What Are Normal Hemoglobin A1c Levels And Are Low Or High Levels Dangerous
In a healthy person, the A1c level is less than 6% of the total hemoglobin. It is recommended that treatment of diabetes be directed at keeping an individual A1c level as close to the normal range .
- In most labs, the normal range for hemoglobin A1c is 4% to 5.9%.
- In well-controlled diabetic patients, hemoglobin A1c levels are less than 7.0%.
- In poorly controlled diabetes, its level is 8.0% or above.
The benefit of measuring hemoglobin A1c is that it gives a more reasonable view of what’s happening over the course of time to the average glucose level in the blood. Hemoglobin A1c values do not bounce up or down as much as daily finger stick blood sugar measurements.
|*Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.SOURCE: Centers for Disease Control and Prevention|
The American Diabetes Association currently recommends an A1c goal of less than 7.0%, while other groups such as the American Association of Clinical Endocrinologists recommend a goal of less than 6.5%. In 2016, the ADA recommended an A1c level of 6.5% as a cutoff level to diagnose diabetes.
Target Levels In People With Diabetes
A doctor will set a persons target A1C level based on many factors. The right target varies from person to person.
For someone with diabetes, the target A1C level may depend on:
- the persons age
- how long they have had diabetes
- their prescribed treatment plan
- any history of adverse effects from the treatment, including episodes of low blood glucose, or hypoglycemia
- any complications from diabetes
- the persons preferences and treatment priorities
In general, a doctor might recommend aiming for A1C levels under 6.5% if a person:
- is young and has a long life expectancy
- has had diabetes for a short period
- is effectively managing their diabetes with lifestyle changes or metformin alone
- is otherwise in good health
A doctor might recommend A1C targets of 7.08.5% if a person:
- is older and has a shorter life expectancy
- has had diabetes for a longer period
- has diabetes that is hard to manage, even with multiple medications
- has a history of severe hypoglycemia or other adverse effects of treatment
- has experienced complications of diabetes
- has other chronic health conditions
A person should work with their doctor to reassess and adjust their A1C targets over time. The condition and treatment goals may change.
To screen for diabetes, a doctor may order an A1C test for someone older than 45. They may also do this for younger people who have other risk factors.
After diagnosing diabetes, a doctor determines how often to test A1C levels.
Symptoms of high blood glucose levels include:
How To Lower Your Hba1c Levels
If your levels have gone above your target since your last check, its understandable to be worried. Even a slightly high HbA1c level puts you more at risk of developing serious complications in your body. But knowing your numbers and what that means is an important and good first step now you need to know how to lower them.
Lots of things can cause your HbA1c levels to change and theres action you and your healthcare team can take to bring them down to your target level:
- Your diabetes team may need to review your medication and increase the dose or try a new one.
- Ask them about local diabetes education courses thereâs always more to learn with diabetes and a course will help you take practical steps to lower your HbA1c.
- Get more active moving more is good for everyone, but it can specifically help to bring down your HbA1c levels.
- Get advice on balanced, healthy eating.
- Stop smoking smoking makes it harder for blood to flow around your body.
And if you want to hear from others who are experiencing this too, think about joining our online forum. Its a place where you can chat to others or just read other peoples stories.
And dont forget, get advice from your healthcare team. Theyre here to help.
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What Factors Can Interfere With A1c Test
Some of these interfering factors that can affect HbA1C test results include
- Inaccurate results: Disease conditions such as sickle cell anemia, kidney disease, liver disease, anemia, Thalassemia, drugs
- False low A1C Value: Pregnancy, hemorrhage, kidney disease, liver disease, anemia, alcohol, folic acid deficiency.
- False High A1C value: Iron deficiency in the blood
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Have A Realistic Weight Loss Goal
Set yourself up for success. Its important to be practical because a slow, steady approach to weight loss tends to get the best results when it comes to keeping weight off.
Its also worth noting the results dont have to be drastic to meaningfully improve your health. Experts say even 5 percent can make a difference. This means if someone at 180 pounds adjusts their exercise and food habits and works their way down to 170 over a few months, the resulting health benefits can be worthwhile.
Talk with your doctor about what weight loss goal makes sense for you and how best to work toward it.
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Check Your Blood Sugar Levels As Your Doctor Has Directed
Work with your doctor to determine if you should check your blood sugar and how often. You may be tempted to pick up an A1C home testing kit, but Dodell says having your A1C checked by your doctor every three to six months is sufficient. A better idea is to use a continuous glucose monitor. He recommends checking your time in range to see if you are at the optimal level. For many people that is 70 to 180 milligrams per deciliter , according to ADA guidelines.
Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C or what it means, dont hesitate to ask your doctor.
Additional reporting by Mikel Theobald
Why Is My A1c High
As blood sugar level rises, so do A1C levels. A high A1C indicates that blood sugar control is not optimal. This in itself is not an emergency, but it gives your healthcare provider a picture of how blood glucose has, or has not, been controlled, says Dr. Williams.
Poor diabetes control or a need for medication adjustments might cause higher A1C. Diet changes, daily exercise, or medication adjustments might quickly lower A1C. Because Type 2 diabetes is a progressive disease, adjustments to ones treatment might be a part of the process of controlling diabetes. Poor diabetes control does not always mean a patient is doing something wrong. But there are other reasons why levels might be high.
As previously mentioned, other health conditions can cause skewed results. These include kidney disease, anemia, liver disease, asplenia, blood loss, hypothyroidism, uremia, and sickle cell anemia. Other factors that might lead to a high A1C level include increased age, pregnancy, and gestational diabetes.
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How A1c Measures Blood Sugar
An A1c test is also known as glycated hemoglobin, glycohemoglobin, or HbA1c. It measures the amount of glucose in your blood. More specifically, it checks hemoglobin, an iron-rich protein that transports oxygen and nutrients throughout the body.
Glucose binds to hemoglobin, creating glycated hemoglobin compounds. The higher your blood glucose level, the more glucose attaches to the hemoglobin. Hemoglobin cells last about 90 days, so the A1C provides an overall picture of your blood sugar control for the previous three months.
For people without diabetes, A1C tests are recommended every three years in adults over the age of 45 and anyone with a high risk of diabetes. Risk factors include a family history of diabetes, a BMI above 25, high blood pressure, a history of heart disease, and a lack of physical activity.
For people with diabetes, regular A1C monitoring can catch a spike in blood sugar levels early. An increase should prompt your healthcare provider to re-evaluate your treatment plan. This may include a review of your medications, diet, and how often your test your blood sugar.
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Different Levels And What They Mean
The ranges of safe levels of blood glucose depend on factors such as what time of day it is and when you last ate. Safe levels of blood sugar are high enough to supply your organs with the sugar they need, but low enough to prevent symptoms of hyperglycemia or complications of diabetes which follow the National Institute of Diabetes and Digestive and Kidney Diseases guides. Dangerous levels of blood glucose are outside of this range.
The target levels can also vary if you have diabetes. For example, if you are diabetic and are monitoring your blood sugar, you might get a reading of 65 mg/dl. That is considered to be mild hypoglycemia, and you would be wise to eat 15 grams of fast-acting carbohydrates and retest your blood sugar in 15 minutes.
If you were not diabetic, you probably would not know that your sugar was low because you would not test and because you would not symptoms, and you would not act.
That is fine because your body is capable, under normal circumstances, of raising your blood glucose to healthy levels when needed, even if you have not eaten. It is important to keep them in control to help prevent issues like heart disease or nerve damage.
Looking for the best prediabetes diet? Learn what foods are best to help you manage your prediabetes.
Can Your A1c Be Too Low
As described above, the answer to this question depends almost entirely on how often you experience hypoglycemia . If you never experience hypoglycemia, your A1c technically cannot be too low. Some people achieve A1c levels below 5% by following a very strict diabetes management and diet regimen and have almost no blood sugar fluctuations.
HOWEVER, if you often experience hypoglycemia, that will result in an artificial low A1c reading because your hypoglycemia events are lowering your blood sugar average. In that case, focusing on increasing time-in-range is much more important than further lowering your A1c. In fact, you may even benefit from a slightly higher A1c with fewer blood sugar fluctuations.
Its also important to note that lowering your A1c below the recommended range of 6-7% hasnt been proven to provide any health benefits. Therefore, a very low A1c shouldnt be a goal in itself.
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What Is A Normal A1c
Now that you have your A1c number, lets look at what that number actually tells you. The American Diabetes Association has established the following guidelines:
This does NOT mean that you need an A1c of less than 5.7% if youre living with diabetes. It means that if you do NOT live with diabetes, your A1c is expected to be below 5.7%. There are different recommendations for what an appropriate A1c is for people living with diabetes.
I had a chance to asked Dr. Anne Peters, MD, Director, USC Clinical Diabetes Program and Professor of Clinical Medicine Keck School of Medicine of USC as well as Gary Scheiner, MS, CDE, owner and Clinical Director of Integrated Diabetes Services and author of Think Like a Pancreas, what their perspectives are on a good A1c target:
The A1c target should be whatever is best given the persons clinical situation. For athletes, too many lows can limit performance, for someone who is pregnant it should be < 6%, for an older person the target should be higher. I generally think an A1c target of 6.0 7.0% is ideal and data shows that going below 7% has fairly little impact on complications. Basically, Id rather see someone with an A1c of 6.9% and low blood sugar variability than an A1c of 6.2% with lots of variability
Gary Scheiner, MS, CDE:
To learn more about blood sugar levels, please read What are Normal Blood Sugar Levels.
What Pe Rmanent Effects Does Low Blood Sugar Down To 23 Have
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Weight Loss And Management
Weight loss and better weight management can both help reduce your blood sugar.2 Indeed, weight loss is often recommended for those diagnosed with insulin sensitivity, prediabetes, and diabetes.
There is evidence that weight loss can not only reduce symptoms of diabetes and lower blood sugar levels, but it may also reduce your risk of developing it in the first place.3
Weight management can feel overwhelming and is a sensitive topic, but better control of your weight can help with managing diabetes, lowering your A1c level, and getting it back within range of average blood sugar levels.
To better manage your weight, you can try eating a healthier and more balanced diet and getting more exercise each day. You should aim for 150 minutes of physical activity each week, which could mean a 30-minute walk each morning.4 You could also try out diabetes-friendly diets, like the ketogenic diet.
Lack Of Overlap Between The Two Sets Of Clinical Trials
As presented above and in Table 1, the list of clinical trials with a mean/median glycated haemoglobin under 7% in at least one of the arms and the list of clinical trials with a favourable overall impact do not overlap. This evidence indicates that achieving levels under 7% are not shown to decrease mortality. Ethical issues have been raised concerning pharmacologically induced decrease of glycated haemoglobin in patients with diabetes to low values, in particular given the results of the ACCORD trial . Furthermore, reducing levels below 7% tends to increase the occurrence of hypoglycaemia . For example, ADVANCE reported nearly double the incidence of severe hypoglycaemia in the intensively treated arm . A serious economic impact also results from establishing low targets for glycated haemoglobin in these patients, arguably using limited resources that could perhaps be better used otherwise.
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How Does Blood Sugar Level Work
With a lack of nutrients and food that contain glucose, the blood sugar level will begin to decline. This is known as hypoglycemia.
After blood sugar becomes low, the pancreas releases a peptide hormone called glucagon. When this happens, the glucose that is stored in the body for energy is instructed to release due to the liver. This causes the glucose to turn into glycogen, known as the glycogenesis process. This is what can help a body to regain energy as the readily stored glycogen, in the liver and muscles, will release into the body.
On the other hand, the blood sugar can also rise and become too high which is known as hyperglycemia.
When the body does not produce enough of the insulin hormone, blood sugar levels begin to increase. This is because glucose relies on the insulin hormone to help it absorb into the bloodstream. Usually, this occurs when the body cannot produce enough insulin, known as type 1 diabetes, or does not respond to insulin correctly, known as type 2 diabetes.
Eating too many processed foods can also cause your blood sugar level to rise. If there is not enough insulin present in the body, too much bad food can cause your blood sugar level to build up.
For those with a normal blood sugar level, this will be due to eating the right foods and your body being able to produce and respond to insulin.
You may be wondering what exactly causes an imbalance in blood sugar levels, so here is a roundup: