How to Lower Your A1c: The Complete Guide

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

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

Have you learnt what a very good A1c goal is, methods to decrease your A1c, and the way shortly you’ll be able to decrease your A1c safely?

These are the questions I’ll reply on this complete information on what A1c is, methods to decrease your A1c, and why reaching a low A1c isn’t the one (or essentially one of the best) objective relating to diabetes administration.

What’s A1c?

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

It’s not an “even common,” however reasonably a weighted common, the place your blood sugar ranges over the previous couple of weeks depend somewhat greater than your blood sugar ranges from 2 to three months in the past.

In response to the Nationwide Institute of Diabetes & Digestive & Kidney Illnesses (NIDDK):

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

Tips on how to take a look at your A1c

Your physician or endocrinologist ought to take a look at your A1c often (sometimes each 3 to six months). The physician merely pricks your finger (or earlobe tip, if you happen to desire) and takes a tiny blood pattern. 

If the physician’s workplace has an A1c equipment, it is best to get your end result earlier than your session is over. (Some workplaces, nonetheless, will ship the pattern to a lab for processing.)

You can even purchase house A1c kits (no prescription required) and do the take a look at your self. Residence A1c kits will be helpful if you happen to go for greater than 3 months between physician visits and need to control how your A1c is trending your self.

The house kits are usually correct inside plus/minus 0.5 share factors, which is greater than ok to provide you a reliable end result. 

The draw back of the house kits is that they require a bigger quantity of blood (usually, a number of massive drops) than an everyday blood sugar test, and if you happen to don’t apply sufficient blood, you’ll get an error message and could have misplaced a take a look at strip.

You’ll find house take a look at kits on Amazon and in some pharmacies.

Learn extra in: Tips on how to Measure Your A1c at Residence.

Why it is best to care about your A1c

A number of vital research have proven that prime common blood sugars improve the danger of diabetes-related problems. Reducing your A1c to the advisable vary will scale back the danger of diabetes-related problems considerably. 

In response to the landmark Diabetes Management and Problems Trial (DCCT) and the follow-up research known as the Epidemiology of Diabetes Interventions and Problems (EDIC), in individuals who used intensive remedy to maintain their A1c on the goal degree:

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

Attaining an A1c within the advisable vary is, subsequently, some of the necessary issues you are able to do to enhance your long-term well being if you stay with diabetes.

Nevertheless, the nearer you get to the advisable A1c goal, the much less profit you’re going to get from decreasing your A1c additional. For instance, taking your A1c from 12.0 % to 11.0 % makes an enormous distinction, whereas decreasing your A1c from 7.0 % to six.0 % supplies a a lot smaller profit. 

The truth is, decreasing your A1c an excessive amount of is probably not a good suggestion if it signifies that you improve how typically you expertise hypoglycemia (low blood sugar).

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

Tips on how to decrease your A1c

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

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

I’ll cowl the 4 most necessary issues you are able to do beneath, nevertheless it’s all the time advisable that you simply begin by having a dialog along with your medical staff earlier than making modifications to your diabetes administration.

Establish the principle “ache factors”

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

In the event you put on a steady glucose monitor (CGM), you’ll be able to have a look at your 7-day, 30-day, and 90-day blood sugar information to see if you happen to can spot any tendencies.

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

It’s additionally very doable that you just are operating your blood sugar somewhat too excessive on a regular basis and may gain advantage from adjusting your diabetes remedy.

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

In the event you depend on guide blood sugar monitoring, it’s somewhat trickier, since most individuals don’t monitor each 5 minutes. On this case, you may strive growing how typically you test for some time, and perhaps even checking in the course of the evening if you happen to get up anyway. 

Most meters mean you can obtain information to your pc, or you’ll be able to add the info to one among varied app-based platforms. This may help you see the info in a extra cohesive method so you can begin searching for tendencies.

Create a plan to your diabetes administration

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

Your physician could counsel a unique remedy regime. For instance, some folks (no matter their sort of diabetes) are prescribed metformin to assist with the daybreak phenomenon. Others may have changes to insulin dosing or different drugs.

In the event you’re utilizing insulin and constantly 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, if you happen to run excessive daily 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 gather the info and do the evaluation, you haven’t any method of realizing this.

I need to make an necessary level right here: growing your diabetes remedy isn’t an indication of failure. It’s typically one of the best (and typically solely) solution to handle your blood sugar and produce down your A1c.

I modify my insulin up and down on a regular basis after I change my weight loss program or train routine. The power to regulate your remedy is a vital software in your diabetes toolbox and one thing it is best to all the time talk about along with your medical staff.

Perceive diet and modify your weight loss program

What you select to eat and drink can have a serious 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 a point, so growing a very good understanding of how they have an effect on your blood sugar will allow you to be proactive and stop 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 low- to medium-carb weight loss program (or perhaps a ketogenic weight loss program). The less carbs you eat, the much less insulin it’s good to take, which makes diabetes administration simpler.

Nevertheless, you don’t must comply with a low-carb weight loss program if it doesn’t be just right for you — bodily or mentally. 

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

It is extremely necessary to comprehend that all of us react in a different way to carbs, so you must discover the weight loss program and meals which might be best for you.

For example, folks react very in a different way to carbs like oats or candy potatoes. Some folks can eat oats with solely a small improve 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 minimize it out of their weight loss program 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, even assume that solely taking a look at carbs when estimating blood sugar influence (and dosing insulin) is an outdated and inefficient solution to pursue diabetes administration. 

Within the opinion of those specialists, it is best to focus extra on whole energy (learn extra about calorie counting and diabetes right here).

The important thing factor to concentrate on is that when protein and particularly fats are consumed with carbohydrates, the vitality from the meal might be launched extra slowly, which signifies that your blood sugars might be impacted extra slowly as properly.

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

By making a acutely aware selection of which kind of diet plan to comply with (nearly all of the time), you’ll be able to extra simply set up wholesome habits that may profit not solely your total well being but additionally your day by day blood sugar ranges, and thereby your A1c.

Enhance 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 always throws your blood sugars for a loop. Not solely is that very irritating, scary, and annoying, however it could possibly additionally have an effect on your A1c and time-in-range negatively.

The secret’s to grasp how several types of train have an effect on your blood sugar ranges and, if you happen to use insulin, to study your formulation for balancing insulin and meals round exercises.

Cardio

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

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

In the event 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 all the way down to decreasing 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 will be conditions wherein decreasing insulin earlier than train can’t be finished, so further carbohydrates should be consumed. 

And it’s additionally necessary to do not forget that totally different folks react in a different way primarily based on a wide range of components, resembling 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 day by day routine, resembling free weights, weight machines, resistance bands, or body weight workout routines, will be instrumental in growing your insulin sensitivity and decreasing your A1c.

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

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

Simply bear in mind that some folks will see a short lived improve in blood sugars throughout intense resistance coaching, reasonably 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 utilize 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 growing your insulin sensitivity, it’s a good way to decrease your blood sugar and A1c constantly. 

In the event you train often, the impact of exercising overlaps from one exercise to the following, and also you primarily obtain a everlasting improve in insulin sensitivity. (Make sure to work along with your healthcare staff to regulate your remedy routine to keep away from lows out of your improved insulin sensitivity.)

Preserve a wholesome weight

If you’re obese, shedding as little as 5 to 10 % of your weight may help with varied well being markers, together with A1c ranges.

In a single research, folks with sort 2 diabetes who misplaced this quantity of weight diminished their A1c by a mean of 0.5 %.

How shortly are you able to decrease your A1c?

Because the A1c take a look at reveals your glucose over the earlier 2 to three months, it would take a minimum of a couple of weeks of constant dietary and train modifications to see the outcomes mirrored in your A1c degree. 

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

(That is merely because of the long-term nature of the take a look at — the enhancements will mirror 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 decreasing your A1c with a little bit of warning. Simply as crash weight-reduction plan isn’t wholesome, there will be some severe well being dangers related to decreasing your A1c too shortly.

I turned to Dr. Anne Peters, MD, Director of the USC Scientific Diabetes Program, and Professor of Scientific Drugs Keck Faculty of Drugs of USC, for a proof:

It’s necessary to work along with your healthcare staff to find out one of the best A1c objective for you and the suitable timeline for working your method towards this goal.

Can your A1c be too low?

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

Nevertheless, this doesn’t imply an especially low A1c is all the time protected or fascinating. Every particular person’s perfect A1c degree can differ, and components resembling their threat of hypoglycemia unawareness, how lengthy they’ve had diabetes, age, and total well being should be thought of. 

Uncommonly, some folks obtain A1c ranges beneath 5.0 % by following a really strict diabetes administration and weight loss program routine and have nearly no blood sugar fluctuations.

Nevertheless, if you happen to typically expertise hypoglycemia, that may lead to an “artificially” low A1c studying as a result of your hypoglycemia occasions are decreasing your blood sugar common. 

In that case, specializing in growing time-in-range is rather more necessary than additional decreasing your A1c. The truth is, you could even profit from a barely increased A1c with fewer blood sugar fluctuations.

It’s additionally necessary to notice that decreasing your A1c beneath the commonly advisable vary of 6.0 to 7.0 % hasn’t been confirmed to supply any well being advantages. Due to this fact, a really low A1c shouldn’t be a objective in itself.

What is an effective 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 tips

This does NOT imply that you simply want an A1c of lower than 5.7% if you happen to’re dwelling with diabetes. It signifies that if you happen to do NOT stay with diabetes, your A1c is anticipated to be beneath 5.7%.

There are totally different suggestions for what an acceptable A1c is for folks dwelling with diabetes.

I had an opportunity to ask Dr. Peters, in addition to Gary Scheiner, MS, CDCES, proprietor and Scientific Director of Built-in Diabetes Companies and writer of Suppose Like a Pancreas, what their views are on a very good 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 mean blood sugar of 154 mg/dL (8.6 mmol/L) as you’ll be able to see from this conversion chart (eAG stands for “estimated common glucose”).

Study extra about changing A1c to common glucose ranges in: Tips on how to Translate Your A1c to a Blood Sugar Degree.

A1c vs. time-in-range

A1c has lengthy been thought of one of the best measure of diabetes administration as a result of it was essentially the most correct software for observing long-term blood sugar tendencies. 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 properly.

This makes it doable 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 particular vary. To see why time-in-range is necessary, check out the three traces within the graph beneath. 

All three traces present a mean 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 totally different fluctuations. I feel we’d all desire our blood sugar to comply with line 3 reasonably than line 1.

Graph used with permission from diaTribe.

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

In response to this interview with a number of diabetes specialists, most suggest that you simply spend lower than 3 % of the time beneath 70 mg/dL (3.9 mmol/L) and fewer than 1 % of the time beneath 53 mg/dL (3 mmol/L). Nevertheless, additionally they agree that the precise time spent in vary must be individualized.

On common, the specialists didn’t anticipate 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 set quantity.

Tips on how to measure time-in-range

In the event you put on a CGM, your time-in-range metrics ought to be listed if you obtain your information (as within the instance from a Dexcom CGM beneath).

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

(Click on to broaden.)

In the event 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 you must talk about along with your medical staff.

What’s extra necessary: 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 very good normal guideline is:

• The upper your A1c, the extra necessary it’s to deal with getting it down.
• The decrease your A1c, the extra necessary time-in-range turns into.

In case your A1c is beneath 6.0 to 7.0 %, specializing in growing your time-in-range will most likely have a bigger optimistic well being influence than decreasing your A1c additional.

So, is A1c a foul solution to gauge whether or not your diabetes administration is on observe? Not essentially, however to cite Scheiner:

Remaining 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 isn’t one thing I take into consideration in my day by day life.

Nevertheless, each 3-6 months after I see my endo, I get somewhat anxious as a result of receiving your A1c can really feel so much like getting your diabetes report card.

And, fairly actually, that’s actually foolish. My A1c quantity doesn’t mirror what’s been occurring 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 very good supply of data, nothing extra.

Nonetheless, we have a tendency to have a look at it and decide, good or unhealthy, how we’ve finished 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 grasp 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.