What is the relationship between mmol/l and mmol/mol

[Tco]

I have recently attended the first day of a Desmond course on type 2 diabetes. I came away frustrated because the course tutors were unable to tell me the relationship between the above mentioned two figures. There appears to be a difference factor of about 10, but I am told that one is the average over several months and the other a "spot" figure. I know that when I last had a blood sugar test, the figure I was given was 5.1 which I understand is within the 4 - 7 range of being normal. But although the tutors knew the figure of my mmol/mol, they declined to give it to me. Neither could they explain what the relationship between the two figures might be. I felt as though I was being patted on the head and given the advice "there there, you have no need to bother your pretty little head with such matters." It was not made clear what the expressions or abbreviations meant. After a lifetime in engineering, I am used to using criteria about which I have been informed.

The course was as announced at the outset, very "structured" and this structure did not seem to take account of any awkward questions that might be raised. I felt somewhat patronised. Because no-one seemed to even try to answer my question. Has anyone something that would help me discover the answer?

Thanks in anticipation

 

[catherinecherub]

Hi and welcome.

There is a graph within this article.
HbA1c can be expressed as a percentage (DCCT unit) or as a value in mmol/mol (IFCC unit). Since 2009, mmol/mol has been the default unit to use in the UK.

http://www.diabetes.co.uk/what-is-hba1c.html

 

[DeejayR]

Absolutely agree with your summation of the course ... patronising. But by asking questions we're rocking the NHS boat so get your answers here.
Welcome, by the way.

 

[Tco]

Thanks to both Catherine and Deejay for your prompt replies.
Incidentally, I was told because I was taking notes, I was therefore not paying attention! This to someone who for years took minutes of technical meetings!

 

[DeejayR]

I rest my case

 

[Celeriac]

Thanks to both Catherine and Deejay for your prompt replies.
Incidentally, I was told because I was taking notes, I was therefore not paying attention! This to someone who for years took minutes of technical meetings!

How rude of them. So they expect you to listen but not take notes. Most people learn to do that in school, even if on laptops now. I would just have switched on my voice recorder.

 

[ButtterflyLady]

Yes, patronising, and ignorant about basic educational methods. Of course you should take notes. And you're an engineer, so I get what you are saying about precision of information. You could probably run the course and run the system of providing the courses, lol.

 

[hankjam]

I have recently attended the first day of a Desmond course on type 2 diabetes. I came away frustrated because the course tutors were unable to tell me the relationship between the above mentioned two figures. There appears to be a difference factor of about 10, but I am told that one is the average over several months and the other a "spot" figure. I know that when I last had a blood sugar test, the figure I was given was 5.1 which I understand is within the 4 - 7 range of being normal. But although the tutors knew the figure of my mmol/mol, they declined to give it to me. Neither could they explain what the relationship between the two figures might be. I felt as though I was being patted on the head and given the advice "there there, you have no need to bother your pretty little head with such matters." It was not made clear what the expressions or abbreviations meant. After a lifetime in engineering, I am used to using criteria about which I have been informed.

The course was as announced at the outset, very "structured" and this structure did not seem to take account of any awkward questions that might be raised. I felt somewhat patronised. Because no-one seemed to even try to answer my question. Has anyone something that would help me discover the answer?

Thanks in anticipation

Every compound has a molecular weight (mass), Salt NaCl is 58.4. A mole of NaCl weighs 58.4 grams, mol is short for mole.
mmol is 1000th of a mol.
mmol/mol is a ratio of two compounds, on this case the ratio of glycated hemoglobin (mmol) to "regular" hemoglobin (mol)

Hope that is good

Hj

 

[phoenix]

Your HbA1c is a measurement of glucose bound to haemoglobin. Glucose molecules in the blood may bind through a chemical reaction to the red blood cells. The more glucose present, the more likely that they will become attatched. Once completely bound (glycated) the glucose stays attached for the life of the blood cell which is around 3 months. The HbA1c measures the proportion of glucose molecules bound to haemoglobin at the time of testing

The measurement until recently was expressed as the percentage of glycated haemoglobin in a quantity of haemoglobin.(so you will see many people writing 5%, 6%,7% etc for their HbA1c measurement)
In the UK and some other countries this has been changed following recent standardisation to a 'proper' SI unit of mmol of HbA1c (glycated haemoglobin) per mol of haemoglobin (mmol/mol).

Since the glycated haemoglobin has arisen over the last 2-3months this measurement gives an indication of glucose levels over that period. Because of the turnover of red cells, it is weighted somewhat towards levels during the later weeks

If red blood glucose levels glycate at an average level, then Hba1c test results may give an indication of what your average glucose levels have been over the last 2-3months (ie if you were continuously testing them) There is an algorithm for this and it's good enough for many people. You can use the converter on this site . The last box is the estimated average glucose http://www.diabetes.co.uk/hba1c-units-converter.html

However there are people who are not average glycators ( their red cells don't live as long, they have less haemoglobin , for some reason less glucose gets bound etc). Moreover, the algorithm was tested on a fairly limited number of subjects. It is for that reason that the UK doesn't include the estimated average glucose level with results. http://care.diabetesjournals.org/content/32/1/e11.full

Your meter readings just show the amount of glucose in the blood plasma at that moment in time. It is expressed in the UK as mmol per litre of plasma .
There are 180.1559 g glucose in a mol. (in other parts of the world, including the US and parts of Europe, they use milligrams per decilitre and to convert mmol/l to mg/dl you multiply by 18)

This is I think a useful video (though as it is from the US uses % of glycated to non glycated haemoglobin so I've put it after )

 

[DavidLP]

I monitored my mmol/L every day for 3 months and the average reading was 5.5 which equates to an mmol/mol of 32.
When I had a 1ac blood test at the end of the 3 month period of self monitoring it came back as 50. When I explain this to the medical people they have no answer and just tended to try and dismiss it. I tend to think that the 1ac test is not that accurate or deliberately inflated to get people on medication when it’s not really needed.

 

[EllieM]

Hi @DavidLP and welcome to the forums. Two thoughts about your post.

1) was that monitoring individual blood tests from a glucometer? If so, you may just be missing the highs.
2) some medical conditions (eg anaemia) can lead to an hba1c reading that is falsely high or low compared to your actual average blood sugar. You could try a fructosamine test if you don't trust the hba1c

HbA1c

Glycated haemoglobin (HbA1c) should not be interpreted in isolation; the measurement accuracy and other parameters, including treatment goals and comorbidities, need to be considered.

www1.racgp.org.au

Once more, welcome

 

[JoKalsbeek]

I monitored my mmol/L every day for 3 months and the average reading was 5.5 which equates to an mmol/mol of 32.
When I had a 1ac blood test at the end of the 3 month period of self monitoring it came back as 50. When I explain this to the medical people they have no answer and just tended to try and dismiss it. I tend to think that the 1ac test is not that accurate or deliberately inflated to get people on medication when it’s not really needed.

Hi David,
Welcome to the forum. You're responding to a post that is almost a decade old, but I see what you mean. So... How often do you test? Because when you say daily, is that once a day? Our blood sugars bounce up and down due to various reasons throughout. In the morning we can get a liver dump of glucose, and generally speaking, the bulk of us have the most insulin resistance at that point in time. Before an afternoon or evening meal we're generally lower than in the two to three hours after the meal, then we can see a raise or even a spike (as a diabetic, likely a spike when eating "normal", EatWell plate foods). Taking that into account, it could well be you've been missing the rises and/or spikes. A HbA1c is fairly accurate, it measures the average of your blood glucose levels in the past three months, leaning more heavily on the most recent weeks. A finger prick only tells you what your bloods are doing right then. So if you test when fasting and not after a meal, you could indeed expect lower numbers in a HbA1c than you're seeing now, while the HbA1c is still correct. Try this: Test before a meal and two hours after. If you have strips to spare, maybe every half hour in between that time, so you don't miss a possible spike. You might be surprised at the results, especially if it is a carby meal (like potatoes, bread, cereal etc).

Mind you, anemia might affect the outcome of a HbA1c test, but 18mmol/mol off is a bit much. So time to investigate and turn into a pincushion, if you're so inclined!

Oh, and another thing.... Medication might not be required at all. I've been diabetes med-free for seven years now (diagnosed diabetic for 7,5), so... It could possibly be done without medicinal intervention.

Again, welcome!
Jo

 

[JoKalsbeek]

Hi @DavidLP and welcome to the forums. Two thoughts about your post.

1) was that monitoring individual blood tests from a glucometer? If so, you may just be missing the highs.
2) some medical conditions (eg anaemia) can lead to an hba1c reading that is falsely high or low compared to your actual average blood sugar. You could try a fructosamine test if you don't trust the hba1c

HbA1c

Glycated haemoglobin (HbA1c) should not be interpreted in isolation; the measurement accuracy and other parameters, including treatment goals and comorbidities, need to be considered.

www1.racgp.org.au

Once more, welcome

So much more to-the-point.... Great minds, though!

 

[Resurgam]

I wanted to reduce my HbA1c into the 30s, from 42. I was eating no more than 50gm of carbs a day. I dropped down to no more than 40gm of carbs a day.
At the end of a year my HbA1c was still 42.
I would have been about 70 so old age might be a factor, slower replacement of blood cells, or the answer to life, the universe and everything......

 

[Outlier]

It's my opinion that to get a "norm" we need a natural higher and natural lower reading that is within the accepted range or very close to it. So that's your norm. Many illnesses nowadays have a stricter/higher/lower norm that they used to, but changing ideas is not necessarily a depiction of truth. You should be fine, given your other observations.

 

[KennyA]

The fingerprint tests measure blood glucose at that point - and there are ways of producing low or high readings depending on a lot of things, of which food is only one. You also dont have any data from when you're not testing. It might be worth looking at some constant glucose monitor graphs on the Internet- you'll see huge variations in BG over the course of a day.

HbA1c counts glycated red blood cells which is a useful proxy for blood glucose over the last three months or so. This means that one measure does not directly translate to the other.

To further complicate matters, both tests also have acceptable levels of inaccuracy. I found that my fingerprint results were absolutely zero use in predicting A1c.