You may have heard of A1C tests as hemoglobin A1C, glycosylated hemoglobin, HbA1c, or estimated average glucose (eAG) tests. They're a tool to screen for pre-diabetes, diagnose diabetes, or monitor a diabetes treatment plan.
The A1C test measures the percent of hemoglobin proteins in the blood coated with sugar. It also reflects average blood sugar (glucose) levels for the past two to three months. There are some flaws with this test, though. So, we also want to consider blood glucose readings, the frequency of highs and lows on these readings, and your lifestyle. For more on A1C testing, check out this article!
Does everyone need an A1C test? It depends on several factors, such as your age and medical history. People over 45 and those under 45 with risk factors for pre-diabetes or diabetes should. If the results are normal, both groups should take the test annually or according to their primary doctor’s recommendations. Those with pre-diabetes should consider having their A1C assessed more frequently.
The frequency of an A1C test for those with diabetes depends on their self-management. Someone who is not on insulin, who has blood glucose values within their target range, should take the test twice a year. People on insulin or those who have trouble keeping their blood glucose stable can get quarterly tests. As we already know, the A1C test looks at your average blood glucose values for two to three months. So, you don’t need to take it more than once every three months.
People with higher blood sugar values have more sugar attached to their hemoglobin, which leads to a higher A1C. It's important to speak with your doctor about your specific A1C goals. But if you're curious, here's what those numbers on your results mean:
As you can see from the image, a 'normal' range is <5.7%, 5.7-6.5% is seen as a risk of pre-diabetes, and >6.5% reads as diabetes.
Even though <5.7% is considered ‘normal,’ some compelling research suggests that a lower A1C aligns with appropriate glucose tolerance more accurately. Some studies have suggested aiming for an A1C around 5.3%, but researchers are still determining the optimal value.
It's common for those diagnosed with type 2 diabetes to aim for an A1C of 7% or less.
Seeing elevated A1C levels can be distressing, and it could leave you wondering if it's possible to lower them. Fortunately for you, the answer is yes! This isn't a quick fix, though, since the amount of time it takes to see any improvements can vary.
If your A1C levels were initially high (think close to 10%), they'll likely come down quicker with diet and lifestyle changes. If your levels were only moderately elevated, it might actually take longer for them to come back down with those same changes. Remember that the test looks at average blood sugar values over two to three months, so you can expect it to take at least that long to see any improvement.
When we eat carbohydrates on their own, our body quickly and easily breaks them down to glucose that it then uses for energy. This can contribute to glucose spikes, and ultimately, to higher A1C levels.
But don't swear off carbohydrates just yet—there's another way to avoid these spikes. Instead, pair protein, fiber (like non-starchy vegetables), and healthy fats with your carbohydrates. This blunts the glucose response and helps you achieve more stable, less extreme glucose values. Over time, this will also lead to lower A1C levels.
A good rule of thumb to follow for great blood sugar control is eating more low-carb vegetables, protein, and healthy fats, along with a moderate serving size of carbohydrates. You can mix and match based on your preferences and lifestyle, but here are some options to help you start out:
Since we're most sensitive to carbs on an empty stomach, the order in which we eat can also affect our glucose. One way to ensure steadier glucose levels is to try meal sequencing. This involves a solid base of healthy fats, protein, or fiber before you eat any carbohydrates. It will help reduce glucose swings.
Planning meals can enable you to hold yourself accountable and stick to your goals. A set schedule for daily meals can also help you avoid making poor eating decisions when hungry and time-crunched. Of course, this doesn't mean that you have to plan every meal, snack, and beverage you consume down to the minute (unless that's what works for you!). But having a rough idea of how you'd like to eat can be helpful.
Be realistic about your schedule and how much time you have for meal preparation. For some people, two to three-day plans are more manageable. For others, planning for the week ahead works best. When you know you have a busy day ahead, focus on meals that you can throw together in a pinch. Or, consider doing some prep work, like chopping vegetables and marinating meats, the night before.
Don't forget to stay flexible so you can plan for emergencies and last-minute disruptions in your schedule. Having a few grab-and-go items in your pantry can make hectic days easier to manage. Some helpful options include rotisserie chicken, bagged salads, hard-boiled eggs, frozen or pre-chopped vegetables, and pre-cooked shrimp. You can add these items to salads and soups or combine them with other ingredients for a simple yet satisfying meal.
Can you tell how many grams of carbohydrates you're consuming just from looking at an apple (if you’re curious, a medium apple has around 25g)? Not many of us possess that skill, which is why it's easy to underestimate how many carbohydrates you're actually eating.
Using a food tracking app can help you learn about appropriate serving sizes and give you an idea of your total carbohydrate intake in a day. This can also help you stay accountable and stick to your goals.
Losing 5-10% of your body weight can improve A1C, so if you're overweight, you may want to consider using that percentage as your weight loss goal. If you're on medications for diabetes, you may find that you need less medication as you lose weight.
The key to weight loss that will actually work is to set a realistic goal with a sustainable weight loss target. A safe bet is 1-2 pounds per week, so if you know that you want to lose 20 pounds, plan on spending two and a half to three months working at it. Using a continuous glucose monitor (CGM) can help you develop a personalized plan for weight loss.
Not sure where to start when it comes to planning meals or choosing foods to help lower your A1C? Working with a dietitian can help! There are many conflicting nutrition recommendations. It can be a challenge to sort through them all and pick the perfect one for your individual needs.
A registered dietitian can help you wade through the options to find the right program for you. They often look at your medical history, preferences, and lifestyle to tailor it to your needs. It's important to pick a dietitian you can be open and honest with. So, take the time to find a dietitian that you can trust to help you on this journey.
The American Diabetes Association recommends getting 150 minutes of moderate-intensity exercise per week. This stems from the fact that all types of exercise improve insulin sensitivity and glucose control. This can also ultimately help with your A1C levels.
Exercise plans, much like meal plans, encourage you to stick to your goals. Here are some tips that may help you plan your new exercise regime:
Did you know that stress can impact your glucose? Our bodies have a fight or flight response to stress. This increases glucose production and reduces insulin sensitivity, leading to higher glucose.
Just like getting started with exercise, learning to manage stress can take some time and practice. Here are a few techniques to consider:
You can't avoid stress altogether, but these techniques, coupled with adequate sleep (more on that below!), can help you manage it. Taking care of your mental health is also essential when you're trying to manage stress. So don't hesitate to seek professional support if you need to.
The role sleep plays when it comes to optimizing A1C is interesting. If you don't already know, sleep and glucose values have what's known as a bidirectional relationship. This means higher glucose can lead to a worse night of sleep and that poor sleep can cause suboptimal glucose the next day.
A study from 2019 looked at sleep duration and A1C levels in 962 individuals with either pre-diabetes or untreated type 2 diabetes. They found that those who slept a consistent seven to eight hours every night had significantly better A1C values than those who slept either five hours or less or more than eight hours.
Consider incorporating healthy sleep hygiene habits to get better sleep and optimize your A1C in the process, like:
Berberine is an herbal compound that may help improve glucose levels. It's often explored as a possible therapy in diabetes, but the specifics of how it works to help glucose levels are not entirely clear.
It's thought to work either by increasing insulin receptor activity (making it easier for glucose to leave the bloodstream and enter our cells) or through its antimicrobial effects. As with any supplement, this could interfere with some medications, so discuss with your doctor before trying.
Do you want to keep a closer eye on your glucose values? Don’t want to wait three months to see if the changes you’re working so hard to make are having the desired effect? NutriSense can help! Our program hooks you up with a continuous glucose monitor (CGM) that gives you real-time feedback. So you can track how your body handles specific foods, sleep, exercise, and more. We’ll also connect you with a registered dietitian to help you understand the data and improve your A1C levels.
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