NutriSense Blog

A User-Friendly Guide to Understanding A1C

October 4, 2021
Reviewed By
Kara Collier, RDN, LDN, CNSC

Glycated hemoglobin, or A1C, is a medical blood test result used to gauge how much glucose has been in a person’s blood over a three-month period. It’s usually preferred to a simple fasting blood glucose level since it reflects an average of the ups and downs of blood glucose levels over a longer time horizon. You can find our primer on normal blood glucose levels here.

What is A1C, and How is it Measured?

Hemoglobin is a molecule found within red blood cells that helps carry oxygen all around our body for cells to use. One unique property of this molecule is it can spontaneously bind to glucose, fructose, and galactose. Since red blood cells tend to live for around 120 days, we can measure the percentage of glucose that’s been bound to hemoglobin, or glycated hemoglobin. You can get this lab tested at any doctor’s office and at many larger pharmacy chains.

A1C Levels

The best practice for interpreting your A1C result is always to discuss it with your primary care provider. This will provide the most context for your specific situation and goals. Here you can find what are generally considered normal levels of A1C and levels that you may want to take a closer look at.

Normal Levels of A1C

The normal range of A1C should be below 5.7%.

Prediabetic Levels of A1C

If your A1C levels are above 5.7%, then they’re above what’s considered normal. However, if they’re below 6.4%, this would still be regarded as a prediabetic range and not diabetes.

Diabetic Levels of A1C

Lastly, if your A1C levels are above 6.4%, this would be considered a marker of diabetes. Persistently elevated blood glucose levels have many adverse health effects. In this case, you should inform your primary care provider of this result as soon as possible.

Reasons to Order an A1C Test

Historically, this blood test has only been performed in the context of diabetes screening and workup. Today, you can always order an at-home test if you’re concerned and want an immediate result from a private laboratory. Alternatively, you can use an at-home test if you’ve been diagnosed with pre-diabetes and want to keep a close eye on your blood glucose trends. If you have symptoms that suggest you may be at risk of pre-diabetes, you can also use such a test to screen yourself, preferably in consultation with your primary care provider. People with other auto-immune diseases may be at increased risk of type 1 diabetes mellitus, for example, and often undergo an A1C test at least once annually. If you want to see a more detailed picture of your daily glucose trends, you can also use our guide comparing glucose monitors to find the best one that will work well for you.

Limitations of A1C Testing

If your blood glucose levels are fluctuating dramatically, in the sense that they have many spikes and lows over a 24-hour period, an average glucose level (what A1c measures) wouldn’t be able to pick up the high’s and low’s. One individual could have the same A1C value as another, but one person could be having glucose spikes to 140 while another is having spikes to 200. Also, because the test relies on the percentage of hemoglobin that has been glycated, the presumption is that hemoglobin is held constant, and the glucose in the blood is what will push the value higher or lower. But in some cases, such as people with chronic anemia, these results can be misleading as they have less hemoglobin than the average person. Even with the same amount of glucose in the blood, their A1C values would be elevated and could appear to indicate pre-diabetes when they are otherwise metabolically healthy. Similarly, someone with an intravascular hemolytic condition would have red blood cells broken down within the blood, causing further inaccuracy. Other examples that could cause your A1C level to be falsely high or low include recent blood loss, smoking, or Vitamin B12 deficiency. 

Common Signs and Symptoms That You Might Have a High A1C

It can be challenging to see if you have pre-diabetes since the symptoms are not specific and often confused with other common diseases or simply having a bad day. Some diseases manifest across multiple organ systems, like Cushing Syndrome, Polycystic Ovary Disease, or Hypothyroidism. In all these cases, as well as in Type 2 Diabetes Mellitus, you can have a finding called acanthosis nigricans, or the presence of darkened skin along the skin folds in the armpit, neck, or groin. Of course, not every presentation is the same. This can also be caused by extreme obesity, and some people also have skin tags growing along the patches of skin folds affected.

Ways to Lower Your A1C Levels

Keep an eye out for an upcoming comprehensive post on ways to control long-term glucose levels, but for the present moment, have a look at our short recommendations.

Exercise / Regular Physical Activity

In addition to improving insulin sensitivity, exercise can improve the metabolic handling of sugars in general. You can read more about this here.

Get Enough Sleep

Although this is an excellent wellness practice in general, it is imperative to get enough sleep if you are trying to keep blood glucose levels within a healthy range.

Reduce Stress

Acute stress is a normal part of life and some stress can actually be beneficial, but chronic stress is quite harmful to controlling blood glucose levels.

Understanding Blood Glucose and Personal Health Starts with NutriSense

Continuous glucose monitors (CGM) let you see exactly how your body responds to foods with different glycemic index values. These have been used in diabetic populations for many years and from the first marketing have been considered very safe and effective by the FDA. NutriSense is proud to offer the same CGM technology for the first time for the public to use alongside their team of world-class Registered Dietitians. NutriSense CGMs come with an innovative app that lets you track your blood glucose levels, and every meal is different. For example, a specific food’s effect on a person’s blood glucose levels will be changed by how it is prepared and what other foods are eaten.

Recent Posts

See All
Team Nutrisense
Hypoglycemia Without Diabetes: Symptoms, Causes, and Prevention
Learn more about hypoglycemia in non-diabetics, including symptoms to watch for, causes, and prevention strategies.
October 26, 2021
Team NutriSense
Getting Personal With Blood Glucose
Read our article to understand how tracking blood glucose levels can help you tailor your health plan to your specific needs.
October 22, 2021
Logan Freedman
Things are back to normal. Week 9 using NutriSense
This week Logan is back to normal. Join Logan, on week 8 of his journey with the NutriSense CGM program as he tries to achieve his goal of losing weight. We will follow Logan over the next 90 days to see what he and Nutrisense can accomplish together.
October 20, 2021

Get Inspiration in Your Inbox

Join our newsletter today to receive health related articles, recipes and special updates!
Thank you!
Oops! Something went wrong while submitting the form.