose respect.

    by hook or Crook picks up a degree in medicine or engineering or any other profession:

    would u mind sharing what degree you picked up and from which university?

  • well because India wants to know. all that he has declared is he has some certificate on how to cultivate mushrooms.

    if i chose a username like shrewdton i don't bcum a shrewd newton. in fact i wuld never do something that horrendous as i respect newton.

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

  • yes, convince, confuse, corrupt are 3 layers of marketing. first one is most difficult fi they try to convince based on only skewed opinions so the so called experts resort to confusing the ignorant and corrupting others.

  • indiacratus

    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.

  • indiacratus


    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

  • But sir thanks for making me laugh

    As per him, weighted average computation is probability and statistics. And he talks about IIT's. More such statements only let readers know the hollowness of knowledge.

    I never get impressed with such mixed up and false knowledge. I can't even laugh on such wrong propaganda so present the correct facts.

    BTW, a once in a lifetime tourist to IIT campuses will never know, but IIT Kharagpur is thinking/contemplating of starting medicine degrees too. Some day this will happen for sure.

    So all the attempt at sarcasm gets busted with this news. Don't be surprised if there are dual degree programs also with Engg and Medicine combined as there are for two Engineering disciplines with 5 year course. Till then engineers are good enough to discuss diabetes management with guys who preach that weighted average is probability and statistics. I am not amused at this knowledge at all.

    As long as people rely on sarcasm as their main tool in debates, they will always falter. They have no data, no science. Just loaded with sarcasm.

  • Anup

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

  • suramo Nothing is impossible if person has the will to dig deep into research papers and has requisite grey matter. Those who superfluously skim through google search will always relate calculating weighted average with probability and statistics.

    Dr Bernstein Mastered diabetes management as an Engineer. All it needs is analytical mind and the ability to dig deep. Only at the age of 45 he entered a medical school.

    America is a country where a high profile employee one day could be delivering Pizzas the next day, as abrupt PINK Slip is the order of the day there. ZERO Job security. Perform or perish.

    Let IIT's step into medical education. Things will become interdisciplinary.

  • Are you also from IIT medicine?

    Don't be surprised. It will happen soon and sharing the following information which no casual tourist on a 3 to 7 day tour to any of the IIT's would ever be aware of.

    So, IIT's will be stepping into Medicine degrees also soon.

    And, that would be the day when you will see more of engineering becoming part of MBBS curriculum too. Then no one will be able to make wrong statements that calculating weighted average is part of probability theory. Why i say this? Well look at the quote from the article:

    “It will bring the two diverse disciplines of engineering and medicine together in education and research. Technology will be used to access and treat large number of patients through satellite centres and secondary hospitals,” the director said.

    For the moment, I am sure I know a lot more correct information / maths / calculations when it comes to theory of probability and statistics.

    So, what next? Time for interdisciplinary engg+medicine is on the horizon in India. They will be taught real probability and statistics too.

    Before that, many engineers are leading from the front already when they dump ADA/USDA diet.

  • Anup

    you are absolutely right.

  • Sir ji,

    I read a lot and do not forget things easily. Perhaps, a result of of training at IIT's because there we were/are trained to understand the BASICS and apply in real world where individual ingenuity is the KEY and not some OUTDATED TEXTBOOKS.

    We are never told to MUG for passing exams. In fact, by and large, mugging for passing to get a paper degree just produces duffers.

  • It is apity that no one pointed out the mistake.

    suramo did as he is a doctor on LC diet.

  • No sir. In the IIT they did not teach

    IIT they teach to read, learn, apply, tweak and achieve results. They are against the idea of "guidelines" from some cozy clubs. Students are trained to LEARN new things. My batch mate -- Met engg -- Is doing Assembly level programming in the US for a company. No degree in Comp Science.

    Sundar Pichai - CEO of Google is a B Tech in Metallurgical Engg from IIT Kharagpur. It's funny that people with just a certificate on mushroom farming are talking of IIT even without knowing anything about it and the real brains that graduate from there. It is IIT and not some Rangathhaiya College of Engg. Probability and Statistics -- I think people will faint when they know what Stats and Maths is taught there.

    What you talk of as probability as an example, is not even probability. It's weighted average. So, please get your facts and details right about theory of probability and statistics. Weighted average even a grade 10 student can do. Don't preach that weighted avg is probability and statistics. It is NOT. Theory of Probability starts with rolling of a dice which even a grade 10 student is taught. then it gets to two, three and "n" dices before moving to next basic chapter on probability.

    Chrome OS was not written in some UNIVERSITY. MSDOS was coded by a college drop out. You know who?

    Yes, I can understand diabetes management better than a diabetologist by and large. I am not bragging, just get your best expert on diabetes and anti high fat guy from AIIMS and I am ready for a debate with him on any Open Platform under public eye and not some behind the curtain talks.

    Challenging ADA is not bringing down the image of any country because ADA gets challenged in every country across the globe. That's a fact. So emotional appeals won't work in scientific world.

    I still haven't got any "to the point" answer to my two questions to you. Why are you avoiding the two questions?

    Talking with backing of medical reports is SCIENCE for the intelligent and PROPAGANDA for the politicians. And yup, engineers can understand self management of diabetes far better than anyone with a certificate on mushroom, grapes or wheat farming. Engineers will never make absurd statements like some special quality Wheat works like SU drug or DPP4 drugs, unless they can back it up with science and data. Only those involved in propaganda resort to such tricks.

  • Oh there are many tourists who visit IIT for some workshops. Attending workshops in IIT for 3 or 6 days means nothing -- absolutely nothing. Even Shatrughan Sinha and Poonam Dhillon visited the campus in the mid 1980's for shooting a movie and they were bluntly denied permission. So they also visited IIT.

    Discuss Diabetes, syndrome we know a lot too. Brushing teeth six times a day is also a syndrome, jumping from one topic to another and mostly irrelevant to the context is also a syndrome. What is that syndrome called? Can you educate us please?

    If you really have to talk about SYNDROMES relevant to this forum, talk about METABOLIC SYNDROME. van den Ende-Gupta syndrome people can google.

    Answer my two questions first, if you can:

    (1) Science behind 60% CARBS. Where is the SCIENCE and DATA?

    (2) What nutrients/micronutrients are missing on 100g carbs, 75g proteins and 100g fat diet, for example?

    Teach and let the students conclude. Followers on profile here reveal who is being listened to and who is not. Diabetics sharing their success here on diet change shows what is working and what is not.

    Let's talk based on science of medical reports.

  • hope this GUPTA Syndrome is not one of those non existent nomenclature of yours like u came up with OEF and LCCF for vco and lchf. if it is, then i don't think anyone would be interested.

    if i say that tomato is not tomato but ORC ie Overgrown Red Cherry, ppl will laugh at me.

  • 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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