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What Is an A1C Test & What Does It Tell Your Doctor?

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By Suzanne Watkins, MS, RD, LD, CNSC, Samaritan Albany General Hospital

Have you recently found yourself puzzling over this acronym? Or maybe you or a family member has been told their A1C is too high, but you’re not quite sure what this means? Here’s a review of what an A1C is, and what to do about it.

What Is the A1C Metric?

An A1C has many names. It can be called a hemoglobin A1C, glycated hemoglobin or HbA1c. Overall, it’s the lab that your provider collects when they want to see what your average blood sugar is over the course of three months. It is used to diagnose prediabetes or diabetes, or if you already have diabetes, monitor how you’ve been managing your blood sugars over a long period of time. A higher A1C means your blood sugars have been running higher; lower A1C means your blood sugars have been running lower.

Think about it this way – when you spill honey on your countertop, it gets sticky. When your blood sugar is high, your blood gets sticky, too, and the little sugar molecules (glucose) will stick onto the protein (hemoglobin) on your red blood cells at a higher rate. The test is telling you what percentage of your red blood cells have a sugar-coated hemoglobin.

What Is the Normal Range for A1C?

An A1C is considered “within normal limits” when it is 5.6 percent or lower. Your health care provider can diagnose prediabetes with an A1C between 5.7 to 6.4 percent, and diabetes with an A1C of 6.5 percent and higher. If you have diabetes, the goal is to keep your A1C at about 7.0 percent or lower.

A graph showing  A1C values from normal to prediabetes to diabetes.

What If My A1C Is Too High?

If your A1C is high, you can bring it down again.

If your A1C falls in the “prediabetes” range (5.7 to 6.4 percent), you are in the perfect position to modify your lifestyle to lower your A1C and send diabetes packing. This can be done by being mindful of your nutrition and physical activity.

If your A1C falls in the “diabetes” range (6.5 percent and higher), you can still lower your A1C with lifestyle changes, but your provider may prescribe some medications as well.

Keep Your Blood Sugars in Check

Whether you have prediabetes or diabetes, here are ways to keep your blood sugars in check.

1.  Be Mindful of Your Nutrition

Carbohydrates are an important fuel source for your body and your brain. You need a certain amount of carbohydrates every day to think straight, feel good and help your body function. Too many carbohydrates, however, can raise your blood sugars and A1C. One of the most effective ways to keep your blood sugars in a good range is to manage the carbohydrates that you eat.

Try some of these practices to limit carbohydrate consumption daily:

  • Drink less sugar-sweetened beverages. This includes regular sodas, coffee drinks, energy drinks and alcoholic beverages. Many people consume more sugars in beverages than they realize, so cutting back on sugar-sweetened beverages or choosing the diet/sugar free option can help a lot.
  • Watch your portion sizes. Pasta, cereal, potatoes, bread – these are all too easy to overindulge. Aim to eat small portions of carbohydrate-containing foods at meals. Study Nutrition Facts labels and try sticking to the recommended serving size on packages.
  • Treat desserts and candies as a special occasion. Allow yourself to have a small slice of cake for your birthday – but remember, every day is not your birthday! Establish a specific and measurable rule for yourself to keep from over-indulging. For example, you can have two squares of chocolate or a 1-ounce bag of potato chips on Friday nights.
  • Choose whole grains to increase the fiber in your diet. Eating fiber-rich foods will improve your digestion and help manage blood sugars. The Dietary Guidelines for Americans recommends a minimum of 14 grams of fiber for every 1,000 calories that you eat. Fiber is found in whole grains such as whole wheat breads and pastas, oats and brown rice. Fiber is also found in nuts, fruits, vegetables, pulses, beans and legumes.
  • Remember to have regular, balanced meals. A healthy meal plan involves plenty of variety of fruits, vegetables, whole grains and proteins. Make a plan that you know you can maintain long term. Take a look at the Idaho Plate Method for ideas on how to prepare well-balanced meals.

2.  Increase Your Physical Activity

Physical activity decreases blood sugars. You don’t need a gym membership to increase your physical activity. Whether you go on a run, or vacuum your living room, movement is going to help you lower your blood sugars and ultimately manage your A1C. Remember that ANY activity you do can be helpful. Find an activity you enjoy and stick with it. Here are some suggestions to increase your daily activity:

  • Walk or bike to visit your neighbors.
  • Park farther away from storefronts, or get off the bus one or two stops before your stop.
  • Clean your home.
  • Garden.
  • Take the stairs instead of the elevator.
  • Carry your own groceries.
  • Wash your car by hand.
  • Stand while talking on the phone with a friend.
  • Try a group class. Parks and Recreation has many different classes that you can try if something sounds fun to you.

Make sure to talk to your health care provider if you are thinking of increasing your physical activity drastically.

3.  Lose a Little Weight If You Are Overweight

 Losing five to 10 percent of your body weight, if you are overweight, can improve your blood sugars. A study published in the journal Diabetes, Obesity and Metabolism found that each 2.2 pounds of weight loss provided a reduction of 0.1 percentage points in A1C for people who were overweight or obese. Make sure to lose this weight slowly and mindfully so the weight does not come back. A weight loss of one to two pounds per week is considered healthier and tends to be more successful long term. It may be helpful to speak with a registered dietitian to help you find a tasty, healthful weight loss plan.

4.  Medications

Your health care provider may prescribe blood sugar-lowering medications based on your numbers and overall health profile. These typically include oral medications, and/or injectable insulin.

5.  Check Your Blood Sugars Often

One of the most challenging things about maintaining your blood sugars and A1C is that your body is unique. Your blood sugars are going to react differently to sweet potatoes than your neighbor’s blood sugars. Taking charge of your blood sugars and A1C is going to require a you-specific regimen, and figuring out that regimen is going to involve collecting data. Your health care provider may order a blood glucose monitor and test strips for you. You also have the option to purchase an inexpensive monitor without a prescription at your local pharmacy. Monitoring your blood sugars regularly gives you and your provider feedback on how well your regimen is working, and if any changes need to be made.

Be aware that low blood sugars and high blood sugars can sometimes be hard to tell apart, even for people who have managed their diabetes for years. So always check your blood sugar before you treat your blood sugars.

When to Seek Medical Attention

As you are checking your blood sugars, know when you need to seek medical attention.

Low Blood Sugars (Hypoglycemia) 

 Any blood sugar lower than 70mg/dl is considered hypoglycemia and needs attention. Symptoms of hypoglycemia may be any of the following:

  • Feeling shaky.
  • Anxiety.
  • Sweating, chills and clamminess.
  • Irritability or impatience.
  • Hunger.
  • Nausea.
  • Fatigue.
  • Impaired or blurred vision.
  • Headaches.
  • Seizures.

If you check your blood sugar and find it’s low, you can treat it using the 15-15 Rule:

Step 1: Eat or drink 15 grams of carbohydrates, with glucose tablets,  ½ cup of juice, 1 tablespoon of honey or sugar, or hard candies.

Step 2: Wait for 15 minutes.

Step 3: Check your blood sugar again. If it’s still below 70mg/dl, repeat.

If, after two rounds of this, you’re still experiencing low blood sugar, call your health care provider.

High Blood Sugars (Hyperglycemia)

Any blood sugar greater than 200mg/dl is considered hyperglycemia, and warrants attention. Symptoms of hyperglycemia can by any of the following:

  • Frequent urination.
  • Increased thirst.
  • Blurred vision or vision changes.
  • Nausea and vomiting.
  • Fatigue.
  • Headache.
  • Delayed wound healing.
  • Confusion

You can treat high blood sugars by exercising as long as your blood sugars are lower than 240mg/dl. Call your provider if your blood sugars are persistently higher than 240mg/dl and you have ketones in your urine. Your provider and/or diabetes educator can work with you to keep your blood sugars in the optimum range.

Know You Are Not Alone

Blood sugar and A1C control can be tricky, but you don’t have to figure this out alone. For more information about blood sugar and A1C control, ask your provider about visiting a diabetes educator.

Feeling overwhelmed with managing diabetes? Watch a video with tips on how to reduce diabetes distress and more.