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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Test, levels, and more for diabetes

The A1C test is a blood test that measures a person’s average blood glucose or blood sugar levels over the past 3 months. An A1C reading of over 5.7% may be a cause for concern, but this will depend on various factors.

Doctors use the A1C test to check for prediabetes and diabetes. A range of 5.7–6.5% suggests a person may have prediabetes. Over 6.5% indicates diabetes.

This test also helps doctors monitor blood glucose levels in people with diagnosed diabetes.

Keeping A1C levels within the normal or target range lowers the risk of developing diabetes or its complications. Read on to learn what A1C test results mean.

The A1C chart below can help a person convert and understand their A1C test results. The doctor can provide more context and describe ways to keep blood glucose levels in a safe range.

Share on PinterestMNT-infographic_guide illustration by Diego Sabogal a1c-chart

The A1C test is also known as the:

• hemoglobin A1C, or HbA1c, test
• glycated hemoglobin test
• glycohemoglobin test

The A1C test measures the percentage of red blood cells that have glucose-coated hemoglobin. This measurement gives doctors an idea of the person’s average blood glucose levels over the past 2–3 months.

Hemoglobin is an iron-rich protein in red blood cells. It helps carry oxygen from the lungs to other tissues.

When glucose enters the blood, it binds to hemoglobin. The more glucose in a person’s bloodstream, the more hemoglobin is bound to glucose.

Undergoing the A1C test is straightforward: A healthcare professional takes a blood sample and sends it to a laboratory for testing.

A doctor may order this test to:

• diagnose prediabetes
• diagnose type 1 or type 2 diabetes
• monitor the blood glucose levels of a person with diabetes to check how well their treatment is working

If a person takes insulin to manage diabetes, their doctor may also ask them to monitor their blood glucose levels at home with a blood glucose meter or continuous glucose monitor.

In this case, the person still needs to undergo regular A1C testing.

Traditionally, A1C levels are reported as a percentage. Alternately, they may be reported as estimated average glucose (eAG), in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L).

Blood glucose meters and continuous glucose monitors also give eAG readings, some from at least 12 days of data.

The A1C test gives a more accurate long-term average. It takes into account fluctuations throughout the day, such as overnight and after meals.

A normal A1C level is below 5.7%. Normal eAG is below 117 mg/dL or 6.5 mmol/L.

If someone’s A1C levels are higher than normal, they may have diabetes or prediabetes. Their doctor might order a repeat test to confirm this.

Target levels in people with diabetes

A doctor will set a person’s target A1C level based on many factors. The right target varies from person to person.

For someone with diabetes, the target A1C level may depend on:

• the person’s age
• their overall health
• whether they are pregnant
• how long they have had diabetes
• their prescribed treatment plan
• any history of adverse effects from the treatment, including episodes of low blood glucose, or hypoglycemia
• any complications from diabetes
• the person’s preferences and treatment priorities

In general, a doctor might recommend aiming for A1C levels under 6. 5% if a person:

• is young and has a long life expectancy
• has had diabetes for a short period
• is effectively managing their diabetes with lifestyle changes or metformin alone
• is otherwise in good health

A doctor might recommend A1C targets of 7.0–8.5% if a person:

• is older and has a shorter life expectancy
• has had diabetes for a longer period
• has diabetes that is hard to manage, even with multiple medications
• has a history of severe hypoglycemia or other adverse effects of treatment
• has experienced complications of diabetes
• has other chronic health conditions

A person should work with their doctor to reassess and adjust their A1C targets over time. The condition and treatment goals may change.

To screen for diabetes, a doctor may order an A1C test for someone older than 45. They may also do this for younger people who have other risk factors.

After diagnosing diabetes, a doctor determines how often to test A1C levels.

If a person is meeting their treatment goals, they may need an A1C test twice a year. When managing blood glucose levels is challenging, a person tends to need this test more frequently.

A person should make an appointment with their doctor if they:

• have questions or concerns about their treatment plan
• are finding it hard to keep their blood glucose levels within the target range
• have had symptoms of high or low blood glucose levels
• think they might have complications of diabetes

Symptoms of high blood glucose levels include:

• fatigue
• unusual thirst
• frequent urination
• blurred vision

Symptoms of low blood glucose levels include:

• nervousness, irritability, or anxiety
• confusion
• dizziness
• hunger
• shaking
• sweating

Anyone who develops any of the symptoms above or notices other changes in their health should let their doctor know.

A doctor orders an A1C test to check whether someone has prediabetes or type 1 or 2 diabetes. Doctors also use this test to monitor blood glucose levels in people with diabetes to see how well their treatment plan is working.

A1C test results are usually a percentage, but they may come as an eAG measurement. Target A1C levels vary from person to person, depending on age, overall health, and other factors.

Having high A1C levels may indicate that the person has diabetes or a high risk of related complications. In this case, the doctor will work with the person to adjust the approach to treatment.

Reading technique for grades 1-4

But how do you know if a child reads well for his age or not? This can be done by checking the reading technique. Many parents do not quite understand the format and meaning of this test, believing that the determining criterion is speed, that is, the number of words read per minute. In fact, the test is focused on assessing not only the pace of reading, but also other skills. Let’s try to deal with the requirements prescribed for reading technique in the Federal Standards.

Reading technique: basic criteria

How fast should you read? Is everything okay with a child with technology? Perhaps his skills do not meet some standards? These questions always concern responsible parents. And I must say that there is nothing wrong with this excitement, because involvement in the process of teaching children is in many ways the key to future success. But is it really worth worrying about reading speed?

To answer this question, it is necessary to understand in detail what exactly is assessed when testing reading technique. According to the requirements of the Federal State Educational Standard, the following are assessed:

• reading speed – the number of characters that a child is able to read in one minute;
• way of reading – reading words syllable by syllable or whole, smoothly;
• correctness – the absence of mistakes and hesitations made by a child when reading;
• awareness – the ability to understand the meaning and idea of ​​what is read;
• expressiveness – the ability to correctly place stresses, observe intonation and maintain pauses when reading.

Analyzing the listed criteria, we can say that the test of reading technique is based on an assessment of two components: semantic and technical. At the same time, the technical side – tempo, expressiveness, correctness – is subordinated to the semantic, that is, the ability to understand the content of the text.

Reading technique: what is really important?

Reading is the most important type of speech activity, based on the ability to perceive and assimilate information. Unlike drawings, diagrams and video sequences, it activates the imagination. Scientists have proven that when reading poetry, other areas of the brain are involved than when mastering prose. This fact is explained by the different structure of phrases and phrases used in prose and poetry. Therefore, the ability to read can be considered as a tool for self-development. But this is not a basic skill, but acquired in the learning process. And here it is important not to force things, but to focus on the abilities and capabilities of the child.

It must be understood that reading technique is only one of the criteria, and it is not necessary to focus only on it. Especially parents whose children are not yet in school. Don’t just chase the pace. At this stage, it is more important to broaden your horizons, get acquainted with different topics, memorize new words. And the best way to achieve this is to read a lot, daily, but not to put speed at the forefront.

As far as schoolchildren are concerned, two parameters are essentially important here: technique and meaningfulness of reading. Technique is usually called the ability to distinguish letters, transform them into sounds, compose syllables and words. Meaningfulness is a deeper concept. It is based on understanding the meaning and content of the text.

It would be erroneous to require the child to make sense of what he has read until he has developed the skill of technical letter recognition. All the efforts of the crumbs, who are just learning to read, are aimed at memorizing and recognizing letters, syllables, words. In order to understand the essence of what is written in the text, he no longer has any intellectual strength or time. Therefore, primary education teachers first focus on technology, and only when it is brought to automatism, they begin to form a meaningful approach to reading.

Reading speed standards for elementary school

Reading speed standards adopted for elementary school students:

• Grade 1: 1st semester – 20-25 words per minute, 2nd semester – 30-40 words;

• Grade 2: I half-year – 40-50 words; II half-year – 50-60 words;

• Grade 3: I half-year – 60-70 words; II half-year – 70-80 words per minute;

• Grade 4: 1st half year – 80-90 words per minute; end of the school year – 100-120 words.

In classes and schools for gifted children, the rate of reading may be higher. So, in the first grade, such children read more than 60 words per minute, in the second – 90-95, in the third – 95-105 words per minute. The pace when reading to yourself should be 20-50 words faster than when reading aloud.

Other test parameters

And a few more parameters that you should pay attention to:

• Grade 1 – the student can read a significant part of the text in syllables.
• Grade 2 – higher requirements are imposed on reading technique: only complex words can be read by syllables, it is important to observe pauses and correctly place stresses.
• Grade 3 – reading must be conscious and expressive, with observance of intonation. In order to correctly assess the skills of the child, retelling is practiced.
• Grade 4 – the student should be able to analyze what he has read and express his personal opinion.

Focusing on the standard, we can draw some conclusions about the effectiveness of training. But even if the child cannot read the number of words prescribed in the standards, you should not worry too much about it. After all, these are just average standards developed on the basis of general data. Each student has their own level and pace of development. Checking the technique is rather information for the teacher and parents. After analyzing the results, you can understand in which aspects of training you need to show more diligence.​​

Checking your reading technique yourself

You can organize a reading test at home, just don’t turn it into a kind of exam. Some children are quite sensitive to any tests, and in stressful situations they cannot always demonstrate everything they are capable of. Come up with a game format or check the technique discreetly. If the child himself wants to know what success he has achieved, then no problems will arise.

Action sequence:

1. Arm yourself with a watch with a second hand. To check, you can use a stopwatch on your smartphone, but it’s better to refuse an hourglass, since a child who has never seen such a thing will be distracted by them.
2. Prepare a text and show it to the child.
3. Ask to read the text aloud.
4. The time should be recorded from the start of reading.
5. If you notice that a child has made a mistake, do not stop him, but simply make a note for yourself.
6. Rate the result. To get the most objective picture of the student’s skills, you should conduct a control check and compare the results.

If you see that the child is not concentrated enough, he is in a bad mood or is not feeling well, check the reading technique on another day.

Correctly evaluate the result

Count the number of words read. Points to pay attention to when counting:

• conjunctions, particles, prepositions consisting of one or two letters are counted as one word;
• when wrapping, the word is counted not as one, but as two;
• words with a hyphen are counted differently: if there are three or more letters on both sides of the hyphen, then the word is counted as two, less than three letters – as one word.

Not only speed is important, but other criteria as well. Be sure to evaluate the correctness of the text you read. All mistakes made should be sorted out with the child. If you notice that there are a lot of hesitations, corrections, changes in endings and whole words, you should consult with the teacher. Perhaps professional correction of reading skills is needed.

It is also important to understand how well the child understood the meaning of the text. It is not necessary to ask the student to retell what they have read. It is enough that he describes the content in a few words. Ask him to identify the main idea. If there are problems with this, then you can resort to retelling.

Pay attention to expressiveness. The student should try to observe intonation, pause in accordance with punctuation marks. Unfortunately, not all children are able to read a passage with an expression. Tell the child in which places you need to increase the pace and emotionality, which words need to be emphasized.

Requirements for texts used to test reading skills

When choosing a text, adhere to the following recommendations:

1. It should be a text unfamiliar to the child, but not too complex, age appropriate.
2. Pay attention to the structure of the sentences: they should be short, without dialogues and a lot of punctuation marks.
3. It is better to choose text without pictures.
4. Font size is also important – it should be large enough.
5. Text should not be split into two pages.

Of course, you shouldn’t check your reading technique using the instructions for household appliances or a manual for housewives. The best option is short stories about nature, animals, seasons.

Tips for Improving Reading Technique

Don’t be discouraged if your test results aren’t up to standard. But what really needs to be done is to put more diligence and not be lazy to practice. You can seek help from specialists or deal with the child on your own. But just remember that you need to do at least 15 minutes every day.

There are many exercises to improve reading technique:

• reading the same text several times in a row with a gradual increase in pace;
• “buzzing reading” – daily five minutes of reading in a low voice;
• “gibberish writing” – the use of texts in which some of the letters are written upside down;
• “word search” – an exercise to find a specific word in the text;
• exercise with syllabic tables.

This is just a part of the exercises to improve your reading skills. There are also recommendations for working on literacy, expressiveness, understanding the meaning of what is read:

• if there are problems with diction, emphasis should be placed on tongue twisters;
• so that the child understands the meaning of what he read, ask him to retell texts more often, make plans, draw illustrations for any passage;
• Poems are most suitable for improving the expressiveness of reading. Only you need to recite them not quietly and calmly, but loudly and emotionally.

It is believed that reading speed should be comparable to conversational speech. This opinion is shared by both distinguished teachers and young innovative teachers. On average, 120-150 words per minute – it was to this pace that the human articulatory apparatus adapted over several centuries of evolution. Of course, such indicators are applicable for middle and high school students, but this does not mean that they should not be strived for. After all, all the basic skills laid down in the primary grades will definitely come in handy in the future. The ability to read an average of 120 words will allow you to quickly master the material and cope with tasks. Naturally, provided that this is a conscious reading with an understanding of the meaning. Therefore, you need to work on the technique and pace of reading constantly.

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