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Whether you call it A1c, hemoglobin A1c, or HbA1c, this is one of the most important numbers to know if you have diabetes.
The A1c is a marker of your overall level of diabetes control, and it helps guide you and your healthcare team to make course corrections, as needed, in your treatment plan.
Keep reading to learn more.
Table of Contents
What is an A1c?
An A1c is a blood test that measures your average blood sugar levels over the past 2 to 3 months.
While your blood sugar finger-sticks give you a snapshot of what your blood sugar level is at a particular point in time — say, before breakfast or two hours after dinner — your A1c result provides a big-picture view of how your diabetes is doing.
For most people with diabetes, the American Diabetes Association (ADA) recommends an A1C of less than 7.0 percent. However, the A1c goal may be different for some people, such as older adults, and needs to be personalized. Be sure you know what your A1c goal is!
Learn more about A1c goals in: Blood Sugar Chart: Blood Sugar and A1c Targets.
Besides helping you and your healthcare team manage your diabetes, the A1c test is also used to screen for and diagnose diabetes, as well as prediabetes.
What does an A1c test measure?
With diabetes, blood glucose (sugar) levels become too high. This happens due to a lack of insulin (a hormone that lowers blood sugar) or insulin not working as well as it should to move glucose from the blood into cells to be used for energy.
Glucose in the blood sticks to hemoglobin, a type of protein found in red blood cells. The higher the glucose level in the blood, the more glucose sticks to hemoglobin. The A1c test measures the percentage of your red blood cells that are “coated” with glucose.
The reason why the A1c test indicates your average blood glucose level over the past 2 to 3 months is because glucose sticks to hemoglobin for as long as the red blood cells are alive — and red blood cells last for about 120 days.
There are three ways to perform an A1c test:
- Lab draw: A phlebotomist (lab technician) draws blood from a vein in your arm and sends it to the lab to be analyzed.
- Point-of-care (POC) A1c: Your healthcare provider does a finger-stick in the office and the result is measured in a matter of minutes.
- At-home A1c kits: These kits are available for purchase at a pharmacy or via an online retailer. Kits generally cost between $50 and $150.
POC A1cs or A1cs obtained from a home kit should not be used to diagnose diabetes or prediabetes.
Find out more in: How to Measure Your A1c at Home.
What does your A1c result mean?
The A1c test is reported as a percentage. The higher the number, or percentage, the higher your blood sugars have been over the past few months.
For the purposes of diagnosing diabetes or prediabetes, here are what the results mean:
- No diabetes: A1c less than 5.7 percent
- Prediabetes: A1c from 5.7 to 6.4 percent
- Type 1 or type 2 diabetes: A1c of 6.5 percent or higher
If you have diabetes, aim to get your A1c checked at least twice a year, or more often if your diabetes treatment plan changes or if your blood sugars are running above your target range.
See: What Is a “Normal” HbA1c?
How can you lower your A1c without medication?
Many people with type 2 diabetes prefer to meet their blood glucose and A1c targets “naturally” (meaning, with lifestyle changes), rather than taking medications. And many with type 1 prefer to use natural approaches as a complement to insulin therapy.
Lifestyle measures can be very effective at lowering your A1c, with or without medication. Here’s a look at strategies that can help.
Have an eating plan
Sticking with a nutritious meal plan plays an important role in managing blood glucose levels and improving your A1c. A structured and consistent approach to eating can make a big difference in your diabetes control.
- An eating plan that encourages eating three meals a day, and possibly some snacks, will get you on your way to lowering your A1c. In addition, aiming to eat your meals at about the same times each day will make it easier to even out your blood sugars. Try not to skip meals or delay eating your meals as much as possible.
- There’s no one plan or diet for people with diabetes. What works for one person won’t work for someone else. It’s helpful to meet with a registered dietitian (RD) for a personalized eating plan to help you meet your diabetes goals. Ask your healthcare provider for a referral to a dietitian in your community.
Be “carb choosey”
Social media influencers and well-meaning family and friends may tell you that “carbs are bad” if you have diabetes. But reality and research show otherwise.
First, it’s difficult for most people to cut out carbohydrates (carbs), and second, avoiding or severely limiting your carb intake can greatly affect the quality of your diet, as well as your overall health. Carb foods provide essential nutrients that you won’t get from other foods.
- Go easy on refined carb foods. White rice, white bread, chips, soda, and the like have been stripped of their fiber and most of their vitamins and minerals. They’re more likely to cause blood sugar “spikes” and are linked with causing inflammation, obesity, and heart disease.
- Focus on unrefined carb foods. Whole grains, fruits, vegetables, and legumes contain fiber, vitamins, minerals, and other plant compounds that promote health, and are less likely to cause blood sugar spikes.
Be carb consistent
Eating too much of any type of carb food can raise blood sugars and A1c levels.
- Aim to eat about the same amount of carbs at your meals and snacks each day. Consider counting grams of carbs and staying within a range at meals — such as 30 to 45 grams. This can help keep your blood sugars more stable.
- Carb goals are different for everyone. Ask a registered dietitian what goal is best for you.
Fit in fiber
Befriend fiber, as it can help with managing blood sugars, lowering the risk of heart disease and some cancers, and even losing weight.
- Kick off the day with a fiber-full breakfast. Oatmeal, whole-grain bread, berries, and nuts or seeds are foods to include.
- Other blood sugar-friendly choices are low-carb vegetables (for example, broccoli, spinach, and tomatoes) as well as beans and legumes, such as lentils and peas.
Start low and go slow when it comes to fiber, since consuming too much too quickly can cause digestive problems. Be sure to drink plenty of water when eating high-fiber foods, too.
Watch portions
While foods that contain carbs have the most impact on blood sugar levels, eating too much of any kind of food can raise blood sugars.
In fact, high-fat meals have been shown to impair insulin sensitivity in people with type 1 diabetes, as well as delay emptying of food from the stomach in people with type 1 or type 2 diabetes. This, in turn, can lead to higher blood sugars.
- Try weighing and measuring your foods, even for a short while, to help you control portions. Keep a small food scale and set of measuring cups handy.
- Start tracking your food intake. Whether you use a notebook or a smartphone app, the practice of journaling has been shown in studies to help with managing blood sugars.
Lose a little weight
Aiming for even small amounts of weight loss (5 to 10 percent of your body weight) can make a big difference in your blood sugar management. In a study of 5,145 people with type 2 diabetes, those who lost 5 to 10 percent of their weight were three times more likely to lower their A1c by a clinically significant 0.5 percent.
- Rethink your plate. An easy way to get started with weight loss (without tediously counting calories) is to fill half your plate with low-carb veggies, a quarter with protein foods, and the other quarter with healthy carbs.
- Plan meals and snacks ahead of time. Doing so can limit last-minute take-out or fast-food meals or grabbing a candy bar for a snack.
Watching portions and tracking your food intake not only helps your diabetes, but it increases your chances of losing weight and keeping it off, too.
Start moving more
You’ve heard it before, but being active is important for so many reasons — and managing diabetes is one of them. It’s not always easy to get started if you aren’t already active, but it’s doable!
- Choose an activity. You don’t have to go to the gym (unless you want to). Walking, dancing, bicycling, and swimming are just a few activities that you might try. Think outside the box, too — climbing stairs, doing housework or yard work, or working out with your favorite exercise videos all “count” as physical activity.
- Commit to at least 150 minutes of physical activity each week. That may sound like a lot, but if you do 30 minutes of activity, five days per week, that’s got you covered. And if 30 minutes sounds daunting, break it up into three 10-minute sessions throughout the day.
- Don’t overlook strength training. Using hand weights, stretch bands, or machines at the gym are ways to strengthen your muscles. A physical activity routine should include aerobic and strength training, and the good news is that both types of exercise help to lower your blood sugars and your A1c.
If you are just starting out with a physical activity plan, it’s a smart idea to check with your healthcare provider first.
Manage stress
Stress is an often-overlooked factor that can raise blood sugars, and ultimately, A1c levels, too. Hormones that are released during times of stress are responsible for increased blood sugars.
In addition, how you respond to stress may impact them, as well. For example, if you’re stressed out, you may forgo your daily exercise or eat high-carb, high-fat comfort foods to try to feel better.
The ADA recommends these tips to navigate stressful times in your life:
- Practice deep breathing to steady your heart rate and calm your nervous system. Inhale to a slow count of four, hold your breath for a count of seven, and exhale for a count of eight.
- Get up and move around. Go for a quick walk, turn on the tunes and dance, or do some stretches. Fifteen minutes of activity can do wonders to boost your mood.
- Close your eyes and imagine you’re at your happy place — at the beach or mountains or walking in the woods.
- Feel gratitude. It’s easy to focus on everything that’s going wrong or not working in your life. Drag your thoughts away from that and instead, reflect on what you’re thankful for: family, friends, a pet, the weather. Chances are, you can name a few things to be grateful for!
- Make time to relax and wind down. Taking a warm bath, fitting in a nap, or curling up with a book are ways to disconnect from your stress, even for a little while, and sleep better, as well.
Get some sleep
According to the Sleep Foundation, “Sleep and physical health are closely connected, so it’s not surprising that sleep affects blood sugar levels.”
Being sleep-deprived — even for one night — can cause insulin resistance, leading to high blood sugars. Some habits that the U.S. Centers for Disease Control and Prevention (CDC) recommends for improving your sleep are:
- Going to bed and getting up in the morning at the same time every day.
- Keeping your room dark, quiet, and at a comfortable temperature.
- Turning off your TV, smartphone, laptop, and any other electronic devices about an hour before bedtime.
- Avoiding large meals, caffeine, and alcohol before bedtime.
If you continue to have trouble sleeping, let your healthcare provider know.
Why lower your A1c?
The higher your A1c result, the more glucose is sticking to hemoglobin in your red blood cells. And this means that glucose levels in your blood are likely higher than they should be.
Why is this important? Major clinical studies, including the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), indicate that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney, and nerve damage caused by diabetes.
The ADA recommends lowering the A1c to less than 7.0 percent (if this can be done safely) to lower the risk of diabetes-related complications.
Read more about reducing your A1c in: How to Lower Your A1c: The Complete Guide.
How long does it take to lower your A1c?
If your A1c result is above your target, you might be anxious to lower it as fast as possible. But, unlike your blood sugars, which can increase or decrease in a matter of minutes, it will take some time to lower your A1c.
Remember that your A1c indicates an average of your blood sugars over the past 2 to 3 months.
Recent increases or decreases in your blood sugars, therefore, won’t be reflected in your A1c result, unless you have had large swings in your blood sugars over the past month. Of note, approximately 50 percent of your A1c value comes from the past 30 days.
In general, it takes about 3 months to notice a change in your A1c result, which is why the recommendation is to get your A1c checked every 3 months. But it may take longer than 3 months to see an A1c change, based on a variety of factors, including how closely you are following your diabetes treatment plan.
Final thoughts
The A1c test is a way for you and your healthcare team to see the big picture of how your diabetes is doing. It’s important to know what your A1c goal is, as well as ways to help lower it if it’s too high.
While insulin is essential for people with type 1 diabetes, and many with type 2 diabetes may require medication, don’t overlook the role of lifestyle factors. Healthy eating, physical activity, stress management, and quality sleep all play a fundamental role in helping you achieve your A1c goal.
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