5 Mistakes People Make About Their A1C

An A1C is more than just a lab result for you and your medical team. 

Understanding A1C test results and common mistakes

Here are 5 mistakes people with diabetes make about with their A1C:

Mistake #1: Thinking an A1C is counting all your sugary blood cells equally

A1Cs can tell you where your blood sugars tend to run the highest. In general, if your A1C is running slightly above the healthy goal of 7% (say 7.5%), then there’s a good chance your after-meal blood sugars are the trouble-makers. Your A1C is also weighted more on the last month’s worth of blood sugar levels. For example, if you’re getting your A1C check in April, March’s glucose management is going to impact it more than January’s or February’s.

Mistake #2: Thinking your A1C is a snapshot

“You can’t really know where you are going until you know where you have been.”  While this sound advice from Maya Angelou was not likely intended for something like diabetes management, it still holds true. Too often people with diabetes (and even medical professionals) see one A1C level as the “big picture” of how well a diabetes management plan is working. That’s a mistake. A1Cs need to be viewed as a trend. An A1C of 8% in a snapshot is often seen as concerning. But, if your A1C trend showed the last few A1C levels were higher than that, an A1C of 8% could be something to celebrate!

Mistake #3: Not using your A1C results to maximize appointments with your primary care provider (PCP)

I hear reports from people with diabetes that their provider told them their A1C “looks good.”  While this message may feel reassuring, it leaves little room for determining what your next diabetes management steps may be. (And while we have national guidelines to drive what’s considered a healthy A1C level, I find each provider varies in their cutoff for healthy levels - and some patients need different levels).  Knowing your A1C gives you a way to create follow-up questions around those results, such as, “If my A1C hits the level where we need to make changes, what are those next steps? And what is that level?”

Mistake #4: Not setting A1C goals based on your specific situation

An A1C can be unrealistic or risky at the typical cutoff of 7% or less. Or a goal of 7% may be too high. If you are younger or planning a pregnancy, your A1C goal may be closer to 6-6.5%. If you’re elderly, have other health conditions (heart disease, kidney disease), have lived with diabetes for decades, and/or use medications that can cause lows, you may need higher A1C goals. Ask your PCP what your personalized goal is based on your specific situation.

Mistake #5: Thinking a lower A1C is always better

“Keep doing what you’re doing, your A1C looks great.” I know the people with diabetes that I work with often celebrate hearing this from their PCP - and express a sense of success that they have an A1C of less than 7%. But an A1C can be sneaky. It’s an average of your blood sugars over three months — which means a healthy result can hide frequent lows. This also means the advice to keep doing what you’re doing is risky and your A1C goal should be raised for both your health and safety.