Type 2 Diabetes
What Is A1C? The Answers to Your Most Important A1C Questions
What is an A1C test for diabetes and how does it differ from daily blood glucose monitoring? Is it really a necessary part of diabetes management? We asked diabetes experts to get the low down on A1C.
What is A1C?
There are diabetes tests every diabetic should know about, and the A1C is a screen that has been used to monitor and track blood glucose for more than 40 years. Health-care providers use this tool to get a three-month window into a patient’s blood sugar levels. “It helps us analyze if you are under good, moderate, or poor glucose control, and can thus help us direct comprehensive care recommendations, and work with you in achieving and maintaining good compliance of treatment goals,” says Mona Morstein, a naturopathic doctor and author of Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes and founder and executive director of the Low Carb Diabetes Association. Don’t miss this step-by-step plan for reversing diabetes.
What is the A1C chart measuring?
A1C is a protein in red blood cells, and it binds with glucose (blood sugar), explains Dr. Morstein. Because these red blood cells have a lifespan of about three to four months, the amount of glucose on A1C protein reveals a long-term picture of blood sugar levels. For example, an A1C of 6.0 simply means about 6 percent of glucose is attached to the red blood cells, and that can give both patients and doctors a sense of the average blood sugar level over time, as opposed to pinprick blood sugar tests, which capture levels at one particular moment. And if you’re battling fluctuating levels, here are seven ways to control your blood sugar.
What range should I shoot for?
The American Diabetes Association recommends aiming under an A1C score of 7 percent (that translates to a daily average glucose level of 154 milligrams per deciliter of blood). However, your doctor may recommend a different number depending on your age or other factors. But that daily average can be deceptive: For example, a person could have an A1C of 6 percent, which translates into an average glucose of 126 for the last three months. However, says Dr. Morstein, “the patient could go down to 40 and up to 192 and wind up with an average of 126, showing very bad glucose control.” If you’re looking to rein in your blood sugar swings, watch out for these dangerous eating habits that can alter A1C. “In reality, a person with diabetes should strive to avoid damage to the body, and the development of diabetic complications, by having have the lowest A1C possible, ideally less than 6.0 or even lower,” says Dr. Morstein.
What do the numbers mean?
Keeping your A1C score lower over time means you’re protecting your organs and blood vessels from the damage high blood sugar levels can do. “If a health care provider wanted the individual to strive for an A1C of 6 percent, they would have to advise them to have an average blood sugar reading of 126 (splitting the difference between the two numbers) or a range of 100-152mg/dl says, Joanne Rinker, MS, RD, CDE, LDN, FAADE, director of Practice and Content Development, American Association of Diabetes Educators. This is the difference is between type 1 and type 2 diabetes.
What factors influence A1C?
Along with your diet and exercise habits, conditions that can influence an A1C are kidney and liver disease, and gestational diabetes in pregnant women. “In the case of gestational diabetes, an A1C test may need to be done more often,” says Rinker. “Anemia and other conditions that effect the red blood cells will cause changes or inaccuracies with the A1C percentage.” A 2017 study revealed African Americans with sickle cell trait had significantly reduced A1C values (5.72 percent vs 6.01 percent), compared to those without sickle cell trait. Follow these simple tips for lowering A1C.
How important is A1C for managing diabetes?
According to Rinker and Dr. Mortstein, the A1C is the most important measurement when working with a person with diabetes, though they’d like to follow patients even more closely if they could. “If we had the ability to check as often as we wanted to, we’d be able to find out so much about the person with diabetes and how their individual body processes blood sugar,” says Rinker. This would entail things like checking blood sugar before meals and two hours after, testing before, during and after exercise, and even factoring in positive or negative stress.
In the absence of regular blood sugar checks, the A1C provides valuable trends for a diabetes educator. “We can talk about how we could work together to make some small adjustments to their meal plans—a self-care behavior that can really improve their blood sugar when it is traditionally high, in this example,” says Rinker. Don’t sabotage your health by falling for these diabetes myths.
How quickly can I lower my A1C?
A high A1C score may be distressing, but the good news is it can come down quickly on a smart diet-and-activity regimen. “There is no real limit to how much an A1C can lower in three months,” says Dr. Morstein. “A person can start off with an A1C of 12 percent and in three months have an A1C of 6.0 percent.” For example, if patients keep a daily food diary along with a glucose graph that tracks sugar checks throughout the day, within several days they could develop a targeted plan that can dramatically lower A1C. “It’s unfortunate that, in conventional care, this is so rarely done,” says Dr. Morstein. “But with physicians who do integrative medicine, it is a very common approach.” says Dr. Morstein. Dropping your A1C lowers your risk of these diabetes complications.
Do I still need to monitor my daily glucose levels?
Yes, according to Deborah Malkoff-Cohen, MS, RD, CDN, CDE, who has a private practice in New York City. The first thing on your to-do list for lowering A1C is to use a continuous glucose monitoring device to track and lower blood glucose. For example, devices like Dexcom and Libre offer monitoring without painful needle sticks, and they can deliver the information right to your smartphone. Then start eating right to lower A1C—these are the best foods for a diabetic. Malkoff-Cohen strongly recommends portion control and always eating carbs with a protein. “Carbs should be the last thing you eat on your plate. Eat protein first,” advises Malkoff-Cohen. Also, talk to your doctor about increasing your activity. In one study, when inactive people with type 2 diabetes did a combination of aerobic and resistance training three times a week for five weeks, their A1C improved about twice as much as doing either exercise alone. Why? Building muscle mass burns more glucose during exercise and when you’re just relaxing on the sofa. The benefit is decreased insulin resistance.