What is A1c?

So here you are in your health provider’s office, freezing in a paper gown, trying to breath while the provider stares at a screen with your second set of lab test results lit up like Christmas tree lights and they aren’t talking. Then, your provider looks up.

There is that drop in your stomach, tension beginning to tighten in your gluteus maximus, and your eyes start to widen into the frozen deer look. All you want to do is put on the stretchy sweatpants and Bubba’s Buffet t-shirt, which cover a multitude of sins, hanging on the hook and get out.  

“Well, your glucose and A1c are still a little high from your last test.”

What does that mean, “a little high”?

Your brain flashes to a relative with a bathroom cabinet with a whole shelf of little plastic bottles labeled with their name and a nearby pharmacy.

If that is you, then read on to find out what your provider is looking at and how you may be able to keep your cabinet shelf clear except for your daily dental care routine and a box of Power Ranger band-aids that never seems to empty.

What is the point to those two biomarkers – glucose and A1c? What do they tell you about your health? Let’s start with –

What is glucose?

The fuel for your body is glucose in the same way gasoline is fuel for your car. Your body will not run without it. Your brain prefers it. Your intestinal tract uses the foods that contain it to keep you regular.

A glucose test measures where your blood level is at the time of the blood draw. The test is evaluating the level of glucose in your blood “pre-prandial” or before eating. That is why you were probably told not to eat anything for 8-12 hours before going to the lab. So, if you ate before a test, anything other than water, plain coffee or tea, that food will throw off the measurement by releasing glucose into the bloodstream.

If you eat something before the test, please tell the lab tech. No one wants you getting an inaccurate reading. And you do not want to have to come back in for another jab in your finger or arm.

What is a healthy glucose level?

A healthy glucose level will be below 99 mg/dL, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes. That is according to the general allopathic medical world. However, those of us who work on reversing or stopping the progression have other biomarker levels, but 99 is a good place to start. Okay, we now know that your pre-meal glucose is a little high. But did that happen on a regular basis or is it just from the last night spent with your friends at your favorite dive restaurant?

How do I know if my blood sugar has been high for a while?

If you have been eating too much food, no matter what the major macronutrient is – carbohydrate, fat or protein, you will make excess glucose that will become fat. Unfortunately, more than simply making fat will happen with excess glucose. That is what we measure with A1c.

The A1c test—aka, hemoglobin A1c or HbA1c test—is a blood test that measures your average blood sugar levels over a 3-month period. [i]

What does A1c stand for?

Your blood has hemoglobin in it. Hemoglobin is the substance that transports oxygen continuously throughout the body via your circulatory system. The short form of hemoglobin is Hgb or Hb. There are eight types of Hb. One of them is type A which means “adult”. This is the type found in most people over the age of 5. Now you know the HbA part of the HbA1c test title.

Ninety-eight percent of HbA is type 1. The other types are genetic alterations that rarely occur. So, now we have HbA1. But what about that “c”?

The “c” means glycosylated hemoglobin. Don’t worry there is no test with these names. Here is what glycosylation is.

Definition of glycosylation of blood cells.

When you eat food, you break it down into glucose. It crosses into your blood stream from your small intestines. The newly transported glucose can stick to the hemoglobin especially when there is more coursing through your veins than you need. It actually crystalizes onto the cell like rock candy while running around your system. Another word for the crystallization is “glycosylation”. The glycosylated glucose will remain on the blood cell until the cell dies off which is in about 90 days. That’s why you may be asked to have an A1c – crystallization – test every three months. Notice we just cut off the Hb part of the name.

Your healthcare provider will be able to tell how well your blood sugars have been managed because they will measure how many of these glycosylated cells are in your blood draw. A high amount of sugar in the blood means something is going wrong in the cells and possibly the pancreas. [See my blog on Insulin Resistance for information on the role of the pancreas.]

What is a high A1c?

The Center for Disease Control and Prevention says that “A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes.” I can tell you from experience that if your A1c is over 5.0% you are already raising the risk that excess glucose is damaging your heart, kidneys and pancreas.

You may have a discussion with your healthcare provider about diet and exercise. You may be freaked out a bit. Don’t despair. Most of the time there are ways you can reverse this through lifestyle and nutrition way before you need to start medications. What is important is to talk to an expert about how to make this happen within the parameters of your life. A handout after a 2-minute discussion with your provider is not enough.

I have seen people start incredible daily workouts only to stop in a few weeks or someone bringing home half of the produce department at the local Piggly Wiggly only to throw it out in 10 days. They are trying to do something, but they don’t have a plan.

If that sounds like you, perhaps we should talk. We can map out a plan that fits within your daily routine, and creates a path out of the current unhealthy state you are in.

You may have noticed that as these articles I write continue I share some of my best weight loss and diabetes reversal techniques. I don’t hide away the information from you. I want to share the wealth. However, some of us need a little direction, encouragement and accountability. That’s where I come in. Your provider and I can work together to have you look forward to your next lab test. But watch out. You may just hear this:

“I hate to say this, but your labs are looking great. I’m afraid you will stop what you are doing.”

No fears. Take a deep breath and, in the words of my clients’, “You know, it wasn’t that hard.” Not when you are starting to feel great and swapping the elastic waist band pants and moo-moo t-shirts for the jeans that have been hiding out in the back of the drawer.

[i] https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html#:~:text=The%20A1C%20test%E2%80%94also%20known,care%20team%20manage%20your%20diabetes.