Understanding the A1c Test

The Hemoglobin A1c test, or simply your A1c, measures a person’s average blood sugar control over the past two to three months. It is often referred to as your diabetes report card.

What does the A1c test measure?

The A1c test has been used since the late 1970s and is a valuable test that allows your physician to assess how well your diabetes is being managed and if your current treatment needs to be modified. Monitoring blood sugar levels is important for day-to-day management of diabetes; however, blood sugar readings only give a snap shot of what is going on.

How is the A1c test done?

The A1c test can be done at your doctor’s office by taking a sample of blood from a finger poke. Results are usually ready within a few minutes. You do not need to fast for this test. There are some conditions that may affect the accuracy of the A1c test. Some of these conditions include low iron levels in the bloodstream, having a recent blood transfusion or having a history of chronic bleeding. Speak with your physician if you think any of these conditions apply to you.

The A1c test can diagnose prediabetes and diabetes

The A1c test can now be used to diagnosis prediabetes and diabetes. A person is considered to have prediabetes (increased risk for diabetes) if their A1c level is between 5.7% and 6.4% (estimated average blood glucose: 117 mg/dL and 137 mg/dL). A person can be diagnosed with diabetes if their A1c is greater than 6.5% (estimated average blood glucose: 140 mg/dL).

How often should the A1c test be done?

The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists (AACE) suggests testing the A1c level one to two times per year for those with stable blood sugar control. For those with unstable blood sugar control, A1c should be monitored quarterly.

A1c goals

Achieving A1c goals decreases the risk for diabetes complications such as retinopathy, nephropathy, neuropathy and cardiovascular disease. A1c goals vary slightly by organization. The ADA recommends an A1c goal of less than 7% and the AACE recommends an A1c goal of less than 6.5%. Higher A1c targets may be appropriate for those with a history of hypoglycemic unawareness.

What to do if your A1c is high

• Make sure you are taking your diabetes medications as prescribed by your physician. Missing medication can prevent you from reaching your target A1c.
• Monitor blood sugar levels more frequently (if you check your blood sugar 1-2 times/day consider increasing to 3-4 times/day)
• Vary the times of day you check your blood sugar. If you only check your blood sugar in the morning (fasting) consider check your blood sugar 1.5-2 hours after completing a meal. This can help you identify other times of day your blood sugar is not in your target range.
• If you take insulin at meals, make sure you take your insulin shot before you start to eat.
• Try exercising shortly after you finish eating a meal
• Avoid over treating low blood sugars
• Lower your target blood sugar. For example: if your current blood sugar target is less than 180 mg/dL, discuss with your doctor if a lower target would be better for you. It may be time to adjust your diabetes medication if your blood sugar is often above your target.