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Diabetes Knowledge

Type 2 diabetes and your HbA1c – what you should know

9/23/2020 by Ginger Vieira

Type 2 diabetes and your HbA1c – what you should know

Living with diabetes means we are constantly being “tested.” And one of the biggest tests we face is an HbA1c test. Your results can fall anywhere from 4.0 to 16 percent (or 20 to 151 mmol/L).

While your A1c is a very important part of your type 2 diabetes management, it shouldn’t be the only number you’re using to assess your diabetes health. According to research uncovered by diaTribe, 14 to 25 percent of A1c results can actually convey very different blood sugar management than accurate!

Without an accurate understanding of where your blood sugars are, your healthcare team can’t make accurate changes and adjustments to your diabetes management plan.

Here, we’ll discuss what an A1c test really measures, what’s “normal” and what’s recommended, and why it’s so important to still check your blood sugar daily despite your A1c result.

3 diabetes acronyms you need to know

There are 3 acronyms you need to know when it comes to understanding your overall blood sugar levels:

  1. HbA1c - Hemoglobin A1c:  Also known as “A1c,” this measures the amount of glucose that has accumulated in your bloodstream over the previous 3 months.
  2. AGEs - Advanced Glycogenated End-Products: AGEs are a fancy name for the glucose that accumulates in your bloodstream and damages nerve-endings and blood vessels throughout your entire body, especially in your eyes, fingers, toes, and kidneys. AGEs are a major contributor to the development of the many diabetes complications you’ve probably been warned about -- like retinopathy (diabetic eye disease) or neuropathy in your hands, feet, and legs. 
  3. eAG - Estimated Average Glucose Level: Using an easy online calculator, you can enter your A1c result to learn what your eAG is. This gives a general idea of where your blood sugars are on average throughout the day.

Let's take a closer look...

What's an A1c test?

Developed in 1968 by Samuel Rahbar, MD, PhD, the HbA1c test has been used since the early 90s to help patients with type 2, type 1.5, type 1, and gestational diabetes understand where their blood sugar levels have been during the previous 3 months.

Also known simply as “A1c,” this test only measures the past 3 months is because that’s how long it takes for your body to produce new red blood cells.

When your blood sugar levels are continuously higher than recommended, this excess glucose (those AGEs described above) are exactly what damages and destroys the nerve-endings and blood vessels throughout your entire body and leads to the development of diabetes complications like retinopathy, neuropathy, and nephropathy.

The higher your blood sugar is →  the more AGEs are present in your bloodstream → the higher your A1c result will be → the higher your risk of developing diabetes complications.

Translating your A1c to a blood sugar level

In order to improve your A1c, it’s important to figure out what your latest A1c result really means about your blood sugar levels and what is the right A1c goal for you and your diabetes.

Every A1c result translates to an estimated average glucose (eAG, or average blood sugar) level. You can determine your own average blood sugar level in your mySugr app* or in this handy online calculator.

*In order to use the mySugr app’s estimated blood sugar tool, you’ll need to check your blood sugar at least 3 times a day for at least 7 days without any missed days.

What's a "normal" A1c, and where should yours be?

In people without diabetes, an A1c below 5.7 percent is considered healthy. Once your A1c result crosses that 5.7 threshold, a diagnosis of prediabetes or type 2 is considered.

Once you’ve been diagnosed, the American Diabetes Association recommends maintaining an A1c at or below 7.0 percent. Thanks to better insulin and a variety of diabetes technology, achieving an A1c below 7.0 is more doable for most of us than it used to be.

For some people, your doctor may recommend a higher A1c level because of safety issues like:

  • Being older and less able to keep up with the demands of diabetes management 
  • Being unable to feel the symptoms of low blood sugar
  • Recovering both physically and emotionally from a severe low blood sugar episode
  • Juggling other stressful life circumstances like: parenting young children, a death in the family, general or specific anxiety, or depression.

It’s important to discuss your A1c goals with your doctor. Be honest and express any concerns and challenges you’re facing that may be impacting your blood sugar management and test results.

Why the A1c test isn't perfect

Thanks to newer technology – including faster and more accurate glucose meters and continuous glucose monitors (CGM) – we’ve learned that the A1c test doesn’t always paint an accurate picture of where your blood sugars have been during those previous 3 months.

If you’re only using your A1c test to determine how well your current diabetes management plan is working for you, you could be missing regular high and low blood sugars that are creating an inaccurate “average” blood sugar level in your A1c result.

For example, if your blood sugar is actually swinging frequently between 50 mg/dL and 300 mg/dL, the A1c result could look like you’re averaging somewhere around 150 to 200 mg/dL.  This could give you a false impression that your blood sugars are mostly near that 7.0 goal when they’re actually not.

Another example: You may be waking up every morning in your goal range at a blood sugar level between 70 to 100 mg/dL but you’re still spiking up over 200 mg/dL after every meal. In an A1c test, this could look like an average blood sugar level of 150 mg/dL, giving you and your healthcare team the impression that your post-meal blood sugar levels are in your goal range below 180 mg/dL, when they actually are much higher.

(Fun fact: during pregnancy and after you donate blood, you actually produce new red blood cells at a much faster rate which can lead to faster changes in your A1c result.)

Without an accurate understanding of where your blood sugars are throughout the day, your healthcare team can’t accurately adjust and prescribe the medications that are helping you manage your diabetes and prevent those long-term complications.

The only way to truly identify how high your blood sugar is after eating or what your morning fasted blood sugar is, for example, is by checking with your glucose meter.

3 tips to help you check your blood sugar more often

Getting into the habit of checking your blood sugar more often isn’t easy. Here are a few simple tips to help you make this very important part of type 2 diabetes management part of your daily routine:

  1. Keep your diabetes kit containing your glucose meter out on the counter or desk where you spend most of your day. Keeping it in sight and easy-to-access will make it a natural reminder that it’s time to check.
  2. Check your blood sugar before you drink that first cup of coffee -- every single day! You can integrate this new habit by taping a little note to your coffee machine: “Have you checked your blood sugar yet?” No matter what, take 10 seconds to wash your hands, prick your finger, and check that blood sugar level before the day gets started.
  3. Set an afternoon or evening reminder in your phone that simply says, “Time to check your blood sugar!” Think specifically about where it would be most beneficial to check-in with your diabetes in that second half of the day. Mid-afternoon? Before dinner? 2 hours after dinner or before going to bed? 

Checking your blood sugar isn’t fun – we get it! But if you don’t know what your blood sugar is, you can’t improve it. Checking in with that number a few times a day means protecting your eyes, fingers, toes, and kidneys years from now. It’s worth it – and you’re worth it!

The mySugr website does not provide medical or legal advice. mySugr blog articles are not scientific articles, but intended for informational purposes only.
Medical or nutritional information on the mySugr website is not intended to replace professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions you may have regarding a medical condition.

Ginger Vieira

Obsessed with jumping rope and her life-long pursuit for a decent gluten-free doughnut, Ginger Vieira has lived with type 1 diabetes and celiac disease since 1999, and fibromyalgia since 2004. Today, Ginger writes books and articles on living with diabetes and speaks at events hoping to remind both people and doctors that anything is possible in life with diabetes.