All About Your A1C

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What has your blood sugar been up to lately? Get an A1C test to find out your average levels—important to know if you’re at risk for prediabetes or type 2 diabetes, or if you’re managing diabetes.

The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months. It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes.

What Does the A1C Test Measure?

When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.

Who Should Get an A1C Test, and When?

Testing for diabetes or prediabetes:
Get a baseline A1C test if you’re an adult over age 45—or if you’re under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:

• If your result is normal but you’re over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.
• If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
• If you don’t have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.
• If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.

Managing diabetes:
If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.

How to Prepare for Your A1C Test

The test is done in a doctor’s office or a lab using a sample of blood from a finger stick or from your arm. You don’t need to do anything special to prepare for your A1C test. However, ask your doctor if other tests will be done at the same time and if you need to prepare for them.

Your A1C Result

Diagnosing Prediabetes or Diabetes

A normal A1C level is below 5.7%, a level of 5. 7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes.

Managing Diabetes
Your A1C result can also be reported as estimated average glucose (eAG), the same numbers (mg/dL) you’re used to seeing on your blood sugar meter:

What Can Affect Your A1C Result?

Get your A1C tested in addition to—not instead of—regular blood sugar self-testing if you have diabetes.

Several factors can falsely increase or decrease your A1C result, including:

• Kidney failure, liver disease, or severe anemia.
• A less common type of hemoglobin that people of African, Mediterranean, or Southeast Asian descent and people with certain blood disorders (such as sickle cell anemia or thalassemia) may have.
• Certain medicines, including opioids and some HIV medications.
• Blood loss or blood transfusions.
• Early or late pregnancy.

Let your doctor know if any of these factors apply to you, and ask if you need additional tests to find out.

Your A1C Goal

The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal.

Younger people have more years with diabetes ahead, so their goal may be lower to reduce the risk of complications, unless they often have hypoglycemia (low blood sugar, or a “low”). People who are older, have severe lows, or have other serious health problems may have a higher goal.

A1C: Just Part of the Toolkit

A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings.

If you’re reaching your A1C goal but having symptoms of highs or lows, check your blood sugar more often and at different times of day. Keep track and share the results with your doctor so you can make changes to your treatment plan if needed.

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Ways to Lower Your A1C

For some, home blood sugar testing can be an important and useful tool for managing blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not the full picture of what’s happened in the long term, says Gregory Dodell, MD, an assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai in New York City.

For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past three months. Called hemoglobin A1C, or A1C, this test can show you how well your type 2 diabetes management plan is working.

Here’s what you should know about it and ways to make sure your A1C is in a healthy range.

   Poll

How often do you get your A1C tested?

How Often Do You Need to Take an A1C Test?

If your blood sugar levels have remained stable and your A1C is within your target range, the American Diabetes Association (ADA) recommends getting the test two times a year. If your therapy has changed or you are not meeting your blood sugar targets, the ADA recommends getting the test four times per year. This simple blood draw can be done in your doctor’s office.

The A1C test results provide insight into how your treatment plan is working and how it might be modified to better control the condition. Often, your blood sample is sent out to a lab, though some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes.

While in-office tests can be used to monitor the disease, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that most point-of-care tests should not be used for diagnosis. That can only be done by lab tests certified by the NGSP, an organization that standardizes A1C test results. Any in-office test results pointing to a change in your health should be confirmed by conventional lab tests.

What Do Your A1C Results Mean?

The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says.

According to the ADA, an A1C level below 5.7 percent is considered normal; between 5.7 and 6.4 signals prediabetes; and over 6.5 percent indicates type 2 diabetes. For many people with type 2 diabetes, the goal is to reduce A1C levels.

Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and whether you have any other health conditions. If you can keep your A1C number below your goal — which, for many people with diabetes, is less than 7 percent, says Dodell — you can reduce the risk of complications, such as nerve damage and eye problems.

What Are Some Top Tips for Lowering A1C?

Your A1C score is a helpful tool, Dodell says, but it is not the only indicator of how healthy you are.

For example, you could hit your A1C goal but still have wide fluctuations in your blood sugar levels, which is more common among people who take insulin. You’ll need to bring these day-to-day fluctuations under control, since they can lower your quality of life and increase your risk of complications, he says.

Think of your diabetes as you would a job, Dodell says. It takes work, but the time and effort you put into it can result in good control and an improved quality of life. “The key to reaching your A1C goal is trying to follow a healthy lifestyle,” he says.

Making these changes can help you improve your day-to-day blood sugar management and lower your A1C.

1. Start an Exercise Plan You Enjoy, and Do It Regularly

Find something you enjoy doing that gets your body moving, whether it’s taking your dog for a walk, playing a sport with a friend, or riding your bike.

The ADA recommends getting 150 minutes of moderate exercise per week, says Jordana Turkel, a certified diabetes care and education specialist (CDCES) and registered dietitian at Park Avenue Endocrinology & Nutrition in New York City.  Different types of exercise (both strength or resistance training and aerobic exercise) can lower your A1C by making your body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising and to aim for two days of strength training per week.

Be sure to check with your healthcare provider before embarking on an exercise plan, though. Together, you can come up with an individualized plan.

And if you monitor your blood sugar daily, check it before and after exercise. As the ADA explains, exercise improves insulin sensitivity and lowers your blood sugar levels. In certain circumstances, though, stress hormones produced during more intense exercise can also increase blood sugar levels. In addition, other factors, such as what you eat before exercise and the timing of your workout, may also affect your numbers.

2. Eat a Balanced Diet With Proper Portion Sizes

It’s best to check with a CDCES or registered dietitian/nutritionist to determine what a balanced diet and appropriate portion sizes mean for you. But a great rule of thumb is to fill half of your plate with veggies, a quarter with protein, and a quarter with whole grains, says Turkel. If you like fruit, limit your portion to a small cup, eaten with a little protein or lean fat to help you digest the carbohydrates in a way that is less likely to spike your blood sugar.

Also, avoid processed foods as much as possible, and try to avoid sugary sodas and fruit juice, which are high in carbs and calories, and thus can lead to spikes in blood sugar and contribute to weight gain, according to the ADA.

3. Stick to a Regular Schedule, So You Can More Easily Follow a Healthy Diet 

Skipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much, Cleveland Clinic points out. This is especially true if you are taking insulin or certain other diabetes drugs. Your doctor can help you determine the best meal schedule for your lifestyle.

4. Follow the Diabetes Treatment Plan Your Healthcare Team Recommends

Diabetes treatment is very individualized, noted a February 2022 article in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. After all, factors including how long you’ve lived with the disease, your socioeconomic status, and any other conditions you’re living with can play a role in the best treatment approach for you.

Your healthcare team will help you determine which steps to take to successfully manage diabetes. Always talk to your doctor before making any changes, such as starting a diet very low in carbohydrates or beginning a new exercise regimen. This is especially important before making any medication or insulin changes.

5. Check Your Blood Sugar Levels as Your Doctor Has Directed

Work with your doctor to determine if you should check your blood sugar — and how often. You may be tempted to pick up an A1C home testing kit, but Dodell says having your A1C checked by your doctor every three to six months is sufficient. A better idea is to use a continuous glucose monitor. He recommends checking your “time in range” to see if you are at the optimal level. For many people that is 70 to 180 milligrams per deciliter (3.9 to 10 millimoles per liter), according to ADA guidelines.

Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C or what it means, don’t hesitate to ask your doctor.

Additional reporting by Mikel Theobald

Blood test for glycated hemoglobin A1c

Glycated (or glycosylated) hemoglobin A1c reflects the sugar level over the previous 2-3 months. A test for its amount is one of the markers for the presence of diabetes. Its results are used both for diagnosing the disease and for monitoring its course, monitoring the effectiveness of treatment. The test gives the attending physician the opportunity to identify violations of carbon metabolism, to choose the best therapy.

General

Hemoglobin in erythrocytes is a protein whose main task is to transport oxygen. Among all the varieties of this protein, the A form predominates. One of its components is called A1c. Glucose in the bloodstream is able to spontaneously combine with hemoglobin. The resulting compound is glycated or glycosylated hemoglobin. Its formation directly depends on the amount of sugar. The compound remains stable throughout the life cycle of the erythrocyte. It is formed and broken down daily along with the renewal of red blood cells.

For patients with diabetes, controlling glucose levels and maintaining them at an optimal level makes it possible to avoid the development of complications that can lead to disability and death. Passing this test during a preventive examination makes it possible to detect diabetes in a timely manner.

The characteristic symptoms of diabetes include a constant feeling of thirst, weakness, decreased vision, frequent urination, and a high susceptibility to infectious diseases. If they appear, you should immediately consult a doctor, undergo an examination, and upon confirmation of the diagnosis, begin treatment.

Indications for examination

Patients with diagnosed diabetes are examined every four months (if necessary, more often, the frequency of a blood test for glycated hemoglobin HbA1c is selected by the doctor on an individual basis). Also, the study is prescribed for pregnant women and patients with suspected diabetes for its primary diagnosis. In the absence of health complaints, it is recommended to take the test during a preventive examination at least once every three years. If there is a history of significant bleeding or hemolysis, false results may be obtained. In such cases, it is recommended to consult a doctor before taking the test. If necessary, he will recommend an alternative analysis or this test will be carried out at a later date.

Study preparation

Blood for analysis must be taken strictly on an empty stomach. There is no need to observe a long hungry pause, it is enough not to eat food for three hours before the study. During this period of time, you can drink only sparkling water.

Interpretation of results

Reference values ​​are 4.8 – 5.9%. An increase in readings may indicate diabetes or a pre-diabetic condition. With iron deficiency or after a blood transfusion, the indicators may increase. For a competent interpretation of the results, it is necessary to consult a doctor. Only a specialist can make the correct diagnosis and, if necessary, prescribe treatment.

Glycated hemoglobin: price of analysis

The cost of this test is higher than a standard sugar test. For the most accurate diagnosis, it is recommended to undergo a study on A1c. The test determines the average sugar level for 3 months. Therefore, external factors (for example, stress) do not significantly affect the result. A single test for sugar in this case is less accurate, often it has to be repeated several times.

What you need to know about HbA1C

Among the many numbers of test results that doctors prepare, a simple HbA1C test value can help you figure out how well you’re monitoring your blood sugar levels.

First of all, let’s find out what is HbA1C?

You can come across different names for this indicator:

• A1c
• Glycated hemoglobin
• Glycosylated hemoglobin
• Hemoglobin A1C

The level of HbA1C (glycated hemoglobin) shows what percentage of hemoglobin in erythrocytes binds to glucose ¹ . Since the lifetime of a red blood cell that contains hemoglobin is several months, the HbA1C test allows you to determine how effective blood sugar control was in the previous 2-3 months.

How often should I check my HbA1C level?

The American Diabetes Association (ADA) recommends that diabetic patients with stable blood sugar levels have an HbA1C test every six months, and if blood sugar targets cannot be achieved or treatment needs to be changed, this test is done every 3 months ² .

What level of HbA1C should I aim for?

The American Diabetes Association recommends that HbA1C levels be 7% or lower, and the closer this is to 6% without risk to health, the better. However, for each person, this level should be set depending on the current state of health and taking into account many factors (in particular, whether the person feels the onset of hypoglycemia). Most likely, if your HbA1C level exceeds 7%, then the doctor will advise you on what needs to be done to lower it, because, among other things, lowering this indicator helps to reduce the risk of long-term complications of diabetes, which we strive to prevent ² .

Is it possible to do without blood sugar measurement if an HbA1C test is done?

Since the HbA1C level is an average value, it cannot guarantee that blood sugar levels during the day are in a safe range. Let’s see what the average value means. The average of the numbers 5-5-5-5 and the numbers 1-9-1-9 will be 5, but on the chart, the numbers 1-9-1-9 will look like sharp ups and downs. This also applies to blood sugar levels. If there are many highs and lows after averaging, the HbA1C level may be similar to the HbA1C level of a healthy person ³ .

Therefore, it is best to evaluate HbA1C test results when self-monitoring blood sugar results are available. It is impossible to understand how the disease develops if you do not conduct self-monitoring of blood sugar levels.

If HbA1C is low, does fluctuating blood sugar matter?

Blood sugar levels tend to fluctuate throughout the day, and this is due to what we eat, how much we move and rest. Currently, along with the results of the analysis of HbA1C, high glycemic variability is also being evaluated – this is how these fluctuations in blood sugar levels are called.

Data from the Diabetes Control and Complications Trial (DCCT ⁴ ) showed that patients with the same level of HbA1C were more susceptible to certain types of complications with more pronounced fluctuations in blood sugar levels. blood.

If you want to know if you are at risk and how your actions affect your blood sugar levels, the Accu-Chek 360° Form (Blood Glucose Test: Before and After Meals) can help you understand how food, exercise, medication, stress, or illness can affect your sugar levels throughout the day.