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The hemoglobin A1c (many people just say “A1c”) is a blood test that reflects average blood sugar levels in your blood stream over the preceding two to three months. The higher your average blood sugar levels have been during this time, the higher the hemoglobin A1c levels are. People who do not have diabetes typically have hemoglobin A1c levels under 5.7. Someone with very poorly controlled blood sugar may have a value over 10.
Several major studies have shown that people with hemoglobin A1c levels close to the normal range will have fewer problems related to diabetes over time, especially where problems with the eyes, kidneys and nerves are concerned. Therefore, people are often told that they should strive to get their hemoglobin A1c under 7. That’s usually a good target, but there are exceptions.
Everyone knows that very low blood sugars (hypoglycemia) are dangerous. The lower your average blood sugar level is, the more likely you are to have episodes of a low blood sugar. Therefore, for most people the risk of low sugar reactions is what limits how far they can lower their hemoglobin A1c. For example, several other studies have shown a higher mortality for people who have hemoglobin A1c levels that are too low. In these studies, having a value in the low- to mid-5 range appeared more dangerous than having values in the 6-range. People who are at high risk of low blood sugar reactions, or those who have less concern about long-term complications, may have targets that are higher than 7. An example might be a person who really does not feel the symptoms of a low blood sugar, or a person in his or her 80s who needs to be more concerned about short-term low sugar reactions rather than complications that will develop over many years. On the other hand, if some is being treated with diet only, or is taking only metformin, which does not cause hypoglycemia on its own, it is very safe for them to have hemoglobin A1c levels in the 5 range.
One more very important point: the hemoglobin A1c represents an average, but fluctuations in the blood sugar are also very important. It’s generally safer to have blood sugars that don’t vary widely. For my patients I would rather have a hemoglobin A1c that is a touch higher without too many peaks and valleys than to have a lower value with wide swings all the time. Best of both worlds: numbers that are close to normal and don’t jump around too much.
Endocrinology Diabetes & Metabolism,
For most people with diabetes, the A1C goal is less than 7% in order to help avoid complications. However, the A1C goal may be modified based on the presence of certain complications, cognitive status and life expectancy. Also, people who have hypoglycemia unawareness (the inability to feel symptoms of low blood glucose) may benefit from a higher A1C goal for safety reasons. Make sure you talk to your healthcare provider about what you own A1C goal should be.
Defining The HbA1C
HbA1C is a measurement of the amount of glycosylated hemoglobin in your blood. Glycosylated hemoglobin is created when glucose (blood sugar) attaches to the hemoglobin in red blood cells. The Higher the HbA1C you have the more glucose in your blood over a 2-3 month period of time. For optimum management of diabetes, the HbA1C test should be taken every 3 months.
The higher your HbA1c levels, the higher the risk of developing future problems such as heart disease, nerve damage, eye disease, kidney disease and stroke. If your HbA1c remains high for a long period of time this will increase the risk but the closer to normal levels the lower the risk for diabetes-related diseases.
Normal levels for people with diabetes are 7% and below. If your child’s HbA1c is higher then 8% depending on age, (set by American diabetes Association) then treatment (insulin, quantity of blood tests, etc.), exercise, or diet need changing.
A hemoglobin A1c level less than 7%means that the blood sugar should only go above 150 mg/dl after a snack or meal for a few hours. On average, a person without diabetes HbA1c level is between 4 to 6 percent. Blood sugars of 70 mg/dl, or lower are dangerous and should be avoided.
Most doctors I have encountered want your sugar levels to be between 70-120 mg/dl but my recommendation is a target area of 80 to 140mg/dl for adults with a goal of 100mg/dl. This blood glucose range is less stressful on the individual living with diabetes and is more obtainable. The American Diabetes Association has set age appropriate levels:
- For children younger then 6 years old, the target is 8.5%
- For six to 12 year olds, the target is under 8%
- For teens age 13 to 19, the target is under 7.5%
- For adults, the target is under 7%
A1c is a commonly used three-month average measure of your blood sugar. Instead of making it a perfunctory measurement, I recommend using that three-month window as a way to both challenge and reward yourself to reach a goal A1c measurement of 6.5. This is just a little higher than normal blood sugar, but lower than the 8 or 9 that many diabetics commonly have. While reaching 6.5 doesn’t mean your diabetes is “cured,” it’s something your doctor will applaud, and it shows that you are successfully managing your disease.
This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.