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Blood work hba1c: 20 Reasons for Blood Sugar Swings (No. 11 Might Surprise You!)


20 Reasons for Blood Sugar Swings (No. 11 Might Surprise You!)


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American Diabetes Association: “Alcohol,” “Diabetes Basics,” “Dairy,” “Food and Fitness: Fruits,” “Hyperglycemia,” “Food & Fitness: Glycemic Index and Diabetes,” “Food & Fitness: Sugar and Desserts,” “Living With Diabetes: Ask the Pharmacist,” “Living With Diabetes: Sexual Health,” “Living With Diabetes: Stress,” “Living With Diabetes: When You’re Sick,” “MyFoodAdvisor,” “News and Research: A Low-Fat Vegan Diet Helps Improve Glucose Control and Heart Health,” “‘Sugar-free’ Claims,” “Sugar Alcohols.”
American Heart Association: “Types of Blood Pressure Medications.”
CDC: “Managing Summer Heat, Travel With Diabetes.”
David, J.A. American Journal of Clinical Nutrition, September 2003.
Diabetes Action: “Medication and Insulin,” “Supplements.”
DiabetesMonitor.com: “Medications May Affect Blood Glucose Level If You Have Type 1 Diabetes.”
DiabetesSisters.org: “Does Our Monthly Cycle Affect Insulin Dosage?”
Harvard School of Public Health: “Coffee: The Good News.
HealthyWomen.org: “Birth Control Pills: Risks.”
Joslin Diabetes Center: “Friendly Tips for Handling the Summer Heat,” “Why Do Blood Glucose Levels Sometimes Go Up After Exercise?” “Why Is My Blood Glucose Sometimes Low After Exercise?”
Elizabeth Mayer-Davis, PhD, registered dietitian; professor of nutrition and medicine, University of North Carolina, Chapel Hill.
National Diabetes Information Clearinghouse: “What I Need to Know About Physical Activity and Diabetes.”
Swank, A.M. Diabetes Health, Sept. 1, 2006.

Glycosylated Hemoglobin Test: Definition & Test


Why is Hemoglobin A1c important.

What’s a glycosylated hemoglobin test?

A glycosylated hemoglobin test measures the amount of glucose (sugar) in your blood. The test is often called A1c, or sometimes HbA1c. It’s a simple blood test used to:

  • Detect prediabetes — high sugar levels that can lead to diabetes, heart disease and stroke.
  • Diagnose diabetes.
  • Tell how well a person with diabetes has been managing the disease.

How does the A1c test work?

A1c testing relies on hemoglobin. Hemoglobin is the part of the red blood cell that carries oxygen throughout the body. When you have glucose in your blood, it glycates (sticks) to hemoglobin. The more glucose in your blood, the more it sticks. And it can stay there for around three months, or about how long the average red blood cell lives.

The A1c test measures the average amount of glucose that’s been attached to hemoglobin over time. So the A1c test provides more information about blood sugar over a longer period of time than home monitoring does.

When is an A1c test needed?

If you have diabetes, you should have an A1c test two to four times a year to see how you’re managing it. Your healthcare team will recommend exactly how often you should get tested.

If you haven’t gotten diagnosed with diabetes, a healthcare provider may order an A1c test if you have symptoms of the condition. These symptoms include:

You may also get an A1c test if you’re at risk for diabetes. Risk factors include:

Test Details

How do I prepare for an A1c test?

You don’t need to fast (restrict food or drink) or do anything else special before the test.

What happens during an A1c test?

Some healthcare provider offices have an A1c machine that requires only a small drop of blood from the fingertip (similar to a home glucose check) and provides a result in just a few minutes.

Other healthcare providers may order the A1c as a lab test to be drawn in the medical office, a hospital or a lab. The test usually takes less than five minutes, and it often takes a day or two to get the result.

The person drawing your blood will:

  • Ask you to expose your upper arm (for example, by rolling up your sleeve).
  • Put a tight band called a tourniquet around your upper arm.
  • Clean the area on the inner arm, where it bends.
  • Insert a thin needle into a vein.
  • Collect blood into a tube attached to the needle.
  • Remove the needle, then put a bandage on the tiny hole.

Are there any risks with an A1c test?

Blood tests are very common and don’t carry any significant risks. You may have slight pain when the needle gets inserted, and a small bruise may develop there.

Results and Follow-Up

When will I know the results of the A1c test?

Ask your healthcare provider when you can expect to get the results. They may be ready the same day or up to a week later.

What do the A1c test results mean?

An A1c test result gets reported as a percentage. The number represents the portion of hemoglobin proteins that are glycosylated, or holding glucose. The higher the percentage, the higher your blood sugar levels have been over the last few months.

  • Less than 5.7% means you don’t have diabetes.
  • 5.7% to 6.4% signals pre-diabetes.
  • 6.5% or higher means a diabetes diagnosis.
  • 7% or lower is the goal for someone trying to manage their diabetes.

What is A1c compared to eAg?

If you have diabetes and track glucose with a home monitor, your healthcare provider might report A1C results as eAG. This converts the information to a different way of measuring. You can then compare it to the results of home glucose monitoring.

Instead of a percentage, eAG gets reported in milligrams per deciliter (mg/dl) or millimoles per liter (mmol/l). For example, an A1c level of 7% equals an eAG of 154 mg/dl and 8.6 mmol/l. The American Diabetes Association offers a calculator and chart to help you convert your numbers.

Additional Details

Can my race or ethnicity affect my A1c results?

There are different kinds of hemoglobin. The most common is hemoglobin A. But some races and ethnicities have different types of hemoglobin, called hemoglobin variants.

A hemoglobin variant doesn’t increase the risk for diabetes, but it can affect A1c results. Labs have different ways to do A1c tests on blood with a hemoglobin variant.

The most common variants are the:

  • Hemoglobin C trait that’s most commonly found in African Americans, people of West African descent and people from South and Central America, the Caribbean Islands and Europe.
  • Hemoglobin D trait that’s most commonly found in people who live in China, India, Turkey, Brazil and some parts of Europe.
  • Hemoglobin E trait that’s most commonly found in Asian Americans, especially those of Southeast Asian descent.
  • Hemoglobin S trait that’s most commonly found in African Americans and Latino Americans.

Talk to your healthcare provider about how often you should get an A1c test. Also discuss whether you might have a hemoglobin variant that could affect the results.

Tests for Blood Sugar (Glucose) and HbA1c

What should my blood sugar level be?

Download a FREE HbA1c to mmol/L chart for your phone, desktop or as a printout.

How does the HBA1c test work?

HbA1c (glycated haemoglobi, haemoglobin A1c) occurs when haemoglobi, the oxygen-carrying protein in red blood cells, becomes bonded with glucose in the bloodstream. The bonding with glucose is called glycation.

The higher a person’s blood glucose levels have bee, the higher the number of red blood cells that will have become glycated, and therefore the higher HbA1c level they will have.

Note that red blood cells exist in the body for around 3 months, therefore an HbA1c levels generally reflects a person’s blood glucose levels over the previous 8-12 weeks.

Limitations of HbA1c tests

Whilst HbA1c tests are usually reliable, there are some limitations to the accuracy of the test. For example, people with forms of anaemia may not have sufficient haemoglobin for the test to be accurate and may need to have a fructosamine test instead.

Being pregnant or having an uncommon form of haemoglobin (known as a haemoglobin variant) can also return an inaccurate HbA1c, while readings can also be affected by short term issues such as illness as they can cause a temporary rise in blood glucose.

Because of the way the HbA1c test measures blood sugar, if you have higher blood sugar levels in the weeks leading up to your HbA1c test, this will have a greater impact on your test result than your glucose levels 2 to 3 months before the test.

HbA1c Test + Normal, Prediabetes & Diabetes Range

HbA1c is an indicator of your long-term glucose levels. This lab test is used to aid in the diagnosis of diabetes and prediabetes. In general, the lower the HbA1C within the normal range, the better. As the number climbs, it increases the risk of diabetes and chronic disease. Read on to find out why you should regularly check your values and whether they are in the normal range.

What is HbA1c?


Glycated hemoglobin (HbA1c) is an important indicator of long-term glucose levels and has been recommended for use in the diagnosis of diabetes mellitus (DM) by the American Diabetes Association (ADA) and World Health Organization (WHO) [1].

HbA1c is created when glucose binds to hemoglobin, which is found in red blood cells [2].

HbA1c is sugar bound to hemoglobin in red blood cells. It can help diagnose diabetes.

How High Blood Sugar Creates HbA1c

Red blood cells (RBCs) are exposed to glucose in the blood. The higher the blood glucose level gets the more HbA1c forms throughout the lifespan of a red blood cell [3].

The lifespan of a red blood cell varies from person to person but averages out to approximately 117 days in men and 106 days in women. Therefore, the HbA1c is an index of average blood sugar levels over the preceding 2 to 3 months. Of this 2 – 3 month period, the immediately preceding 30 days contribute 50% to HbA1c [3].

Normal adult hemoglobin consists predominantly of HbA1, of which HbA1c comprises approximately 5% [4].

However, HbA1c does not always correlate with blood glucose levels. It is possible to have high blood glucose but low HbA1c due to the presence of hemoglobin variants, inflammation, or other factors that increase red blood cell turn over.

If your red blood cells live longer than 90 days or they are smaller (as measured by MCV in a blood test), then your HbA1C will be artificially higher.

High blood sugar creates HbA1c in red blood cells, which live for 2-3 months. Thus, HbA1c is a measure of blood sugar levels over this time span. In some health conditions, HbA1c can increase or decrease regardless of blood sugar levels

HbA1c Test


A healthcare professional will take a blood sample from your arm, which will be sent to the lab to measure your HbA1c levels. Finger prick tests can use a single drop of blood to get a reading, which is often more convenient for children or people who have difficulty giving larger blood samples.

Your doctor will usually order this test as part of a routine health checkup or if you are at risk of diabetes. If you have diabetes, they will order the test to monitor your health status or your response to medication [5].

In most cases, you don’t need to prepare for the test in any particular way or fast, unless you are also testing your fasting blood glucose at the same time. Check with your health care provider to be sure.

The HbA1c test requires a blood sample, either drawn from your arm or taken with a finger prick.

How Often Should You Test HbA1c?

According to the American Diabetes Association, screening for diabetes is recommended in people over 45 (every 3 years), or at any age if you have certain risk factors, including [6]:

  • Being overweight, obese, or physically inactive
  • Having a close (first or second degree) relative with diabetes
  • Belonging to a certain race/ethnic group (Native Americans, African-Americans, Hispanic Americans, Asians/South Pacific Islanders)
  • Having signs of insulin resistance or conditions associated with insulin resistance, such as high blood pressure (hypertension), low good cholesterol and/or high triglycerides (dyslipidemia), and polycystic ovary syndrome
  • Having had diabetes in pregnancy (gestational diabetes)

Diabetic patients with stable blood glucose levels should test HbA1c approximately twice a year [7].

Your doctor may suggest quarterly monitoring (every 3 months) if you have newly diagnosed or pregnancy-associated diabetes, rapidly changing HbA1c levels, changes in treatment or insulin dose, or if you have a history of hypoglycemia (low blood sugar) [8].

Testing HbA1c five or more times per year is redundant because HbA1c is a measure of average blood sugar over three months [8].

Diabetics with stable blood sugar usually test twice a year, while newly-diagnosed patients or pregnant women with diabetes may need to repeat the test every 3 months.

Advantages of HbA1C Over Other Blood Glucose Tests

  • The HbA1c test can be taken at any time and does not require fasting [9].
  • It is unaffected by physical activity or stress prior to testing [9].
  • As a marker of long-term blood sugar levels, it is unaffected by short-term hormonal surges [9].
  • As a test, HbA1c has a low variability, both when measured in a single individual, and among people [9].
  • HbA1c is more stable than glucose at 37°C [9].
  • Symptomatic patients can be tested immediately at the same visit, saving costs [9].

However, some health conditions that affect red blood cells and hemoglobin (e.g. anemia) can falsely increase or decrease HbA1c levels [10].

The HbA1c test is simple, quick, can be taken at any time, and doesn’t require you to fast. Its readings are unaffected by previous exercise, stress, or short-term hormonal fluctuations. However, conditions that affect red blood cells and hemoglobin can make it inaccurate

Unit Conversion

HbA1c is usually measured in percent or mmol/mol (mili-mols per mol).

Measuring HbA1c percentages are considered to be the “old way” and most labs nowadays report its values as mmol/mol.

If you need to convert between the two, the Australian Diabetes Society recommends the following formula [11]:

Old (%) = 0.0915 New (mmol/mol) + 2.15%

New (mmol/mol) = 10.93 Old (%) – 23.5 mmol/mol

As an example, using this formula, 5% HbA1c equals 31 mmol/mol (54.7-23.5).

Most labs now report HbA1c in mmol/mol, while percentages are considered to be outdated. However, you can easily convert between the two.

HbA1c Normal Range

In Healthy People

In healthy people, HbA1c values range between 4.0% and 5.6% (20 – 38 mmol/mol) [12].

Integrative medicine doctors often tighten those parameters to as low as 5.2% (33 mmol/mol) as prevention measures, though this is not part of international guidelines and isn’t supported by research.

Screening for Prediabetes

People with HbA1c values of 5.7 – 6.4% (39 – 46 mmol/mol) are considered at high risk for diabetes [13].

In 2015, the American Diabetic Association (ADA) suggested that an HbA1c of 5.7 – 6.4% (39 – 46 mmol/mol) was reasonable for the diagnosis of pre-diabetes and that patients with HbA1c > 6.0% (>42 mmol/mol) should be considered to be at very high risk of developing diabetes [1].

Diagnosing Diabetes

Values ≥ 6.5% (48 mmol/mol) can indicate diabetes [2].

However, HbA1c as a single measurement may not be adequate to diagnose diabetes [14].

Your doctor will interpret this test, taking into account your medical history and other test results.

The normal range for HbA1c is 4 – 5.6% (20 – 38 mmol/mol) in healthy people; values between 5.7% and 6.4% (39 – 46 mmol/mol) point to prediabetes, while HbA1c over 6.5% (47 mmol/mol) may indicate diabetes.

What Causes Normal HbA1c Levels to Vary?

1) Seasonal changes

HbA1c levels were reported to be higher in colder (January-March) than in warmer (July-September) months in a study of over 600 diabetics [15].

This variation amounts to about 0.3% (3.3 mmol/mol). These differences may be due to differences in exercise, carbohydrate intake, and the number of illness events between summer and winter months [16].

HbA1c levels may slightly increase in colder months compared to warmer months.

2) Ethnic differences

HbA1c levels are often reported to be different depending on race, ethnicity, and ancestry.

African-Caribbean and South Asian subjects were reported to have HbA1c levels 0.27 – 0.4% higher compared to those with European ancestry, despite lower fasting blood glucose in oral glucose tolerance tests [9, 17].

In South Africa, Black African patients with diabetes were more likely to reach the HbA1c target (<7%) and less likely to have eye, kidney, or heart disease complications [18].

People of African-Caribbean and South Asian ancestry may have mildly higher HbA1c levels than people of European ancestry.

3) Genetic Variants of Hemoglobin

HbA1c results can be inaccurate in persons with elevated amounts of hemoglobin variants. These variants (Hemoglobin S, C, E, and F) are more prevalent in non-whites [19].

Hemoglobin S (the cause of sickle cell anemia) is found in approximately one in 12 African Americans, one in 100 Hispanics and other races [19].

Hemoglobin C is found in approximately one in 50 African Americans [19].

Hemoglobin E (a cause of beta thalassemia) is associated with Asian descents, particularly southeast coastal Asia, with up to 30% in some areas [19].

Hemoglobin F is the normal hemoglobin typically found in a fetus and in low concentration in adults. In some genetic diseases like Hereditary Persistence of Fetal Hemoglobin, Sickle Beta Thalassemia, and some other diseases, hemoglobin F can be elevated [19].

People with certain hemoglobin variants get inaccurate HbA1c readings.

4) Gender Differences

Men have to undergo greater metabolic disturbances and put on more fat to develop HbA1c-defined diabetes than do women [20].

5) Age

HbA1c increases with age, even in the absence of diabetes [21, 22, 23, 9].

People aged over 70 have about 0.5% higher HbA1c compared to those under 30 [21].

Age results in an increase of 0.074% – 0.094% in HbA1c per decade. This age-dependent increase in HbA1c is greater in those with a family history of diabetes, and higher BMI [21, 23, 22].

One study argues against the increase of HbA1c with age though [24].

Older people can have higher levels even if they are healthy.

6) Recent Blood Donation

HbA1c decreases after donating blood. Therefore, HbA1c levels are likely to be underestimated after blood donation in patients with diabetes [25].

This is as a result of lower hemoglobin after giving blood and doesn’t mean that your blood sugar levels are lower.

People with diabetes who recently gave blood may get misleadingly low HbA1c readings despite having high blood sugar levels.

7) Pregnancy

Normal Pregnancy

HbA1c levels fluctuate very slightly during pregnancy. HbA1c levels decrease during the second trimester of a normal non-diabetic pregnancy and rise during the third trimester [26].

Pregnancy Risks

A study suggests that HbA1c of 5.9 – 6.7% (41 – 49 mmol/mol) identifies a higher-risk group of women with gestational diabetes [27].

In other studies, HbA1c>5.9% (41 mmol/mol) was associated with an increased risk of large infants, cesarean section, and high blood pressure (preeclampsia) [28, 29].

HbA1c levels should stay close to the normal range during a healthy pregnancy. High HbA1c levels in pregnancy may cause diabetes and health problems in both the mother and baby.

Post-partum Weight Loss in Diabetic Women

Pre-pregnancy BMI and weight retention after delivery were positively associated with HbA1c levels during the first year after delivery in 136 women with type 1 diabetes. Interventions to modify the behaviors associated with these bodyweight factors before pregnancy and after delivery may help women with type 1 diabetes maintain good blood sugar and HbA1c levels after pregnancy [30].

A study suggests that women with type 1 diabetes who have extra weight before pregnancy and after childbirth are more likely to have high HbA1c levels.


HbA1c is a measure of your average blood glucose levels over the past 3 months. Doctors usually order the HbA1c test to check for or monitor prediabetes or diabetes. Because blood sugar and insulin fluctuations are directly associated with most chronic disease, HbA1C is one of the most useful tests for preventative health as well. Healthy people should keep their levels in the normal range, which is 4-5.6 % (20 – 38 mmol/mol). Slightly higher levels point to prediabetes, while high levels (above 6.5% or 48 mmol/mol) indicate diabetes. However, your doctor will make a diagnosis taking into account your medical history, symptoms, and other test results. HbA1c may slightly vary depending on the season (higher in warm months), a person’s ethnicity, gender, concurrent diagnoses, and genetic makeup. Levels should remain close to normal in a healthy pregnancy.

What now?

Read our other posts to learn about:

HbA1c testing – HSE.ie


HbA1c and what it measures

HbA1c is known as glycated haemoglobin. It is made when the glucose (sugar) in your body sticks to your red blood cells. Your body cannot use the glucose properly, so more of it sticks to your blood cells and builds up in your blood. Red blood cells are active for around 8 to 12 weeks, which is why the reading is taken quarterly.

A high HbA1c means you have too much glucose in your blood. This means you’re more likely to develop serious problems with your:

  • eyes
  • heart
  • feet
  • nerves
  • kidneys
  • liver

HbA1c test

The HbA1c test is a blood test that is usually done by your GP or diabetes care team. Your glucose meter test tells your blood glucose at a particular time. The HbA1c test gives your average glucose over a number of weeks. It will be checked as part of your routine check-up.

You may need to have it checked more often if:

  • you’re planning for a baby
  • your treatment has recently changed
  • you’re having problems managing your blood sugar levels

An HbA1c test is also used to diagnose diabetes, and to check your levels if you’re at risk of developing diabetes.

The test is sometimes called haemoglobin A1c or just A1c.

Your HbA1c results

You should get the results quickly. This lets your healthcare team know if they need to change your treatment or medication to manage your levels better.

Most people with Type 2 diabetes should aim for a HbA1c of 53mmol/mol or lower.  Your GP or diabetes team will work with you to decide what target HbA1c is best for you.  If more than 58mmol/mol, discuss with your GP.

Your HbA1c can change for lots of reasons, including:

  • if you’re unwell
  • if you’re taking other medicines, like steroids
  • changes in lifestyle
  • if you’re feeling very stressed or you’re depressed.

The longer your HbA1c level is high, the more you’re at risk of developing serious complications, so know your result and talk to your diabetes team about them.

Maintaining a healthy and balanced diet and getting regular exercise will help get your HbA1c levels under control.

HbA1c (Hemoglobin A1c) A1c Chart, Test, Levels, & Normal Range

Hemoglobin is a kind of molecule that is present in red blood cells and helps in carrying oxygen to the body’s tissue. Hemoglobin A1c or HbA1c or glycosylated hemoglobin is a form of hemoglobin that contains sugar. Read this blog to know about the hba1c test means, normal range of hba1c chart in detail with cost.

People with diabetes are known to have a higher amount of glycosylated hemoglobin level than non-diabetic people. Therefore, in order to have a control level of blood glucose, HbA1c tests are done.

Need to Monitor HbA1c Level

Blood Glucose levels can fluctuate every minute depending upon your activity and the food you eat. Therefore, it is important to regularly monitor your blood glucose or sugar levels. It helps in understanding how your blood glucose levels are changing and how your meals are affecting it.

Generally, urine tests and daily pricks methods were used to measure sugar levels in people with high blood sugar levels. Although, these tests are somewhat accurate but have the limitation to be accurate at a certain moment. HbA1c test is helpful in measuring average blood sugar levels over the past 2-3 months. People with diabetes are required to get this test done regularly so that they can keep a check on their blood sugar levels. This ultimately helps in diabetes management.

Reasons for Fluctuations in Glycosylated Hemoglobin

Use of Insulin, fasting, oral intake of glucose or frequent fluctuations in your blood sugar levels are the most common reasons for the alteration in glycosylated hemoglobin levels. If people with diabetes notice the fluctuations in their glycosylated Hb level, they should consult doctors to maintain the HbA1c levels at the normal range. This helps in reducing risks and avoiding complications due to diabetes.

Also Read: List of Important Blood Sugar Tests

The Measure of Glucose in Glycosylated Hemoglobin

In the glycosylated hemoglobin test, the percentage of hemoglobin that is bound to the glucose is measured. The average concentration of blood glucose is reflected in this test over a period of the past three months. The glycosylated hemoglobin can be measured in percentage or in units of mmol/mol. This is now a standard unit in which glycosylated hemoglobin is measured all over the world.

Know Your Normal Range of HbA1c With Help of Chart

People can have different normal ranges of HbA1c. Here you can check out with the help of hba1c normal range chart, what should be the normal levels of glycosylated hemoglobin for individuals:

  • In non-diabetic people: Several reports have revealed that the complications of diabetes can be reduced if your HbA1c range is below 7%. A healthy person can have HbA1c measure less than 6% of the total hemoglobin. Below 6.0%, or below 42 mmol/mol is the normal value for a non-diabetic adult.
  • In a pre-diabetic person: If your blood sugar levels are slightly higher than the normal range then you are a pre-diabetic person. Your diabetes levels are not too high to be considered as type-2 diabetes. With a proper lifestyle and diet management, you can control your diabetes. Your normal HbA1c value is 6.0% to 6.4%, or 42 to 47 mmol/mol.
  • In diabetic people: Any person suffering from type-2 diabetes then your normal value is 6.5% or above, or 48 mmol/mol or above. This range may be normal but there is a need for proper guidance of doctors and medications along with healthy lifestyle change to maintain the range. If your value goes beyond the mentioned range then it can increase the risk of heart stroke, peripheral artery disease, glaucoma, diabetic foot, diabetic kidney disease and more.

Not all High Values of HbA1c Means You are Diabetic

If someone gets the higher values in HbA1c reports, it does not necessarily mean that you are suffering from high diabetes. A lot of people are there who have a variant form of hemoglobin other than type A. This is known as hemoglobinopathy and can seriously show the high or low values of HbA1c.

If you are anaemic or have a deficiency of iron in your body then also you are likely to get the wrong values on the average of 3 month diabetes test. Therefore, if you want the average of 3 months blood glucose test done, make sure you are not anaemic.

There are some medications also well which can alter your results of glycosylated hemoglobin test levels. These include:

  • Supplements like Vitamin C or E, iron, vitamin B12 and folate
  • Erythropoietin therapy
  • Aspirin
  • Antiviral and antimicrobial medicines.

If you are going for a glycosylating hemoglobin test, your doctor will make sure of the factors that can affect your test results.

What Causes High or Low Hemoglobin A1c Levels?

The level of Hemoglobin A1c is largely dependent upon the blood sugar levels. The higher the blood glucose (sugar) level, the higher is the amount of hemoglobin A1c. Factors responsible for altering the levels of Hemoglobin A1c include:

  • Oral or intravenous glucose consumption
  • Fasting
  • Insulin usage
  • Combinations of any of above stated factors

How Does A1c work?

A1c testing depends upon hemoglobin. Hemoglobin is present in the person’s RBC and transfers oxygen all through the body. When glucose is present in the blood, it sticks (glycates) to the hemoglobin. The higher the amount of glucose in the blood results in more sticking to the hemoglobin. The A1c test assesses the average glucose getting adhered to the hemoglobin over time.

What is A1C and eAG? and What is the Difference?

If a person has Diabetes and is doing tracking of his or her blood sugar levels using a home monitor, then the physician may report A1C results as eAG. Rather than a percentage, the reporting of eAG results is done in milligrams per deciliter (mg/dl) or millimoles per liter (mmol/l) units. For instance, 7% A1c level is equivalent to eAG of 154 mg/dl or 8.6 mmol/l.

Does Low Hemoglobin Affect A1C?

Low hemoglobin has a straight forward relationship with the levels of HbA1c. This means that hemoglobin level drops when hemoglobin levels drop down.

Hemoglobin A1c Conversion Chart (HbA1c chart)

Till now there is no specific guideline by concerned health organizations for using Hemoglobin A1c test as the tool to screen diabetes. However, HbA1c high values indicate that a person may have diabetes.

The following chart shows the correlation between HbA1c levels and average blood sugar levels.

A1(%) Mean blood sugar (mg/dl)
6 135
7 170
8 205
9 240
10 275
11 310
12 345

Studies have shown that 1% reduction in HbA1c glucose level reduces the risk of microvascular diseases upto 10%. Thus, when you get closer to HbA1c normal level, the absolute risk of microvascular diseases or complications also get lower.

Also Read: Normal Blood Sugar Levels for Adults with Diabetes

Benefits of Testing Diabetes with HbA1c Over Other Diabetes Test

There are a number of benefits for which diabetes test using HbA1c is preferred over the other types of diabetes test. Some of the benefits include:

  • No preparations are required: There is no need of preparations beforehand to get the HbA1c test done. It can be done at any time of the day. However, the other diabetes tests require fasting. In such a type of test, a person is required to fast for atleast 5-6 hours. After the fasting test for diabetes is done, there is another after meal blood test done to know the levels of your blood sugar post meal.
  • No special diet to follow: An oral glucose tolerance test is another kind of test to diagnose diabetes. In this type of test a special diet is required to be followed for 3 days before you get your test done. Along with this, you are also supposed to fast overnight before the test. However, while going for HbA1c checked, you can eat or drink anything you like.
  • Convenient and time saving: Within a couple of hours multiple blood tests are done to know the blood sugar levels in various other tests to diagnose or check sugar levels. However, HbA1c is a single blood test. You can even get the HbA1c report within 24 hours of the test and the procedure is also simple.

Limitations of Measuring Value of Hemoglobin A1c

Hemoglobin a1c  blood test is not suitable if you need to track your day to day blood sugar level. This is because HbA1c does not get influenced with the fluctuations of blood glucose level. You also cannot diagnose the presence or absence of hypoglycemia or hyperglycemia. You may also get the false high value of HbA1c levels in case of kidney failure, high intake of alcohol, anaemia, thalassemia and sickle cell disease.

Natural Ways to Bring HbA1c Normal

Those who have higher levels of HbA1c can bring down the level of HbA1c to the normal range through medications. Apart from this, there are some natural ways as well which can bring your HbA1c normal. These include:

  • Quit smoking to get hemoglobin A1c levels down.
  • Eat a balanced and healthy diet so that your immune system and hormonal balance is maintained.
  • Exercising is another natural way to control your increased levels of glycosylated hemoglobin. It helps in losing weight and lowering blood sugar which ultimately results in enhancing insulin sensitivity.
  • Adopt a healthy lifestyle to keep your blood sugar levels in control.


What is normal a1c levels for non diabetics?

The normal value of HbA1c blood test for non-diabetics is between 4% to 5.6%. i.e between 68 to 100 mg/dL

What does a1c stand for?

When the glucose binds to hemoglobin (Hb) it becomes Glycated hemoglobin HbA1c. A stands for adult and HbA1c is the most common type of hemoglobin present in blood that binds to glucose. Thus this test measures the amount of glucose binded to HbA1c.

What is hba1c glycated haemoglobin used for?

HbA1c test or Glycosylated hemoglobin test is a blood test carried out to find out whether you are diabetic or not. Glucose in our body binds to hemoglobin present in the blood. Thus, this blood test calculates the amount of glucose that binds to hemoglobin. Hemoglobin have a lifespan of 3 months. Thus, this test value gives the average amount of glucose present in the blood for past 3 months.

How does a1c test work?

HbA1C test works by measuring the amount of glucose that binds with the hemoglobin. A blood sample is drawn fromthe patient and the amount of binded hemoglobin and glucose is measured in percentage. If the values are less than 5.7 then the result outcome is normal.

What does the hba1c test indicate?

The Hemoglobin A1c blood test value measures the average amount of glucose present in the blood for the past 3 months. Thus, if the value is high it indicates prediabetics or diabetes.

Is fasting required for hba1c test?

The HbA1c (Hemoglobin A1c) is a very effective test for diabetes diagonsis. There is no need to fast before the test. You can eat and drink before getting tested.

What is hba1c in blood test?

HbA1c is known as glycosylated hemoglobin test.  This blood test is used to find out the average blood sugar levels for 3 months. It does by calculating the amount of glucose that binds to hemoglobin.

How much does hba1c test cost?

The HbA1c (Hemoglobin A1c) is a blood test carried out for diabetes diagonsis. It can cost from INR 300 to INR 800. Price varies from city to city and as per patient preference like sample collection from home.

What is the normal hba1c level?

HbA1c (Hemoglobin A1c), blood test measures the average blood sugar levles. The normal levels for this test is a value betwee 4% and 5.6%. Values in the range of 5.7% and 6.4% signfy prediabetic condition, while value above 6.5% signifies diabetes.

What is full form of hba1c?

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated’.

What is the cost of Hemoglobin A1c level test?

Well, the cost of this test is a bit higher than the normal blood sugar test but it gives you the most accurate results over the past three months. In India, the average cost of HbA1C or glycosylate hemoglobin test is around Rs 500.

Can you check the gestational diabetes with HbA1c ?

No. Gestational diabetes cannot be diagnosed with an HbA1c blood test. An oral glucose tolerance test is used instead to check gestational diabetes.

Can HbA1c blood test be done at home?

A home test is ideally good for those who are known diabetic. You can get the FDA approved test kit to monitor your glucose management over the time. You just have to follow the HbA1c test procedure mentioned in the kit to get the test results.

How is glycosylated hemoglobin tested?

There is no need of fasting before the test unlike the blood glucose test. Glycosylated Hb test is a simple blood test. Blood samples can be taken by the doctor or pathologist.

A1c Chart, Test, Levels, & Normal Range

The individuals having the stable blood glucose level should have a Hemoglobin A1c test done in every six months. However, people with diabetes or those who are trying to have a control on their blood sugar level should get this test done every three months.


  1. https://www.webmd.com/diabetes/guide/glycated-hemoglobin-test-hba1c
  2. https://www.medicinenet.com/hemoglobin_a1c_test/article.htm
  3. https://www.emedicinehealth.com/hemoglobin_a1c_hba1c/article_em.htm
  4. https://www.healthline.com/health/type-2-diabetes/ac1-test#TOC_TITLE_HDR_1
  5. https://www.medifee.com/tests/hba1c-cost/

90,000 Pass a blood test for Glycated hemoglobin A1c in the KDL


Glycated hemoglobin (HbA1c) – irreversible connection of glucose with hemoglobin in erythrocytes. This process occurs continuously and depends on the concentration of sugar in the blood and the duration of its effect on red blood cells. The level of glycohemoglobin does not change during the life of erythrocytes (90-120 days). Thus, the HbA1c index reflects the average glucose concentration during the previous period (approximately 8-12 weeks) and allows for a much more effective assessment of the degree of glycemia (the level of increased blood sugar) than the determination of glucose in blood and urine.

In what cases is the HbA1C hemoglobin test usually prescribed?

At present, the analysis for glycated hemoglobin together with the determination of fasting glucose is the most accurate tool for the diagnosis of diabetes mellitus (DM) and other forms of glucose metabolism disorders, including “latent forms” and pregnancy diabetes. The Hb1Ac content is not affected by the time of day, exercise, diet, food intake, emotional stress and other external and internal factors that complicate the interpretation of other studies.This test is used to assess the compensation of the disease, the effectiveness of treatment and calculate the risk of complications.

An HbA1c test must be taken every 3 months for all patients diagnosed with diabetes.

What exactly is determined in the analysis process?

In a whole blood sample, a specific type of hemoglobin, hemoglobin A1C, is isolated and measured by high pressure liquid chromatography.

What do the test results mean?

According to the World Health Organization (WHO), the concentration of Hb1Ac in healthy people is no more than 6.0%.

Values ​​from 6.0 to 6.5% are considered borderline and may indicate disorders of carbohydrate metabolism: impaired glucose tolerance, prediabetes, diabetes.

Values ​​above 6.5% are typical for diabetic patients.

A decrease in the level of glycohemoglobin can be observed in patients with anemia and during the recovery period of the body after blood loss

Typical due date for the test.

Usually, the result of a test for glycated hemoglobin is possible within 1-2 days after donating blood.

How to prepare for the analysis?

No special training required. Detailed information can be found in the corresponding section of the article.

Diagnostics of glycosylated hemoglobin (HbA1c) at the MediScan diagnostic center in Domodedovo

Diabetes mellitus (DM), without exaggeration, continues to play one of the most dramatic roles in the history of world medicine.

Timely diagnosis of diabetes mellitus allows for prophylaxis, prevention of the development of diabetes and its complications.

One of the diagnostic methods is to determine the level of glucose in the blood. Since the measured glucose level shows the concentration at the time of blood sampling, it is difficult to draw conclusions about the state of carbohydrate metabolism in the intervals between measurements.

Glycosylated hemoglobin (HbA1c) is an indicator that can give the average level of glucose in the blood for a long time.

Glycosylated hemoglobin (the term “glycated hemoglobin” is also used) is formed as a result of non-enzymatic attachment of glucose to the N-terminal regions of the R-chains of hemoglobin A1 globin and is designated as HbA1c.The HbA1c concentration is directly proportional to the average blood glucose concentration. In healthy people, the concentration of HbA1c in the blood is from 4 to 6%, in patients with diabetes mellitus, its level is 2-3 times higher (depending on the degree of hyperglycemia). The formed HbA1c accumulates inside the erythrocytes and remains during the entire life of the erythrocyte. The half-life of erythrocyte circulation in the bloodstream is 60 days, thus the HbA1c concentration reflects the patient’s glycemic level 60-90 days before the study [5, 6].A large number of studies using traditional glucose measurement methods have confirmed the relationship between HbA1c and a patient’s glycemic level. The results of studies carried out by the GST in the 90s of the last century served as the basis for confirming the hypothesis that the level of HbA1c reflects the level of glucose in the blood and is an effective criterion for monitoring patients with diabetes mellitus.

The HbA1c level is recognized as the gold standard in assessing the glycemic status of patients with diabetes.

Numerous prospective and epidemiological studies indicate improved glycemic control as measured by HbA1c levels.

According to numerous studies, glycated hemoglobin has proven its reliability, demonstrating a correlation with the average values ​​of glycemia, and reflects the average concentration of blood glucose over the previous 2-3 months.

Research carried out in laboratories and at the point of care is accurate and correct when properly controlled and adapted to international standards.

It is believed that random determination of plasma glucose levels in a clinical setting does not play a special role in the quality treatment of patients with diabetes.

Currently, all diabetic associations use the concept of target values ​​for glycated hemoglobin. Thus, the last target HbA1c value recommended in the ADA / EASD Agreed Algorithm on the basis of practicality and reduction in the development of complications, “in the general population <7%”, with the proviso “for specific patients, HbA1c should be as close to normal as possible (<6 %) without significant hypoglycemia ".

Correspondence of the HbA1c level to the average daily plasma glucose level for three months

HbA1c,% Glucose, mmol / L HbA1c,% Glucose, mmol / L HbA1c,% Glucose, mmol / L
4 3.8 9.5 12.5 15 21.3
4.5 4.6 10 13.3 15.5 22.1
5 5.4 10.5 14.1 16 22.9
5.5 6.2 11 14.9 16.5 23.7
6 7.0 11.5 15.7 17 24.5
6.5 7.8 12 16.5 17.5 25.3
7 8.6 12.5 17.3 18 26.1
7.5 9.4 13 18.1 18.5 26.9
8 10.2 13.5 18.9 19 27.7
8.5 11.0 14 19.7 19.5 28.5
9 11.7 14.5 20.5 20 29.2

DiaLab is pleased to inform you that this study has recently been performed on a high-quality analyzer D10 (Bio Rad) with a reference high-performance liquid chromatography method, which is the gold standard in the quantitative determination of glycosylated hemoglobin.

Rules for taking material:

Before taking blood for this test it is enough not to eat food for two hours .

Blood sampling is carried out in a test tube with EDTA (lilac cap).

Immediately after taking blood, without shaking, invert the tube 6-8 times (the tube is inverted correctly if the air bubble has moved from one end of the tube to the other). Rapid mixing can cause foaming and hemolysis (platelet agglutination).

Storage temperature: 2 to 8 ° C.

Term of completion: 1 working day.

Glycated hemoglobin (HbA 1c)

The main task of a doctor in the treatment of diabetes mellitus is to normalize blood glucose levels. The patient can control this metabolite in the blood either independently (with portable glucometers) or in the laboratory. According to a one-time determination of blood glucose, it is possible to judge only the concentration of glucose at the time of sampling, therefore, it is not possible to assume about the state of the patient’s carbohydrate metabolism between measurements.To assess carbohydrate metabolism in a patient over a longer period of time, it is necessary to test for the content of glycated hemoglobin (HbA1c) in the blood.

According to data from the National Institute of Diabetes, Digestive and Kidney Diseases (USA) 10-year study called DCCT (The Diabetes Control and Complications Trial) in the USA and Canada in 1983-1993, it was found that control the level of glycemia, correlated with the level of concentration of HbA1c, is directly related to the risk of developing long-term complications of type 1 diabetes and their progression.In 1999, specialists from the UK showed that a decrease in the glucose content in the patient’s serum, assessed by the concentration of HbA1c, reduces the number of microangiopathies in type 2 diabetes mellitus.

Glycated hemoglobin is hemoglobin in which a glucose molecule is non-enzymatically linked to the β-terminal valine of the β-chains of hemoglobin A1 globin and is designated as HbA1c. The HbA1c content has a direct correlation with the blood glucose level. Normally, the concentration of HbA1c is from 4.4 to 6.1%, in patients with diabetes mellitus, its level depends on the degree of hyperglycemia and is usually 2 to 3 times higher than normal values.Glycated hemoglobin accumulates inside erythrocytes and remains during the entire period of erythrocyte circulation in the bloodstream, which is about 60 days. Thus, the concentration of HbA1c reflects the degree of glycemia 60 – 90 days before the study. Multiple studies of glucose measurement using traditional methods have confirmed the relationship between HbA1c and the patient’s glycemic level. The results of DCCT studies conducted in the 90s confirmed the hypothesis that the level of HbA1c is directly related to the level of glucose in the blood and is the most appropriate criterion for monitoring the effectiveness of treatment in patients with diabetes mellitus.

In the early 90s, there was no single internationally agreed standardization of the measurement of glycosylated hemoglobin, which reduced the clinical effectiveness of this test. To achieve a uniform standard and overcome the challenges associated with its development, the International Federation of Clinical Chemistry (IFCC) established in 1993 the Working Group on the Standardization of HbA1c Assessment. The result of her work is the National Glycosylated Hemoglobin Research Standardization Program (NGSP).Most manufacturers of devices and kits for the analysis of blood for glycosylated hemoglobin were required to be checked for compliance with the results with the data obtained by reference methods. If the test result satisfies the reference data, the manufacturer is issued an “NGSP certificate of conformity”. The American Diabetes Association (ADA) recommends that all laboratories use NGSP-certified blood glycosylated hemoglobin tests.

There are many analytical methods available to determine HbA1c.These methods include electrophoresis, liquid chromatography, affinity chromatography, immunological techniques, column techniques. One of the main criteria when choosing an analyzer for performing a blood test for glycated hemoglobin is the presence of a reference NGSP method, which is liquid chromatography. When using standardized research methods, the laboratory has the ability to compare the results obtained with the data obtained using reference methods.This comparison maximizes the reliability of the research results.

Of undoubted importance is the use in the work of the attending physician only of such research results that are obtained in laboratories using NGSP-certified blood tests for glycated hemoglobin.

Therapist, endocrinologist.

Medical tests – Glycosylated hemoglobin (HbA1c)

Glycated hemoglobin, Glycosylated hemoglobin

is an indicator reflecting the blood glucose content for the last 1-3 months.The main indications for use are: control of the course of diabetes mellitus (once every 3 months), control of the effectiveness of treatment of diabetes mellitus, an indicator of the risk of developing complications of diabetes mellitus.

Glycosylated or glycated hemoglobin (HbA1c) is a compound of hemoglobin and glucose formed in the body. Approximately 5-8% of hemoglobin in erythrocytes binds stably to a glucose molecule. The process of attaching glucose to the hemoglobin molecule is a normal process, but during the life of the erythrocyte, with an increased prolonged glucose content in the blood, this percentage increases.Such molecules of hemoglobin are called glycosylated. Several types of glycosylated hemoglobins have been found. It is believed that hemoglobin – HbA1c has the greatest clinical significance. The concentration of glycosylated hemoglobin depends on the concentration of glucose in the blood. Considering that the life of an erythrocyte is on average 120 days, then the determination of the HbA1c content will reflect the average glucose in the blood serum for 1-3 months before the study.

Determination of glycosylated hemoglobin is recognized by the World Health Organization as necessary to control the course of diabetes mellitus once every 3 months.This allows you to monitor your glucose levels between doctor visits. The higher the HbA1c content in the patient’s blood serum, the worse the glucose concentration was controlled.

Normalization of the level of HbA1c in the blood occurs 4-6 weeks after reaching the normal level of glucose. When monitoring diabetes treatment, it is recommended to maintain the level of glycated hemoglobin less than 7% and revise therapy if its content is more than 8% (according to the method for determining HbA1c with normal values ​​in the range of 4-6%).

Glycated hemoglobin is used as an indicator of the risk of developing complications of diabetes mellitus.

The values ​​may vary between laboratories depending on the analytical method used, therefore dynamic control is best done in one laboratory or at least by the same method.

Test results can be falsely altered for any condition that affects the average life of red blood cells. Bleeding or hemolysis causes a false decrease in the HbA1c result.Blood transfusions also distort the outcome. With iron deficiency anemia, a false increase in HbA1c is observed.

Factors distorting the result

Inadequate blood sampling – insufficient mixing of blood with the anticoagulant (EDTA) in the tube.

Factors that increase the result

1. Carbamylated hemoglobin (formed in patients with uremia).


3. Indapamide.

4. Morphine.

5. Propranolol.

Factors causing a false increase

Hemoglobin F (fetal) and labile intermediates may cause false increases in results.

Increase in content

1. Hyperglycemia.

2. Thalassemia.

3. Chronic renal failure.

4. Treatment by hemodialysis.

5. Splenectomy.

6. An increased level of triglycerides or HbF causes an increase in the level of glycosylated hemoglobin.

Decrease in content

1. Hemolytic anemia.

2. Hypoglycemic conditions.

3. Blood transfusion.

With compensated diabetes mellitus against the background of effective antidiabetic therapy, the content of glycosylated hemoglobin does not exceed 8%.

In diabetes mellitus, which is difficult to treat, the content of glycosylated hemoglobin is more than 10%.

The increase in glycated hemoglobins reflects the hyperglycemia that occurred during the life span of erythrocytes (120 days). Different analytical methods can detect different forms of glycated hemoglobins. This must be borne in mind when interpreting the results.

Description of the analysis Glycosylated hemoglobin (HbA1c) in Khartsyzsk

Code: 02-405

Price: 550 rub


Glycosylated (glycated) hemoglobin is a specific compound of erythrocyte hemoglobin with glucose, the concentration of which reflects the average blood glucose level over a period of about three months.

Part of the glucose circulating in the blood spontaneously binds to hemoglobin, forming the so-called glycosylated hemoglobin. The higher the concentration of glucose in the blood, the more glycosylated hemoglobin is formed. Having combined with hemoglobin, glucose remains “in conjunction” with it until the very end of the erythrocyte’s life, that is, 120 days (three months). Glycated hemoglobin is formed in the blood and disappears from it every day, since old red blood cells die, and young (not yet glycated) take their place.
The Glycosylated Hemoglobin Test is used to monitor the condition of patients diagnosed with diabetes mellitus. It helps to assess how effectively glucose regulation is going on during the course of treatment.

An analysis is also prescribed if the patient is suspected of having diabetes mellitus, when symptoms of high blood glucose are detected. The Glycosylated hemoglobin test is prescribed for the diagnosis of diabetes mellitus and pre-diabetic state in addition to the fasting plasma glucose test and the glucose tolerance test.
The indicator is defined as a percentage. Patients with diabetes mellitus should strive to keep the level of Glycosylated hemoglobin no higher than 7%.

Preparation for analysis

Blood for research is donated in the morning on an empty stomach after an 8-12 hour night fasting period (you can drink water).On the eve of donating blood, fatty foods should be excluded from the diet.


Interpretation of results

Interpretation of test results contains information for the attending physician and is not a diagnosis.

Reference values ​​(normal):

Glycosylated hemoglobin,%

3.8 – 6.0

For all

Increased hemoglobin value: other conditions with impaired glucose tolerance

  • iron deficiency
  • splenectomy
  • Decreased glycosylated hemoglobin value:

    • hypoglycemia
    • hemolytic anemia
    • bleeding 2 9044

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      News in detail


      In modern high-quality laboratory diagnostics of diabetes mellitus, the definition of glycosylated hemoglobin (HbA1C) is increasingly used, which shows an integral indicator of sugar concentration over the last 3 months, which allows an objective assessment of the quality of treatment of carbohydrate metabolism disorders or their early diagnosis.

      The study of glycosylated hemoglobin in the clinical diagnostic laboratory of the BCDC has been carried out since 2016 on an automatic analyzer of a new generation D 10 “Bio-Rad” designed to determine glycosylated and other fractions of hemoglobin and passed the procedure of International (NGSP, ISO) and Russian certification. The analyzer is based on high pressure liquid ion exchange chromatography (HPLC). Modern HPLC analyzers are fully automated systems with high throughput.The principle of the method – the separation of hemoglobin into fractions with the subsequent measurement of each individual type of hemoglobin – allows you to obtain significantly more accurate results compared to other types of devices

      What is Glycosylated Hemoglobin?

      Erythrocytes contain hemoglobin, which is essential for the transport of oxygen and carbon dioxide. Glucose can combine with hemoglobin in a non-enzymatic way to form glycosylated hemoglobin (HbA1C).This process is greatly accelerated by hyperglycemia. The average life span of erythrocytes is on average about 95 – 120 days, so the HbA1C level reflects the integral glucose concentration over the last 3 months, in contrast to the traditional blood glucose measurement, which gives an idea of ​​the blood glucose level only at the time of the study. In accordance with the WHO recommendations, the determination of glycosylated hemoglobin is considered optimal and necessary for the control of diabetes mellitus.Patients with diabetes mellitus are recommended to conduct a study of the level of glycated hemoglobin at least once a quarter.

      Why Glycosylated Hemoglobin?

      Glucose content is a labile indicator that changes under the influence of various factors. Therefore, a one-step test for sugar level can show its increase, which does not always indicate the presence of violations of its metabolism. And, conversely, a normal content does not mean that there are no problems with carbohydrate metabolism.That is why the determination of the level of glycosylated defective hemoglobin is an objective indicator in the early detection of disorders of carbohydrate metabolism in the body. There is no need to perform any special recommendations before making a blood test for glycosylated hemoglobin, unlike the traditional test for sugar level.

      Why is it important to detect sugar metabolism disorders as early as possible?

      Defective glycosylated HbA1C no longer performs the function of transporting oxygen to a sufficient extent, which causes tissue and organ hypoxia.And the higher this indicator, the more reduced the level of oxygen in the tissues, which leads to retinopathies, nephropathies, polyneuropathies, cardiopathies and angiopathies.

      What are the indications for testing:

      Suspected diabetes mellitus, both type 1 and type 2

      Violation of carbohydrate metabolism in children.

      Diabetes with abnormal renal threshold in which a significant proportion of carbohydrates are excreted by the kidneys.

      Gestational diabetes – an increase in blood sugar during pregnancy, in the case when there was no diabetes before.

      Control of diabetes mellitus therapy

      REMEMBER: Diabetes mellitus is a serious disease with a long-term chronic increase in blood sugar and the appearance of irreversible complications!