"Hi everyone! This is Dr. Stephanie Camaglia Reznick. I'm a board-certified internist and one of the medical directors for virtual care here at Oscar.
In today's video, I'm going to be starting off a series about diabetes. In this segment, we'll be talking about what is diabetes and what is an A1c. So, let's jump in.
What is diabetes?
Diabetes is a condition in which the sugar in your bloodstream is too high. Sometimes people refer to blood sugar as blood glucose, and the terms can be used interchangeably.
What causes diabetes?
To answer this question, we need to take a step back.
All parts of our body are made of cells, and cells run on blood sugar, or blood glucose. Think of it this way, if your cell was a car, then sugar would be the gasoline.
Now for the sugar to get into the cell, it has to go through a receptor. That is you can think of being almost unlocked by insulin.
If you continue with the car analogy, you can think of the cell being the car, the gas tank or the cover to the gas tank being the receptor, and insulin being a key to open the gas tank so that the blood sugar or gasoline can get in.
In type 1 diabetes, the body, the pancreas specifically, doesn't make enough insulin. You don't have enough keys needed to get the blood sugar into the cell.
In type two diabetes, you are making enough insulin. But the key gets jammed easily, the receptor doesn't open as easily. So you need more keys to get it open, meaning you need more insulin to get the receptor to let the blood sugar into the cell. We call this insulin resistance.
Your body initially responds by creating more insulin and that's able to overcome the kind of jammed lock that's going on in the cell.
For some type two diabetics, this goes on for so long that the pancreas gets tired of making so much insulin and starts producing less insulin, or not enough insulin to overcome that jammed lock. This is typically when you may need to start taking insulin. And when I say taking insulin, I mean the exogenous insulin that you inject.
What is hemoglobin A1c?
Now that we have an understanding of what is diabetes, I'd like to talk about an A1c. Those who have diabetes probably recognize the term as it's a blood test that your clinician might be checking for you.
Your red blood cells are in your bloodstream, just like your blood sugar, and the sugar can sometimes get stuck on to the red blood cell. The higher your blood sugar levels, that is the more sugar there is in your bloodstream, the more of it that sticks on to the red blood cells.
Hemoglobin A1c, with hemoglobin being part of the red blood cell, reflects how much sugar has latched on to the red blood cell.
Now everyone needs to have some sugar in their blood, the cells need the gasoline to run on. So no one's A1c is zero. But a normal A1c is considered less than 5.7. 6.5 and above is considered the diagnostic level for diabetes. In between, it's this gray zone called prediabetes where you have some of the insulin resistance that I spoke about earlier, but you don't have frank diabetes yet. That said you're at risk for progressing to frank diabetes. I'll talk more about risk factors (opens in new tab) and what you can do about it in another video.
For diabetics, the A1c goal is to be 7 or less most of the time. That said some people especially those with multiple medical problems, may be more sensitive to low blood sugars or hypoglycemia. In these patients, we often recommend a slightly higher A1c, perhaps 7.5 or 8. Make sure to talk with your doctor or other medical clinician on what is the best goal for you."
This content does not constitute medical advice and is not meant to be a substitute for professional medical advice, including diagnosis or treatment. Contact your physician with any questions you may have regarding COVID-19 or your personal health. If you are experiencing a medical emergency, dial 911 for immediate assistance.
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