Therapies for Diabetes and the Hemoglobin A1C Test

Therapies for Diabetes and the Hemoglobin A1C Test: Main Image
The hemoglobin A1C test can help identify blood glucose patterns over time

Note: This article discusses the potential benefits of using analog insulin for treating diabetes. Ask your healthcare provider to learn more about your options and before making changes to your everyday self-care and diabetes-management practices.

Diabetes is generally caused by an insulin-related problem: in type 1 diabetes, the pancreas stops producing insulin. In type 2 diabetes, the body’s cells become progressively less sensitive to insulin (known as insulin resistance), the pancreas becomes less efficient at producing insulin, or both. When people are insulin deficient or resistant, their cells are less able to take up glucose and use it for energy. As a result, glucose accumulates in the blood while the body’s cells are deprived of what they need to maintain health. To counteract these problems, insulin is often prescribed for people with diabetes. Insulin is always used in treatment for type 1 diabetes, and is sometimes included in treatment for type 2 diabetes.

The body’s need for insulin and the effectiveness of individual treatment programs may be tracked using blood glucose monitors, which measure blood glucose in a given moment, and with tests such as the hemoglobin A1C (also known as glycosylated hemoglobin, or just A1C), which help identify blood glucose patterns over time. Taking insulin and other prescribed medications, keeping an eye on blood glucose control, eating a balanced diet, and exercising regularly may help give people with diabetes more freedom to pursue their goals and avoid or better manage diabetes-related health problems.

More on insulin

  • What types of insulin are there? Insulins are categorized by how quickly they work, how long it takes for them to reach their maximum effect, and how long their action lasts. Products available to treat type 1 and type 2 diabetes include rapid-acting, short-acting, intermediate-acting, and long-acting. Some products contain combinations of these types.
  • Which insulin is right for me? With the many forms available, the choice of which product or combination of products to use is determined by a doctor based on the type and severity of diabetes, diet and exercise patterns, and other individual considerations.
  • What is insulin made from? Insulin was first gathered from cow and pig pancreases, but while these sources helped many people, they were not identical to human insulin and caused some side effects. More recently, synthetic human insulin and insulin analogs (which are slightly altered versions of human insulin) can provide greater flexibility in controlling high blood glucose.

How people take insulin

Insulin is usually injected under the skin. It is measured in units and comes in concentrations of between 100 and 500 units of insulin per 1 ml of injectable fluid.

An inhaled version of rapid-acting insulin has recently become available. Although it is not an option for people with chronic lung disease, inhaled insulin may be a useful part of a diabetes management program for some patients. At this time its use is limited by a narrow range of available dosages and high expense.

There are several methods of injection for people with diabetes:

  • Syringes. Most commonly, people inject insulin into an area of their body using a syringe with a small needle on the end. Syringes are available with various thicknesses (gauges) of needles. A bigger gauge number correlates to a thinner needle and therefore generally less pain.
  • Pen devices. Pen devices are an alternative to syringes that allow the user to inject premeasured amounts of insulin. Insulin pens have replaceable needles and an insulin reservoir containing multiple doses. The patient can select the appropriate dose using a dial on the device prior to injection. The pens may be reusable, with reloadable or disposable cartridges.
  • Insulin pumps. Insulin pumps provide a constant infusion of insulin under the skin via a catheter and needle. Pumps offer higher precision of dosing and more blood glucose control than individual injections, and can more closely simulate a functioning pancreas; however, they can be expensive and require frequent monitoring of blood glucose.

Managing insulin use

People with a prescription for insulin work with their healthcare providers to determine the best program for administration. Many people with diabetes monitor their own blood glucose levels to know when and how much insulin they should take. For the best control, people with diabetes should use two types of monitoring: self-monitoring, which is usually done several times daily or several times weekly, and lab analysis of A1C levels several times each year to determine whether changes in blood glucose patterns are short- or long-term.

The A1C test

People with diabetes regularly monitor their blood glucose to ensure it stays within safe levels. In addition to daily testing, the A1C test, which reflects average blood glucose control over the previous three months, is performed at least twice a year. Since a person’s blood glucose may be higher on some days than others, A1C is a better test for helping doctors decide whether adjustments are needed in insulin or other diabetes medication doses based on long-term trends in their blood glucose control.

A1C is measured as a percentage, and, according to the American Diabetes Association (ADA), the A1C goal for most non-pregnant adults with diabetes is less than 7%. Even higher targets are appropriate for certain populations with diabetes, such as children, the elderly, or those who have experienced severe hypoglycemia. Age and other unique biological considerations may impact a person’s A1C, so it is important that results are interpreted by your healthcare provider. A1C testing may help:

  • confirm the results seen in daily or other regular blood glucose monitoring,
  • demonstrate whether a treatment program is working, or
  • show the impact of healthy choices on diabetes control.

(Diabetes Care 2017;40)

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