Diabetes is lived mostly between appointments: at mealtimes, at work and at home with the family. Medical follow-up is there to check, at regular intervals, that the balance is holding and that the body stays protected. World Diabetes Day, on 14 November, is a good moment to take stock of that follow-up: what the blood tests say, what is checked each year and what happens day to day.
What HbA1c measures
HbA1c, or glycated haemoglobin, is a blood test that reflects your average blood sugar level over roughly the last two to three months. Some of the sugar in the blood attaches to red blood cells, which live for a few months; measuring that share gives a picture of the period gone by rather than of a single moment.
You do not need to fast for it. It is commonly checked every three to six months, at an interval your doctor sets according to your situation.
Fasting glucose and HbA1c: two different pieces of information
Fasting glucose measures the sugar in your blood at one precise moment, in the morning before eating. It varies from one day to the next with the previous evening’s meal, sleep, stress or an infection. HbA1c smooths those variations out over several weeks.
The two complement each other. Day-to-day readings, when your doctor has asked for them, help to make sense of individual days; HbA1c shows whether the overall picture is moving in the right direction. Neither is enough on its own to judge a treatment, and both are read with your doctor.
A target decided with your doctor
There is no single HbA1c figure that suits everyone. The target depends on age, how long diabetes has been present, other conditions, the risk of low blood sugar and the way a person lives. A target designed for a young, active adult is not necessarily the right one for an older or frailer person.
That is why the target is set with your doctor, and it may change over time. Comparing your result with a relative’s, or with a figure read somewhere else, does not tell you very much.
The year’s check-ups
Over the years, diabetes can affect both small and large blood vessels. Part of the follow-up is therefore to check the organs most at risk regularly, often once a year, as your doctor plans:
- an eye examination, including a look at the back of the eye to check the retina
- a foot examination: feeling, circulation, and the condition of the skin and nails
- blood and urine tests to follow how the kidneys are working
- a blood pressure reading at every consultation
- a check of cholesterol and other blood fats
- an assessment of the heart, with an electrocardiogram when the doctor thinks it useful
- a check of the mouth and gums at the dentist
These tests are simple and most are painless. They make it possible to spot a change early, at a point when it is easier to act.
Day to day: meals, walking, sleep and Ramadan
Meals at regular times, with vegetables, pulses and starchy foods in sensible amounts, help to keep blood sugar steady. Bread, semolina and pastries still have their place at the table; it is how much and how often that is worth discussing, ideally with a doctor or a dietitian.
Walking, even half an hour a day split into several shorter outings, is one of the most useful habits. Enough sleep matters too, because short nights make the balance harder to keep. These are general pointers that are adapted to each person, especially where there are problems with the feet or the heart.
Ramadan needs preparing for as well. Fasting with diabetes is possible for some people and not advised for others: mealtimes, treatment and the risk of low blood sugar or dehydration all change during the month. It is important to talk it over with your doctor several weeks beforehand, so that you can decide together whether fasting is possible and how to organise it.
Signs that call for prompt advice
Some situations are worth seeing a doctor about without waiting for the next appointment: intense thirst with passing a lot of urine, unusual tiredness or unexplained weight loss, dizzy spells with sweating, shaking or confusion, a foot wound that does not heal or changes in appearance, vision that suddenly blurs, or vomiting that makes it impossible to drink. If someone feels seriously unwell, call the emergency services.
At Clinique Sakina, the diabetes check-up brings together, in a single morning, an endocrinology consultation, HbA1c, blood glucose, kidney, blood fat and urine tests, and an electrocardiogram; the eye examination can be arranged separately in ophthalmology. It can be booked online.
Remember
This article is general information and does not replace a consultation. For your target, your treatment or fasting, talk to your doctor.
General information: it does not replace your doctor’s advice.
