A1C is a blood test that measures your average blood sugar level for the past two to three months. A1C is also called a hemoglobin A1C, HbA1c, glycated hemoglobin, or glycated hemoglobin test. In the body, a protein called hemoglobin carries oxygen and nutrients throughout the body. You can collect glucose along the way and the glucose will bind to hemoglobin, which is then converted to glycated hemoglobin. The higher the blood glucose level, the more glucose binds to hemoglobin. The A1C test measures the amount of hemoglobin with glucose attached to it.
This test is often used to diagnose prediabetes and diabetes, and to track treatment plans for people with diabetes. Experts have identified A1C levels for a healthy person, prediabetes, and type 2 diabetes , and knowing your A1C level can help you make adjustments to your treatment and lifestyle.
A1C ranges and what they mean
The A1C result is presented as a percentage, reflecting the percentage of glucose and hemoglobin bound. For example, an A1C level where there are five glycated hemoglobins out of 100 hemoglobin would be 5%.
- Normal: less than 5.7%
- Prediabetes: 5.7% to 6.4%
- Diabetes: 6.5% and more
The higher the A1C, the higher the blood glucose level. If your A1C is in the prediabetes range, you should speak with your doctor to determine the best way to prevent type 2 diabetes, as prediabetes is a known risk factor for type 2 diabetes. In general, within the prediabetic range, the higher the A1C, the greater the risk of diabetes.
The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes.
What happens when the A1C is too high?
The high A1C level cannot be ignored. Research shows a direct correlation between high A1C levels and serious complications of diabetes. An A1C level greater than 7% means that a person is at a higher risk of complications from diabetes, which should make sure that the person has a plan to control their blood sugar and reduce that risk. If these strategies already exist, an increase in A1C may indicate that they need to be modified.
Several factors can falsely raise or lower your A1C score, including:
- Kidney failure, liver disease, or severe anemia.
- Immigrants from Africa, the Mediterranean or Southeast Asia
- Certain blood disorders (such as sickle cell anemia or thalassemia)
- Certain medications, including opioids and some HIV medications.
- Loss of blood or blood transfusion.
- Early or late pregnancy
If not treated properly, high blood sugar levels can lead to serious complications such as heart disease, stroke, vision loss, nerve damage, kidney and gum disease. Short-term problems to watch out for include hypoglycemia and hyperglycemia .
Heart disease and stroke
People living with diabetes have high blood sugar levels, and over time this can damage the blood vessels and nerves that control the heart, which can lead to heart disease . People with diabetes have been found to develop heart disease at a younger age than people without diabetes. Also, the longer you have diabetes, the greater your chances of developing heart disease.
The most common type of heart disease is coronary artery disease , which occurs when plaque builds up on the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made up of cholesterol deposits that constrict the inside of the arteries and reduce blood flow. This process is called atherosclerosis or hardening of the arteries. Reduced blood flow to the heart can lead to a heart attack .
Reduced blood flow to the brain can also cause a stroke . Diabetic patients are especially at significantly higher risk of stroke and have a higher mortality rate.
Those who have diabetes are also more likely to have other conditions that increase their risk for heart disease, including:
- High blood pressure : This increases blood flow to the arteries and can damage the walls of the arteries.
- Too much low-density lipoprotein (LDL) cholesterol – This is also known as bad cholesterol and can lead to plaque buildup on the walls of damaged arteries.
- High triglycerides : This, when combined with low HDL cholesterol or high LDL cholesterol, is believed to help strengthen the arteries.
People with diabetes are also more likely to have heart failure when their heart cannot pump blood well.
Diabetes can also damage the eyes, which can lead to blurred vision and vision loss . Eye problems that can occur in people with diabetes are called diabetic eye diseases, which include diabetic retinopathy , diabetic macular edema (fluid retention in the retina ), cataracts , and glaucoma . However, people with diabetes can take steps to prevent diabetic eye disease by taking care of their diabetes.
If blood glucose levels remain high over time, they can damage the tiny blood vessels at the back of the eyes. This damage can start during prediabetes. Damaged blood vessels can leak fluid and cause swelling. New weak blood vessels can also start to grow. These blood vessels can bleed in the middle of the eye, leave scars, or cause dangerously high pressure inside the eye.
Diabetic retinopathy is the most common cause of vision loss in people with diabetes. Early detection and treatment of diabetic retinopathy can reduce the risk of blindness by 95%.
At the first eye injury, warning signs are often missing. A comprehensive dilated eye exam helps your doctor identify and treat vision problems early, before serious vision loss occurs. Adults with type 1 diabetes undergo eye enlargement exams for five years after diagnosis and then every year thereafter. Adults with type 2 diabetes should have an eye exam soon after diagnosis and an enlarged eye exam every year.
Damage to the nerves caused by diabetes is called diabetic neuropathy . High blood sugar damages your nerves, and these nerves can stop sending messages to various parts of your body. Nerve damage can cause problems ranging from mild numbness to pain. Half of people with diabetes have nerve damage.
There are several types of neuropathy:
- Peripheral nerve damage: This type of damage affects the hands, feet, legs, and arms and is the most common type of nerve damage in people with diabetes. This usually starts with the legs; usually on both legs at the same time.
- Autonomic nerve damage: affects the heart, bladder, stomach, intestines, genitals, or eyes.
- Proximal nerve injury: Nerves in the thighs, thighs, buttocks, or legs are affected. It can also affect the abdomen and chest area.
- Focal nerve injury: Individual nerves are affected, most often in the arm, head, trunk, or leg.
People with diabetes should pay attention to the symptoms of nerve damage by recognizing new symptoms associated with pain, numbness, or new incontinence or bowel control problems. As with other complications, keeping your blood sugar levels as close to your target range as possible is the best way to prevent or delay nerve damage.
People with diabetes can also get diabetic kidney disease . About one in three adults with diabetes has kidney disease. High blood glucose levels can damage the blood vessels in the kidneys. When this happens, they stop working. Many people with diabetes also develop high blood pressure, which can also damage the kidneys.
Diabetes doesn't just lead to high blood sugar levels. People with diabetes also have sugar in their saliva, which ends up in their mouth. Therefore, your teeth and gums are more exposed to sugar, which promotes the growth of microbes and plaque, irritating the gums and causing them to become ill .
In addition to gum disease, the jaw and tongue, as well as other tissues in the mouth, can be affected. Gum disease and other more common oral problems in people with diabetes include:
- Gingivitis (swollen or diseased gums)
- Canker sores (oral candidiasis)
- Xerostomia (dry mouth)
- Oral burning
Some of the first signs of gum disease are swollen, painful, or bleeding gums. Sometimes you may not have any signs of gum disease. You may not realize this until you are seriously injured. The best defense is to visit the dentist twice a year for cleanings and check-ups.
While the complications of diabetes are serious, there are ways to control your blood sugar levels to lower your A1C levels and prevent them. With the help of a healthcare professional, a treatment plan that includes medications and lifestyle changes can help lower your levels and avoid complications.
Track healthy eating and diet
Your diet has a big impact on the way your body makes and uses blood sugar. To maintain healthy blood sugar levels and therefore lower A1C, it is helpful to eat healthy and track your food intake. Tracking your food intake helps you plan healthy options ahead of time, as well as analyze what may have been causing your blood sugar spike.
Here are some healthy snacks to help lower your A1C levels:
Stress Relief Techniques
Stress management is critical to overall health and helps people with diabetes in particular.
Research has shown that acute stress can increase glucose production and interfere with glucose utilization. This means that better stress management can have a positive effect on blood sugar levels.
Some methods to relieve stress include:
- To meditate
- Talk therapy
Exercise helps people with diabetes for a number of reasons, including weight loss and stress relief, but it also directly affects blood sugar levels. When you exercise, your muscles need and use sugar, which lowers blood levels. Studies have shown that regular and prolonged physical activity training has a positive effect on glycemic control and body composition in patients with type 2 diabetes. It also contributed to the development of the cardiovascular system among these patients.
The more you exercise, the greater the decrease in A1C. Try to be active for at least 10 minutes every day.
Medications and periodic monitoring
The A1C is an important tool for managing diabetes, but it is not a substitute for regular home blood sugar tests. Blood sugar rises and falls during the day and at night, which does not show up on your A1C. Two people can have the same A1C: one with constant blood sugar levels and the other with high and low fluctuations.
If you reach your A1C goal but have symptoms of rising or falling, check your blood sugar more often and at different times of the day. Track your results and share them with your healthcare provider so that you can make changes to your medication and treatment plan as needed.
Get the word of drug information
The A1C blood test is just one of many tools for monitoring and controlling blood sugar levels. A1C is the average blood sugar level for 90 days, so healthcare professionals will likely recommend checking your blood sugar between A1C tests if your blood sugar is not being monitored. Checking your blood sugar regularly can help you identify factors that affect your blood sugar and adjust your treatment plan. Controlling diabetes is your best defense against the various complications that diabetes can cause. Discuss problems and new symptoms with your doctor to make sure your treatment plan is tailored to your needs.