How to Lower Your A1c: The Complete Guide

This publish could include affiliate hyperlinks. Please learn our disclosure.

As folks with diabetes, we are sometimes instructed that having an A1c in goal is a vital objective in our diabetes administration. However have you learnt why?

Have you learnt what your A1c goal is, decrease your A1c if wanted, and the way shortly you possibly can decrease your A1c safely?

These are the questions I’ll reply on this complete information on what an A1c is, decrease your A1c, and why reducing A1c isn’t the one (or essentially the most effective) objective in terms of diabetes administration.

What’s A1c?

The A1c, often known as hemoglobin A1c, HbA1c, glycated hemoglobin, or glycohemoglobin, is a blood check that measures your common blood sugar during the last 2 to three months. 

It’s not an “even common,” however fairly a weighted common, the place your blood sugar ranges over the previous few weeks rely a little bit greater than your blood sugar ranges from 2 to three months in the past.

In line with the Nationwide Institute of Diabetes & Digestive & Kidney Ailments (NIDDK):

It’s essential to notice right here that the time period “regular A1c stage” on this context refers to folks with out diabetes. I’ll get again to what a “regular A1c stage” is for folks dwelling with diabetes beneath.

The way to check your A1c

Your physician or endocrinologist ought to verify your A1c often (usually each 3 to six months). The physician merely pricks your finger and takes a tiny blood pattern. 

If the physician’s workplace has an A1c equipment, you must get your outcome earlier than your session is over. (Some places of work, nonetheless, will ship a blood pattern from the lab for processing.)

You may also purchase residence A1c kits (no prescription required) and do the check your self. Residence A1c kits could be helpful should you go for greater than 3 months between physician visits and wish to control how your A1c is trending.

The house kits are typically correct inside plus/minus 0.5 share factors, which is greater than adequate to present you a reliable outcome. 

The draw back of the house kits is that they require a bigger quantity of blood (typically, a number of massive drops) than an everyday blood sugar verify, and should you don’t apply sufficient blood, you’ll get an error message and may have misplaced an A1c check strip.

You’ll find residence check kits on Amazon and in some pharmacies. Ensure that your property A1c equipment is used previous to the expiration date.

Learn extra in: The way to Measure Your A1c at Residence.

Why you must care about your A1c

A number of vital research have proven that prime common blood sugars enhance the chance of diabetes-related issues. Reducing your A1c to the beneficial vary will scale back the chance of diabetes-related issues. 

In line with the landmark Diabetes Management and Problems Trial (DCCT) and the follow-up examine referred to as the Epidemiology of Diabetes Interventions and Problems (EDIC), in folks with diabetes who used intensive remedy to maintain their A1c on the goal stage:

• Eye illness threat was lowered by 76 %
• Kidney illness threat was lowered by 50 %
• Nerve illness threat was lowered by 60 %
• Any heart problems occasion threat was lowered by 42 %
• Nonfatal coronary heart assault, stroke, or threat of loss of life from cardiovascular causes was lowered by 57 %

Attaining an A1c within the beneficial vary is, subsequently, some of the essential issues you are able to do to enhance your long-term well being whenever you reside with diabetes.

In some circumstances, reducing your A1c an excessive amount of is probably not a good suggestion if it implies that you enhance how typically you expertise hypoglycemia (low blood sugar).

I’ll clarify why a measure generally known as “time-in-range” (TIR) is simply as essential as a low A1c later on this information.

The way to decrease your A1c

Now that you’ve got a radical understanding of A1c, in addition to why taking a look at your A1c in isolation isn’t optimum, the apparent query is:

How do you decrease your A1c whereas enhancing or sustaining your time-in-range?

I’ll cowl what, in my expertise, are the 4 most essential issues you are able to do beneath, however it’s all the time beneficial that you just begin by having a dialog along with your medical workforce earlier than making modifications to your diabetes administration.

Determine the primary “ache factors”

Whether or not you’re largely self-managing your diabetes or working intently along with your medical workforce, step one ought to all the time be to attempt to establish the primary “ache factors,” or the reason why your A1c is increased than you’d like. The one possible way of doing that is by monitoring your blood sugars very intently.

When you put on a steady glucose monitor (CGM), you possibly can have a look at your 7-day, 30-day, and 90-day blood sugar knowledge to see should you can spot any traits.

For instance, you may discover that you’re working excessive from 1 a.m. to five a.m. each night time, each morning (as within the daybreak phenomenon, an early-morning enhance in glucose stage), or day-after-day after meals. Or maybe you all the time go low after train. All of us have completely different blood sugar patterns.

It’s additionally very potential that you just are working your blood sugar a little bit too excessive on a regular basis and may gain advantage from adjusting your diabetes treatment.

Figuring out patterns like that makes it potential to pinpoint areas of potential enchancment so you can begin making a plan for restrict your excessive and low blood sugars.

When you depend on guide blood sugar monitoring, it’s a little bit trickier, since most individuals don’t monitor each 5 minutes. On this case, you may strive rising how typically you verify for some time, and possibly even checking throughout the night time should you get up anyway. 

Most meters let you obtain knowledge to your pc, or you possibly can add these knowledge to one in every of varied app-based platforms. This may also help you see the information in a extra cohesive method so you can begin on the lookout for traits.

Create a plan in your diabetes administration

Now that you’ve got a greater thought of what your “ache factors” are, you can begin making modifications to your diabetes administration.

Your physician could recommend a distinct treatment regime. For instance, some individuals are prescribed metformin to assist with the daybreak phenomenon. Others may have changes to insulin dosing or different medicines.

When you’re utilizing insulin and persistently have excessive blood sugars within the morning, getting your blood sugar fluctuations and A1c down is perhaps so simple as adjusting your nighttime basal (background) insulin. 

Or, should you run excessive day-after-day after meals, your insulin-to-carb ratio is perhaps off, and adjusting that might be what units you on a path towards a decrease A1c. Till you accumulate the information and do the evaluation, you don’t have any method of realizing this.

I wish to make an essential level right here: rising your diabetes treatment is just not an indication of failure. It’s typically the most effective (and typically solely) option to handle your blood sugar and produce down your A1c.

I alter my insulin up and down on a regular basis once I change my weight loss plan or train routine. The power to regulate your treatment is a vital instrument in your diabetes toolbox and one thing you must all the time talk about along with your medical workforce.

Perceive vitamin and alter your weight loss plan

What you select to eat and drink can have a significant influence in your waistline, temper, and well-being, in addition to your blood sugar ranges.

All macronutrients (carbohydrates, proteins, and fat) can have an effect on your blood sugar to some extent, so creating a superb understanding of how they have an effect on your blood sugar will allow you to be proactive and forestall blood sugar swings.

Carbohydrates (carbs)

Carbohydrates have the best influence in your blood sugar, which is why many individuals with diabetes can profit from following a lower-carb weight loss plan. The less carbs you eat, the much less insulin you must take, which makes diabetes administration simpler.

Nonetheless, you don’t must observe a low-carb weight loss plan if it doesn’t give you the results you want — bodily or mentally. 

As I wrote in my piece about which weight loss plan is finest for folks with diabetes, it is extremely potential to have nice blood sugar administration on a medium- (and even high-) carb weight loss plan, so long as you experiment, take notes, and be taught to take the correct quantities of insulin for the carbs you’re consuming.

It is rather essential to appreciate that all of us react in another way to carbs, so it’s important to discover the weight loss plan and meals which can be best for you.

For example, folks react very in another way to carbs like oats or candy potatoes. Some folks can eat oats with solely a small enhance in blood sugar, whereas others see a fast spike. 

By merely realizing this, folks having difficulties with a sure sort of carb can select to cut back their consumption or lower it out of their weight loss plan altogether.

Protein and fat

Whereas carbs have an effect on blood sugar most importantly, protein and fats additionally have an effect. Some, like Dr. Sheri Colberg, PhD, one of many world’s main voices on diabetes and train, assume that solely taking a look at carbs when estimating blood sugar influence (and dosing insulin) is an outdated and inefficient option to pursue diabetes administration. 

Within the opinion of some consultants, you must focus extra on complete energy (learn extra about calorie counting and diabetes right here).

The important thing factor to pay attention to is that when protein and particularly fats are consumed with carbohydrates, the power from the meal will likely be launched extra slowly, which implies that your blood sugars will likely be impacted extra slowly as effectively.

Whereas I don’t consider your diabetes administration ought to fully dictate how you reside your life and which weight loss plan you select to observe, it may be price evaluating which meals decisions make life simpler for you. 

By making a acutely aware alternative of which kind of vitamin plan to observe (the vast majority of the time), you possibly can extra simply set up wholesome habits that may profit not solely your general well being but additionally your every day blood sugar ranges, and thereby your A1c.

Improve exercise (train)

Whereas train is important for constructing and sustaining good well being and enhancing insulin sensitivity, it may be a double-edged sword if it continuously throws your blood sugars for a loop. Not solely is that very irritating, scary, and annoying, however it will possibly additionally have an effect on your A1c and time-in-range.

The hot button is to know how several types of train have an effect on your blood sugar ranges and, should you use insulin, to be taught your formulation for balancing insulin and meals round exercises.

Cardio

Cardio, similar to brisk strolling, jogging, swimming, biking, or dancing, are all glorious varieties of train. As little as 20 to half-hour a day could make a major distinction in terms of enhancing insulin resistance and managing blood sugar ranges.

Not solely does train scale back blood glucose throughout train, however it additionally improves your insulin sensitivity for hours after your exercise, that means that you just want much less insulin.

When you deal with your diabetes with insulin, you’ll have to handle your insulin ranges so that you don’t expertise exercise-induced hypoglycemia. This comes right down to lowering your insulin considerably or consuming carbs earlier than your exercise.

For many individuals, it is probably not essential to “carb up” to do as much as 60 minutes of steady-state cardio, however there could be conditions through which lowering insulin earlier than train can’t be achieved, so extra carbohydrates have to be consumed. 

And it’s additionally essential to keep in mind that completely different folks react in another way primarily based on a wide range of elements, similar to insulin sensitivity, timing of their final insulin dose, and health ranges, so this is probably not the case for you.

Resistance coaching

Including resistance coaching to your every day routine, similar to free weights, weight machines, resistance bands, or body weight workout routines, could be instrumental in rising your insulin sensitivity and reducing your A1c.

Whereas cardio will decrease blood sugar throughout train and doubtlessly as much as about 48 hours after train, resistance coaching can enhance insulin sensitivity for for much longer. 

It’s because muscular tissues work as little “glucose tanks” and also you’ll retailer extra glucose in your muscular tissues fairly than sending it on to your bloodstream. The extra muscular tissues you have got, the higher your insulin sensitivity.

Simply remember that some folks will see a short lived enhance in blood sugars throughout intense resistance coaching, fairly than a lower. 

The rationale for the rise in blood sugar is that the improved insulin sensitivity from exercising is surpassed by your physique’s elevated glucose manufacturing from the adrenaline launched by the exercise. 

This adrenaline causes your liver to interrupt down glycogen to create glucose, and your physique is producing the glucose quicker than you should use it.

For an in depth information, learn: How Resistance Coaching Impacts Your Blood Sugar.

The shorter-term results apart, as a result of resistance coaching is so efficient at rising your insulin sensitivity, it’s an effective way to decrease your blood sugar and A1c persistently. 

When you train often, the impact of exercising overlaps from one exercise to the subsequent, and also you primarily obtain a everlasting enhance in insulin sensitivity. (You’ll want to work along with your healthcare workforce to regulate your remedy routine to keep away from lows out of your improved insulin sensitivity.)

Preserve a wholesome weight

In case you are obese, dropping as little as 5 to 10 % of your weight may also help with varied well being markers, together with A1c ranges.

In a single examine, folks with sort 2 diabetes who misplaced this quantity of weight lowered their A1c by a median of 0.5 %.

How shortly are you able to decrease your A1c?

For the reason that A1c check reveals your glucose over the earlier 2 to three months, it’ll take a minimum of just a few weeks of constant dietary and train modifications to see the outcomes mirrored in your A1c stage. 

The precise timeframe will differ primarily based on particular person elements such because the depth of the modifications and the way your physique responds.

(That is merely because of the long-term nature of the check — the enhancements will replicate in your glucose a lot sooner.)

On this video, I clarify how I lowered my A1c in 30 days by following 5 easy steps:

Why you shouldn’t decrease your A1c too shortly

It may be a good suggestion to strategy reducing your A1c with a little bit of warning. Simply as crash weight-reduction plan isn’t wholesome, there could be some severe well being dangers related to reducing your A1c too shortly.

I turned to Dr. Anne Peters, MD, Director of the USC Medical Diabetes Program, and Professor of Medical Drugs Keck College of Drugs of USC for an evidence:

Can your A1c be too low?

As described above, the reply to this query relies upon virtually solely on how typically you expertise hypoglycemia. When you (virtually) by no means expertise hypoglycemia and your A1c is at goal, this is able to recommend that your diabetes administration is efficient.

Nonetheless, this doesn’t imply an especially low A1c is all the time secure or fascinating. Every particular person’s splendid A1c stage can differ, and elements similar to their threat of hypoglycemia unawareness, how lengthy they’ve had diabetes, age, and general well being should be thought-about. 

When you typically expertise hypoglycemia, that may end in an “artificially” low A1c studying as a result of your hypoglycemia occasions are reducing your blood sugar common. 

In that case, specializing in rising time-in-range is way more essential than additional reducing your A1c. In truth, you could even profit from a barely increased A1c with fewer blood sugar fluctuations.

It’s additionally essential to notice that reducing your A1c beneath the widely beneficial vary of 6.0 to 7.0 % hasn’t been confirmed to offer any well being advantages. Due to this fact, a really low A1c shouldn’t be a objective in itself.

What is an efficient A1c goal?

Now that you’ve got your A1c quantity, let’s have a look at what that quantity really tells you. The American Diabetes Affiliation has established the next pointers:

This does NOT imply that you just want an A1c of lower than 5.7% should you’re dwelling with diabetes. It implies that should you do NOT reside with diabetes, your A1c is anticipated to be beneath 5.7%.

There are completely different suggestions for what an applicable A1c is for folks dwelling with diabetes.

I had an opportunity to ask Dr. Peters, in addition to Gary Scheiner, MS, CDCES, proprietor and Medical Director of Built-in Diabetes Providers and creator of Assume Like a Pancreas, what their views are on a superb A1c goal:

Dr. Peters:

Scheiner:

Learn extra about A1c in: What’s a “Regular” HbA1c? and What’s a Harmful Degree of A1c?

Of their Requirements of Care in Diabetes — 2024, the American Diabetes Affiliation recommends an A1c goal of beneath 7.0 % for adults dwelling with diabetes. 

An A1c of seven.0 % roughly interprets to a median blood sugar of 154 mg/dL (8.6 mmol/L) as you possibly can see from this conversion chart (eAG stands for “estimated common glucose”).

Be taught extra about changing A1c to common glucose ranges in: The way to Translate Your A1c to a Blood Sugar Degree.

A1c vs. time-in-range

A1c has lengthy been thought-about the most effective measure of diabetes administration as a result of it was essentially the most correct instrument for observing long-term blood sugar traits. This has modified with the introduction of steady glucose monitoring (CGM). 

By utilizing a CGM, now you can get a really correct image of not solely your common blood sugar, however your blood sugar fluctuations as effectively.

This makes it potential to trace one other key element of diabetes administration: time-in-range.

Time-in-range refers back to the share of time throughout which your blood sugar is inside a selected vary. To see why time-in-range is essential, check out the three traces within the graph beneath. 

All three traces present a median blood sugar of about 154 mg/dL (8.6 mmol/L, which equates to an estimated common A1c of about 7.0 %) however with very completely different fluctuations. I feel we might all favor our blood sugar to observe line 3 fairly than line 1.

Graph used with permission from diaTribe.

Some pointers state that your blood sugar vary needs to be set to 70 to 180 mg/dL (3.9 to 10 mmol/L), however you could discover that to be too huge or slim of a variety for you. 

On this interview with a number of diabetes consultants, most suggest that you just spend lower than 3 % of the time beneath 70 mg/dL (3.9 mmol/L) and fewer than 1 % of the time beneath 54 mg/dL (3 mmol/L). Nonetheless, in addition they agree that the precise time spent in vary must be individualized.

On common, the consultants didn’t count on the overall diabetes inhabitants to be in vary greater than 50 % of the time at most, so speaking about incremental enchancment makes extra sense than setting a hard and fast quantity.

The way to measure time-in-range

When you put on a CGM, your time-in-range metrics needs to be listed whenever you obtain your knowledge (as within the instance from a Dexcom CGM beneath).

Some CGM gadgets provide alerts when glucose ranges are predicted to enter or go away the goal vary, which may enable customers to reply proactively and spend extra time in vary.

(Click on to increase.)

When you don’t use a CGM, all you are able to do is have a look at your guide blood sugar measurements and take note of the quantity of excessive and low blood sugar readings outdoors of your goal vary.

What’s a suitable excessive and low is one thing it’s important to talk about along with your medical workforce.

What’s extra essential: a low A1c or a excessive time-in-range?

Ideally, you’d have an A1c beneath 7.0 % accompanied by low blood sugar variability (excessive time-in-range). A superb basic guideline is:

• The upper your A1c, the extra essential it’s to give attention to getting it down.
• The decrease your A1c, the extra essential time-in-range turns into.

In case your A1c is beneath 6.0 to 7.0 %, specializing in rising your time-in-range will in all probability have a bigger constructive well being influence than reducing your A1c additional.

So, is A1c one of the simplest ways to gauge whether or not your diabetes administration is on observe? Not essentially, however to cite Scheiner:

Closing ideas: My perspective on A1c as an individual dwelling with diabetes

I’ve a really ambivalent relationship with my A1c myself. I’ve been dwelling with sort 1 diabetes for over 20 years, and my A1c is just not one thing I take into consideration in my every day life.

Nonetheless, each 3-6 months once I see my endo, I get a little bit anxious as a result of receiving your A1c can really feel rather a lot like getting your diabetes report card.

And, fairly truthfully, that’s actually foolish. My A1c quantity doesn’t replicate what’s been happening in my life for the final 3 months. It doesn’t inform me how a lot effort I’ve put into managing my diabetes and it doesn’t outline me as an individual. It’s a superb supply of knowledge, nothing extra.

Nonetheless, we have a tendency to take a look at it and choose, good or unhealthy, how we’ve achieved with our diabetes administration. However we actually shouldn’t!

That doesn’t imply that I feel we shouldn’t get our A1c checked. I completely assume we should always, however we additionally want to know what it means in addition to why we should always look past the A1c quantity. I hope this information has given you the data and instruments to take action.