When you have type 2 diabetes, you likely check your blood sugar regularly and follow your treatment plan. Your doctor may suggest regular A1c blood tests a few times a year to monitor your progress. Lowering your A1c can help protect your health, and there’s a lot you can do to meet that goal.
Unlike a regular blood sugar test, the A1c test can tell you how much sugar 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 A1c goal for many adults with diabetes is to be lower than7%. But your actual target 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.
Why Your A1c Level Matters
Your A1c levels can alert your doctor about prediabetes or help them diagnose it. Normally, your blood sugar levels go up and down throughout the day. But A1c doesn't change as quickly, and this helps your doctor look at how well your treatment plan is working.
A1c helps find prediabetes
Your body goes through a process called prediabetes before you develop diabetes. Your A1c levels can start to rise to 5.7%-6.4%.
Prediabetes happens because your body has problems managing insulin. It's the hormone that helps glucose (blood sugar) get into cells, where your body can use it for energy.
If your body has a harder time getting glucose into cells over time, it can lead to insulin resistance which can raise blood sugar levels.
Helps track blood sugar to prevent diabetes
A1c levels can help you manage your blood sugar levels. Knowing how well your plan is working helps you take part in reversing prediabetes. For some people, diet and exercise can help prevent diabetes. Try to eat a diet high in:
- Fruits
- Veggies
- Nuts
- Whole grains and fiber
- Olive oil
More than half of the people with prediabetes who completed a lifestyle change program were less likely to get diabetes three years later than those who did not. If diet and exercise aren't enough, your doctor may talk about medicine to help prevent your type 2 diabetes.
A1c helps treat diabetes
Your doctor looks at A1c to get a better idea about how well your treatment is working over time. Depending on your situation, you'll work with your doctor to set A1c targets that make the most sense for your health.
For most people with diabetes, you'll keep A1c levels lower than 7% using treatments such as:
- Lifestyle changes
- Medicine
- Taking insulin
It's normal for your A1c level to change over time. These levels may not reflect your healthy lifestyle, but your A1c test can help you make the best treatment decisions.
Work toward the same goal
Getting on the same page as your doctor can help you:
- Set the best A1c target for your health
- Know your personal A1c target
- Take steps to lower your blood sugar
- Actively take a role in your treatment plan
Reach target A1c levels
Keeping your blood sugar levels under control can also help you reach your target A1c. Even better, lower blood sugar over time helps lower your risk for heart, kidney, eye, and nerve problems because of diabetes.
Know your numbers, ask your doctor about testing your A1c. Regular blood pressure and cholesterol checks can also help prevent heart problems earlier.
What the Numbers Mean
Your A1c number is a percentage that shows your average blood sugar over the last two to three months. This percentage is the portion of hemoglobin with glucose stuck to it.
Sharp changes in your blood sugar don't usually show up on A1c testing. That’s because your A1c shows your average blood sugar over the last 2-3 months.
The higher A1c number means higher blood sugar levels overall over the last few months. You and your doctor will work together to personalize your A1c goal.
Key A1c Levels to Know | ||
|---|---|---|
Age | A1c Level | Why It's Important |
Children and adolescents (under 18) | 5.7% to 6.4% | Catch prediabetes (5.7% to 6.5%) or diabetes (6.5% or more) early. |
Adults 18 to 64 | 5.7% to 6.4% | Screen, diagnose diabetes, and keep A1c less than 7% to lower the risk of complications. |
Adults 65 and up (healthy) | Less than 7.5% | Keep up lifestyle changes to maintain blood sugar. |
Adults 65 and up (complex health problems) | Less than 8.0% | Personal A1c targets (screening stops after the age of 70) |
Adults 65 and up (limited life expectancy) | Less than 8.5% | Can prevent hypoglycemia with a relaxed A1c goal. |
Keep in mind that these A1c goals may not fit everyone. Talk to your doctor; they’ll help you set an A1c goal that works for you.
What is estimated average glucose (eAG)?
If you check your blood sugar at home, you're used to seeing your glucose readings in milligrams per deciliter (mg/dL), not in percentages. Instead of an A1c percentage, your doctor can add up your average blood sugar over the last few months in mg/dL, or eAG.
This can make your A1c result easier to understand. The American Diabetes Association offers an online calculator to convert your A1c to eAG.
Ways to Lower Your A1C
After you and your doctor decide on the best A1c target, you'll put a treatment plan in place. This might involve medicines, lifestyle changes, or insulin.
How do you get there? Here are a few things 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. Measuring portions can help keep your servings in check, helping you avoid overeating.
This is a great way to keep blood sugar levels in control and lower your A1c level. Once you measure your food, you'll get an idea of what healthy portion sizes look like 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 like, especially of high-carb items such as:
- Cereal
- Rice
- Pasta
But this will help ensure you don't eat more than you should.
Be carb smart
Carbohydrates indeed affect your blood sugar more than other nutrients. Chances are that if you overdo starchy carbs on a regular basis, your A1c will start to rise.
But remember, not all carbs are 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, so try:
- Carrots
- Greens
- Zucchini
- Tomatoes
Fill about one-quarter of your plate with lean protein like chicken or tofu. And add whole grains, such as brown rice or quinoa, to the last quarter of your plate for a well-balanced plan.
Adding fiber is also key. Some studies show that after eating 18 grams or more fiber a day for 12 weeks, people with diabetes saw a dip in their blood sugar levels. The American Diabetes Association suggests eating at least 28 grams of fiber a day for a 2,000-calorie diet.
Make a plan
The guidelines give you a lot of flexibility for what to put on your plate. 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 foods
- High-carbohydrate food choices
- Fast food, like bagels or frozen pizza
- Foods that cause your blood sugar and A1c to soar
At the start of each week, pencil in a rough plan for what foods you'll eat at each meal. This way, you can prepare and know what groceries you'll need.
Try a Mediterranean diet. It's low in saturated fat and high in vegetables and fruits. It can reliably lower A1c numbers, too. Planning ahead can offer plenty of choices that limit post-meal blood sugar spikes.
Consider downsizing your weight loss goal
You may already be at your target weight. If not, losing just 5%-10% of your current weight can make a difference in your A1c.
Here's why: As you shed extra pounds, the insulin in your body works better to lower your blood sugar levels. This can drive your A1c levels down over time.
In one study, people with type 2 diabetes who lost 5%-10% of their body weight were three times as likely to lower their A1c by half a percentage point. You may have a different goal for your weight, so always ask your doctor to help you make the best weight loss plan that matches your overall goals.
Rethink your exercise plan
Staying active is one of the most important habit changes you can make to lower your A1c. But don't just sweat it out on the treadmill; strength training is another effective workout.
Be it the elliptical machine or your cycling class — you can choose to move anyway that's fun for you. Any exercise you prefer is great as long as it's a challenging one.
Both aerobic movement and resistance (weight) training can lower A1c levels if they're part of a regular routine. There's solid science to support how much working out helps you lower your A1c level and improve circulation.
Since exercise helps your muscles take up sugar from your bloodstream, moving also 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
It's important to your meds exactly as your doctor prescribes them, such as:
- Metformin
- Glucagon-like peptide-1 (GLP-1)
- Insulin
That can also mean regular blood sugar testing. Check your blood sugar levels regularly to stay on top of your medication. If you miss doses regularly, your blood sugar numbers may go up, raising your A1c.
Following your medication plan and regular doctor visits can help you keep your blood sugar under control.
If your goal is to cut down on or even stop needing your meds, consult your doctor. But don't stop the meds on your own.
Be savvy about supplements
Many dietary supplements claim to lower A1c levels, but often there's not enough research to back that up. Still, some may show promise:
- Berberine, made up of extracts from a variety of plants
- Coenzyme Q10 (CoQ10), an antioxidant that lowers inflammation in your body
- Cinnamon (may lower A1c levels over time)
- Flaxseed, ginseng, and magnesium
Unless you have a specific vitamin or mineral deficiency, the American Diabetes Association points out that there are no proven benefits to supplements. So it's best to check with your doctor before taking any supplements to treat diabetes.
Put your plan on repeat
Stick to your plan 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. Focus on making steady progress. Rest assured: Your A1c number will come down, and it'll be worth it.
Takeaways
Monitoring your blood sugar and regular A1c testing can guide your diabetes treatment plan. Your A1c level not only helps diagnose your diabetes, but it can also tell your doctor how well your treatment is working. Your A1c can change over your lifetime as you take steps to keep your blood sugar levels under control. Take your medications, make follow-up visits, and hit your A1c target to help lower your risk for diabetes complications.
A1c FAQs
What’s the difference between A1c and daily glucose monitoring?
Your A1c shows your average blood sugar level over the past two to three months and also helps your doctor understand how well your treatment is working. Daily glucose monitoring shows your blood sugar level at a specific moment, such as before or after a meal.
What is the hemoglobin variant?
It's a different type of hemoglobin you can inherit that isn't measured very well by the A1c blood test. Talk to your doctor if you:
- Are of African, Mediterranean, or Southeast Asian heritage
- Have any family members with sickle cell anemia or thalassemia
If A1c testing doesn't work for you, your doctor might suggest testing:
- Fructosamine
- Glycated albumin
- 1,5-anhydroglucitol
The fructosamine and glycated albumin testing can tell you about your blood sugar levels over the last two to three weeks.
Can illness affect A1c?
Because the test measures hemoglobin found in your blood cells, any condition changing your blood cells can lead to higher or lower A1c values. Let your doctor know if you:
- Are pregnant or think you might be
- Have anemia or a blood cancer
- Have a blood cell condition such as a hemoglobinopathy
- Have recently lost blood, had erythropoietin (EPO) therapy, or hemolysis
Is a lower A1c always better?
Lower A1c targets paired with some situations may raise your risk for low blood sugar (hypoglycemia). For instance, your doctor might suggest a higher A1c target (such as 7%-8% or higher) if you have:
- A shorter life expectancy
- Difficulty reaching a lower target
- Had diabetes for a long time
- Had severe low blood sugar or did not know your blood sugar was low (hypoglycemia unawareness)
- Serious complications from diabetes, such as kidney, nerve, or heart problems
