of hemoglobin subtypes (predominantly hba in normal adults). hence, people with recent blood loss, hemolytic anemia, or genetic differences in the hemoglobin molecule (hemoglobinopathy) such as sickle-cell disease and other conditions, as well as those who have donated blood recently, are not suitable for this test. due to glycated hemoglobin's variability (as shown in the table above), additional measures should be checked in patients at or near recommended goals. people with hba1c values at 64 mmol/mol or less should be provided additional testing to determine whether the hba1c values are due to averaging out high blood glucose (hyperglycemia) with low blood glucose (hypoglycemia) or the hba1c is more reflective of an elevated blood glucose that does not vary much throughout the day. devices such as continuous blood glucose monitoring allow people with diabetes to determine their blood glucose levels on a continuous basis, testing every few minutes. continuous use of blood glucose monitors is becoming more common, and the devices are covered by many health insurance plans, but not by medicare in the united states. the supplies tend to be expensive, since the sensors must be changed at least every 2 weeks. another useful test in determining if hba1c values are due to wide variations of blood glucose throughout the day is 1,5-anhydroglucitol, also known as glycomark. glycomark reflects only the times that the person experiences hyperglycemia above 180 mg/dl over a two-week period. concentrations of hemoglobin a1 (hba1) are increased, both in diabetic patients and in patients with kidney failure, when measured by ion-exchange chromatography. the thiobarbituric acid method (a chemical method specific for the detection of glycation) shows that patients with kidney failure have values for glycated hemoglobin similar to those observed in normal subjects, suggesting that the high values in these patients are a result of binding of something other than glucose to hemoglobin. in autoimmune hemolytic anemia, concentrations of hba1 is undetectable. administration of prednisolone will allow the hba1 to be detected. the alternative fructosamine test may be used in these circumstances and it also reflects an average of blood glucose levels over the preceding 2 to 3 weeks. all the major institutions such as the international expert committee report, drawn from the international diabetes federation, the european association for the study of diabetes, and the american diabetes association, suggest the hba1c level of 48 mmol/mol (6.5 dcct %) as a diagnostic level. the committee report further states that, when hba1c testing cannot be done, the fasting and glucose-tolerance tests be done. diagnosis of diabetes during pregnancy continues to require fasting and glucose-tolerance measurements for gestational diabetes, and not the glycated hemoglobin. modification by diet meta-analysis has shown probiotics to cause a statistically significant reduction in glycated hemoglobin in type 2 diabetics. trials with multiple strains of probiotics had statistically significant reductions in glycated hemoglobin, whereas trials with single strains did not. standardization and traceability hemoglobin a1c is now standardized and traceable to ifcc methods hplc-ce and hplc-ms. the change to the newer unit of mmol/mol is part of this standardization. the standardized test does not test for iodine levels in the blood; hypothyroidism or iodine supplementation are known to artificially raise the a1c. veterinary medicine hba1c testing has not been found useful in the treatment of cats and dogs with diabetes, and is not generally used; fructosamine is favoured instead.