At Relish Health, a hemoglobin A1c (HbA1c or A1c) is a routine lab. It measures the extent to which hemoglobin in the blood has been affected (“glycosylated”) by blood sugar. Optimizing blood sugar balance is important for controlling inflammation and promoting longevity. With over 100 million Americans living with diabetes or pre-diabetes and millions more with suboptimal blood sugar balance, having a clear picture of your blood sugar levels is crucial.
What Is Diabetes And Prediabetes?
Type 2 diabetes is an impairment in the way the body regulates and uses sugar (glucose) as a fuel. For the development of the disease, there are primarily two interrelated problems at work. Your pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into your cells — and cells respond poorly to insulin and take in less sugar. These insulin management concerns can start to occur years or decades before a formal diagnosis of diabetes.
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. The CDC estimates that more than 1 in 3— American adults have prediabetes with more than 80% unaware of their condition.
How Is Diabetes And Prediabetes Diagnosis?
There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to confirm the diagnosis.
Measuring A1C:
The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don't have to fast or drink anything.
Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:
A normal A1C level is below 5.7%
Prediabetes is diagnosed if the level is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes.
Type 2 diabetes is diagnoses if a level is above 6.5%
Fasting Plasma Glucose (FPG):
This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
A fasting glucose is only designed to measure glucose levels during the fasting period. It does not give a full picture of how a person’s body is handling sugar over a period of days or weeks. It does not provide any predictive insight into trends toward diabetes, prediabetes or other blood sugar handling issues. Fasting glucose levels can be highly affected by factors completely outside of diet such as poor sleep the night before or high stress levels.
Normal Fasting Glucose: less than 100 mg/dl
Prediabetes: 100 mg/dl to 125 mg/dl
Diabetes: 126 mg/dl or higher
Oral Glucose Tolerance Test (OGTT):
The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
Normal OGTT: Two-hour blood glucose less than 140 mg/dl blood
Prediabetes: Two-hour blood glucose of 140 to 199 mg/dl
Diabetes: Two-hour blood glucose of greater than or equal to 200 mg/dl
Random Plasma Glucose Test:
This test is a blood check at any time of the day when you have diabetes symptoms. Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.
What Are Optimal Glucose Levels?
In functional medicine, we are always looking beyond “normal” when it comes to lab marker ranges. When interpreting labs, “normal” does not necessarily equate to optimal if you are interested in preventing disease.
Optimal/Functional A1c Ranges:
Optimal Range for A1c: less than 5.3%
Less than Optimal/Pre-diabetic stage: A1c 5.4-6.0% (Your lab will call this “normal” but, in functional medicine we consider this a concerning zone.)
Sub-optimal: Any A1c above 6.0% reveals a problem with blood sugar control.
In functional medicine, and at Relish Health, we want to catch blood sugar issues as early on as possible. The A1c test offers us a window into your last 8-10 weeks of blood sugar balance. It gives us clues into how sugars may be affecting your cells and tissues and can predict if you may progress to having diabetes. Prediction is key to prevention when it comes to disease.
Health Effects of Chronically High A1c
The consequences of sub-optimal blood sugar balance over time include an increased risk of:
Cardiovascular disease including elevated blood pressure, increased risk of heart attacks and strokes, and even impotence
Diabetes
Increased annual brain shrinkage and risk for cognitive decline
What Causes A High A1c?
It is tempting to place all the blame for a high A1c levels on too much sugar in the diet. In reality, there are many lifestyle factors that can directly affect your A1c levels such as:
Sleep issues. Sleep deprivation is a leading causal factor behind blood sugar imbalances.
Stress. Chronic stress can trigger excessive stress hormones that raise blood sugar and can create insulin resistance.
Too many carbs, or too many of the “wrong” carbs. Excessive consumption of sugar and refined carbohydrates can trigger blood sugar imbalances. However, not all carbs will hurt you. “Good carbs” like those found in moderate amounts of whole fruits, vegetables and even sweet potatoes or white potatoes with the skins-on can be included in a healthy diet.
Artificial sweeteners. Artificial sweeteners like aspartame, sucralose and saccharin have recently been shown to affect blood sugar and insulin levels.
Not enough muscle mass and lack of exercise. Muscle helps your body regulate blood sugar. If you have a low lean muscle mass due to lack of exercise this could contribute to higher A1c levels.
Ways to Lower your A1c Levels
Relish Health can help you develop a personalized plan, but in general you can lower your A1c levels by:
Reducing your intake of refined carbs and sugar. Minimize consumption of pastries, bagels, breads, pastas, cereals, and candy. Focus on eating non-starchy vegetables, proteins, fats, and small amounts of whole grains, fruits, and starchy veggies like sweet potatoes or beets.
Increase your protein intake. Protein helps stabilize blood sugar while increasing satiety. Aim to have a small amount of lean animal or plant-based protein at every meal and snack. Relish Health can help you determine your protein needs with body composition analysis.
Exercise regularly. Focus on exercises that build muscle mass. High intensity interval training (HIIT), weight training, yoga, and other weight-bearing exercises are excellent choices.
Manage stress. This is one of the most profound things you can do to impact your blood sugar levels. Stress managing activities include exercising, listening to music, journaling, spending time with friends, laughing, meditation, spending time in nature and limiting your screen time.
Optimize your sleep. Aim for 7.5-9 hours of sleep a night. Sleeping less may cause your blood sugar balance to suffer.
How Often Should You Check Your A1c?
Physicians typically recommend patients with type 2 diabetes check their A1c every three to six months to ensure adequate treatment. At Relish Health, we believe in the same vigilance to make sure that your lifestyle changes are giving you the results you want. If your A1c level falls in the concerning zone, we will recommend you check your A1c progress at least every 6 months.
If your A1c level is currently at an optimal level, we recommend checking your A1c once a year or every other year as part of routine preventative care. Many lifestyle choices over time can influence insulin resistance and blood sugar imbalances. Knowing your A1c level empowers you to manage your blood sugar balance proactively before it ever has the chance to become disease.