A1c Chart For Type 2 Diabetes
5 ways to lower your a1c. for many people with type 2 diabetes, the goal is to lower a1c levels to a healthier percentage. your a1c goal is specific to you. several factors come into play. Get an a1c test to find out your average levelsimportant to know if youre at risk for prediabetes or type 2 diabetes, or if youre managing diabetes. the a1c testalso known as the hemoglobin a1c or hba1c testis a simple blood test that measures your average blood sugar levels over the past 3 months.. Find out why the hemoglobin a1c test is so important for people with diabetes. learn more about what hemoglobin a1c is, normal a1c levels, and view our helpful a1c chart..
A1c chart: how to type 2 diabetes symptoms. This a1c levels chart shows normal a1c levels for people without diabetes as well as the a1c criteria used to diagnosed prediabetes and diabetes. learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on diabetes self-management. The above levels, for people diagnosed with type 2 diabetes, are the general goals set by the american diabetes association and the american association of clinical endocrinologists. as suggested earlier, there is some variation in the blood sugar levels goals set by different organizations..
Normal A1c Levels With And Without Diabetes
Sometimes people have A1C testing when they already know they have diabetes. Other times, a healthcare provider may order A1C testing because a person is at risk of prediabetes or diabetes.
Again, its important to have A1C screening, especially if you have a high risk. Testing will help your provider figure out the best treatment plan for you. While theres no cure for diabetes, there are effective medications and habits to support a healthy life.
A1c As A Diagnosis For Prediabetes
Since A1c is a measure of average blood glucose and therefore this value is less subjective to day-to-day fluctuations caused by stress and everyday living, it is one of the preferred criteria for diagnosing diabetes.
In addition, when diagnosed with prediabetes, you may be required to have additional tests such as:
- Glucose tolerance: a measure of your blood sugar 2 hours after carbohydrate intake
- Fasting blood glucose: a measure of your blood sugar after a 8 hour fast
The following chart indicates the diagnostic criteria for prediabetes and diabetes.
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The Importance Of Standard Deviation
A1c is only one part of the blood glucose picture. Another important element of glucose control is standard deviation a statistical measure of consistency. A patient with a low standard deviation will only experience mild blood sugar swings, while one with a high standard deviation will experience much greater swings both above and below their ideal range.
Here is an example of what blood glucose levels from two individuals with the same A1c level of 5.1% may look like over the course of ten days. Although both individuals have the same blood glucose average of 101 mg/dL, one experiences significantly bigger glucose swings.
Graphic by Maria Muccioli
I would congratulate the patient on the top for their success. But the patient on the bottom is living very dangerously because they experience bad hypos daily. This patient should change their insulin strategy immediately.
Here is a real graph from Dexcom Clarity for an individual who has achieved a normal A1c with a very small standard deviation:
The data shows that this patient hasnt experienced any serious hypoglycemia. Id like to think that a knowledgeable endocrinologist would recognize the low risk and be very happy with these results.
Doctors And Patients Should Discuss Goals Of Treatment Together And Come Up With An Individual Plan
Blood sugar goals should take into account a patients life expectancy and general health, as well as personal preferences, and include a frank discussion of the risks, benefits, and costs of medications. This is a big deal because it reflects a change in how we think about blood sugar control. Its not a simply number to aim for its a discussion. Diabetes medications have many potential side effects, including dangerously low blood sugar and weight gain . Yes, uncontrolled blood sugars can lead to very bad things, but patients should get all the information they need to balance the risks and benefits of any blood sugar control plan.
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> > > Best Diabetes Solution Available
Type 2 diabetes causes the body to become resistant to the hormone insulin. This hormone unlocks cells. There are two types of diabetes: type 1 and type 2. While both types of the disease can cause problems, you can minimize the impact by following healthy eating and being physically active. The sooner you know more about diabetes, the better prepared you will be to deal with it. Once you know more about the disease, youll be better prepared for treatment.
Type 2 diabetes is a chronic condition that causes the body to produce too much insulin. It is also known as type 2 diabetes. If you have type 1, you can control your blood glucose levels by eating a balanced diet. If you have type 2 diabetes, you can even prevent it by adopting healthy lifestyle habits and modifying your diet. Its important to seek information that can help you be your own health advocate. There are many different types of diabetes, so its important to learn as much as you can about the condition.
How Is The A1c Test Used After Diagnosis Of Diabetes
Your health care professional may use the A1C test to set your treatment goals, modify therapy, and monitor your diabetes management.
Experts recommend that people with diabetes have an A1C test at least twice a year.4 Health care professionals may check your A1C more often if you arent meeting your treatment goals.4
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Time In Range For Diabetes Management
Glycemic control, the process of properly managing your blood glucose, is a very important aspect of living with any form of diabetes. Hyperglycemia and hypoglycemia are two of the main challenges for people with diabetes, and controlling these fluctuations is crucial to reducing your risk for long-term complications like peripheral neuropathy, chronic kidney disease, fatty liver disease, high cholesterol, high blood pressure, and Alzheimers disease.
Most doctors use a standard measure called the hemoglobin A1c to measure your blood average over a 90-120 day period.
The A1c measures the percentage of hemoglobin in your blood that has been glycosylated. This provides doctors with an indicator of how much glucose has attached to hemoglobin over the course of the lifetime of hemoglobin molecules .
The higher the percentage, the more glucose has attached to hemoglobin, and the higher your average blood glucose.
The A1c test can also be used to diagnose diabetes, based on the following guidelines:
Image courtesy of the American Diabetes Association: https://www.diabetes.org/a1c
- If your A1c level is below 5.7%, you are considered at the lowest risk for prediabetes and type 2 diabetes.
- If your A1c level is between 5.7% and less than 6.4%, you may be diagnosed with prediabetes.
- If your A1c level is 6.5% or higher, you may be diagnosed with type 2 diabetes.
Monitoring your time in range allows you to determine a few key things that the A1c measurement does not directly measure:
Is The A1c Test Used During Pregnancy
Health care professionals may use the A1C test early in pregnancy to see if a woman with risk factors had undiagnosed diabetes before becoming pregnant. Since the A1C test reflects your average blood glucose levels over the past 3 months, testing early in pregnancy may include values reflecting time before you were pregnant. The glucose challenge test or the oral glucose tolerance test are used to check for gestational diabetes, usually between 24 and 28 weeks of pregnancy. If you had gestational diabetes, you should be tested for diabetes no later than 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. Even if your blood glucose is normal, you still have a greater chance of developing type 2 diabetes in the future and should get tested every 3 years.
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The Basics Of High Blood Sugar
Diabetes is a problem with your body that causes blood sugar levels to rise higher than normal. This is also called hyperglycemia.
When you eat, your body breaks food down into sugar and sends it into the blood. Insulin then helps move the sugar from the blood into your cells. When sugar enters your cells, it is either used as fuel for energy right away or stored for later use. In a person with diabetes, there is a problem with insulin. But, not everyone with diabetes has the same problem.
There are different types of diabetestype 1, type 2 and gestational diabetes. If you have diabetestype 1, type 2 or gestationalyour body either doesn’t make enough insulin, can’t use the insulin well, or both.
My Personal Quest For A Normal A1c Level
When I learned in 1994 that I had diabetes and that my A1C level was 14.4, I was gradually able to bring it way down. Lately I have been doing everything I can think of to try to get my A1C down to normal. But in 2008 my level in nine separate A1C tests always ranged from 5.2 to 5.6. That’s far from normal, according to Dr. Bernstein. My favorite Certified Diabetes Educator is also doing everything she can to get a normal A1C level. And she doesn’t even have diabetes — which she double-checked by taking a glucose tolerance test — but her most recent A1C was 5.4.
What could we be doing that is so wrong? Each of us is thin, eats a very healthy diet, exercises a lot, takes care of our teeth and gums, which is a major source of infection. Could we have other infections or stresses that prevent us from getting our A1C levels down to “normal”?
It turns out that my favorite Certified Diabetes Educator and I have normal A1C levels after all. I learned this just yesterday when I finally tracked down actual research determining what normal levels are.
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What Is A1c And Why Is It Used
A1c estimates a persons average blood sugar levels over a 2 to 3-month span. It is the best measure we have of how well blood glucose is controlled and an indicator of diabetes management.
Though A1c doesnt provide day-to-day information, keeping A1c low has been proven to lower the risk of microvascular complications like kidney disease , vision loss , and nerve damage . The relationship between A1c and macrovascular complications like heart disease is harder to show in clinical trials, but having high blood sugar is a major risk factor for heart disease.
A1c is usually measured in a lab with routine blood work, or with a countertop machine in a doctors office using a fingerstick.
A1c measures the quantity of glycated hemoglobin, which refers to sugar attached to a red blood cell protein called hemoglobin. The number is reported as a percentage of the total hemoglobin in the blood. If a person consistently has higher blood glucose levels over time, A1c levels go up because more red blood cells are coated with sugar. The test is representative of a 2 to 3-month average because once a red blood cell becomes coated with sugar, the link is irreversible. It is only when the red blood cell is “recycled” that the sugar coating disappears.
Is There An Alternative To The A1c Test
There are other tests that are helpful when screening for diabetes. They include:
Fasting blood glucose
Oral glucose tolerance testing
You do fasting and oral tolerance testing first thing in the morning, before you eat or drink anything. With a mixed-meal tolerance test, youll have a sugary drink shortly before the blood glucose test.
Your provider may order a fructosamine blood test if A1C testing isnt accurate for you. It checks for the concentration of fructosamine, a protein in your blood, to get an estimate of blood glucose levels over time.
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Blood Glucose Levels Move Up And Down
Your results can vary because of natural changes in your blood glucose level. For example, your blood glucose level moves up and down when you eat or exercise. Sickness and stress also can affect your blood glucose test results. A1C tests are less likely to be affected by short-term changes than FPG or OGTT tests.
The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.
Blood Glucose Measurements Compared with A1C Measurements over 4 Days
The straight black line shows an A1C measurement of 7.0 percent. The blue line shows an example of how blood glucose test results might look from self-monitoring four times a day over a 4-day period.
Can You Have A High A1c And Not Have Diabetes
Yes, you can have a high A1C level and not have diabetes. This is because an A1C test measures the amount of glucose thats attached to hemoglobin. So anything that affects hemoglobin can alter the results. Certain medications, such as steroids, can also raise blood glucose levels in people who dont have diabetes.
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Start Measuring Your Blood Glucose Levels With A Dietitian
The best thing to do for your health is to learn more about how your body handles its blood sugar and what causes it to spike. A continuous glucose monitor lets you see how your body responds to foods with varying glycemic index values.
Those with diabetes have been using these safe, effective, FDA-approved devices for years. Now, you can get your own with NutriSense, which offers the same technology for the public for the first time, 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.
So What Affects My Blood Sugar Levels
It is important to understand what can make your blood sugar rise or fall, so that you can take steps to stay on target.
Things that can make blood sugar rise include:
- A meal or snack with more food or more carbohydrates than usual
- Changes in hormone levels, such as during menstrual periods
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How Accurate Are A1c Tests
A1C levels rise well before the clinical onset of diabetes, making early diagnosis possible according to the 2017 Standards of Medical Care in Diabetes by the American Diabetes Association . Sometimes, however, in the early stages of diabetes, blood sugar levels are not high enough to show up as problematic. Testing environments, such as temperature in the lab, equipment used, and handling of samples, can affect the results however, this is more common in the fasting plasma glucose and the OGTT than in the A1C. Strict quality controls and advancements in testing have made the A1C test more precise than in the past, according to the NIDDK. Doctors should be aware of laboratories that use an NGSP-certified method of testing for A1C levels. The NIDDK warns that blood samples taken at home or analyzed in a healthcare providers office should not be used for diagnosis.
There are some health conditions and situations that might skew the results of the test. These include:
- Blood loss or blood transfusions
Also, the test can be unreliable for people of African, Mediterranean, or Southeast Asian descent, people with a family member with sickle cell anemia, and those with thalassemia. For those who fall into these groups, a healthcare provider might suggest a different test or a specialized A1C.
Normal Hba1c Range For Diabetes
Those with diabetes are advised to aim for a HbA1c level of:
- 6.5% or 48 mmol/mol.
A value lower than this 6.5% target indicates great blood sugar control, a value higher indicates the need for improvement.
Now this range is 0.5% higher than the normal range given for those without diabetes, as its unlikely that diabetes patients can match that exact same blood sugar control.
In fact, some experts believe a more realistic healthy range for diabetics should be 7-7.5%.
Summary: The normal HbA1c range is below 6.0% for the average adult, and 6.5% or less for those with diabetes. Some argue the the normal range should be slightly higher for diabetics.
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We Dont Even Need To Follow The A1c For Some Patients
Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level. Who would be included in this group? People with a life expectancy of less than 10 years, or those who have advanced forms of dementia, emphysema, or cancer or end-stage kidney, liver, or heart failure. There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls. There is the added consideration that elderly and sick patients often end up on a long list of medications that can interact, causing even more side effects.
Tracking Blood Sugar Control Over Time
One easy, accurate way for us to measure a persons blood sugar over time is the hemoglobin A1c level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months.
Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people , with a lower goal closer to normal, or under 6.5% for younger people.
We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didnt meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still werent at goal, then it was time to start insulin injections.
While all this sounds very orderly and clinically rational, in practice it hasnt worked very well. I have seen firsthand how enthusiastic attention to the A1c can be helpful as well as harmful for patients.
And so have experts from the Clinical Guidelines Committee of the American College of Physicians, a well-established academic medical organization. They examined findings from four large diabetes studies that included almost 30,000 people, and made four very important new guidelines around blood sugar control. Heres the big picture.
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