- All About Your A1C
- How to Lower A1C Levels Naturally
- Why lower your A1C?
- How long does it take to lower your A1C levels?
- Seven ways to lower your A1C levels
- Healthy eating
- 1. Come up with a plan
- 2. Be carb choosey
- 3.Be carb consistent
- 4. Watch portions
- Being active
- 5. Come up with a plan
- 6. Commit to 150 minutes each week
- 7. Combine cardio and resistance
- How to Lower Your A1c Level
- Hemoglobin A1C (HbA1c) Test: MedlinePlus Lab Test Information
- Reduce your A1C levels: Lifestyle, diet, and nutrition
- Natural sugar
- Low-sugar options
- Whole grains
- Starchy vegetables and legumes
- Hemoglobin A1c (HbA1c) Test: Normal, Low/High Levels, Chart, Ranges
- What is hemoglobin A1c?
- What causes high or low hemoglobin A1c levels?
- What are normal hemoglobin A1c levels, and are low or high levels dangerous?
- Hemoglobin A1c conversion chart (HbA1c chart)
- How often should you check your hemoglobin A1c levels?
All About Your A1C
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.
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.
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.
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.
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.
Diagnosing Prediabetes or Diabetes
|5.7% to 6.4%|
|6.5% or above|
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.
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:
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.
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 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.
How to Lower A1C Levels Naturally
Call it what you will: hemoglobin A1C, glycosylated hemoglobin, HbA1c or just “A1C,” these numbers, known as A1C levels, play a huge role in how your diabetes is managed. It’s also used to diagnose diabetes, as well as prediabetes.
Your A1C is a blood test that provides information about your average blood sugar levels over the past three months. Your provider and diabetes care team use this number to gauge how things are going and if and how to tweak your diabetes treatment plan.
For most people who have diabetes, the American Diabetes Association (ADA) recommends an A1C of less than 7 percent. The American Association of Clinical Endocrinologists (AACE) advises a tighter goal of 6.5 percent or lower.
Your goal may be completely different, and that’s OK (just make sure you know what it is!).
Why lower your A1C?
A1C goals aren’t decided upon thin air. The targets that the ADA, AACE or your provider advise for you are clinical research, as well as other factors, such as your age, your overall health and your risk of hypoglycemia.
Landmark clinical trials, such as the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC), for example, have correlated lowering A1C with a decrease in diabetes-related complications.
So, for every one point that you lower your A1C, you’ll lower your complication risk as follows:
• Eye disease by 76%
• Nerve damage by 60%• Heart attack or stroke by 57%
• Kidney disease by 50%
It’s important to realize that your A1C levels reflects an average of your blood sugar numbers. Your A1C levels might be 6.7%, but that may be because you’re having a lot of low blood sugars, for example.
For this reason, your A1C levels should be viewed as part of the picture, and not in isolation.
Your blood sugar readings, frequency of highs and lows, and quality of life need to be considered as part of your overall diabetes management plan.
How long does it take to lower your A1C levels?
Is it possible to lower A1C levels overnight? Well, the short answer is no. Un your blood sugars, which can go up or down in a matter of minutes, your A1C will take some time to change. Remember what your A1C measures: your average blood sugars over the past three months.
The good news is that if your A1C is on the high side, say, 10% or higher, it will ly start to drop within two to three months (in other words, the higher it is, the faster it comes down). On the other hand, if your A1C is 7.5%, it may take a little longer to lower A1C levels.
Seven ways to lower your A1C levels
There are a number of ways to get your A1C down. Taking medication is one way (and the reality is that many people with diabetes need to take medication), but lifestyle measures are effective, too. Here’s a rundown of what can work.
What and how much you eat factors in to your blood sugar control and, in turn, affects your A1C. There’s so much controversy about the best “diet” for diabetes and there’s no shortage of arguments on this topic.
However, realize that there is no one “diet” that will work for everyone. And despite popular belief, the American Diabetes Association does not prescribe any one type of eating plan.
In actuality, they state that many different types of eating patterns, including lower carb, vegetarian, DASH and Mediterranean can be beneficial.
One of the best ways to figure this all out is to meet with a registered dietitian, preferably one who has experience in working with people who have diabetes. Your doctor can provide you with a referral to meet with a dietitian. In the meantime, consider the following for lowering A1C levels:
1. Come up with a plan
Getting into the habit of eating three meals a day, and possibly some snacks, is a great way to get started on controlling A1C levels. In addition, aiming to eat your meals at about the same times each day will make it easier to stabilize your blood sugars. Try not to skip meals or delay eating your meals as much as possible.
2. Be carb choosey
Carb naysayers will proclaim that carb foods are evil and should be avoided as much as possible. But reality and research shows otherwise.
It’s difficult for most people to cut out carbs and it’s not the smartest thing to do from a nutrition standpoint, as carb foods can and do provide important nutrients that you won’t get from eating just protein and fat. However, you do need to consider the types of carbs you eat.
Refined carbs, such as white bread, white rice, chips, soda, cookies and other sweets have been stripped of their fiber and most of their vitamins and minerals; contain “empty” calories; and can cause “spikes” in blood sugars.
Eating refined and processed carbs has been linked to an increase risk of diabetes, heart disease, inflammation, and obesity. The carbs to focus on are unrefined, meaning, they retain their fiber, vitamins, minerals and other plant compounds that promote health. These carbs include whole grains, whole fruits and vegetables and legumes (beans and peas).
3.Be carb consistent
Along with eating healthy carb foods comes the concept of carb control for controlling A1C levels. Eating too much carb from any food source can mean higher blood sugars and a higher A1C. Aim to eat the same amount of carb at your meals and snacks each day.
Many people count grams of carb and aim for a range at their meals — for example, 30–45 grams per meal. Doing so helps you keep your blood sugars steady, whether you take diabetes medicine or not.
Because people do need different amounts of carb, it’s best to check with a dietitian as to what your carb goals should be.
4. Watch portions
Eating too much carb is one thing; eating too much protein or fat is another. Keep an eye on your portions of all of the foods that you eat, especially if you are trying to lose weight (losing weight, if you need to, can help lower your blood sugars and A1C). Using the plate method or sample menus are a couple of ways to help you get on track with an eating plan.
We’re all bombarded with messages to exercise or be physically active, and after a while, it’s easy to tune them out. But if your goal is to lower your A1C, it’s time to pay attention.
Yes, carb counting and losing weight helps, but don’t overlook the power of physical activity, too.
Exercise provides numerous health benefits, including a lower risk of heart disease, weight loss, increased energy and a lower risk of depression and stress. Add lower blood sugars to the list.
5. Come up with a plan
If you haven’t been active for a while, you might be wondering how to get started. The first step is to think about what you might to do. One of the best ways to get moving is to start walking. All you need is a good pair of sneakers. However, bicycling, swimming, using an exercise video or taking a Zumba class, for example, are all great ways to be active.
6. Commit to 150 minutes each week
One reason why people don’t exercise is because they think they need to spend hours at the gym, huffing and puffing away. Not true. The goal is to aim for doing at least 150 minutes of physical activity each week, or 30 minutes, five days a week.
And the good news is that you can break those 30 minutes into 10-minute segments, three times a day. If you haven’t been exercising, start slowly and build up, 5 minutes at a time.
By the way, don’t forget to check with your doctor before starting any new exercise program.
7. Combine cardio and resistance
Exercises that strengthen your heart and lungs and that use large muscle groups are often called aerobic or cardio exercises. These include walking, swimming and bicycling.
Ideally, your exercise routine should also include resistance, or strengthening, exercises, such as using hand weights, resistance bands, calisthenics or weight machines.
Both types of exercise work in different ways to promote health, but they both lower blood sugars and A1C.
More on how to lower your A1C next week!
Want to learn more about A1C? Read “How to Lower Your A1C: More Steps You Can Take,” “What Does A1C Stand For?” and “H-B-A-1-C: What It Is and Why It Matters.”
En Español: Cómo Reducir los Niveles de A1C Naturalmente
Originally Published October 4, 2018
How to Lower Your A1c Level
When you have diabetes, you probably know you should check your blood sugar regularly. Your doctor will also recommend that you take an A1c blood test a few times a year, with a goal of lowering the results to help protect your health. And there’s a lot you can do to move toward meeting that goal.
Un a regular blood sugar test, the A1c test measures the amount of sugar that clings to a protein, called hemoglobin, in your red blood cells. The test shows your average blood sugar levels over the past few months, so you know how well your diabetes is under control.
In general, the goal for your A1c is to be lower than 7%. Exactly how much lower will depend on your individual treatment plan. When you take steps to get your A1c in a healthy range, you lower your risk of complications such as nerve damage, eye problems, and heart disease.
Your doctor will let you know the best target for your A1c. How do you get there? Here are a few tactics to try, in addition to taking any medications your doctor prescribes.
Get some new kitchen gear. You’ll want to get a set of measuring cups and a kitchen scale if you don’t already have them. These will help you with your portion sizes. Your blood sugar will go up if you eat more food than your body needs. Keeping servings in check is a good way to reduce your A1c level.
At first, it’s a good idea to measure your food to give you an idea of what healthy portion sizes look for different foods. That’s where the measuring cups and scale come in handy. You may be surprised at first to see what one serving looks , especially of high-carb items cereal, rice, and pasta. But this will help ensure you don’t eat more than you intend to.
Be carb smart. It’s true that carbohydrates affect your blood sugar more than other nutrients you eat. Chances are that if you overdo starchy carbs on a regular basis, your A1c number will start to creep up. But remember, all carbs aren’t a problem. You want ones that have a lot of fiber and nutrients, more than those that just serve up starch.
Tweak your plate. Experts advise filling about half your plate with vegetables that are low in starch, such as carrots, greens, zucchini, or tomatoes. One-quarter of your plate should be a lean protein chicken or tofu, and the last quarter should be whole grains brown rice or quinoa.
Make a plan. The guidelines for what to put on your plate give you a lot of flexibility. But even though it sounds simple, you’ll probably be better off if you plan your meals.
Why? If you skip set menus and eat on the fly, it’s easy to end up with calorie-dense, high-carbohydrate food choices — fast food, bagels, and frozen pizza — that will cause your blood sugar and A1c numbers to soar.
Instead, at the start of each week, pencil in a rough plan for what foods you’ll eat at each meal and what groceries you’ll need. This way, you’ll be prepared with plenty of choices that limit post-meal blood sugar spikes. A Mediterranean diet, which is low in saturated fat and high in vegetables and fruit, reliably lowers A1c numbers.
Maybe downsize your weight loss goal. Not everyone with type 2 diabetes is overweight. But if you are, you may not need to drop as much as you think to make a difference in your A1c level.
If you’re overweight, diabetes doctors will often recommend you try to lose just 5% to 10% of your current weight.
Here’s why: As you shed extra pounds, the insulin in your body lowers your blood sugar levels more efficiently, which will cause your A1c levels to drop over time.
In one study, people with type 2 diabetes who lost 5% to 10% of their body weight were three times as ly to lower their A1c by 0.5%.
You may have a different goal for your weight or other health considerations on your mind. Ask your doctor to help you make a weight loss plan that matches your overall goals.
Rethink your exercise plan. Other than upgrading your nutrition, exercise is one of the most important habit changes you can make to lower your A1c. But don’t just grind it out on the treadmill, or you’ll miss another effective workout: strength training.
No offense to the elliptical machine or your cycling class. You can choose whatever type of exercise you prefer as long as it’s a challenging workout. Both aerobic exercise and resistance (weight) training lower A1c levels if they’re part of a regular routine.
There’s solid science to support how much working out helps you whittle down your A1c level. Since exercise prompts your muscles to take up sugar from your bloodstream, it helps your blood sugar levels drop more quickly after you eat a meal. As you make exercise a regular habit, you’ll see a downward trend in your A1c numbers.
Never miss your meds. You can reliably lower your A1c through diet and exercise. But if your doctor has prescribed medication, such as metformin, miglitol, or insulin, it’s important to take them exactly as prescribed. If you miss doses regularly, your blood sugar numbers may creep up and cause your A1c to rise.
But if you follow the medication plan that your doctor recommends and go to every appointment, your blood sugar should stay under control — and your lower A1c number will reflect that. If your goal is to cut down on, or even stop needing, your meds, tell your doctor that you want to work toward that.
But don’t stop them on your own.
Be savvy about supplements. Many dietary supplements say they’ll lower your A1c. But there’s not always much research to back that up. Still, some may have promise.
These include berberine, made up of extracts from a variety of plants, and coenzyme Q10 (CoQ10), an antioxidant that reduces inflammation in your body. Cinnamon may also lower A1c levels over time.
As with any supplement, it’s best to check with your doctor first.
Put your plan on repeat. Stick with it and give it time. Since your A1c level reflects your average blood sugar over several months, it’s going to take that long for your A1c to drop. You won’t do everything perfectly, and that’s OK. Just keep moving in the direction you want to go in. And rest assured: Your A1c number will come down, and it’ll be worth it.
Mayo Clinic: “A1C Test,” “Hyperglycemia in Diabetes,” “Diabetes Diet: Create Your Healthy Eating Plan.”
Merck Manual: “Formation of Blood Cells.”
National Institutes of Health: “The A1C Test and Diabetes.”
Harvard T.H. Chan School of Public Health: “Carbohydrates and Blood Sugar.”
Joslin Diabetes Center: “Key to Success: Portion Control.”
Pakistan Journal of Medical Sciences: “Effect of Vitamin D Supplementation on Reduction in Levels of HbA1 in Patients Recently Diagnosed with Type 2 Diabetes Mellitus Having Asymptomatic Vitamin D Deficiency.”
Utah.gov: “How Can You Lower Your A1C To a Healthy Number?”
Diabetology and Metabolic Syndrome: “Resistance Exercise Training Lowers HbA1c More Than Aerobic Training in Adults With Type 2 Diabetes.”
American Diabetes Association: “Medication Management: What Are My Options?”
© 2019 WebMD, LLC. All rights reserved.
Hemoglobin A1C (HbA1c) Test: MedlinePlus Lab Test Information
URL of this page: https://medlineplus.gov/lab-tests/hemoglobin-a1c-hba1c-test/
A hemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to hemoglobin.
Hemoglobin is the part of your red blood cells that carries oxygen from your lungs to the rest of your body. An HbA1c test shows what the average amount of glucose attached to hemoglobin has been over the past three months.
It's a three-month average because that's typically how long a red blood cell lives.
If your HbA1c levels are high, it may be a sign of diabetes, a chronic condition that can cause serious health problems, including heart disease, kidney disease, and nerve damage.
Other names: HbA1c, A1c, glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin
An HbA1c test may be used to check for diabetes or prediabetes in adults. Prediabetes means your blood sugar levels show you are at risk for getting diabetes.
If you already have diabetes, an HbA1c test can help monitor your condition and glucose levels.
You may need an HbA1c test if you have symptoms of diabetes. These include:
- Increased thirst
- Increased urination
- Blurred vision
Your health care provider may also order an HbA1c test if you are at higher risk for getting diabetes. Risk factors include:
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
You don't need any special preparations for an HbA1c test.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
HbA1c results are given in percentages. Typical results are below.
- Normal: HbA1c below 5.7%
- Prediabetes: HbA1c between 5.7% and 6.4
- Diabetes: HbA1c of 6.5% or higher
Your results may mean something different. If you have questions about your results, talk to your health care provider.
If you have diabetes, the American Diabetes Association recommends keeping your HbA1c levels below 7%. Your health care provider may have other recommendations for you, depending on your overall health, age, weight, and other factors.
The HbA1c test is not used for gestational diabetes, a type of diabetes that only affects pregnant women, or for diagnosing diabetes in children.
Also, if you have anemia or another type of blood disorder, an HbA1c test may be less accurate for diagnosing diabetes. If you have one of these disorders and are at risk for diabetes, your health care provider may recommend different tests.
Reduce your A1C levels: Lifestyle, diet, and nutrition
Share on PinterestA doctor or nurse will take a blood test to assess a person’s A1C levels.
An A1C test measures how well the body is maintaining blood glucose levels. It shows the average percentage of sugar-bound hemoglobin in a blood sample.
When glucose enters the blood, it binds to a red blood cell protein called hemoglobin. Hemoglobin carries oxygen around the body.
The higher blood glucose levels are, the more hemoglobin it binds.
Red blood cells live for around 4 months, so A1C results reflect long-term blood glucose levels.
A1C tests use blood from a finger prick or blood draw.
Physicians will usually do more than one A1C test before diagnosing diabetes.
The first test will help a physician work out an individual’s baseline A1C level for later comparison.
How often a person with a diagnosis of diabetes needs to do an A1C test will vary, depending on the type of diabetes and management factors.
Many studies have shown that lowering A1C levels can help slow the progression of diabetes and reduce the risk of complications — such as nerve damage and cardiovascular disease — in both type 1 and type 2 diabetes.
Even small changes in A1C levels can have significant effects.
The American Diabetes Association recommend maintaining A1C levels below 7 percent for most people.
A doctor will diagnose diabetes if a person’s A1C level is 6.5 percent or higher on two separate occasions.
Physical activity, diet, and possibly medication, can help manage blood glucose levels, and therefore also A1C levels.
Everyone, especially people with diabetes, can benefit from a healthful diet that includes plenty of fresh fruit and vegetables and whole foods and is low in sugar, salt, and fat.
Monitoring carbohydrate intake can help a person manage their glucose levels.
General diet tips to lower A1C levels include:
- being mindful of portion sizes
- eating regularly, every 3-5 hours
- eating similar sized portions at meals and snacks
- planning meals ahead of time
- keeping a journal of food, medication, and exercise
- spreading out carbohydrate-rich foods throughout the day
- choosing less processed or whole foods whole grains, fruits, vegetables, legumes, and nuts
- eating a balanced diet complete with healthy proteins, fats, and carbohydrates
- seeking out the help of a registered dietitian
A healthcare professional will advise each person on their dietary needs, including the number of carbs they should consume. This will depend on individual factors, including the person’s exercise levels and treatment plan.
Food that takes longer to digest, such as whole grains, will have a slower and less significant impact on blood sugar levels.
A person will digest simple sugars — present in candies and white bread — more quickly. This can trigger a blood sugar spike.
Frequent glucose spikes can speed up the development of diabetes and increase the risk of complications.
A person with diabetes needs to manage their carb intake, but they do not need to avoid carbs altogether. Carbohydrates are the body and brain’s main fuel source and contain important nutrients.
Tips for a healthful carb intake include:
- spreading carb intake throughout the day
- choosing the right kinds of carb
There are three types of carbohydrate:
- Sugars: The body absorbs these quickly, causing blood glucose level to spike.
- Starch: These take longer to absorb, and are less ly to cause a glucose spike.
- Fiber: This is essential for health. Its benefits include reducing the risk of high blood sugar levels.
Fiber is complex and takes longer to break down, so it provides more sustainable energy and decreases the risk of a spike in blood sugar. Fiber also helps keep the digestive tract healthy.
Research has found that when women consume at least 25 grams (g) of fiber a day and men 38 g or more, the chance of developing type 2 diabetes can fall by 20–30 percent.
Sources of fiber include whole grains, nuts, and whole fruits and vegetables. Fresh, whole fruit contains more fiber than fruit juice made with fresh fruits.
The body absorbs refined sugars, such as candies, quickly, and this can lead to dangerous rises in blood glucose.
Fruits, vegetables, and low-fat dairy products contain less processed sugars that are more healthful than refined sugars.
Whole fruits, vegetables, and dairy products all contain far higher levels of vital nutrients than most processed foods and less sugar.
All whole fruits and vegetables contain natural sugars, but they also tend to be rich in other nutrients, including fiber.
Low-sugar fruit and vegetable options include:
- tangerines, nectarines, and plums
- broccoli and cauliflower
- kale, cabbage, bok choy, and Brussels sprouts
- spinaches, collard greens, and Swiss chard
- cucumbers and zucchini
- cranberries, raspberries, blackberries, and strawberries
People with diabetes do not need to avoid fruits, but they should account for the carbohydrates and sugars they contain. They should also eat fruits in moderation.
Dried fruits contain more sugar than fresh fruits.
Lactose is the sugar that occurs in dairy products. One cup of 1-percent fortified milk contains 12.8 grams of carbohydrate, which is mostly lactose.
Low-sugar, dairy-free options include unflavored, fortified soy, rice, almond, flax, and coconut milk or products
Lactose levels are similar in full-fat, reduced-fat, and non-fat milk, but people with type 2 diabetes often need to take care of their weight. For this reason, a low-fat version may be a better option.
Starches or complex carbohydrates include:
- starchy vegetables
Most of a person’s carbohydrate consumption should consist of these. For most grains and starches, half a cup contains one 15 gram serving of carbohydrates.
Starches are better carbohydrate choices than simple sugars, but the body can absorb highly processed starches rapidly, leading to increases in blood sugar levels.
Whole-grain breads, cereals, pastas, and rices contain B and E vitamins, minerals, essential fatty acids, and fiber.
Bleached or processed grains and cereals generally contain fewer nutrients and higher levels of sugar than whole-grain products.
Some products that claim to contain whole wheat still have high levels of refined grains, and they may contain added sugar.
The best whole-grain options include:
- whole-wheat flour
- buckwheat or buckwheat flour
- cracked wheat
- whole-grain barley
- whole rye
- whole oats
- brown rice
- wild rice
- whole faro
- whole-grain corn or corn meal
A healthcare professional will advise on how much carbohydrate a person should consume each day.
Starchy vegetables and legumes
Plenty of starchy vegetables and legumes also contain high levels of nutrients and fiber in their skins or pods.
Some vegetables have higher concentrations of starch than others. These include root vegetables potatoes. People should monitor their consumption of these vegetables more closely than others.
Healthful, starchy vegetable and legume options include:
- green peas
- black, lima, and pinto beans
- butternut, acorn, and spring squash
- dried black-eyed or split peas
- low-fat refried beans or baked beans
- yams or sweet potatoes
- palm hearts
A1C test results appear as a percentage. A higher A1C level means a greater risk of diabetes and its complications.
Physicians may also refer to average glucose, or eAG, when they talk about A1C levels. The eAG corresponds to A1C, but it appears as milligrams per deciliter (mg/dl), blood sugar.
Both A1C results and eAG refer to a person’s average 3-month blood glucose levels.
|A1C value||eAG value||ADA diagnosis|
|5.6% or less||117 mg/dl or less||Normal|
|6.5% or more||137 mg/dl||Diabetes|
A person with prediabetes has a good chance of reversing their high blood sugar levels and preventing diabetes from developing. Get some tips and strategies for managing prediabetes here.
A1C level recommendations vary between individuals. People with more advanced diabetes will have higher A1C targets than healthy adults without diabetes. Factors life expectancy, treatment response, and medical history also have an impact.
|A1C value||eAG value||ADA recommended goal for|
|5.6% or below||117 mg/dl or below||Healthy, adults without diabetes|
|6.5%||140 mg/dl||People with short-term diabetes, managed type 2 diabetes, no cardiovascular disease, long life expectancy|
|7% or less||154 mg/dl or less||Most non-pregnant adults with diabetes|
|8% or less||183 mg/dl or less||People with long-standing or severe diabetes, limited life expectancy, extensive additional health complications, or poor treatment response|
A1C levels are a measure of blood glucose over 2–3 months. A person whose A1C level is 6.5 percent or more will need to take steps to lower their levels.
Strategies include healthful dietary choices, exercise, and medication, for some people.
Click here to find out more about healthy blood glucose levels.
Hemoglobin A1c (HbA1c) Test: Normal, Low/High Levels, Chart, Ranges
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Hemoglobin A1c Levels and Ranges
Hemoglobin is the molecule within red blood cells.that carries oxygen to the body’s tissues. A small percentage of the hemoglobin has sugar attached to it, and this type of hemoglobin is known as hemoglobin A1c.. The amount of hemoglobin A1c depends on the level of sugar (glucose) in the blood: the higher the blood sugar the higher is the amount of hemoglobin A1c.
- The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells.
- Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time.
- Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%.
- Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes.
- Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%.
- Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control.
- Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c.
In type 1 and type 2 diabetes, uncontrolled blood sugar can lead to a number of associated complications, for example:
- Foot problems
- Urological and sexual problems (urinary tract infections [UTIs], erectile dysfunction [ED]
- Yeast infections
- Heart disease
- Kidney disease
- Diabetic neuropathy
- Diabetic eye disease
Read more about the complications of diabetes »
What is hemoglobin A1c?
To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time, it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins.
The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives the doctor an idea of how much glucose has been around in the blood for the preceding three months.
Hemoglobin A1c is a minor component of hemoglobin to which glucose binds. Hemoglobin A1c levels depend on blood glucose concentrations. The higher the sugar concentration in the blood, the higher the detectable hemoglobin A1c levels.
At any point in time, hemoglobin A1c levels represent the average blood sugar concentrations in the person with diabetes for approximately the preceding 3 months. Other ways hemoglobin A1c may be termed include HbA1c, A1c and Hb1c.
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What causes high or low hemoglobin A1c levels?
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Hemoglobin A1c levels can be altered by:
- Oral or IV glucose intake
- Use of insulin
- Combinations of these and other factors
The goal for people with diabetes, with their doctor's help, is to establish stable blood glucose levels resulting in hemoglobin A1c levels that are at least below 7% to reduce or stop complications of diabetes (for example, diabetic nerve, eye, and kidney disease).
What are normal hemoglobin A1c levels, and are low or high levels dangerous?
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- In most labs, the normal range for hemoglobin A1c is 4% to 5.9%.
- In well-controlled diabetic patients, hemoglobin A1c levels are less than 7.0%.
- In poorly controlled diabetes, its level is 8.0% or above.
The benefits of measuring hemoglobin A1c is that is gives a more reasonable view of what's happening over the course of time (about 3 months) to the average glucose level in the blood. Hemoglobin A1c values do not bounce up or down as much as daily finger stick blood sugar measurements.
Hemoglobin A1c conversion chart (HbA1c chart)
While there are no guidelines to use hemoglobin A1c test levels as a screening tool, it gives a health-care professional a good idea that someone may be have diabetes if the value is elevated; however, it is used as a standard tool to determine blood sugar control in patients known to have diabetes.
The correlation between hemoglobin A1c levels and average blood sugar levels is presented in the following conversion chart:
The American Diabetes Association currently recommends an A1c goal of less than 7.0%, while other groups such as the American Association of Clinical Endocrinologists recommend a goal of less than 6.5%. In 2016, the ADA recommended that an A1c level of 6.5% as a cutoff level to diagnose diabetes.
Studies have shown there is a 10% decrease in relative risk for microvascular complications for every 1% reduction in hemoglobin A1c. So, if a person with diabetes has an initial hemoglobin A1c level of 10.7 and drops to 8.
2, though they are not yet at goal (about 6.5%), they have managed to decrease their risk of microvascular complications by about 20%.
The closer to normal the hemoglobin A1c, the lower the absolute risk for microvascular complications.
How often should you check your hemoglobin A1c levels?
The American Diabetes Association (ADA) suggests if people with diabetes want to reduce their hemoglobin A1c levels quickly, they should get their hemoglobin A1c levels checked every three months until they reach their treatment goals.
People with diabetes who are meeting treatment goals and have stable blood control are recommended to check their hemoglobin A1c every six months according to the ADA.
Tracking hemoglobin A1c levels allows an individual and their health-care professional to determine how well the person is controlling their blood sugar (glucose) levels over time. However, they are not a substitute for daily glucose monitoring.
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Medically Reviewed on 10/22/2019
American Diabetes Association. “Diagnosing Diabetes and Learning About Prediabetes.” Updated: Nov 21, 2016. McCulloch, DK, MD, et al. ” Patient education: Preventing complications in diabetes mellitus (Beyond the Basics).” UpToDate. Updated: Feb 05, 2018. National Diabetes Educational Initiative. Diabetes Management Guidelines 2016. Updated: Jan 2016. NIH. The A1C Test and Diabetes. NIH. Updated: April 2018.