Episode
A Normal HbA1c Can Hide a Decade of Insulin Resistance
- Podcast
- Mikkipedia
- Published
- Sep 13, 2026
- Duration seconds
- 1355
- Processing state
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- https://share.transistor.fm/s/29b2967d
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Summary
Episode Summary HbA1c turns up on almost every routine blood panel, and in this Monday mini episode Mikki looks at how much it can genuinely tell you. She starts with the physiology — haemoglobin picks up glucose non-enzymatically, red cells live 100 to 120 days, and the result is a weighted average of glucose exposure that leans heavily on the most recent month. That matters more than it first appears, because anything that shortens or lengthens red cell lifespan moves the number without blood glucose changing at all. Iron deficiency, heavy menstrual bleeding, foot strike haemolysis in runners, thalassaemia and sickle trait, recent blood donation and B12 deficiency can each push a result in one direction or the other. From there Mikki works through the research-based critiques: insulin resistance and beta cell decline can precede an abnormal HbA1c by many years, the test is highly specific but only about 50 per cent sensitive against an oral glucose tolerance test, an average conceals the shape of the glucose curve, and both genetics and ordinary measurement noise move the number independently of glucose. She closes on the practical side — where HbA1c does earn its place, why she still thinks a result of 40 or 41 deserves a conversation with your doctor, and which markers are worth reading alongside it. Key Topics What HbA1c actually measures. Glycation is non-enzymatic with no regulatory brake, so it proceeds in proportion to how much glucose is around and how long the cell is exposed. A red cell cannot repair it, making it a passive record of the preceding 8 to 12 weeks. The "three-month average" is weighted, not even. About 50 per cent of the movement toward a new value happens in the first month, which is why a result can shift over six weeks. Falsely low results.…