How To Lower A1c
If your A1c test shows that your levels are too high, your doctor will tell you to lower it. Here are some useful tips on how to do that:
Can The A1c Test Result In A Different Diagnosis Than The Blood Glucose Tests
Yes. In some people, a blood glucose test may show diabetes when an A1C test does not. The reverse can also occuran A1C test may indicate diabetes even though a blood glucose test does not. Because of these differences in test results, health care professionals repeat tests before making a diagnosis.
People with differing test results may be in an early stage of the disease, when blood glucose levels have not risen high enough to show up on every test. In this case, health care professionals may choose to follow the person closely and repeat the test in several months.
How Much Does An A1c Test Kit Cost
The A1CNow SelfCheck I used in the video is $53.83 on Amazon for 4 tests. I chose this kit as it was the cheapest solution, but similar home A1C kits can be found on Amazon ranging from $60-$100 for 4 tests.
You can also find home A1C kits in most pharmacies such as CVS and at Walmart.
A1C kits that require you to collect a blood sample at home and send it to a lab is also available. One FDA-cleared kit that Ive tried is the Home Access Health home A1C test which was $40 .
These tests require a significantly larger blood collection and you can end up waiting up to 4 weeks for your test results, depending on how fast the mail gets to the lab and back to you.
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What Does A1c Measure
You may be wondering what makes this test different, especially if you already check your blood sugar multiple times a day. The A1C test goes by a few names, including glycosylated hemoglobin, glycated hemoglobin, or hemoglobin A1C . All of these names hint at what is being measured the amount of sugar attached to hemoglobin.
Hemoglobin is a protein found inside red blood cells, and its job is to carry oxygen to the lungs and all of the cells in your body. Glucose enters your blood stream and sticks, or glycates, with the hemoglobin. The higher your blood glucose, the more sugar-coated or glycated the hemoglobin becomes.
Since the lifecycle of a red blood cell is about four months, the A1C percentage reflects average blood sugar levels detected on hemoglobin cells of varying ages days, weeks, or months old. If your blood glucose control has generally been steady, your hemoglobin cells will not be highly sugar-coated, or glycated, leading to a lower A1C value.
How To Do An A1c Conversion
Here’s how to convert your blood sugar readings into an A1C percentage, according to the ADA and diabetes educators:
Step 1. You’ll want to have a substantial number of blood glucose readings ready to analyze. To truly find out your average blood sugar, you should measure it at different times of the day, Cox recommends. For instance, if you always measure your blood sugar in the morning before you eat, you may not know that your blood sugar is going too high or low at other times in the day. Talk to your doctor about how often to measure your blood sugar each day and when.
Step 2. Add up all the readings you’re using for the conversion. Note the resulting number.
Step 3. Divide the number from Step 2 by the total number of readings you took to reach that number. For instance, if your Step 2 total is 18,000 and you had 100 readings, your math is: 18,000 divided by 100 = 180. This is your average glucose level for the 100 readings.
Step 4. Add 46.7 to the average blood glucose reading from Step 3. If your average reading was 180, your math is: 180 + 46.7 = 226.7.
Step 5. Divide your answer from Step 4 by 28.7. Using the same example as above, your math is: 226.7 divided by 28.7 = 7.89. This means you have an average hemoglobin A1C of 7.89 percent.
You can also use the ADA‘s online conversion calculator to do the math for you.
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Why Is It Important To Measure Your A1c
Since elevated blood sugars can lead to a number of short- and long-term complications, its advisable to keep an eye on your A1C and ensure that its held at a healthy level.
If you find that your blood sugars are increasing above your target, there are several things you can do to reduce them, such as discussing adjusting your medication with your doctor, changing your diet, and making lifestyle changes
You can read our complete guide to lowering your A1C for more information.
Since the A1C tests give you a picture of your blood sugar level for the last 3 months, it makes sense to have your A1C measured at least every 3 months to keep track of how your blood sugars are progressing.
It the test is used for a diabetes diagnosis, you might have to also have your fasting blood sugar and antibody levels measured to determine which type of diabetes you live with, such as type 1 or type 2 diabetes.
What Should My A1c Goal Be
The American Diabetes Association recommends aiming for an A1c of 7% or less, while the American Association of Clinical Endocrinologists advises a tighter target of 6.5% or less. In Singapore, the Ministry of Health recommends a target of 7.0% in the latest clinical practice guidelines.
This is a number you should discuss closely with your doctor your individual goal may be different depending on your medical condition, history of recurrent low blood glucose levels, and presence of other complications.
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Using A1c To Prevent Complications
People with diabetes need to manage their blood sugar levels to prevent these becoming too high.
Managing glucose levels can reduce the risk of complications affecting the small blood vessels, especially of the eyes and kidneys, and the coronary arteries.
This can help to prevent the many problems that can occur with diabetes, including:
- vision loss
- kidney disease
Reaching and maintaining an A1C of 7 percent or lower can significantly reduce these risks.
However, an individual will work out their own blood sugar and A1C targets with their doctor or another healthcare provider, as each person is different.
A doctor may suggest the A1C test at the beginning of a pregnancy, to see if someone with risk factors for diabetes has a high score.
Later in the pregnancy, they may test for gestational diabetes in other ways as pregnancy can affect the A1C test result.
If a person has gestational diabetes, the doctor may also test up to 12 weeks after delivery, as gestational diabetes can sometimes develop into type 2 diabetes afterward.
A1c Tests Can Be Affected By Changes In Red Blood Cells Or Hemoglobin
Conditions that change the life span of red blood cells, such as recent blood loss, sickle cell disease, erythropoietin treatment, hemodialysis, or transfusion, can change A1C levels.
A falsely high A1C result can occur in people who are very low in iron for example, those with iron-deficiency anemia. Other causes of false A1C results include kidney failure or liver disease.
If youre of African, Mediterranean, or Southeast Asian descent or have family members with sickle cell anemia or a thalassemia, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes. People in these groups may have a different type of hemoglobin, known as a hemoglobin variant, which can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care professionals may suspect interferencea falsely high or low resultwhen your A1C and blood glucose test results dont match.
Not all A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test to measure their average blood glucose level. The NGSP provides information for health care professionals about which A1C tests are appropriate to use for specific hemoglobin variants.
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How Precise Is The A1c Test
When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.
Health care professionals can visit www.ngsp.org to find information about the precision of the A1C test used by their lab.
Oral Glucose Tolerance Test
The oral glucose tolerance test takes a little more time than the other two glucose tests for diabetes. In this test, your blood is taken after an overnight fast, and then again two hours after you drink a sugary drink.
Its normal for blood sugar to rise after the drink. Normal blood sugar falls to below 140 mg/dL within two hours, however.
If your blood sugar is between 140 and 199 mg/dL, your doctor will diagnose prediabetes. Anything 200 mg/dL or above is diagnostic for type 2 diabetes.
| Type of results |
You should have healthy fats each day as well.
Using the information from your food log, you can begin to make small changes. The goal is to choose less processed, whole foods, instead of highly processed foods that contain added sugar, little fiber, and unhealthy fats.
For example, if you arent eating the recommended servings of vegetables, try adding one serving of vegetables a day to your diet.
You can do this by having a salad with lunch or dinner, or snacking on carrot sticks. Just be careful about add-ons such as salad dressing or dips. They can sneak in unhealthy fats or extra calories. Check out these 10 healthy salad dressing recipes.
Youll also want to work on reducing the number of empty-calorie foods and beverages youre consuming, as well as switching out simple carbohydrate foods for complex carbohydrates. Examples of substitutions you can try to include:
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Why Should A Person Get The A1c Test
Testing can help health care professionals
- find prediabetes and counsel you about lifestyle changes to help you delay or prevent type 2 diabetes
- find type 2 diabetes
- work with you to monitor the disease and help make treatment decisions to prevent complications
If you have risk factors for prediabetes or diabetes, talk with your doctor about whether you should be tested.
What Blood Sugar Markers Are Reliable
Testing accurately for blood sugar is like putting pieces of a puzzle together. Fasting blood glucose, A1c and post-meal blood sugar are all pieces of the puzzle. But post-meal blood glucose testing is by far the most reliable and accurate way to determine whats happening with blood sugar, and the most sensitive way of predicting future diabetic complications and heart disease.
Ive posted several articles on ChrisKresser.com on this subject. For more on why post-meal blood sugar is a superior marker, read When Your Normal Blood Sugar Isnt Normal . For my recommendations on how patients can measure their post-meal blood sugars at home, and what healthy targets should be, read How to Prevent Diabetes and Heart Disease for $16.
Another useful but underused blood sugar marker is fructosamine. Fructosamine is a compound that results from a reaction between fructose and ammonia or an amine. Like A1c, its a measure of average blood sugar concentrations. But instead of measuring the previous 12 weeks like A1c, fructosamine measures the previous 2-3 weeks. And unlike A1c, fructosamine is not affected by the varying length of red blood cell lifespans in different individuals. Fructosamine is especially useful in people who are anemic, or during pregnancy, when hormonal changes cause greater short-term fluctuations in blood glucose levels.
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Bg Meter Average Does Not Usually Reflect The Average Over A Full 24 Hours
This reason is pretty obvious. If you are not on a CGM, it’s tough to get a full picture of your average blood glucose throughout the day. We generally check much more during the day than at night, and nighttime glucose values may be very different from daytime values. We also tend to test more often before eating , and less often after meals .
So, for most people, BG meter average doesn’t accurately reflect average blood glucose over a full 24 hours. A1C, on the other hand, does. If you want your BG meter average to better reflect your A1C values, check more often! And make sure you check at various times throughout the day, including 1-3 hours after eating.
A1c Results And What The Numbers Mean
| Diagnosis* | |
|---|---|
| Diabetes | 6.5 percent or above |
When using the A1C test for diagnosis, your doctor will send your blood sample taken from a vein to a lab that uses an NGSP-certified method. The NGSP, formerly called the National Glycohemoglobin Standardization Program, certifies that makers of A1C tests provide results that are consistent and comparable with those used in the Diabetes Control and Complications Trial.
Blood samples analyzed in a doctors office or clinic, known as point-of-care tests, should not be used for diagnosis.
The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes. The A1C test may give false results in people with certain conditions.
Having prediabetes is a risk factor for developing type 2 diabetes. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes.
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How To Calculate Your A1c Levels
Do you feel overwhelmed by the jargon and measurements involved in controlling your blood sugar? It can be challenging to keep track of everything, especially if youâre already preoccupied with a diabetes diagnosis. Still, itâs worth carving out a little more space in your memory for something as important as A1C.
If youâve recently taken a blood test or if youâve been discussing or treating diabetes with your doctor, youâve likely heard about A1C. Only a lab test can accurately measure A1C, and itâs best if a medical professional analyzes it. The results help provide an approximate value for how much glucose has been in your bloodstream on average for the past 2-3 months. Managing A1C effectively will keep you out of your doctorâs office longer, prevent the onset of diabetes and help bring you back from the brink of a diagnosis. In this article, weâll fill you in on what exactly A1C is and how you can keep an eye on it yourself between blood tests.
The Average Bg To A1c Conversion Equation Is Not Perfect
Most average BG to A1C conversion tables and calculators use the below equation to estimate A1C:
Average BG = 28.7 X A1C – 46.7
This equation is based on data from a 2008 study of over 500 subjects at 10 international centers around the world. The A1C values were all measured in a central laboratory, so differences in laboratory method or technique were not a factor.
People were studied for 12 weeks, with two days of CGM and three days of 7-point glucose profiles each week. The BG meters used were carefully standardized and calibrated.
The graph below shows the data used to derive the relationship between average glucose and A1C. As you can see, there is A LOT of scatter.
A number of data points are off the trend line by ± 1%. And for some A1C values, the spread is enormous… Check out the range of A1Cs for people with an average glucose of ~110 mg/dL — it goes from below 4% to almost 9%!
So, importantly, the study concluded that the equation could be used to convert A1C to average blood glucose values for “most patients.” Not all patients, just “most.”
Results of a study of 507 subjects. Published in Diabetes Care 31:1473-1478, 2008.
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Why Was My Hba1c Result Higher/lower Than The Result Given By The Calculator
In addition to the reasons given just above, there are some other practical reasons which may explain difference between the calculators estimate and your lab results. We will look at a few of the more common reasons for differences.
If you take a relatively high proportion of your blood glucose tests at the same time of day, eg upon waking, the HbA1c result the calculator gives will give a decent reflection of your early morning results but may not so well represent your blood glucose levels at other timers in the day.
Similarly, if you take more before meal, rather than after meal, readings, the HbA1c result given by the calculator will give a better reflection of your before meal results than after meal ones.
Typically, most peoples after meal results are higher than their before meal results, so if you take significantly more before meal results than after meal readings, you may find that the calculator gives you a lower result than your lab test result will.