All you need to know about A1C levels and diabetes

You’ve probably heard of A1C. And you might know it has to do with diabetes.

But what is A1C? And what affects it?

What is A1C?

“A1C is basically a test to show the three-month average of your estimated blood sugar,” says Jennifer Berdinka, RD, a diabetes educator at PeaceHealth in Bellingham, Washington. The test gives you another way of looking at your metabolic health.

The full name of the A1C test is HbA1C. Hb stands for hemoglobin, the protein that makes blood look red. A1 is the type of protein. C stands for glycated (sugar).

The average life span of a red blood cell is about three months. Results of the A1C test are given as the percentage of your red blood cells with sugar attached. For example, if the results of your A1C test is 7, then about 7% of your hemoglobin cells have sugar sticking to them. (Hint. That’s a bit high.)

But the A1C is just one way of looking at blood sugar. If you have diabetes, you’re familiar with the need to check your blood sugar throughout the day. A1C is the longer-term picture while your daily glucose readings give you real-time snapshots. 

“Daily monitoring with a glucometer or finger sticks is really very helpful so that you can see the effects of foods you're eating and so you know on a daily basis what your actual blood sugar is at any given time,” Berdinka says.

How often to check A1C?

If your day-to-day blood sugar levels fall outside the target range (more on that soon), you might need to have an A1C test about every three months, she says.

If your daily blood sugar levels are fairly stable, your doctor might stretch out the need for an A1C check to every six months.

If you don’t have diabetes, your doctor might order an A1C as part of a periodic or regular checkup.

What your A1C reading should be

For someone with diabetes, medical providers like to see an A1C below 7%. A reading of 6.5% would be ideal.

If your A1C is below 5.7%, it means your blood sugar is in the typical range and you don’t have pre-diabetes or diabetes.

Your A1C reading can vary. Age, pregnancy or complex health conditions can make your A1C target different, says Berdinka. You’ll want to work closely with your primary care provider to pinpoint your goal.

Keeping your A1C within range reduces your risk of complications with diabetes. High blood sugar over a long period of time can lead to serious conditions such as blurred vision, hardening of arteries or nerve damage.

8 things that can affect your A1C

Following are a few things that can affect your A1C:

1. Mindful eating.  This could be the most important point: Pay attention to the amount and the type of carbohydrates you eat. Carbs with a low glycemic index are your friends. Whole grain is better than white flour. Veggies and fruits high in fiber and low in sugar are also better choices.  
   
   “And instead of eating just carbs by themselves, try combining them with lean proteins and healthy fats,” says Berdinka. Good plant-based fats to consider include olive oil, avocados, nuts or seeds. The combination can keep your blood sugar levels from spiking.
2. Exercise.  Physical activity of any kind is very important for healthy A1C. Walking, swimming, biking, gardening or any type of aerobic exercise reduces insulin resistance. 
   
   Insulin is a hormone that plays a key role in moving sugar out of the blood and into our cells. If you have diabetes, the walls of your cells aren’t able to use insulin the way they should. In effect, sugar gets “locked out.” Exercise helps lower insulin resistance, allowing the glucose in your blood to enter your cells more easily. That’s better for your overall blood sugar levels.
3. Bigger muscle mass. Stronger muscles make exercise easier and more enjoyable. They also help lower insulin resistance. If you’re new to strength training, you can try some light weights at the gym, yoga or even gardening to build up your muscles.
4. Modest weight loss. A lot of research shows that you don’t have to lose a lot of weight to make a difference in your A1C reading. As little as 7 to 10% weight loss is often enough to significantly lower insulin resistance and improve your overall blood sugar.
5. Managed stress. Stress raises your blood sugar. “Your stress hormones, whether it's cortisol or adrenaline, boost your blood sugar so you can go into fight, flight or freeze mode,” Berdinka says. 
   
   Find ways to lower or manage your stress and anxiety. Everyone is different. But exercise helps a lot of people. Meditation or deep breathing might also work. You can experiment with different activities to see what helps you feel calm.
6. Good sleep. Sleep is a powerful stress management tool. If you have insomnia or get up multiple times in the night, it may lead to higher stress hormones — and you know what that means...potentially higher blood sugar. Adopt healthy sleep habits and see how it pays off.
7. Medication, if needed.  Medication is often necessary to help lower someone’s A1C. Work with your primary care provider to find the right medication for you. 
   
   “Keep in mind that medication is only one piece of diabetes management,” says Berdinka. “It really does need to be a coordinated effort of eating a healthy diet, exercising and stress management. It’s the combination of activities along with medication that can help lower blood sugar.”
8. A good support system. Managing diabetes can be tough. But you don’t have to do it alone. Diabetes educators like Berdinka and other professionals at PeaceHealth are eager to help. “We really like to partner with patients to empower them with information they can use to feel better,” she says. 
   
   Ask your primary care provider about educational and support resources available to help you.