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A1C and Prediabetes: How Are They Connected?

Colleen Magnani, RDN, CDCES

Published in Glucose

8 min read

June 21, 2023
sugar cubes and a spoonful of sugar
sugar cubes and a spoonful of sugar

With the rising prevalence of prediabetes worldwide, understanding the connection between prediabetes and your blood sugar levels is increasingly important. A number of different factors can lead to an increased risk of this condition, and some people may experience few if any symptoms of prediabetes if they develop it.

Let’s explore the role of A1C levels in a prediabetes diagnosis, as well as healthy ways to keep your A1C levels in an optimal range and stay on top of your wellness.

What is an A1C Test?

how a1c test works graphic

Also known as a HbA1c test, an A1C test measures your average blood sugar level over the past two to three months. Instead of measuring the amount of sugar in your bloodstream, your A1C level represents the percentage of hemoglobin in your red blood cells that are coated in sugar. 

When sugar enters your bloodstream, it attaches itself to hemoglobin. Everyone has some amount of sugar attached to the hemoglobin in their blood cells, but people with high blood sugar levels have higher levels of it.

An A1C test is a type of blood sugar test used to diagnose prediabetes and diabetes. An A1C less than 5.7 percent is considered normal. Generally, an A1C between 5.7 and 6.4 percent is considered prediabetes, and 6.5 percent or higher is considered diabetes. 

To see an estimate of your A1C levels, try our A1C level calculator here.

Who Should Get an A1C Test?

According to the Centers for Disease Control and Prevention (CDC), A1C testing is recommended for those who have already been diagnosed with diabetes, adults over 45, and those who are under 45 but are overweight or have one or more risk factors for prediabetes or type 2 diabetes.

If you have prediabetes, you should repeat an A1C test as often as your healthcare provider recommends. 

Understanding Prediabetes: Causes, Signs, and Treatment 

list of causes of prediabetes

Prediabetes is a condition in which blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes. Anyone can develop prediabetes, even if you’re not overweight, but certain people may be at higher risk. Risk factors for prediabetes include:

  • Being 45 years or older
  • Being obese or overweight
  • Having a family history of diabetes
  • Living a sedentary lifestyle or being physically active less than three times a week
  • Having a history of gestational diabetes
  • Being of a certain ethnicity, such as African American, Hispanic, American Indian, or Alaskan Native, Pacific Islander, or Asian American

Prediabetes vs. Diabetes

Diabetes is a chronic condition where the body either doesn't produce enough insulin or is unable to effectively use the insulin it produces. This leads to consistently elevated blood sugar levels, which can have serious long-term health consequences such as cardiovascular disease and kidney failure.

On the other hand, prediabetes is a condition where blood sugar levels are higher than normal but not yet high enough to be classified as a diagnosis of diabetes. It serves as a warning sign and an opportunity for early intervention.

People with prediabetes have a high risk of developing type 2 diabetes and other associated health complications. However, studies also show that prediabetes can be reversed with lifestyle changes like healthy eating, regular exercise, and weight management.

Signs of Prediabetes

list of symptoms of prediabetes

Prediabetes often has no signs or symptoms and can only be diagnosed by a doctor through blood glucose tests such as an oral glucose tolerance test or a fasting plasma glucose test.

However, there are possible warning signs that prediabetes has progressed to type 2 diabetes, and these include:

  • Increased hunger or thirst
  • Frequent urination
  • Fatigue
  • Blurred vision
  • Numbness or tingling in the hands and feet
  • Frequent infections or slow-healing sores
  • Unintended weight loss

Treatment for Prediabetes

a bowl of chickpeas, avocado, and veggies

Treatment for prediabetes primarily focuses on lifestyle changes that improve blood sugar control and lower the risk of diabetes. These can include weight loss if you’re overweight, healthy eating, regular physical activity, and stress management.

Some people with prediabetes or diabetes are treated with medications, including Biguanides, Thiazolidinediones, α-Glucosidase Inhibitors, and GLP-1 agonists. However, treatment and management of prediabetes is not a one-size-fits-all approach, and is usually personalized based on an individual's specific needs, and medical history.

Collaborating with healthcare professionals, including dietitians and exercise specialists, can provide valuable guidance and support when developing a diabetes prevention program or plan.

6 Healthy Ways to Keep Your A1C Levels Low

list of tips to help you lower a1c

Keeping your A1C levels at a healthy level is important for your overall health. Luckily, there are plenty of steps you can take that can support optimal A1C levels, including dietary changes, physical activity, and healthy lifestyle changes. 

Here are a few of the things you can do:

1) Build a Nutrient-Rich Meal Plan

A nutritious meal plan plays a crucial role in keeping A1C levels low and managing blood sugar effectively. Here are some tips for building a nutrient-rich meal plan:

  • Incorporate a diverse range of nutritious foods, including fruits, vegetables, whole grains to glucose tolerance, lean proteins, and healthy fats into your meals. Each of these provides essential nutrients that contribute to overall health. 
  • Focus on fiber-rich foods, such as non-starchy vegetables and legumes as they help slow down digestion and may prevent rapid blood sugar spikes. However, carb-containing foods may not all be tolerated equally for those with prediabetes and testing your personal tolerance is important. 
  • Include lean sources of protein, such as poultry, fish, tofu, legumes, and low-fat dairy, in each meal. Protein helps regulate blood sugar levels, and supports muscle and tissue health as well as helping to maintain a healthy weight.
  • Opt for sources of healthy fats, such as avocados, nuts, seeds, olive oil, and fatty fish, which provide essential fatty acids and promote cardiovascular health.

2) Manage Portion Sizes and Track Carb Intake

a bowl of quinoa with veggies, egg, and bread

Being mindful of your portion sizes and  carbohydrate intake can contribute to healthy A1C levels. The American Diabetes Association advises monitoring the amount of carbs you eat in each meal or snack to prevent sharp spikes or prolonged elevation of blood sugar. 

Carbohydrates are broken down into glucose during digestion and can lead to glucose spikes when eaten in large amounts. Make sure to pair your carbs with a source of protein and and fiber to reduce the chance of higher glucose spikes.

3) Commit to Regular Exercise

Getting appropriate amounts of exercise plays a crucial role in keeping A1C levels low and managing your blood sugar. Physical activity enhances insulin sensitivity, allowing the body to use insulin more effectively. 

Appropriate amounts of exercise also supports weight loss and weight maintenance efforts, which is important for managing A1C levels.  Excess weight and obesity are risk factors for developing or worsening insulin resistance, which can negatively impact blood sugar control. However, over-training or improperly fueling for your workouts can backfire, adding more metabolic stress and potentially raising glucose levels as well. So finding the right balance is important.

4) Partner With a Certified Nutrition Professional

Partnering with a qualified nutritionist can provide you with specialized guidance, education, and support to make healthy dietary decisions and effectively manage blood sugar levels. A nutrition professional such as a registered dietitian or certified nutrition specialist can provide individualized guidance and dietary support based on your unique needs, preferences, and health goals.

They can also take your unique medical history, lifestyle, cultural background, and dietary restrictions into account. They can help you make practical meal plans that align with your dietary goals and blood sugar targets, which can be especially useful in managing your A1C levels. 

5) Address Stress and Mental Well-Being

a woma doing yoga in the park

Addressing your mental health is important for your physical health. Emotional stress can trigger the release of stress hormones like cortisol and adrenaline, which can raise blood sugar levels.

Prolonged or chronic stress from a variety of sources can lead to sustained elevated blood sugar levels, making it difficult to maintain healthy A1C levels. Try managing your stress levels by properly fueling your body with the nutrients it needs to function, getting enough sleep, practicing breathing techniques, meditating, or engaging in other stress-relieving activities

6) Track Your Blood Glucose 

Regular monitoring of blood glucose levels can increase your awareness and understanding of how different factors, like diet, physical activity, medication, stress, and sleep, affect your blood sugar levels. One innovative solution to tracking your blood sugar is using a continuous glucose monitor (CGM). 

This device continuously monitors glucose levels throughout the day, offering real-time insights into blood sugar trends and patterns. Through a program like the Nutrisense program, you’ll also receive personalized guidance from registered dietitians and nutritionists that can help you interpret your blood sugar data, provide recommendations, and support you in making meaningful changes to your lifestyle.

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Engage with Your Blood Glucose Levels with Nutrisense

Your blood sugar levels can significantly impact how your body feels and functions. That’s why stable blood glucose levels can be an important factor in supporting overall wellbeing.

With Nutrisense, you’ll be able to track your blood glucose levels over time using a CGM, so you can make lifestyle choices that support healthy living.

When you join the Nutrisense CGM program, our team of credentialed dietitians and nutritionists are available for additional support and guidance to help you reach your goals.

Ready to take the first step? Start with our quiz to see how Nutrisense can support your health.

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Heather Davis, MS, RDN, LDN

Reviewed by: Heather Davis, MS, RDN, LDN

Heather is a Registered and Licensed Dietitian Nutritionist (RDN, LDN), subject matter expert, and technical writer, with a master's degree in nutrition science from Bastyr University. She has a specialty in neuroendocrinology and has been working in the field of nutrition—including nutrition research, education, medical writing, and clinical integrative and functional nutrition—for over 15 years.