can apple cider vinegar lower a1c?

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A1C is a blood test for type 2 diabetes and prediabetes. It measures your average blood glucose, or blood sugar, level over the past 3 months. Doctors may use the A1C alone or in combination with other diabetes tests to make a diagnosis. They also use the A1C to see how well you are managing your diabetes. This test is different from the blood sugar checks that people with diabetes do every day.

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 between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year.

Type 2 diabetes is above 6.5%

If you have diabetes, you should have the A1C test at least twice a year. The A1C goal for many people with diabetes is below 7. It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.

The A1C test is a blood test that measures the body’s average blood sugar levels over the past 3 months. The test can help doctors identify prediabetes, diagnose diabetes, and monitor the effectiveness of diabetes treatments.

The A1C test, also known as the hemoglobin A1C, HbA1C, glycated hemoglobin, or glycohemoglobin test, measures the amount of sugar attached to hemoglobin in the blood.

Hemoglobin is a protein present in red blood cells (RBCs), and sugar naturally attaches to it. However, as people with higher blood sugar levels have more sugar-coated hemoglobin, it is a useful test to help check and monitor diabetes status.

As higher A1C levels are often associated with diabetes complications, it is important to reach and maintain target A1C results. An individual’s personal A1C goal will depend on many factors, including age and any other medical conditions. Although it is an important tool for managing diabetes, testing A1C levels does not replace other strategies, such as regular blood sugar testing at home.

A person can work toward lowering and maintaining their A1C level by following their treatment plan, getting regular physical exercise, and taking steps to lose weight, if the doctor has advised doing so.

In this article, we discuss healthy and concerning A1C levels, the possible complications of high levels, and strategies to reduce A1C levels.

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What are dangerous levels?

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A1C test resultsTrusted Source represent how well the body is maintaining blood glucose levels by showing the average percentage of sugar-bound hemoglobin in a blood sample. A higher A1C level suggests a higher riskTrusted Source of diabetes and its complications.

When discussing A1C levels, a doctor may also refer to estimated average glucose, or eAG. The eAG corresponds to A1C, but it appears as milligrams per deciliter (mg/dl), as with blood sugar. Both A1CTrusted Source and eAG refer to a person’s average 3-month blood glucose levels.

A1C value eAG value Potential diagnosis

5.6% or less 117 mg/dl or less Normal

5.7–6.4% 117–137 mg/dl Prediabetes

6.5% or more 137 mg/dl Diabetes

However, A1C level recommendations can vary among individuals due to a number of factors. What may be high for one person might be within range for another person.

For example, people with more advanced diabetes will have higher A1C targets than those without diabetes. Various underlying conditions, includingTrusted Source blood disorders, can also have an effect, as can potentially modifiable factors, such as stress, medications, and lifestyle changes.

A1C value eAG value Potential targets forTrusted Source:

5.6% or below 117 mg/dl or below healthy adults without diabetes

6.5% 140 mg/dl people with short-term diabetes, managed type 2 diabetes, no cardiovascular disease, long life expectancy

7% or less 154 mg/dl or less most non-pregnant adults with diabetes

8% or less 183 mg/dl or less people with long-standing or severe diabetes, limited life expectancy, extensive additional health complications, or poor treatment response

A person with an A1C level indicating prediabetes may wish to consider making lifestyle changes, such as adopting a well-balanced diet and staying active, to help manage or even reverse the condition before it progresses to type 2 diabetes.

If a person has a higher A1C level, suggesting diabetes, it is advisable for them to contact a doctor. The doctor will be able to run further diagnostic tests to confirm the person’s diabetes status.

The A1C goal for most people with diabetes is 7% or lessTrusted Source. However, personal targets can vary, and a diabetes care team may consider other factors to help a person set their own individual goals.

If a person with diabetes has an A1C test result that is much higher than their set target, a doctor can help advise lifestyle and medication changes to lower their A1C level.

What is A1C, and what does it measure?

The A1C test is a blood test that measures a person’s average blood sugar levels over the past 3 months. In particular, it measures the percentage of hemoglobin in the blood with an attached molecule of glucose.

When glucose attaches to hemoglobin, experts refer to the resulting compound as glycosylated hemoglobin. The name of the test derives from the fact that about 95–98% of the hemoglobin present in the body is type A1. Type A1 hemoglobin has subtypes, including A1C. As this is the most abundant subtype, it is a good marker for glucose control.

The test uses a 3-month average because RBCs typically live for about 3 months. Therefore, this timeframe reflects the sugar exposure to the cells over that time. The test does not require any specific preparations, so a person does not need to fast prior to the test, and a doctor can perform it at any time of the day.

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How the test works

The A1C test estimates the average blood sugar level over the past 3 months. The test is able to measure this by identifying the percentage of glycosylated hemoglobin in the blood.

If there is more glucose present in the blood, more glucose is available to attach to hemoglobin. Therefore, if a person has a high percentage of glycosylated hemoglobin, it indicates that they have had high blood sugar for an extended period.

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Complications of high A1C

A high A1C level can be concerning, as it may indicate that an individual has a higher risk of diabetes complications. For those without a diabetes diagnosis, it suggests that, without interventions, they may develop the condition. For individuals living with diabetes, it may indicate that their current treatment plan is not effective and that they should contact a doctor.

Potential complications that can result from high blood sugar levels includeTrusted Source:

kidney disease

eye disease

stroke and cardiovascular disease

metabolic syndrome

neuropathy

Setting A1C goals

As many factors can affect a suitable A1C range, there is no standardized approach when it comes to setting A1C goals. A diabetes healthcare team can help provide an individual with a target level that accounts for various factors, including the current A1C value and the date of the next test.

If the test result is already within a healthy range, the goal should be to maintain that. However, if a person enters the higher ranges, a doctor can suggest changes to their goals and treatment plans. They can help the person determine a reasonable target and the best strategy to achieve that goal.

Tips to lower A1C

If a person’s A1C level is above their target, a doctor can provide suggestions to help lower it and reduce the risk of potential complications. A person should discuss any drastic lifestyle changes with a doctor before making them. Suggestions to help lower A1C levels may include:

Reviewing medication: This may involve changing to a different medication or increasing the current dosage. It is also important to ensure that a person is correctly following their treatment plan.

Regular physical exercise: Physical activity is good for general health, and as the body requires glucose to exercise, it can be a beneficial way to lower blood sugar levels.

Healthy diet: A balanced and nutritious diet can help with managing sugar levels. Additionally, it can help people achieve any weight loss goals.

Stopping smoking: Smoking has many potential health risks, and quitting smoking may also help improve blood flow.

Diabetes education courses: Some people may benefit from attending educational courses and learning strategies to manage their sugar levels more effectively.

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Summary

An A1C test is a diagnostic tool that measures blood sugar levels over the last 3 months. It can help doctors identify people at risk of developing diabetes and monitor the effectiveness of treatments in those living with the condition.

It measures the percentage of hemoglobin in red blood cells that has an attached glucose molecule. If a person has high blood sugar, more glucose is available to attach to hemoglobin. This means that individuals with high blood sugar will have a higher percentage of glycosylated hemoglobin and an increased risk of potential complications.

People can work toward lowering their A1C levels by implementing different strategies, such as following their current treatment plan, getting regular exercise, and taking steps to lose weight, if necessary.

By Suzanne Watkins, MS, RD, LD, CNSC, Samaritan Albany General Hospital

Have you recently found yourself puzzling over this acronym? Or maybe you or a family member has been told their A1C is too high, but you’re not quite sure what this means? Here’s a review of what an A1C is, and what to do about it.

What Is the A1C Metric?

An A1C has many names. It can be called a hemoglobin A1C, glycated hemoglobin or HbA1c. Overall, it’s the lab that your provider collects when they want to see what your average blood sugar is over the course of three months. It is used to diagnose prediabetes or diabetes, or if you already have diabetes, monitor how you’ve been managing your blood sugars over a long period of time. A higher A1C means your blood sugars have been running higher; lower A1C means your blood sugars have been running lower.

Think about it this way – when you spill honey on your countertop, it gets sticky. When your blood sugar is high, your blood gets sticky, too, and the little sugar molecules (glucose) will stick onto the protein (hemoglobin) on your red blood cells at a higher rate. The test is telling you what percentage of your red blood cells have a sugar-coated hemoglobin.

What Is the Normal Range for A1C?

An A1C is considered “within normal limits” when it is 5.6 percent or lower. Your health care provider can diagnose prediabetes with an A1C between 5.7 to 6.4 percent, and diabetes with an A1C of 6.5 percent and higher. If you have diabetes, the goal is to keep your A1C at about 7.0 percent or lower.

A graph showing  A1C values from normal to prediabetes to diabetes.

What If My A1C Is Too High?

If your A1C is high, you can bring it down again.

If your A1C falls in the “prediabetes” range (5.7 to 6.4 percent), you are in the perfect position to modify your lifestyle to lower your A1C and send diabetes packing. This can be done by being mindful of your nutrition and physical activity.

If your A1C falls in the “diabetes” range (6.5 percent and higher), you can still lower your A1C with lifestyle changes, but your provider may prescribe some medications as well.

Keep Your Blood Sugars in Check

Whether you have prediabetes or diabetes, here are ways to keep your blood sugars in check.

1.  Be Mindful of Your Nutrition

Carbohydrates are an important fuel source for your body and your brain. You need a certain amount of carbohydrates every day to think straight, feel good and help your body function. Too many carbohydrates, however, can raise your blood sugars and A1C. One of the most effective ways to keep your blood sugars in a good range is to manage the carbohydrates that you eat.

Try some of these practices to limit carbohydrate consumption daily:

Drink less sugar-sweetened beverages. This includes regular sodas, coffee drinks, energy drinks and alcoholic beverages. Many people consume more sugars in beverages than they realize, so cutting back on sugar-sweetened beverages or choosing the diet/sugar free option can help a lot.

Watch your portion sizes. Pasta, cereal, potatoes, bread – these are all too easy to overindulge. Aim to eat small portions of carbohydrate-containing foods at meals. Study Nutrition Facts labels and try sticking to the recommended serving size on packages.

Treat desserts and candies as a special occasion. Allow yourself to have a small slice of cake for your birthday – but remember, every day is not your birthday! Establish a specific and measurable rule for yourself to keep from over-indulging. For example, you can have two squares of chocolate or a 1-ounce bag of potato chips on Friday nights.

Choose whole grains to increase the fiber in your diet. Eating fiber-rich foods will improve your digestion and help manage blood sugars. The Dietary Guidelines for Americans recommends a minimum of 14 grams of fiber for every 1,000 calories that you eat. Fiber is found in whole grains such as whole wheat breads and pastas, oats and brown rice. Fiber is also found in nuts, fruits, vegetables, pulses, beans and legumes.

Remember to have regular, balanced meals. A healthy meal plan involves plenty of variety of fruits, vegetables, whole grains and proteins. Make a plan that you know you can maintain long term. Take a look at the Idaho Plate Method for ideas on how to prepare well-balanced meals.

2.  Increase Your Physical Activity

Physical activity decreases blood sugars. You don’t need a gym membership to increase your physical activity. Whether you go on a run, or vacuum your living room, movement is going to help you lower your blood sugars and ultimately manage your A1C. Remember that ANY activity you do can be helpful. Find an activity you enjoy and stick with it. Here are some suggestions to increase your daily activity:

Walk or bike to visit your neighbors.

Park farther away from storefronts, or get off the bus one or two stops before your stop.

Clean your home.

Garden.

Take the stairs instead of the elevator.

Carry your own groceries.

Wash your car by hand.

Stand while talking on the phone with a friend.

Try a group class. Parks and Recreation has many different classes that you can try if something sounds fun to you.

Make sure to talk to your health care provider if you are thinking of increasing your physical activity drastically.

3.  Lose a Little Weight If You Are Overweight

 Losing five to 10 percent of your body weight, if you are overweight, can improve your blood sugars. A study published in the journal Diabetes, Obesity and Metabolism found that each 2.2 pounds of weight loss provided a reduction of 0.1 percentage points in A1C for people who were overweight or obese. Make sure to lose this weight slowly and mindfully so the weight does not come back. A weight loss of one to two pounds per week is considered healthier and tends to be more successful long term. It may be helpful to speak with a registered dietitian to help you find a tasty, healthful weight loss plan.

4.  Medications

Your health care provider may prescribe blood sugar-lowering medications based on your numbers and overall health profile. These typically include oral medications, and/or injectable insulin.

5.  Check Your Blood Sugars Often

One of the most challenging things about maintaining your blood sugars and A1C is that your body is unique. Your blood sugars are going to react differently to sweet potatoes than your neighbor’s blood sugars. Taking charge of your blood sugars and A1C is going to require a you-specific regimen, and figuring out that regimen is going to involve collecting data. Your health care provider may order a blood glucose monitor and test strips for you. You also have the option to purchase an inexpensive monitor without a prescription at your local pharmacy. Monitoring your blood sugars regularly gives you and your provider feedback on how well your regimen is working, and if any changes need to be made.

Be aware that low blood sugars and high blood sugars can sometimes be hard to tell apart, even for people who have managed their diabetes for years. So always check your blood sugar before you treat your blood sugars.

When to Seek Medical Attention

As you are checking your blood sugars, know when you need to seek medical attention.

Low Blood Sugars (Hypoglycemia) 

 Any blood sugar lower than 70mg/dl is considered hypoglycemia and needs attention. Symptoms of hypoglycemia may be any of the following:

Feeling shaky.

Anxiety.

Sweating, chills and clamminess.

Irritability or impatience.

Hunger.

Nausea.

Fatigue.

Impaired or blurred vision.

Headaches.

Seizures.

If you check your blood sugar and find it’s low, you can treat it using the 15-15 Rule:

Step 1: Eat or drink 15 grams of carbohydrates, with glucose tablets,  ½ cup of juice, 1 tablespoon of honey or sugar, or hard candies.

Step 2: Wait for 15 minutes.

Step 3: Check your blood sugar again. If it’s still below 70mg/dl, repeat.

If, after two rounds of this, you’re still experiencing low blood sugar, call your health care provider.

High Blood Sugars (Hyperglycemia)

Any blood sugar greater than 200mg/dl is considered hyperglycemia, and warrants attention. Symptoms of hyperglycemia can by any of the following:

Frequent urination.

Increased thirst.

Blurred vision or vision changes.

Nausea and vomiting.

Fatigue.

Headache.

Delayed wound healing.

Confusion

You can treat high blood sugars by exercising as long as your blood sugars are lower than 240mg/dl. Call your provider if your blood sugars are persistently higher than 240mg/dl and you have ketones in your urine. Your provider and/or diabetes educator can work with you to keep your blood sugars in the optimum range.

Why Should You Use Apple Cider Vinegar (ACV) For Diabetes? – Dr.Berg

Know You Are Not Alone

Blood sugar and A1C control can be tricky, but you don’t have to figure this out alone. For more information about blood sugar and A1C control, ask your provider about visiting a diabetes educator.

Feeling overwhelmed with managing diabetes? Watch a video with tips on how to reduce diabetes distress and more.

The A1C Test & Diabetes

On this page:

What is the A1C test?

Why should a person get the A1C test?

How is the A1C test used to diagnose type 2 diabetes and prediabetes?

Is the A1C test used during pregnancy?

Can other blood glucose tests be used to diagnose type 2 diabetes and prediabetes?

Can the A1C test result in a different diagnosis than the blood glucose tests?

Why do diabetes blood test results vary?

How precise is the A1C test?

How is the A1C test used after diagnosis of diabetes?

What A1C goal should I have?

How does A1C relate to estimated average glucose?

Will the A1C test show short-term changes in blood glucose levels?

Clinical Trials for the A1C Test and Diabetes

What is the A1C test?

The A1C test is a blood test that provides information about your average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test can be used to diagnose type 2 diabetes and prediabetes.1 The A1C test is also the primary test used for diabetes management.

A health care professional draws blood.

An A1C test is a blood test that reflects your average blood glucose levels over the past 3 months.

The A1C test is sometimes called the hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test. Hemoglobin is the part of a red blood cell that carries oxygen to the cells. Glucose attaches to or binds with hemoglobin in your blood cells, and the A1C test is based on this attachment of glucose to hemoglobin.

The higher the glucose level in your bloodstream, the more glucose will attach to the hemoglobin. The A1C test measures the amount of hemoglobin with attached glucose and reflects your average blood glucose levels over the past 3 months.

The A1C test result is reported as a percentage. The higher the percentage, the higher your blood glucose levels have been. A normal A1C level is below 5.7 percent.

Why should a person get the A1C test?

Testing can help health care professionals

find prediabetes and counsel you about lifestyle changes to help you delay or prevent type 2 diabetes

find type 2 diabetes

work with you to monitor the disease and help make treatment decisions to prevent complications

If you have risk factors for prediabetes or diabetes, talk with your doctor about whether you should be tested.

Couple walking with their dog.

You may be able to prevent or delay type 2 diabetes with lifestyle changes such as weight loss or being physically active most days of the week.

How is the A1C test used to diagnose type 2 diabetes and prediabetes?

Health care professionals can use the A1C test alone or in combination with other diabetes tests to diagnose type 2 diabetes and prediabetes. You don’t have to fast before having your blood drawn for an A1C test, which means that blood can be drawn for the test at any time of the day.

If you don’t have symptoms but the A1C test shows you have diabetes or prediabetes, you should have a repeat test on a different day using the A1C test or one of the other diabetes tests to confirm the diagnosis.2

A1C results and what the numbers mean

*Any test used to diagnose diabetes requires confirmation with a second measurement, unless there are clear symptoms of diabetes.

Diagnosis* A1C Level

Normal below 5.7 percent

Prediabetes 5.7 to 6.4 percent

Diabetes 6.5 percent or above

When using the A1C test for diagnosis, your doctor will send your blood sample taken from a vein to a lab that uses an NGSP-certified method. The NGSP External link, formerly called the National Glycohemoglobin Standardization Program, certifies that makers of A1C tests provide results that are consistent and comparable with those used in the Diabetes Control and Complications Trial.

Blood samples analyzed in a doctor’s office or clinic, known as point-of-care tests, should not be used for diagnosis.

The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis NIH external link-related diabetes. The A1C test may give false results in people with certain conditions.

Having prediabetes is a risk factor for developing type 2 diabetes. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes.

Is the A1C test used during pregnancy?

Health care professionals may use the A1C test early in pregnancy to see if a woman with risk factors had undiagnosed diabetes before becoming pregnant. Since the A1C test reflects your average blood glucose levels over the past 3 months, testing early in pregnancy may include values reflecting time before you were pregnant. The glucose challenge test or the oral glucose tolerance test (OGTT) are used to check for gestational diabetes, usually between 24 and 28 weeks of pregnancy. If you had gestational diabetes, you should be tested for diabetes no later than 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. Even if your blood glucose is normal, you still have a greater chance of developing type 2 diabetes in the future and should get tested every 3 years.

Can other blood glucose tests be used to diagnose type 2 diabetes and prediabetes?

Yes. Health care professionals also use the fasting plasma glucose (FPG) test and the OGTT to diagnose type 2 diabetes and prediabetes. For these blood glucose tests used to diagnose diabetes, you must fast at least 8 hours before you have your blood drawn. If you have symptoms of diabetes, your doctor may use the random plasma glucose test, which doesn’t require fasting. In some cases, health care professionals use the A1C test to help confirm the results of another blood glucose test.

Can the A1C test result in a different diagnosis than the blood glucose tests?

Yes. In some people, a blood glucose test may show diabetes when an A1C test does not. The reverse can also occur—an A1C test may indicate diabetes even though a blood glucose test does not. Because of these differences in test results, health care professionals repeat tests before making a diagnosis.

People with differing test results may be in an early stage of the disease, when blood glucose levels have not risen high enough to show up on every test. In this case, health care professionals may choose to follow the person closely and repeat the test in several months.

Why do diabetes blood test results vary?

Lab test results can vary from day to day and from test to test. This can be a result of the following factors:

Blood glucose levels move up and down

Your results can vary because of natural changes in your blood glucose level. For example, your blood glucose level moves up and down when you eat or exercise. Sickness and stress also can affect your blood glucose test results. A1C tests are less likely to be affected by short-term changes than FPG or OGTT tests.

The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.

Blood Glucose Measurements Compared with A1C Measurements over 4 Days

View full-sized imageGraph shows blood glucose in mg/dL on the y-axis and day of the week on the x-axis. A black line straight across the center shows an A1C of 7.0%. A blue line starts at 145 mg/dL and rises and falls, with the lowest level at 140 mg/dL and the highest at 175 mg/dL pre-lunch on Monday. Each day, the fasting or pre-breakfast level is the lowest level.

Blood glucose (mg/dL) measurements were taken four times per day (fasting or pre-breakfast, pre-lunch, pre-dinner, and bedtime).

The straight black line shows an A1C measurement of 7.0 percent. The blue line shows an example of how blood glucose test results might look from self-monitoring four times a day over a 4-day period.

A1C tests can be affected by changes in red blood cells or hemoglobin

Conditions that change the life span of red blood cells, such as recent blood loss, sickle cell disease NIH external link, erythropoietin treatment, hemodialysis, or transfusion, can change A1C levels.

A falsely high A1C result can occur in people who are very low in iron; for example, those with iron-deficiency anemia NIH external link. Other causes of false A1C results include kidney failure or liver disease.

If you’re of African, Mediterranean, or Southeast Asian descent or have family members with sickle cell anemia or a thalassemia NIH external link, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes. People in these groups may have a different type of hemoglobin, known as a hemoglobin variant, which can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care professionals may suspect interference—a falsely high or low result—when your A1C and blood glucose test results don’t match.

Doctor sharing test results with patient.

If you’re of African, Mediterranean, or Southeast Asian descent, you could have a different type of hemoglobin that affects your diabetes care.

Not all A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test to measure their average blood glucose level. The NGSP provides information for health care professionals about which A1C tests are appropriate to use for specific hemoglobin variants External link.

Read about diabetes blood tests for people of African, Mediterranean, or Southeast Asian descent. The NIDDK has information for health care providers on Sickle Cell Trait & Other Hemoglobinopathies & Diabetes.

Small changes in temperature, equipment, or sample handling

Even when the same blood sample is repeatedly measured in the same lab, the results may vary because of small changes in temperature, equipment, or sample handling. These factors tend to affect glucose measurements—fasting and OGTT—more than the A1C test.

Health care professional shares test results with woman.

Your health care professional can help you understand your test results.

Health care professionals understand these variations and repeat lab tests for confirmation. Diabetes develops over time, so even with variations in test results, health care professionals can tell when overall blood glucose levels are becoming too high.

How precise is the A1C test?

When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.

Health care professionals can visit www.ngsp.org External link to find information about the precision of the A1C test used by their lab.

How is the A1C test used after diagnosis of diabetes?

Your health care professional may use the A1C test to set your treatment goals, modify therapy, and monitor your diabetes management.

Experts recommend that people with diabetes have an A1C test at least twice a year.4 Health care professionals may check your A1C more often if you aren’t meeting your treatment goals.4

What A1C goal should I have?

People will have different A1C targets, depending on their diabetes history and their general health. You should discuss your A1C target with your health care professional. Studies have shown that some people with diabetes can reduce the risk of diabetes complications by keeping A1C levels below 7 percent.

Managing blood glucose early in the course of diabetes may provide benefits for many years to come. However, an A1C level that is safe for one person may not be safe for another. For example, keeping an A1C level below 7 percent may not be safe if it leads to problems with hypoglycemia, also called low blood glucose.

Less strict blood glucose control, or an A1C between 7 and 8 percent—or even higher in some circumstances—may be appropriate in people who have

limited life expectancy

long-standing diabetes and trouble reaching a lower goal

severe hypoglycemia or inability to sense hypoglycemia (also called hypoglycemia unawareness)

advanced diabetes complications such as chronic kidney disease, nerve problems, or cardiovascular disease

How does A1C relate to estimated average glucose?

Estimated average glucose (eAG) is calculated from your A1C External link. Some laboratories report eAG with A1C test results. The eAG number helps you relate your A1C to daily glucose monitoring levels. The eAG calculation converts the A1C percentage to the same units used by home glucose meters—milligrams per deciliter (mg/dL).

The eAG number will not match daily glucose readings because it’s a long-term average—rather than your blood glucose level at a single time, as is measured with a home glucose meter.

Will the A1C test show short-term changes in blood glucose levels?

Large changes in your blood glucose levels over the past month will show up in your A1C test result, but the A1C test doesn’t show sudden, temporary increases or decreases in blood glucose levels. Even though A1C results represent a long-term average, blood glucose levels within the past 30 days have a greater effect on the A1C reading than those in previous months.

Clinical Trials for the A1C Test and Diabetes

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Scientists are conducting research to learn more about diabetes, including studies about A1C. For example

how the relationship between A1C and blood glucose may vary in different racial and ethnic groups

to find other tests that may be better than A1C for some people

to look for ways to further improve A1C test results. Because the A1C value depends on the average life span of your red blood cells, knowing whether the life span of your red blood cells is longer or shorter may give your doctor helpful information.

Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you NIH external link.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov NIH external link.

References

[1] Gillett MJ. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–1334.

[2] American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(suppl 1):S13–S27.

[3] Penttilä I, Penttilä K, Holm P, et al. Methods, units and quality requirements for the analysis of haemoglobin A1c in diabetes mellitus. World Journal of Methodology. 2016;6(2):133–142.

[4] American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(suppl 1):S55–S64.

What Is an A1c Test?

The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It's also called HbA1c, glycated hemoglobin test, and glycohemoglobin. It’s a lot like a baseball player's season batting average. A single game doesn't tell you how a player is performing in their career. And 1 day's test results don't give you the complete picture of how your treatment is working.

People who have diabetes need this test regularly to see if their levels are staying within range. It can tell if you need to adjust your diabetes medicines. The A1c test is also used to diagnose diabetes.

What Is Hemoglobin?

Hemoglobin is a protein found in red blood cells. It gives blood its red color, and its job is to carry oxygen throughout your body.

How the Test Works

The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.

Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.

If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.

alc and blood sugar

What's a Normal Hemoglobin A1c Test?

For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have prediabetes and a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.

  alc normal to high ranges

Setting Goals for A1c Levels

The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes. Someone who has had untreated diabetes for a long time might have a level above 8%.

If you have diabetes and your level is above your target, your doctor may change your treatment plan to get your level down.

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A combination of diet, exercise, and medication can bring your levels down.

People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year.

Lower A1C naturally with this trick!

People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements such as vitamins C and E and high cholesterol levels. Kidney disease and liver disease may also affect the test.

How Often Do You Need the Test?

Your doctor probably will have you take the A1c test as soon as you’re diagnosed with diabetes. You’ll also have the test if your doctor thinks you may get diabetes. The test will set a baseline level so you can see how well you’re controlling your blood sugar.

How often you’ll need the test after that depends on several things, like:

The type of diabetes you have

Your blood sugar control

Your treatment plan

You’ll probably get tested once a year if you have prediabetes, which means you have a strong chance of developing diabetes.

You may get tested twice each year if you have type 2 diabetes, you don't use insulin, and your blood sugar level is usually in your target range.

You could get it three or four times each year if you have type 1 diabetes.

You may also need the test more often if your diabetes plan changes or if you start a new medicine.

It’s not a fasting test. You can take it any time of day, before or after eating. 

People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements, such as vitamins C and E, and high cholesterol levels. Kidney disease and liver disease may also affect the test.

It’s called the A1C test, and it’s a powerhouse.

It can identify prediabetes, which raises your risk for diabetes. It can be used to diagnose diabetes. And it's used to monitor how well your diabetes treatment is working over time. It's also a critical step in forming your game plan to manage diabetes with your diabetes care team.

The big picture: monitoring treatment

This relatively simple blood test can tell you a lot. The test results give you a picture of your average blood sugar level over the past two to three months. The higher the levels, the greater your risk of developing diabetes complications. Your doctor will tell you how often you need the A1C test, but usually you’ll have the test at least twice a year if you’re meeting your treatment goals. If you're not meeting your goals or you change treatments, you may need to get an A1C test more often.

So, what do the numbers mean?

When it comes to the numbers, there's no one-size-fits-all target. A1C target levels can vary by each person's age and other factors, and your target may be different from someone else's. The goal for most adults with diabetes is an A1C that is less than 7%.

A1C test results are reported as a percentage. The higher the percentage, the higher your blood sugar levels over the past two to three months. The A1C test can also be used for diagnosis, based on the following guidelines:

A1C scale

If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range.

If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.

Finally: A1C is also defined as ‘estimated average glucose,’ or eAG

Another term you may come across when finding out your A1C is eAG. Your doctor might report your A1C results as eAG. eAG is similar to what you see when monitoring your blood sugar at home on your meter. However, because you are more likely to check your blood sugar in the morning and before meals, your meter readings will likely be lower than your eAG.

The A1C test is a common blood test used to diagnose type 1 and type 2 diabetes. If you're living with diabetes, the test is also used to monitor how well you're managing blood sugar levels. The A1C test is also called the glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C or HbA1c test.

An A1C test result reflects your average blood sugar level for the past two to three months. Specifically, the A1C test measures what percentage of hemoglobin proteins in your blood are coated with sugar (glycated). Hemoglobin proteins in red blood cells transport oxygen.

The higher your A1C level is, the poorer your blood sugar control and the higher your risk of diabetes complications.

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Why it's done

The results of an A1C test can help your doctor or other health care provider:

Diagnose prediabetes. If you have prediabetes, you have a higher risk of developing diabetes and cardiovascular disease.

Diagnose type 1 and type 2 diabetes. To confirm a diabetes diagnosis, your doctor will likely look at the results of two blood tests given on different days — either two A1C tests or the A1C test plus another test, such as a fasting or random blood sugar test.

Monitor your diabetes treatment plan. The result of an initial A1C test also helps establish your baseline A1C level. The test is then repeated regularly to monitor your diabetes treatment plan.

How often you need the A1C test depends on the type of diabetes, your treatment plan, how well you're meeting treatment goals and your primary care doctor's clinical judgment. For example, the A1C test may be recommended:

Once every year if you have prediabetes

Twice a year if you don't use insulin and your blood sugar level is consistently within your target range

Four times a year if you take insulin or have trouble keeping your blood sugar level within your target range

You may need more-frequent A1C tests if your doctor changes your diabetes treatment plan or you begin taking a new diabetes medication.

More Information

Diabetes

Diabetic hyperosmolar syndrome

Hyperglycemia in diabetes

Show more related information

 

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How you prepare

The A1C test is a simple blood test. You don't need to fast for the A1C test, so you can eat and drink normally before the test.

What you can expect

During the A1C test, a member of your health care team takes a blood sample by inserting a needle into a vein in your arm or pricking your finger tip with a small, pointed lancet. If the blood is taken from a vein, the blood sample is sent to a lab for analysis.

Blood from a finger prick may be analyzed in your doctor's office for same-day results. This in-office test is only used for monitoring your treatment plan, not for diagnosis or screening.

Results

A1C test results are reported as a percentage. A higher A1C percentage corresponds to higher average blood sugar levels. Results for a diagnosis are interpreted as follows:

Below 5.7% is normal.

5.7% to 6.4% is diagnosed as prediabetes.

6.5% or higher on two separate tests indicates diabetes.

For most adults living with diabetes, an A1C level of less than 7% is a common treatment target. Lower or higher targets may be appropriate for some people.

The target of less than 7% is associated with a lower risk of diabetes-related complications. If your A1C level is above your target, your doctor may recommend an adjustment in your diabetes treatment plan.

A1C and self-monitoring

A part of your treatment plan will include self-monitoring at home with a blood glucose meter or other device. Your health care team will direct you on how often and when you should test your blood sugar.

Your self-monitoring device reports your blood sugar levels in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L). The measurement shows your blood sugar level at the time you do the test. Therefore, there is some variability throughout the day based on eating, exercise, stress and other factors.

Self-monitoring helps you make choices about diet and exercise and daily treatment goals, but it also helps you track whether you are meeting your A1C target. For example, if your A1C target is below 7%, your self-monitoring blood sugar levels should be, on average, below 154 mg/dL (8.6 mmol/L).

A1C test results generally correspond with the following results of blood sugar levels:

A1C level Estimated average blood sugar (glucose) level

6% 126 mg/dL (7 mmol/L)

7% 154 mg/dL (8.6 mmol/L)

8% 183 mg/dL (10.2 mmol/L)

9% 212 mg/dL (11.8 mmol/L)

10% 240 mg/dL (13.4 mmol/L)

11% 269 mg/dL (14.9 mmol/L)

12% 298 mg/dL (16.5 mmol/L)

Limitations of the A1C test

Some factors may interfere with the accuracy of A1C test results. These include:

Pregnancy

Recent or heavy blood loss

Recent blood transfusion

Conditions that result in insufficient red blood cells (anemias)

Hemoglobin variants

The most common form of the oxygen-transporting hemoglobin protein is called hemoglobin A. The presence of other variants of the protein may result in inaccurate A1C test results. Hemoglobin variants are more common among people of African, Mediterranean or Southeast Asian descent.

If you have a hemoglobin variant, your test may need to be sent to a specialized lab or you may need a different test for diagnosis and monitoring of diabetes.

Can low vitamin D cause high A1C?

Vitamin D deficiency, long suspected to be a risk factor for glucose intolerance, is commonly found in people with poor diabetes control, according to a new study.

''Our study could not show cause and effect," says Esther Krug, MD, an endocrinologist at Sinai Hospital of Baltimore and assistant professor of medicine at Johns Hopkins University School of Medicine, Baltimore, who presented the findings at ENDO 2010, the annual meeting of The Endocrine Society, in San Diego.

But she did find that vitamin D deficiency was common in her study, with more than 91% of participants deficient. As the deficiency worsened, so did diabetes control. Only eight of the 124 participants took vitamin D supplements, she found.

About 18 million people in the U.S. have been diagnosed with diabetes, according to the American Diabetes Association, and about 6 million more are believed to have the condition but are undiagnosed.

Low Vitamin D, Poor Diabetes Control: The Study

Krug and her colleagues decided to look at vitamin D deficiency in the wake of reports suggesting that vitamin D has an active role in regulating pancreatic beta cells, which make insulin.

So they evaluated the medical charts of 124 people with type 2 diabetes (in which the body doesn't make enough insulin or the cells ignore the insulin) seen at an outpatient clinic from 2003 to 2008. The charts contained information on the patients' age, race, vitamin D levels, calcium intake, family history of diabetes, and results of their hemoglobin A1c blood test. The A1c provides an average measurement of blood sugar control over about a 12-week span. (For people with diabetes, the goal is 7%; for people without, the normal range is 4%-6%.)

Krug's team divided the vitamin D levels they found into four groups: normal (defined in the study as above 32 nanograms per deciliter), mild deficiency, moderate deficiency, or severe.

In all, 113 of the 124 patients (91.1%) were vitamin D deficient -- 35.5% severely, 38.7% moderately, and 16.9% mildly.

The average A1c was higher in patients with severe vitamin D deficiency compared to those with normal levels of vitamin D. Those with severe deficiency had an average of 8.1%; those with normal vitamin D levels averaged 7.1%.

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Krug found racial differences. ''In people of color, vitamin D levels were even lower than in Caucasians and they were associated with even poorer diabetes control," she tells WebMD.

Only 6.4% were on vitamin D supplementation. This was true, Krug says, even though they had medical coverage and saw their doctors. She suspects a lack of awareness on the part of the physicians partly explains the frequent deficiencies she found.

Aggressive screening of vitamin D levels is crucial for people with diabetes, Krug says. Once a supplement is recommended, she says, the blood levels should be rechecked to see if the supplement sufficiently increases vitamin D levels.

Vitamin D Facts

Vitamin D is crucial not only to maintain bone strength, but research also suggests it plays a role in immune system functioning, cancer prevention, and cardiovascular health. It is produced when ultraviolet rays from the sun strike the skin and is also found in fish, eggs, fortified milk, cod liver oil, and supplements.

Adequate intakes, set by the Institute of Medicine of The National Academies, are 200 international units (IU) a day for adults up to age 50, 400 IU for people aged 51-70, and 600 IU for people 71 and older. But some experts say much more is needed; the recommendations are under review, with an update expected in 2010.

Second Opinion

The new study lends support to a growing body of scientific and clinical data linking vitamin D with insulin and glucose, says Ruchi Mathur, MD, an endocrinologist and assistant professor of medicine at Cedars-Sinai Medical Center, Los Angeles, who reviewed the study for WebMD.

Other research has shown that supplementing with vitamin D and calcium slows the progression to type 2 diabetes, Mathur says. Even so, she tells WebMD, ''At present, a direct link between vitamin D and type 2 diabetes is not conclusively established."

She has another caveat. ''One important point that is missing ... is the prevalence of vitamin D deficiency in the general population" compared to those in the study. As vitamin D deficiency is being noted with ''an alarming increase in frequency'' overall, she says, ''it may shed doubts on the authors' conclusions."

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It's also possible, she says, that people with poor glycemic control have it because of a general unhealthy lifestyle, not just their low vitamin D status. They may engage in less outdoor exercise, for instance, or have unhealthy eating habits.

Because of the possible link, however, she agrees that screening for vitamin D deficiency in people with type 2 diabetes may be warranted.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

Can lemon water lower A1C?

It is an ideal thirst quencher you are looking for in scorching day. It is a miracle potion for those looking shed some extra pounds. It has also been your go-to drink after a nasty hangover. You guessed it, we are talking about a glass of the versatile and ever-so lemon water. The refreshing beverage is low-calorie delicious alternative to your sugary and aerated beverages. This is one of the prime reasons why experts recommend drinking lemon water to diabetics. Diabetes is a condition characterised by elevated blood sugar levels. Diabetes currently affects over 425 million people worldwide. It is not easy to reverse the condition. Lack of proper care, medication and late diagnosis can make diabetes management even tougher. Your diet plays a crucial role in managing your blood sugar levels. Diabetics should refrain from refined carbohydrates and take foods and drinks that are high on fibre and antioxidants. A plain glass of lemon water may also make a great addition to your diabetes diet. Here's how. 

(Also Read: 5 Vegetables You Must Include In Your Diabetes Diet)

 

Diabetes Management: Why Should Diabetics Drink Lemon Water Regularly? 

Lemon water may not directly impact your blood sugar levels and cause it to come down, but it can surely help prevent untimely spikes. The easy to make beverage is very low in carbohydrates and calories, and keeps you hydrated, which is very essential for diabetics to ensure. Diabetics are at risk of dehydration because higher than normal blood glucose depletes your body of fluids. Lemon is packed with soluble fibres, which do not break down easily and ensure slow release of sugars in the blood stream. Soluble fibres also help keep the heart healthy by regulating cholesterol and stabilising blood pressure. Lemons are abundantly loaded with vitamin C. American Diabetes Association dubs citrus fruits like lemon, oranges and grapefruit as "Diabetes Superfood." Lemons are full of fibre, vitamin C, folate and potassium, which would help benefit a healthy diabetic diet. A study published in the journal 'Advances in Nutrition' revealed that naringinen, a chemical compound found in lemons and other citrus fruits, may have antidiabetic properties. It was an animal study conducted on rats. 

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Squeezing lemon juice and drinking it with water may not amount to your daily recommended intake of fibre or vitamin C. But it is still a better bet than the sodas you find in markets, filled with empty calories and sugar. Make sure you do not add sugar to your lemon water when you are making it at home. It is best to consume it early in the morning on an empty stomach.

Does apple cider vinegar help you lose weight and lower blood sugar? | Nourishable Raw Episode 14

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information. 

What foods increase A1c?

The blood sugar level regulation mechanism

When you eat rice, bread, or any other typical food high in carbohydrates, it is digested by the stomach and small intestine, where it is absorbed into the blood as glucose. Figure 1 shows how it is absorbed into the body.

Figure 1: Absorption of glucose

1The sugar in food is absorbed into the blood as glucose.

2The pancreas secretes insulin in reaction to the increase in glucose.

3Because the glucose is absorbed into the liver, muscle, adipose (fat) tissue and other cells, the blood sugar level drops to the level it was before anything was eaten.

This is the mechanism found in healthy people.

When glucose enters the bloodstream, insulin facilitates its uptake into the body's cells. When an excess of glucose is ingested, insulin over secretion occurs. Insulin increases the biosynthesis of fat and suppresses its breakdown. Thus, it becomes easier for fat to accumulate in body tissues.

Blood sugar level will not drop if the sugar in the blood is not properly processed due to, for example, too little insulin being secreted, or resistance to the action of insulin. If blood sugar levels have not decreased several hours after eating on a regular basis, this indicates a susceptibility to diabetes. To avoid this and stay healthy, we should eat types of foods that will not cause a sudden, extreme rise in blood sugar levels.

What is BMI?

BMI = weight (kg) ÷height (m)2 BMI is a measure of body fat based on your weight in relation to your height. BMI less than 18.5 = low body weight, BMI 18.5 to 25 = ordinary body weight, BMI 25 or more = obese.

What is a healthy blood sugar level

Fasting blood sugar level 99mg/dL (Japan Society of Ningen Dock)

Postprandial blood sugar level (2 hours after eating) 7.8mmol/L (140mg/dL) (International Diabetes Federation)

Blood sugar level rises every time you eat

Chart: Meals and increases in blood sugar level

Your blood sugar level rises immediately after eating a meal or snack (Figure 2). In a healthy person, insulin then starts working, and the blood sugar level returns to the pre-meal level 2 hours after eating.

In untreated diabetes patients, the blood sugar level does not return to the pre-meal level of its own accord. Some people's blood sugar level remains high two hours after eating, even though on an empty stomach it would be at a normal level. As a result, the risk of developing diabetes increases as insulin is not properly secreted, or does not work properly in the body.

In order to make sure insulin works properly, it is important not to overeat and to avoid becoming obese. Knowing which foods will not cause a sudden and extreme spike in blood sugar level and using this knowledge in your daily life will help you to prevent obesity and diabetes, and maintain good health.

What foods do not raise blood sugar level much?

High calorie foods may or may not cause the blood sugar level to rise

Many people think that all high-calorie foods raise blood sugar level, but this is not always the case.

In general, foods that cause blood sugar level to rise the most are those that are high in carbohydrates, which are quickly converted into energy, such as rice, bread, fruits and sugar.

Next are foods high in protein, such as meats, fish eggs, milk and dairy products, and oily foods.

However, even though carbohydrates affect blood sugar levels, if you don't eat them your diet will be unbalanced and you won't feel satisfied after your meal, which can lead to excessive consumption of foods rich in protein and fat.

Food containing three major nutrients

Carbohydrates

(Sugars and dietary fiber) Rice, bread, noodles, potatoes, beans, vegetables, mushrooms, seaweeds, fruits, sugar etc.

Protein Meats, fish and shellfish, eggs, soybeans and soy products, milk and dairy products etc.

Fat Oil and fats

Carbohydrates do raise blood sugar levels quickly. However, recent studies have shown that even amongst foods that have the same amount of carbohydrates, there are two categories: those that cause a sudden rise in blood sugar levels and those that cause a more moderate rise, depending on the amount of dietary fiber contained.

Taking bread as an example, whole grain rye bread and pizza crusts are low GI foods, while French bread and bagels are high GI foods.

It is important to know which foods are low GI and which are high GI.

The University of Sydney has defined foods with a GI value of over 70 as "high GI foods," foods with a GI value of between 56 and 69 as "mid-range GI foods," and foods with a GI value of 55 or under as "low GI foods", when using glucose as the reference food (where glucose = 100).

Because high GI foods cause a sudden spike in the blood sugar level, large amounts of insulin are secreted in order to process the sugar in the blood, causing a spike in insulin secretion to handle the sugar. When low GI foods are eaten, the sugar is gradually absorbed into the body so the blood sugar level rises gradually. Thus, an appropriate amount of insulin is secreted and sugar is promptly taken up by the tissues.

Thus, knowing which foods are low GI foods (causing moderate amounts of sugar to be absorbed) is very important to living a healthy life.

Making sure that carbohydrates, an essential type of nutrient, are absorbed by the body in moderate amounts is related to blood sugar levels, obesity, and of course a healthy diet.

GI of main food

Category Food GI

Grain Barley 22

Boiled rolled barley 46

Boiled soybeans 15

Glutinous rice 87

Rice cake 48

Croissant 67

Bagel 69

Rye bread 50

White bread 71

Burger bun 61

English muffin 77

Baguette 57

Vegetables Boiled carrot 33

Potato 66

Boiled potato 49

Fried potato 70

Mashed potatoes 83

Boiled sweet potato 44

Fruits Grapefruit 25

Prune 29

Dried apricot 30

Apricot 34

Apple 40

Plum 24

Strawberry 40

Orange 40

Peach 28

Marmalade 40

Grapes 43

Mango 51

Blueberry 53

Kiwi fruit 58

Dried fig 61

Banana 47

Cherry 63

Raisins 64

Pineapple 66

Watermelon 72

Beans Dried peas (boiled) 22

Dried red peas (boiled) 29

White kidney beans (boiled) 31

Quail beans (steamed) 33

Chick peas (boiled) 33

Baked beans (canned) 40

Dairy Products Skimmed milk 32

Milk 34

Greek yoghurt with honey 36

Condensed milk 61

Snacks Blueberry muffin 59

Bran muffin 60

Pancake 66

Doughnut 75

Scone 92

Shortbread 64

Peanuts 13

Popcorn 55

Chocolate 49

Processed Food Lasagne 28

Salmon sushi 48

Spaghetti bolognaise 52

Hamburger 66

Cheese pizza 60

Minestrone 48

Tomato Soup 52

Honey 58

What should an 80 year old A1C be?

Older adults with type 2 diabetes mellitus are a large, heterogeneous and growing population who are at high risk for adverse cardiovascular events.1 Unfortunately, there is a paucity of randomized control data on cardiovascular outcomes in patients with diabetes who are over the age of 80. Mean age of participants in the three major relevant trials, VADT (Veterans Affairs Diabetes Trial), ACORRD (Action to Control Cardiovascular Risk in Diabetes) and ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation), were 60, 62 and 66 years respectively.2-4 The ASCVD risk calculator, which helps clinicians make decisions about prescribing statins and aspirin based on a patient's cardiovascular risk factors, including diabetes, is based on a pooled cohort analysis from five studies of patients aged 40-79.5 Therefore caring for patients over age 80 requires an individualized rather than guideline driven approach.6 Choosing Wisely, a collective initiative of multiple professional societies that focuses on reducing medical tests and treatment that may be harmful or of marginal medical value, supports this patient-based approach.

In many older patients, the risks of over-treating diabetes outweigh the benefits. The American Geriatrics Society recommends a goal a1c of 7.5-8% in older patients with moderate comorbidities and life expectancy less than 10 years;7 the American Diabetes Association recommends a more relaxed goal of 8-8.5% for older patients with complex medical issues.1 These recommendations are supported by evidence that low a1c targets did not reduce risk of macrovascular complications in VADT, ADVANCE and ACCORD.2-4 In fact, strict glycemic control increased cardiovascular events in patients who experienced hypoglycemic episodes. Secondary analysis of ADVANCE data found that participants with severe hypoglycemic episodes had significantly higher adjusted risk of major cardiovascular events and death from major cardiovascular events.10 This is explained by the pathophysiology of hypoglycemia in patients with underlying cardiovascular disease, in whom low blood glucose and the resultant catecholamine surge can induce cardiac arrhythmias, contribute to sudden cardiac death, and cause ischemic cerebral damage.8,9

According to US Veterans Affairs data, risk factors for hypoglycemia are present in as many as 50% of older patients being treated for diabetes.11 Risk factors for hypoglycemia include advanced age, renal impairment, memory problems and sulfonylurea use. In ADVANCE participants, advanced age was an independent risk factor for severe hypoglycemic episodes.3 Similarly, ACCORD subjects who screened positive for memory problems were at high risk for hypoglycemia.4 In retrospective studies of emergency room visits, older patients taking sulfonylureas were at twice the risk of hypoglycemia,12 and CKD further increases this risk.13 Additionally, severe hypoglycemic episodes be associated with increased risk of dementia.14

Despite these risks, glycemic control should not be completely abandoned in older patients. Better glucose control in the elderly has been associated with improvement in cognitive functioning and lower mortality following myocardial infarction.15,16 Metformin is the American Diabetes Association's recommended first line agent based on efficacy and side effect profile.1 Metformin decreases insulin resistance, decreases gut resorption of glucose, inhibits hepatic gluconeogenesis, reduces weight gain, and has been associated with decreased blood pressure and plasma lipid levels. Additionally, metformin is safe in the elderly and may even increase longevity based on evidence from animal models.17 Metformin's major adverse effect is a type B lactic acidosis that may develop at the upper therapeutic limit. This risk is higher in patients with low GFR, limiting use of the drug in older people. Current US Food and Drug Administration guidelines contraindicate metformin at GFR <30 and do not recommend initiating the drug at GFR between 30-45.18 However, for patients tolerating the drug who experience a drop in GFR, new guidelines state reduced renal dosing is a safe option.19 Additionally, risk of type B lactic acidosis increases when the body's metabolic demands are high. Some nephrologists suggest that temporarily stopping metformin during "sick days" would mitigate this problem, however randomized control trials are needed.20

If renally-dosed Metformin does not provide adequate control, a second agent may be necessary. The American Diabetes Association recommends adding a second oral anti-hyperglycemic agent if a1c is not at goal after 3 months of monotherapy. The choice of second agent should be based on an individual patient's co-morbidities; no single choice is favorable. Long acting sulfonylureas are contraindicated in the elderly, short acting sulfonylureas should avoided in those at risk for hypoglycemia, and thiazolidinediones should be avoided in patients with heart failure.21 Evidence from the EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) and GLP1 RA trials suggests that SGLT-2 inhibitors may decrease risk of all-cause mortality, cardiovascular events and hospitalization for heart failure in diabetic patients with established cardiovascular disease.22,23 However, older patients were largely under-represented in these trials, and the associated increased risk of urinary tract infections presents a major drawback in older adults. Oral dipeptidyl peptidase 4 inhibitors have few side effects and low risk of hypoglycemia, however a systemic review found these medications do not decrease risk of major cardiovascular events.24

In summary, risk factors for hypoglycemia, including renal impairment, memory problems and sulfonylurea use, are common in older patients being treated for diabetes. Hypoglycemia puts patients at risk for adverse cardiovascular events. Individualized a1c targets should be adopted in older adults, with more lenient a1c goals in frail, high risk patients. Metformin is not associated with increased risk of hypoglycemia, and can be continued in patients with GFR >30. More research is needed to establish the risks and benefits of second line agents.

References

American Diabetes Association. Improving care and promoting health in populations: standards of medical care in diabetes - 2018. Diabetes Care 2018;41:S7-12.

Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360:129-39.

ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008;358:2560-72.

Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008;358:2545-59.

Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63:2935-59.

Blaum C, Cigolle CT, Boyd C, et al. Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. Med Care 2010;48:327-34.

American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society guidelines for improving the care of older adults with diabetes mellitus: 2013 update. J Am Geriatr Soc 2013;61:2020-6.

Snell-Bergeon JK, Wadwa RP. Hypoglycemia, diabetes, and cardiovascular disease. Diabetes Technol Ther 2012;14:S51-8.

Launer LJ, Miller ME, Williamson JD, et al. Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy. Lancet Neurol 2011;10:969-77.

Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia and risks of vascular events and death. N Engl J Med 2010;363:1410-8.

US Department of Veterans Affairs. Quality, Safety & Value for Clinicians. https://www.qualityandsafety.va.gov/ChoosingWiselyHealth-SafetyInitiative/HypoglycemiaSite/For_Clinicians.asp. Accessed Feb 1 2018.

Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011;365:2002-12.

Moen MF, Zhan M, Hsu VD, et al. Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol 2009;4:1121-7.

Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP, Selby JV. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009;301:1565-72.

Yaffe K, Falvey C, Hamilton N, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol 2012;69:1170-5.

Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation 2005;111:3078-86.

Martin-Montalvo A, Mercken EM, Mitchell SJ, et al. Metformin improves healthspan and lifespan in mice. Nat Commun 2013;4:2192.

Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care 2011;34:1431-7.

Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 2014;312:2668-75.

Heaf J. Metformin in chronic kidney disease: time for a rethink. Perit Dial Int 2014;34:353-7.

American Diabetes Association. Standards of medical care in diabetes - 2016 abridged for primary care providers. Clin Diabets 2016;34:3-21.

Zinman B, Wanner C, Lachin JM, et al. Empaglifloxin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-28.

Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-22.

Rotz ME, Ganetsky VS, Sen S, Thomas TF. Implications of incretin-based therapies on cardiovascular disease. Int J Clin Pract 2015;69:531-49.

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Keywords: Blood Glucose, Diabetes Mellitus, Type 2, Diabetes Mellitus, Thiazolidinediones, Gliclazide, Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Metformin, Glycated Hemoglobin A, Insulin Resistance, Acidosis, Lactic, Cardiovascular Diseases, Weight Gain, Aspirin, Geriatrics, Blood Pressure, Hypoglycemia, Glucosides, Benzhydryl Compounds, Perindopril, Myocardial Infarction, Heart Failure, Arrhythmias, Cardiac, Vascular Diseases, Lipids, Renal Insufficiency, Chronic, Metabolic Syndrome

Can you have a high A1C and not be diabetic?

If your blood sugar has ever surged up or you experience a regular surge in your sugar level, your doctor will probably recommend you to get an A1C test to see if you might have type 2 diabetes or prediabetes.

What is A1C and A1C test?

A1C or hemoglobin A1C Is a protein that resides in red blood cells and carries oxygen to the rest of your body. Moreover, since glucose is in your blood, these hemoglobins affix themselves to the glucose and become Haemoglobin AIC or HbA1C. When your sugar level surges, it means you have higher levels of hemoglobin AIC in your blood.

So, what do the doctors do in this regard? Well, most of the GPs recommend such patients to take the A1C test. An A1C test is a sugar level test that, over the last 3 months, measures the level of blood sugar levels in your blood. If the AIC test comes higher, it means you have a higher level of glucose or sugar in your blood. Typically, the sugar level should be less than 5.7%.

So, what if your test says you have a higher level of A1C but you do not have diabetes?

Yes, some conditions may raise the level of A1C in your blood, but that does not mean you have diabetes. According to a study by Elizabeth Selvin, a single elevated A1C level greater than 6% was found in the general population with no history of diabetes. Such adults may have compromised fasting glucose or other cardiovascular diseases. Other factors that contribute to higher levels of A1C in no-diabetic patients are:

Anemia:

A lack of iron, vitamin B12 can also falsely level up your A1C test results. This means your body is not making new blood cells, and older ones with glucose are floating around.

Kidney diseases and disorders:

Many kidney diseases usually lower the levels of vitamins and minerals, causing anemia, which may cause a rise in your A1C level. Uremia, a condition where the blood develops high Urea levels, can also falsely increase A1C level.

High Triglycerides

High levels of triglycerides (a fat in the blood that does not convert into calories and forms into triglycerides) may result in a spike in your A1C test result.

Spleen disorders:

Spleen’s primary function is to remove old blood cells from your bloodstream. When you go through splenectomy or other spleen disorder, i.e., sickle cell disease or asplenia, this function is lost, which means the old blood cells float around for a while resulting in a higher level of A1C.

Thyroid disorders:

Lower levels of thyroid hormones (hypothyroidism) can also erroneously increase A1C levels.

Certain medications:

Certain medications and their long-term use (aspirin, opioids such as morphine, fentanyl, hydrocodone, and hydromorphone, among others) can also misleadingly increase A1C level.

Donated Blood:

Donated blood in your system can also give incorrect (higher or lower levels) of A1C results. According to a study by (Angelique et al.), blood donations can give incorrect readings and impact the level of hemoglobin in diabetic and non-diabetic patients, thus affecting the checking of diabetes.

Interestingly, your ethnicity can also affect your A1C result.

Everyone has a different type of hemoglobin, depending on their ethnicity. A1C test works best with type A hemoglobin. Hemoglobin variants such, C, D or E, can affect the precision of A1C as well (higher level or low levels).

It is crucial to note that the A1C test is not always accurate. Repeated checks can give higher or lower measurements for the same blood samples. Doctors rely on other tests as well called fructosamine blood tests. This test gives an extended-term assessment of your sugar level.

Does exercise help A1C levels?

There are a few ways that exercise lowers blood sugar:

Insulin sensitivity is increased, so your muscle cells are better able to use any available insulin to take up glucose during and after activity.

When your muscles contract during activity, your cells are able to take up glucose and use it for energy whether insulin is available or not.

This is how exercise can help lower blood sugar in the short term. And when you are active on a regular basis, it can also lower your A1C.

Apple Cider Vinegar Benefits | Can It Reverse Insulin Resistance and Type 2 Diabetes?!

Understanding Your Blood Sugar and Exercise

The effect physical activity has on your blood sugar will vary depending on how long you are active and many other factors.  Physical activity can lower your blood sugar up to 24 hours or more after your workout by making your body more sensitive to insulin.

Become familiar with how your blood sugar responds to exercise. Checking your blood sugar level more often before and after exercise can help you see the benefits of activity. You also can use the results of your blood sugar checks to see how your body reacts to different activities. Understanding these patterns can help you prevent your blood sugar from going too high or too low.

Hypoglycemia and Physical Activity

People taking insulin or insulin secretagogues (oral diabetes pills that cause your pancreas to make more insulin) are at risk for hypoglycemia if insulin dose or carbohydrate intake is not adjusted with exercise. Checking your blood sugar before doing any physical activity is important to prevent hypoglycemia (low blood sugar).  Talk to your diabetes care team (doctor, nurse, dietitian or pharmacist) to find out if you are at risk for hypoglycemia.

If you experience hypoglycemia during or after exercise, treat it immediately:

Follow the 15-15 rule:

1. Check your blood sugar.

2. If your reading is 100 mg/dL or lower, have 15-20 grams of carbohydrate to raise your blood sugar. This may be:

    4 glucose tablets (4 grams per tablet), or

    1 glucose gel tube (15 grams per gel tube), or

    4 ounces (1/2 cup) of juice or regular soda (not diet), or

    1 tablespoon of sugar or honey

3. Check your blood sugar again after 15 minutes. If it is still below 100 mg/dL, have another serving of 15 grams of carbohydrate.

4. Repeat these steps every 15 minutes until your blood sugar is at least 100 mg/dL.

If you want to continue your workout, you will usually need to take a break to treat your low blood sugar. Check to make sure your blood sugar has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood sugar can occur during or long after physical activity. It is more likely to occur if you:

Take insulin or an insulin secretagogue

Skip meals 

Exercise for a long time

Exercise strenuously

If hypoglycemia interferes with your exercise routine, talk to your healthcare provider about the best treatment plan for you. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s). For people engaging in long duration exercise, a combination of these two regimen changes may be necessary to prevent hypoglycemia during and after exercise.

What is the highest A1C ever recorded?

Every 3 months, or whenever we get around to it, those of us with diabetes find ourselves getting that all-important A1C lab test that gauges how we’re managing our blood sugar levels over time. This can be a lot of pressure, especially when we’ve put in a whole bunch of work in hopes of seeing some improvement.

The American Diabetes Association generally recommends aiming for an A1C of 7 percent or less for both adults and children with type 1 diabetes (T1D). But recent research shows that only a minority of patients reach those goals.

Because, frankly, diabetes can be maddeningly unpredictable — so most of us struggle along in pursuit of lowering our A1C, with constant worry about not hitting the mark.

Have you ever wondered what the highest A1C in history might be? Who would even hold this dubious record, and how high is it possible to go without falling into a coma with any type of diabetes?

DiabetesMine investigated this issue because inquiring minds like to know.

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Highest blood sugar in diabetes history?

GodfriedEdelman/Getty images

We began by looking in the “Guinness Book of World Records,” of course. Oddly, the Guinness staff don’t seem to have any listings related to A1Cs. They do, however, report that Michael Patrick Buonocore survived a blood glucose (BG) level of 2,656 milligrams per deciliter (mg/dL) upon admittance to the ER in March 2008 in East Stroudsburg, Pennsylvania. Buonocore was just a kid at the time, and that record-high sugar level led his parents to eventually launch a nonprofit called Michael’s Miracles that provides financial assistance to families with T1D in need.

So does Buonocore also hold the record for highest A1C?

No, he doesn’t. That’s because while he’s living proof that it’s possible to survive stratospheric blood sugar levels, a skyscraping A1C requires both altitude and time. Remember that A1Cs provide a 3-month average of our blood sugars. Individual high BG readings, even crazy-high ones, don’t alter the test as much as you’d think if they last only a short time. Because T1D presents in children so quickly, Buonocore’s actual A1C level at diagnosis would probably have been rather middle of the road. It takes a long, slow burn to make an A1C boil.

But just to be sure, I reached out to his parents, who told me that his A1C was 11.9 percent at diagnosis. Higher than we expected but not too high given the four-digit BG reading.

How high can an A1C result go?

The highest A1C turns out to be a tricky piece of data to ferret out. If you try Google, you find a gazillion people talking about their own personal highest A1Cs and comparing notes with others.

Most A1C point-of-care machines cap out at a certain number, including those at-home testing A1C kits you can buy online.

At the federal clinic where I’d worked for over a decade, our A1C results capped out at 14 percent. If the A1C is higher than that — particularly at T2D diagnosis time — the machine just reads “>14%.” How much higher is anyoneguess. It could be 14.1 percent, or it could 20 percent.

If you do the math, clocking a 14 percent means you’re possibly experiencing a 24-7-90 (24 hours a day, 7 days per week, for 90 days) blood sugar average of 355 mg/dL.

Of course, labs can calculate higher A1Cs. Personally, the highest I’ve ever seen is an A1C result in the low 20s. If your A1C was, say 21 percent, it would take a 3-month average blood sugar of 556 mg/dL.

How is that possible? If your blood sugar were in the 500s, wouldn’t you go into a coma long before the 3 months were up? Those with T1D would, but those with T2D do not generally go into comas because they have insulin in their bodies all the time, even if they can’t process it well enough to keep their BG at safe levels.

Now, coma-free does not mean problem-free. Blood sugar levels this high are toxic. People diagnosed with sky-high A1Cs are generally also diagnosed with complications right out of the gate — most commonly retinopathy and sometimes kidney and nerve damage, as well.

But that doesn’t answer the question of the unfortunate individual who holds the record for highest A1C ever.

Someone I know mentioned they’d once seen a 27 percent A1C, but that’s hard to believe without any documentation to back it up. In asking my own healthcare colleagues, I posed this question online to a group of endocrinologists: What’s the highest A1C you’ve ever seen, or what’s the highest you’ve ever heard a colleague talk about?

I had my money on 35 percent. That would be a 3-month blood sugar average of 1,000 mg/dL. But the answers I got were surprising, as none of my esteemed colleagues had ever seen or heard of A1Cs as high as I had commonly seen in my clinic in New Mexico.

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Endos comment on the highest A1Cs seen

Dr. Silvio Inzucchi at the Yale School of Medicine is a diabetes guru who wrote a go-to e-book for clinical facts, “Diabetes Facts and Guidelines.” He told DiabetesMine, “The highest we usually see is in the 12-14 percent range, though I think I’ve seen an 18 percent a long time ago.”

In the same ballpark is Donna Tomky, a New Mexico nurse practitioner and diabetes educator who has been past president of the American Association of Diabetes Educators (now the Association of Diabetes Care and Education Specialists).

“Over the years, I’ve seen an A1C as high as 19 percent in a type 1 individual who purposely omitted insulin and was admitted for DKA,” she said.

In terms of youth and children, Dr. Shara Bialo, a pediatric endocrinologist and fellow T1D in New Jersey, told DiabetesMine that her clinic uses the same point-of-care A1C test that only goes as high as 14 percent. But when one of her patients lands in the hospital, a serum draw is done to determine that person’s A1C.

“The highest I have seen personally is a 17 percent, but my colleague had a patient with a 19 percent,” she said, noting both were “teenagers with established T1D and one of whom just found out she was pregnant.”

Dr. David Hite, a diabetes education consultant based in California, reports: “I had a patient in the clinic with a 17 percent. That’s rare. I usually see new diabetics in the clinic under 14 percent. They come in because they feel like crap and can’t tolerate conditions needed to get it lower.”

Well-known USC Keck School of Medicine endocrinologist Dr. Francine Kaufman (who now serves as chief medical officer of Senseonics, Inc.) took the top prize in my straw poll with her one-word answer: 22 percent. Repeat after me: Wow!

If you’re wondering why the results aren’t generally higher, that may be because endos and diabetes specialty clinics usually see those with T1D, people who can’t survive long in the high-octane environment needed to clock those dangerously high A1C scores. That honor has to go to our T2D cousins, who are typically seen by general practitioners and primary care doctors.

Often, surveys of those physicians show initial high A1C results at the time of T2D diagnosis, with those results lowering dramatically after the T2D patient begins to be treated.

WERBUNG

What high A1C results mean

The American Association of Clinical Chemistry is the leading authority on these diagnostic lab tests, and Dr. Darci Block is one of the big wigs who’s been a part of the Mayo Clinic’s Clinical Core Laboratory Services Division. While some lab tests can show higher results than a clinic’s point-of-care method, she wonders why it would matter just how high a particular result is above 14 percent. To her, anything over 14 is so poor that it becomes “not clinically important” given the already-urgent need to address the diabetes management, Block says.

Then again, other experts do believe that lowering an A1C of 22 percent at diagnosis to 17 percent could be clinically important. It’s certainly an indication that the patient is on the right path.

But Block also points out that crazy-high A1C test results likely have a significant error range. For what it’s worth, she says she’s personally never seen readings higher than 17 percent in her career.

Dr. David Goldstein, the University of Missouri Health Sciences Center Diabetes Diagnostic Laboratory, said he didn’t know of any group or company that keeps track of high A1Cs. But he personally has seen an 18 percent result, reflecting a plasma glucose of roughly 400 mg/dL. In newly diagnosed T1D children, the average A1C is about 10 to 12 percent, he said — similar to what was recorded in Buonocore, the boy who marked the highest single BG reading in history in the “Guinness Book of World Records.”

But Goldstein went on to point out an interesting fact that no one else did.

“There is a practical limit to how high the A1C can get because the kidneys filter out and excrete glucose from the blood when the plasma glucose level gets over 180 to 200 mg/dL,” he said. “This is called the renal threshold for glucoseTrusted Source, and it differs among people. Only in people with kidney failure or with a high renal threshold can the plasma glucose level be sustained at a high enough level to result in a very high A1C.”

That means while we may not be able to conclusively figure out the highest A1C ever, the experts make it clear that whoever holds that dubious honor also has ruined kidneys. This brings us back to Block’s assertion that “too high is just too high,” and the specific digits don’t really matter.

Maybe she’s right there. Renowned diabetes educator and author Gary Scheiner of Integrated Diabetes Services in Pennsylvania put it more colorfully. About any A1C above 12 percent, he said: “At that high, there’s no way the patient could possibly be thinking clearly. A little bird should pop up and just start humming ‘Purple Haze.'”

What happens if your A1C stays high?

A1C is a blood test that determines the body's average blood sugar level over the past two to three months. A1C is also referred to as the hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test. In the body, a protein called hemoglobin transports oxygen and nutrients throughout the body. It can pick up glucose on the way, and glucose will bind to the hemoglobin, which then becomes a glycated hemoglobin. The higher the glucose level in your bloodstream, the more glucose will attach to the hemoglobin. The A1C test measures the amount of hemoglobin with attached glucose.

This test is used frequently to diagnose prediabetes and diabetes, as well as to monitor treatment plans for people with diabetes. Experts have determined healthy, prediabetes, and type 2 diabetes ranges for A1C, and knowing your A1C level can help you make adjustments to treatments and lifestyle.

Female nurse is taking blood of a senior patient at hospital

Yoshiyoshi Hirokawa / Getty Images

A1C Ranges and What They Mean

An A1C result is presented as a percentage, which reflects the percentage of glucose and hemoglobin that are bound together. For example, the A1C level where there are five glycated hemoglobin out of 100 hemoglobin would be 5%.

The A1C ranges for normal, prediabetes, and diabetes are as follows:1

Normal: Less than 5.7%

Prediabetes: 5.7% to 6.4%

Diabetes: 6.5% or higher

The higher the A1C, the higher your blood glucose levels have been. If your A1C falls into the range of prediabetes, you should talk to your healthcare provider to determine the best way to prevent type 2 diabetes because prediabetes is a known risk factor of type 2 diabetes.2 In general, within the prediabetes range, the higher the A1C, the greater the risk of diabetes.

The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes.1

What Happens When A1C Is Too High

A high A1C level should not be ignored. Studies show a direct correlation between high A1C and severe diabetes complications.3 An A1C level above 7% means someone is at an increased risk of complications from diabetes, which should prompt a person to make sure they have a plan in place to manage their blood sugar levels and decrease this risk. If these strategies are already in place, an increase in A1C may show that they need to be tweaked. 

Several factors can falsely increase or decrease your A1C result, including:4

Kidney failure, liver disease, or severe anemia

Being of African, Mediterranean, or Southeast Asian descent

Certain blood disorders (such as sickle cell anemia or thalassemia)

Certain medicines, including opioids and some HIV medications

Blood loss or blood transfusions

Early or late pregnancy

If better management doesn't take place, high blood sugar can lead to serious complications like heart disease, stroke, vision loss, nerve damage, kidney disease, and gum disease. Short-term problems to look out for include hypoglycemia and hyperglycemia.

 Key Elements to Manage and Prevent Diabetes Complications

Heart Disease and Stroke

People living with diabetes have high blood sugar, and over time this can damage the blood vessels and nerves that control the heart, leading to heart disease. It has been found that people with diabetes tend to develop heart disease at a younger age than people without diabetes.5 Also, the longer you have diabetes, the more likely you are to have heart disease.

The most common type of heart disease is coronary artery disease, which is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart.6 Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack.

Decreased blood flow to the brain can also cause a stroke. Patients with diabetes are particularly at a significantly higher risk of stroke and have a higher mortality.7

Those who have diabetes are also more likely to have other conditions that raise the risk for heart disease, including:6

High blood pressure: This increases the force of blood through your arteries and can damage artery walls.

Too much low-density lipoprotein (LDL) cholesterol: Also, known as bad cholesterol, this can lead to the formation of plaque on damaged artery walls.

High triglycerides: This combined with a low HDL cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.

People with diabetes are also more likely to have heart failure, which is when your heart can’t pump blood well. 

 What Causes Plaque in Your Arteries?

Blindness

Diabetes can also cause damage to your eyes that can lead to poor vision and vision loss.8 Eye problems that can affect people with diabetes are referred to as diabetic eye disease, which include diabetic retinopathy, diabetic macular edema (fluid retention in the retina), cataracts, and glaucoma. However, people with diabetes can take steps to prevent diabetes eye disease by taking care of their diabetes.

If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.

Diabetic retinopathy is the most common cause of vision loss in people with diabetes.8 Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95%.

There are often no warning signs when damage to your eyes first develops. A full, dilated eye exam helps your healthcare provider find and treat eye problems early—before much vision loss can occur.

Adults with type 1 diabetes should get a dilated eye exam within five years of being diagnosed, and then every year after that. For adults with type 2 diabetes, they should have an eye exam soon after diagnosis and a dilated eye exam every year after. However, an exam every one to two years may be considered after one or more normal eye exams.9

 Common Causes of Vision Loss

Nerve Damage

Nerve damage caused by diabetes is called diabetic neuropathy. High blood sugar damages your nerves, and these nerves may stop sending messages to different parts of your body. Nerve damage can cause problems ranging from mild numbness to pain. Half of all people with diabetes have nerve damage.10 

There are several types of neuropathy:10

How to Reverse Insulin Resistance FAST! (BEST FOODS FOR INSULIN RESISTANCE)

Peripheral nerve damage: This type of damage affects your hands, feet, legs, and arms, and it’s the most common type of nerve damage for people with diabetes. It generally starts in the feet—usually in both feet at once.

Autonomic nerve damage: This affects your heart, bladder, stomach, intestines, sex organs, or eyes.

Proximal nerve damage: This affects nerves in the thighs, hips, buttocks, or legs. It can also affect the stomach and chest area.

Focal nerve damage: This affects single nerves, most often in your hand, head, torso, or leg. 

People with diabetes should be looking out for symptoms of nerve damage by recognizing new symptoms related to pain, numbness, or new problems with continence or bowel control. Like with other complications, keeping your blood sugar as close to your target range as possible is the best way to help prevent or delay nerve damage.9

Kidney Disease

People with diabetes could also get diabetic kidney disease. About one out of three adults with diabetes has kidney disease.11 High blood glucose can damage the blood vessels in your kidneys. When that happens, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage the kidneys.12

 Watch These Nutrients If You Have Diabetes-Related Kidney Disease

Gum Disease

Diabetes doesn't only lead to high blood sugar levels. People with diabetes also have sugars in saliva, which come in contact with the mouth. Their teeth and gums are therefore exposed to more sugars, which helps germs and plaque grow, irritating the gums and causing gum disease.

In addition to gum disease, your jaw and tongue, and other mouth tissue can be affected. The most common gum disease and other mouth problems that people with diabetes have include:13

Gingivitis (unhealthy or inflamed gums)

Periodontitis

Thrush (oral yeast infection)

Xerostomia (dry mouth)

Oral burning

Some of the first signs of gum disease are swollen, tender, or bleeding gums. Sometimes you may not have any signs of gum disease. You may not know you have it until you have serious damage. Your best defense is to see your dentist twice a year for a cleaning and checkup.

 Encourage Healthy Dental Hygiene With a Toothbrushing Chart

Lowering A1C

While diabetes complications are severe, there are ways to manage blood sugar to lower your A1C levels and prevent them. With the help of medical professionals, a treatment plan, which includes medication and lifestyle changes, will help lower your levels and avoid complications.

Healthy Eating and Meal Tracking

Your diet has a huge impact on the way your body produces and uses blood sugar. In order to maintain a healthy blood sugar level and therefore lower A1C, healthy eating and meal tracking help. Meal tracking helps you plan ahead for healthy options as well as look back on what might have spiked your blood sugar.

A few healthy snacks to lower your A1C include:

Berries

Nuts

Eggs

Yogurt

Apples

 Reducing A1C With Smart Breakfast Choices

Stress Relief Techniques

Managing stress is crucial to staying healthy in general, and can particularly help people with diabetes.

Studies have shown that acute stress can increase glucose production and interfere with glucose utilization. This means better control of stress can have a positive impact on blood sugar levels.14

Some stress relief techniques include:

Yoga

Journaling

Meditating

Talk therapy

Stay Active

Exercise helps people with diabetes for a variety of reasons, including weight loss and stress relief, but it also directly affects blood sugar levels. When you exercise, your muscles need and use sugar, which lowers the levels in the blood. Research has shown that long-term regular physical activity training had positive effects on glycemic control and body composition among patients with type 2 diabetes.15 It also promoted cardiovascular fitness among these patients.

The more exercise, the greater A1C reduction. Most people with diabetes should aim for at least 150 minutes of moderate-intensity exercise each week.16

Medication and Regular Monitoring

A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings.4

If you’re reaching your A1C goal but having symptoms of highs or lows, check your blood sugar more often and at different times of day. Keep track and share the results with your healthcare provider so you can make changes to your treatment plan and medications if needed.

 10 Steps for Using a Glucometer

A Word From Verywell

The A1C blood test is just one of many tools to check and monitor blood sugar. A1C is an average of your blood sugar level over 90 days, so healthcare providers will likely recommend checking levels of blood sugar between A1C tests if blood sugar isn't managed. Keeping track of your blood sugar regularly can help you identify things that affect your blood sugar level and tweak your management plan. Managing diabetes is your best defense against the various complications that this condition can cause. Discuss concerns and new symptoms with your healthcare provider to make sure your treatment plan addresses your needs.

Can I lower my A1C in a month?

We are always told that having a low A1c is an important goal in our diabetes management, but do you know why? Do you know what a good A1c target is, how to lower your A1c, and how quickly you can lower your A1c safely?

These are the questions I will answer in this comprehensive guide on what A1c is, how to lower your A1c, and why achieving a low A1c isn’t the only (or necessarily the best) goal when it comes to diabetes management.

How to lower your A1c

Table of Contents

What is A1c?

A1c, hemoglobin A1c, HbA1c or glycohemoglobin test (all different names for the same thing) is a blood test that measures your average blood sugar over the last 2-3 months. It’s not an “even average,” but an average where your blood sugars over the last few weeks count a little more than your blood sugars 2-3 months ago.

According to the National Institute of Diabetes & Digestive & Kidney Diseases:

“The A1c test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about three months. Thus, the A1c test reflects the average of a person’s blood glucose levels over the past three months. The A1c test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1c level is below 5.7 percent.”

It’s important to note here that the term “normal A1c level” in this context refers to people without diabetes. I will get back to what a “normal A1c level” is for people living with diabetes below.

How to test your A1c

Your doctor or endocrinologist should test your A1c regularly (typically every 3-6 months). The doctor simply pricks your finger (or ear if you prefer) and takes a tiny blood sample. If the doctor’s office has an A1c kit, you should get your result before your consultation is over.

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You can also buy home A1c kits (no prescription required) and do the test yourself. Home A1c kits can be useful if you go for more than three months between doctor visits and want to keep an eye on how your A1c is developing yourself.

The home kits are generally accurate within plus/minus 0.5 percentage points, which is more than good enough to give you a trustworthy result. The downside of the home kits is that they require a larger amount of blood (four large drops) than a regular blood sugar test, and if you don’t apply enough blood, you’ll get an error message and will have lost a test strip.

You can find home test kits on Amazon and in some pharmacies.

Why you should care about your A1c

Multiple studies have shown that high average blood sugars increase the risk of diabetes-related complications. Lowering your A1c to the recommended range will reduce the risk of diabetes-related complications significantly:

Eye disease risk is reduced by 76%

Kidney disease risk is reduced by 50%

Nerve disease risk is reduced by 60%

Any cardiovascular disease event risk is reduced by 42%

Nonfatal heart attack, stroke, or risk of death from cardiovascular causes is reduced by 57%

Achieving an A1c in the recommended range is, therefore, one of the most important things you can do to improve your long-term health when you live with diabetes.

However, the closer you get to the recommended A1c target, the less benefit you will get from lowering your A1c further. Taking your A1c from 12% to 11% makes a big difference while lowering your A1c from 7% to 6% provides a much smaller benefit. In fact, lowering your A1c too much may not be a good idea if it means that you increase how often you experience hypoglycemia (low blood sugar).

I will explain why “time-in-range” is just as important as a low A1c later in this guide.

What is a “normal” A1c?

Now that you have your A1c number, let’s look at what that number actually tells you. The American Diabetes Association has established the following guidelines:

A1c levels for people with and without diabetes

This does NOT mean that you need an A1c of less than 5.7% if you’re living with diabetes. It means that if you do NOT live with diabetes, your A1c is expected to be below 5.7%. There are different recommendations for what an appropriate A1c is for people living with diabetes.

I had a chance to asked Dr. Anne Peters, MD, Director, USC Clinical Diabetes Program and Professor of Clinical Medicine Keck School of Medicine of USC as well as Gary Scheiner, MS, CDE, owner and Clinical Director of Integrated Diabetes Services and author of Think Like a Pancreas, what their perspectives are on a good A1c target:

Dr. Peters:

“The A1c target should be whatever is best given the person’s clinical situation. For athletes, too many lows can limit performance, for someone who is pregnant it should be <6%, for an older person the target should be higher. I generally think an A1c target of 6.0 – 7.0% is ideal and data shows that going below 7% has fairly little impact on complications. Basically, I’d rather see someone with an A1c of 6.9% and low blood sugar variability than an A1c of 6.2% with lots of variability”

Gary Scheiner, MS, CDE:

“A1c goals should be individualized based on the individual capabilities, risks, and prior experiences. For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly. Someone with significant hypoglycemia unawareness and a history of severe lows should target a higher A1c than someone who can detect and manage their lows more effectively. And certainly, someone who has been running A1c’s in double digits for quite some time should not be targeting an A1c of 6%… better to set modest, realistic, achievable goals.”

In their Standards of Medical Care in Diabetes, the American Diabetes Association recommends an A1c target of below 7% for adults living with diabetes. An A1c of 7% roughly translates to an average blood sugar of 154 mg/dl (8.6 mmol/L) as you can see from this conversion chart.

Table of conversions between average blood sugar and A1c

To learn more about blood sugar levels, please read “What are Normal Blood Sugar Levels“.

A1c vs. Time-in-Range

A1c has long been considered the best measure of diabetes management because it was the most accurate tool to observe long-term blood sugar trends. This has changed with the introduction of Continuous Glucose Monitoring (CGM). By using a CGM, you can now get a very accurate picture of not only your average blood sugar, but your blood sugar fluctuations as well.

This makes it possible to track another key component of diabetes management: Time-in-Range.

Time-in-range refers to the percentage of time in which your blood sugar is within a specific range. To see why time-in-range is important, take a look at the three lines in the graph below. All three lines show an average blood sugar of about 154 mg/dl (which equals an A1c of about 7%) but with very different fluctuations. I think we would all prefer our blood sugar to follow line 3 rather than line 1.

Graph showing 3 different blood sugar curves with same A1c but very different time in range

Graph used with permission from Diatribe

Some guidelines state that your blood sugar range should be set to 70-180 mg/dl (3.9-10 mmol/l), but you may find that to be too large or small of a range for you. According to this interview with several diabetes experts, most recommend that you spend less than 3% of the time below 70 mg/dl (3.9 mmol/l) and less than 1% of the time below 53 mg/dl (3 mmol/l). However, they also agree that the actual time spent in range needs to be individualized.

On average, the experts didn’t expect the general diabetes population to be in range more than 50% of the time at most, so talking about incremental improvement probably makes more sense than setting a fixed number.

How to measure Time-in-Range

If you wear a Continuous Glucose Monitor (CGM), your time-in-range should be listed when you download your data (as in the example from a Dexcom CGM below). If you don’t use a CGM, all you can do is look at your manual blood sugar tests and pay attention to your amount of high and low blood sugars. What’s an acceptable high and low is something you have to discuss with your medical team.

Screenshot from a Dexcom CGM showing time in range

What is more important: a low A1c or a high Time-in-Range?

Optimally, you’d have an A1c below 7% accompanied by a low blood sugar variance (high time-in-range). A good general guideline is:

The higher your A1c, the more important it is to focus on getting it down.

The lower your A1c, the more important time-in-range becomes.

If your A1c is below 6-7%, focusing on increasing your time-in-range will probably have a larger positive health impact than lowering your A1c further.

So is A1c a bad way to gauge whether your diabetes management is on track? Not necessarily, but to quote Gary Scheiner, MS, CDE:

“I’ve never been a huge fan of using A1c to gauge the “quality” of a person’s glucose control, simply because it represents an average… and an average can reflect lots of highs and lows rather than time spent within one’s target range. However, it’s not something we can ignore either since there is a correlation between A1c and the risk of long-term complications.”

Can your A1c be too low?

As described above, the answer to this question depends almost entirely on how often you experience hypoglycemia (low blood sugar). If you (almost) never experience hypoglycemia, your A1c technically cannot be too low. Some people achieve A1c levels below 5% by following a very strict diabetes management and diet regimen and have almost no blood sugar fluctuations.

HOWEVER, if you often experience hypoglycemia, that will result in an “artificial” low A1c reading because your hypoglycemia events are lowering your blood sugar average. In that case, focusing on increasing time-in-range is much more important than further lowering your A1c. In fact, you may even benefit from a slightly higher A1c with fewer blood sugar fluctuations.

It’s also important to note that lowering your A1c below the recommended range of 6-7% hasn’t been proven to provide any health benefits. Therefore, a very low A1c shouldn’t be a goal in itself.

How to lower your A1c

Now that you have a thorough understanding of A1c and time-in-range, as well as why looking at your A1c in isolation isn’t optimal, the obvious question is:

How do you lower your A1c while improving or sustaining your time-in-range?

I will cover the four most important things you can do below but it’s always recommended that you start by having a conversation with your medical team before making changes to your diabetes management.

Identify the main “pain points”

Whether you are self-managing your diabetes or work closely with your medical team, the first step should always be to try to identify the main “pain points” or reasons why your A1c is higher than you’d like. The only real way of doing this is by tracking your blood sugars very closely.

If you wear a Continuous Glucose Monitor, you can look at your 7-day, 30-day, and 90-day data to see if you can spot any trends. For example, you might find that you are running high from 1-5 AM every night, every morning (hello Dawn Phenomenon) or every day after meals. Or perhaps you always go low after exercise. We all have different blood sugar patterns.

Apple cider vinegar for diabetes: How to use Apple Cider Vinegar to Lower Your Blood Sugar Level

It’s also very possible that you simply are running your blood sugar a little too high all the time and could benefit from adjusting your diabetes medication. Identifying patterns like that makes it possible to pinpoint areas of potential improvement so you can start making a plan for how to limit your high and low blood sugars.

If you rely on manual blood sugar testing, it’s a little trickier since most people don’t test every five minutes. What I would recommend is increasing how often you test for a while, and maybe even test during the night if you wake up anyway. Most meters allow you to download data to your computer, or you can upload the data to app-based platforms like One Drop or mySugr. This can help you see the data in a more cohesive way so you can start looking for trends.

Create a plan for your diabetes management

Now that you have a better idea of what your “pain points” are, you can start making changes to your diabetes management.

Your doctor may suggest a different medication regime. For example, some people (regardless of their type of diabetes) are prescribed Metformin to help with Dawn Phenomenon (morning blood sugar spikes not related to eating). Others may need adjustments to insulin dosing, etc.

If you’re insulin-dependent and consistently have high blood sugars in the morning, getting your blood sugar fluctuations and A1c down might be as simple as adjusting your nighttime basal insulin. Or, if you run high every day after meals, your carb-to-insulin ratio might be off, and adjusting that could be what sets you on a path of a lower A1c. Until you collect the data and do the analysis, you have no way of knowing this.

I want to make an important point here: increasing your diabetes medication is not a sign of failure! It’s often the best (and sometimes only) way to control your blood sugar and bring down your A1c.

I adjust my insulin up and down all the time when I change my diet or exercise routine. Adjusting your medication is an important tool in your diabetes toolbox and something you should always discuss with your medical team.

Understand nutrition and adjust your diet

What you choose to eat and drink can have a major impact on not only your waistline, mood, and well-being, but also on your blood sugar levels.

All macronutrients (carbohydrates, proteins, and fats) can affect your blood sugar to some degree so developing a good understanding of how they affect your blood sugar will enable you to be proactive and prevent blood sugar swings.

Carbohydrates (carbs)

Carbohydrates have the greatest impact on your blood sugar, which is why many people with diabetes can benefit from following a low- to medium-carb diet (or even a ketogenic diet). The fewer carbs you eat, the less insulin you need to take, which makes diabetes management easier.

However, you don’t have to follow a low-carb diet if it doesn’t work for you – physically or mentally. As I wrote in my post about which diet is best for people with diabetes, it is very possible to have great blood sugar control on a medium (or even high) carb diet, as long as you experiment, take notes, and learn to take the right amounts of insulin for the carbs you are eating.

It is very important to realize that we all react differently to carbs so you have to find the diet and foods that are right for you.

As an example, people react very differently to carbs like oats or sweet potato. Some people can eat oats with only a small increase in blood sugar while others see a quick spike. By simply knowing this, people struggling with a certain type of carb can choose to reduce their consumption or cut it out of their diet altogether.

Protein & fats

While carbs affect blood sugar most significantly, protein and fat also have an impact. Some, like Dr. Sheri Colberg, even think that simply looking at carbs when estimating blood sugar impact (and dosing insulin) is an outdated and inefficient way to perceive diabetes management and that you should focus more on total calories (read more here).

The key thing to be aware of is that when protein and especially fat is consumed with carbohydrates, the energy from the meal will be released more slowly, which means that your blood sugars will be impacted more slowly as well.

While I don’t believe your diabetes management should completely dictate how you live your life and which diet you choose to follow, it can be worth evaluating what food choices make life easier for you. By making a conscious choice of which type of nutrition plan to follow (the majority of the time), you can more easily establish healthy habits that will benefit not only your overall health but also your daily blood sugar levels, and thereby your A1c.

Increase activity (exercise)

While exercise is essential for building and maintaining good health and improving insulin sensitivity, it can be a double-edged sword if it constantly throws your blood sugars for a loop. Not only is that very frustrating, scary, and annoying, but it can also affect your A1c and time-in-range negatively.

The key is to understand how different types of exercise affect blood sugars and, if you use insulin, learn your formula for insulin and food around workouts.

Cardio

Cardio, such as brisk walking, jogging, swimming, biking, or dancing, are all excellent types of exercise, and as little as 20-30 minutes a day can make a significant difference when it comes to improving insulin resistance and managing blood sugar levels.

Not only does exercise reduce blood glucose during exercise, but it also improves your insulin sensitivity for hours after your workout, meaning that you need less insulin.

If you treat your diabetes with insulin, you will have to manage your insulin levels so you don’t experience exercise-induced hypoglycemia. This comes down to reducing your insulin significantly or consuming carbs before your workout.

In general, it should not be needed to “carb up” to do up to 60 minutes of steady-state cardio, but there can be situations where reducing insulin before exercise can’t be done, so additional carbohydrates must be consumed.

Resistance training

Adding resistance training to your daily routine, even if it’s just bodyweight exercise, can be instrumental in increasing your insulin sensitivity and lowering your A1c.

Whereas cardio will lower blood sugar during exercise and potentially up to 36 hours after exercise, resistance training can increase insulin sensitivity for much longer since muscles work as little “glucose tanks” and you’ll store more glucose in your muscles rather than sending it directly to your bloodstream. The more muscles you have, the better your insulin sensitivity.

Just be aware that most people will see an increase in blood sugars during resistance training (research was mainly done on people living with type 1 diabetes) rather than a decrease. The reason for the increase in blood sugar is that the improved insulin sensitivity from exercising is surpassed by your body’s increased glucose production. Your body is producing glucose faster than you can use it!

For a detailed guide to resistance training and diabetes, please see my article “How Resistance Training Affects Your Blood Sugar.”

Because resistance training is so effective at increasing your insulin sensitivity, it’s a great way to lower your blood sugar consistently. If you exercise regularly, the effect of exercising overlaps from one workout to the next and you essentially achieve a permanent increase in insulin sensitivity.

How quickly can you lower your A1c?

Because A1c is simply a measure of your average blood sugar over 2-3 months, it can (in theory) decrease by any amount over that time period. If you, from one day to the next, decreased your daily average blood sugar from 300 mg/dl (16.7 mmol/l) to 120 mg/dl (6.7 mmol/l), your A1c would decrease from 12% to 6% in around two months.

However, it may not be a good idea to lower your A1c so quickly, as I will explain below.

Why you shouldn’t lower your A1c too quickly

It can be a good idea to approach lowering your A1c with a bit of caution. Just as crash dieting isn’t healthy, there can be some serious health risks associated with lowering your A1c too quickly. I turned to Dr. Peters for an explanation:

“If you lower your A1c too quickly, many bad things can happen. First, weight gain and total body swelling. Next, it can cause bleeding in the retina (back of the eyes) which can lead to blindness, and third, it can cause painful neuropathy that never goes away. It’s slightly different for newly diagnosed patients, but, in general, no one should try to go from an A1c of 10% to 6% quickly. Take slow steps. Wanting to get to a “low” number very fast only causes harm. Diabetes is a long-term disease, so slow steps to establish new habits that can last a lifetime is the way to go. Anything too sudden and the body reacts badly.”

My perspective on A1c as a person living with diabetes

I have a very ambivalent relationship with my A1c myself. I’ve been living with type 1 diabetes for over 20 years, and my A1c is not something I think about in my daily life. However, every three months when I see my endo, I get a little anxious because receiving your A1c can feel a lot like getting your diabetes report card.

And, quite honestly, that’s really silly. My A1c number doesn’t reflect what’s been going on in my life for the last three months. It doesn’t tell me how much effort I’ve put into managing my diabetes and it does not define me as a person. It’s a good source of information, nothing more.

Still, we tend to look at it and judge, good or bad, how we’ve done with our diabetes management. But we really shouldn’t!

That doesn’t mean that I think we shouldn’t get our A1c checked. I absolutely think we should, but we also need to understand what it means as well as why we should look beyond the A1c number. I hope this guide has given you the knowledge and tools to do so!

How high can your A1C go?

What has your blood sugar been up to lately? Get an A1C test to find out your average levels—important to know if you’re at risk for prediabetes or type 2 diabetes, or if you’re managing diabetes.

The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months. It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes.

What Does the A1C Test Measure?

When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.

Who Should Get an A1C Test, and When?

Testing for diabetes or prediabetes:

Get a baseline A1C test if you’re an adult over age 45—or if you’re under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:

If your result is normal but you’re over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.

If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.

If you don’t have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.

If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.

Managing diabetes:

If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.

How to Prepare for Your A1C Test

The test is done in a doctor’s office or a lab using a sample of blood from a finger stick or from your arm. You don’t need to do anything special to prepare for your A1C test. However, ask your doctor if other tests will be done at the same time and if you need to prepare for them.

Your A1C Result

Diagnosing Prediabetes or Diabetes

Normal

Below 5.7%

Prediabetes 5.7% to 6.4%

Diabetes 6.5% or above

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.

Managing Diabetes

Your A1C result can also be reported as estimated average glucose (eAG), the same numbers (mg/dL) you’re used to seeing on your blood sugar meter:

A1C %

eAG mg/dL

7

154

8

183

9

212

10

240

What Can Affect Your A1C Result?

A patient using a Glucometer

Get your A1C tested in addition to—not instead of—regular blood sugar self-testing if you have diabetes.

Several factors can falsely increase or decrease your A1C result, including:

Kidney failure, liver disease, or severe anemia.

A less common type of hemoglobin that people of African, Mediterranean, or Southeast Asian descent and people with certain blood disorders (such as sickle cell anemia or thalassemia) may have.

Certain medicines, including opioids and some HIV medications.

Blood loss or blood transfusions.

Early or late pregnancy.

Let your doctor know if any of these factors apply to you, and ask if you need additional tests to find out.

Your A1C Goal

The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal.

Younger people have more years with diabetes ahead, so their goal may be lower to reduce the risk of complications, unless they often have hypoglycemia (low blood sugar, or a “low”). People who are older, have severe lows, or have other serious health problems may have a higher goal.

A1C: Just Part of the Toolkit

A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings.

If you’re reaching your A1C goal but having symptoms of highs or lows, check your blood sugar more often and at different times of day. Keep track and share the results with your doctor so you can make changes to your treatment plan if needed.

What foods to avoid if your A1C is high?

Diabetes is a chronic disease that has reached epidemic proportions among adults and children worldwide (1Trusted Source).

Uncontrolled diabetes has many serious consequences, including heart disease, kidney disease, blindness, and other complications.

Prediabetes has also been linked to these conditions (2Trusted Source).

Importantly, eating certain foods can raise your blood sugar and insulin levels and promote inflammation, which may increase your risk of disease.

This article lists 11 foods and drinks that people with diabetes or prediabetes should avoid.

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Why does carb intake matter for people with diabetes?

Carbs, protein, and fat are the macronutrients that provide your body with energy.

Among them, carbs have the greatest effect on your blood sugar by far. This is because they’re broken down into sugar, or glucose, and absorbed into your bloodstream.

Carbs include starches, sugar, and fiber. However, fiber isn’t digested and instead absorbed by your body in the same way other carbs are, so it doesn’t raise your blood sugar.

Best Time to Drink ACV to Lower Glucose (Sugars in Blood) - Dr. Mandell

Subtracting fiber from the total carbs in a portion of food will give you its digestible or net carb content. For instance, if a cup of mixed vegetables contains 10 grams of carbs and 4 grams of fiber, its net carb count is 6 grams.

When people with diabetes consume too many carbs at a time, their blood sugar levels can rise to dangerously high levels.

Over time, high levels can damage your body’s nerves and blood vessels, which may set the stage for heart disease, kidney disease, and other serious health conditions.

Maintaining a low carb intake can help prevent blood sugar spikes and greatly reduce the risk of diabetes complications.

Therefore, it’s important to avoid the foods and drinks listed below.

1. Sugar-sweetened beverages

Sugary beverages are the worst drink choice for someone with diabetes.

First, they’re very high in carbs, with a 12-ounce (354-mL) can of cola providing 38.5 grams (3Trusted Source).

The same amount of sweetened iced tea and lemonade each contain almost 45 grams of carbs exclusively from sugar (4Trusted Source, 5Trusted Source).

In addition, these drinks are loaded with fructose, which is strongly linked to insulin resistance and diabetes. Indeed, studies suggest that consuming sugar-sweetened beverages may increase the risk of diabetes-related conditions like fatty liver disease (6Trusted Source, 7, 8).

What’s more, the high fructose levels in sugary drinks may lead to metabolic changes that promote belly fat and potentially harmful cholesterol and triglyceride levels.

In separate studies in adults with overweight and obesity, consuming 25% of calories from high fructose beverages on a weight-maintaining diet led to increased insulin resistance and belly fat, lower metabolic rate, and worse heart health markers (9Trusted Source, 10Trusted Source).

To help control blood sugar levels and prevent disease risk, consume water, club soda, or unsweetened iced tea instead of sugary beverages.

SUMMARY

Sodas and sweet drinks are high in carbs, which increase blood sugar. Also, their high fructose content has been linked to insulin resistance and an increased risk of obesity, fatty liver, and other diseases.

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2. Trans fats

Artificial trans fats are extremely unhealthy.

They’re created by adding hydrogen to unsaturated fatty acids to make them more stable.

Trans fats are found in margarines, peanut butter, spreads, creamers, and frozen dinners. Furthermore, food manufacturers often add them to crackers, muffins, and other baked goods to help extend a product’s shelf life.

Although trans fats don’t directly raise blood sugar levels, they’ve been linked to increased inflammation, insulin resistance, and belly fat, as well as lower levels of HDL (good) cholesterol and impaired arterial function (11Trusted Source, 12, 13Trusted Source, 14Trusted Source, 15Trusted Source, 16Trusted Source).

While more research is needed to gain a clearer understanding of the relationship between trans fats and insulin resistance, the links mentioned above are especially concerning for people with diabetes, as they’re at an increased risk of heart disease.

Artificial trans fats have been outlawed in most countries, and in 2018 the Food and Drug Administration (FDA) banned the use of partially hydrogenated oil — the major source of artificial trans fat in the food supply — in most processed foods (17Trusted Source).

This doesn’t mean that all foods in the United States are now free of artificial trans fats. Manufacturers aren’t required to list trans fats on the nutrition facts labels if a product contains under 0.5 grams of trans fat per serving (18Trusted Source).

It’s best to avoid any product that contains the words “partially hydrogenated” in its ingredient list.

SUMMARY

Trans fats are unsaturated fats that have been chemically altered to increase their stability. They’ve been linked to inflammation, insulin resistance, increased belly fat, and heart disease.

WERBUNG

3. White bread, rice, and pasta

White bread, rice, and pasta are high carb, processed foods.

Eating bread, bagels, and other refined-flour foods has been shown to significantly increase blood sugar levels in people with type 1 and type 2 diabetes (19, 20).

This response isn’t exclusive to products made with refined white flour. In one study, gluten-free pastas were also shown to raise blood sugar, with rice-based types having the greatest effect (21Trusted Source).

Another study found that high carb foods not only raised blood sugar but also decreased brain function in people with type 2 diabetes and mental deficits (22).

These processed foods contain little fiber. Fiber helps slow the absorption of sugar into the bloodstream.

In other research, replacing these low fiber foods with high fiber foods was shown to significantly reduce blood sugar levels in people with diabetes. Moreover, people with diabetes experienced reductions in cholesterol.

Increased fiber consumption also improved gut microbiota, which may have led to improved insulin resistance (23Trusted Source).

SUMMARY

White bread, pasta, and rice are high in carbs yet low in fiber. This combination can result in high blood sugar levels. Alternatively, choosing high-fiber, whole foods may help reduce blood sugar response.

4. Fruit-flavored yogurt

Plain yogurt can be a good option for people with diabetes. However, fruit-flavored varieties are a very different story.

Flavored yogurts are typically made from nonfat or low fat milk and loaded with carbs and sugar.

In fact, a 1-cup (245-gram) serving of fruit-flavored yogurt may contain almost 31 grams of sugar, meaning nearly 61% of its calories come from sugar (24Trusted Source).

Many people consider frozen yogurt to be a healthy alternative to ice cream. However, it can contain just as much or even more sugar than ice cream (25Trusted Source, 26Trusted Source).

Rather than choosing high sugar yogurts that can spike your blood sugar and insulin, opt for plain, whole milk yogurt that contains no sugar and may be beneficial for your appetite, weight control, and gut health (27, 28Trusted Source).

SUMMARY

Fruit-flavored yogurts are usually low in fat but high in sugar, which can lead to higher blood sugar and insulin levels. Plain, whole milk yogurt is a better choice for diabetes control and overall health.

5. Sweetened breakfast cereals

Eating cereal can be one of the worst ways to start your day if you have diabetes.

Despite the health claims on their boxes, most cereals are highly processed and contain far more carbs than many people realize.

In addition, they provide very little protein, a nutrient that can help you feel full and satisfied while keeping your blood sugar levels stable during the day (29Trusted Source).

Even some “healthy” breakfast cereals aren’t good choices for those with diabetes.

For instance, just a 1/2-cup serving (about 56 grams) of granola contains 44 grams of carbs, while Grape Nuts contain 47 grams. What’s more, each provides no more than 7 grams of protein per serving (30Trusted Source, 31Trusted Source).

To keep blood sugar and hunger under control, skip most cereals and choose a protein-based low carb breakfast instead.

SUMMARY

Many breakfast cereals are high in carbs but low in protein. A high protein, low carb breakfast is the best option for diabetes and appetite control.

6. Flavored coffee drinks

Coffee has been linked to several health benefits, including a reduced risk of diabetes (32).

However, flavored coffee drinks should be viewed as a liquid dessert rather than a healthy beverage.

Studies have shown your brain doesn’t process liquid and solid foods similarly. When you drink calories, you don’t compensate by eating less later, potentially leading to weight gain (33Trusted Source, 34Trusted Source).

Flavored coffee drinks are also loaded with carbs.

For instance, a 16-ounce (473-mL) Caramel Frappuccino from Starbucks contains 57 grams of carbs, and the same size of the Blonde Vanilla Latte contains 30 grams of carbs (35, 36).

To keep your blood sugar under control and prevent weight gain, choose plain coffee or espresso with a tablespoon of heavy cream or half-and-half.

SUMMARY

Flavored coffee drinks are very high in liquid carbs, which can raise blood sugar levels and fail to satisfy your hunger.

7. Honey, agave nectar, and maple syrup

People with diabetes often try to minimize their intake of white table sugar, as well as treats like candy, cookies, and pie.

However, other forms of sugar can also cause blood sugar spikes. These include brown sugar and “natural” sugars such as honey, agave nectar, and maple syrup.

Although these sweeteners aren’t highly processed, they contain at least as many carbs as white sugar. In fact, most contain even more.

Below are the carb counts of a 1-tablespoon serving of popular sweeteners:

white sugar: 12.6 grams (37Trusted Source)

honey: 17.3 grams (38Trusted Source)

agave nectar: 16 grams (39Trusted Source)

maple syrup: 13.4 grams (40Trusted Source)

In one study, people with prediabetes experienced similar increases in blood sugar, insulin, and inflammatory markers regardless of whether they consumed 1.7 ounces (50 grams) of white sugar or honey (41Trusted Source).

Your best strategy is to avoid all forms of sugar and use natural low carb sweeteners instead.

SUMMARY

Honey, agave nectar, and maple syrup aren’t as processed as white table sugar, but they may have similar effects on blood sugar, insulin, and inflammatory markers.

8. Dried fruit

Fruit is a great source of several important vitamins and minerals, including vitamin C and potassium.

When fruit is dried, the process results in a loss of water that leads to even higher concentrations of these nutrients.

Unfortunately, its sugar content becomes more concentrated as well.

One cup (151 grams) of grapes contains 27.3 grams of carbs, including 1.4 grams of fiber. By contrast, 1 cup (145 grams) of raisins contains 115 grams of carbs, 5.4 of which come from fiber (42Trusted Source, 43Trusted Source).

Therefore, raisins contain more than four times as many carbs as grapes do. Other types of dried fruit are similarly higher in carbs than their fresh counterparts.

If you have diabetes, you don’t have to give up fruit altogether. Sticking to low sugar fruits, such as fresh berries or a small apple, can provide health benefits while keeping your blood sugar in the target range.

SUMMARY

Dried fruits become more concentrated in sugar and may contain more than four times as many carbs as fresh fruits do. Avoid dried fruit and choose fruits low in sugar for optimal blood sugar control.

9. Packaged snack foods

Pretzels, crackers, and other packaged foods aren’t good snack choices.

They’re typically made with refined flour and provide few nutrients, although they have plenty of fast-digesting carbs that can rapidly raise blood sugar.

Here are the carb counts for a 1-ounce (28-gram) serving of some popular snacks:

saltine crackers: 20.7 grams of carbs, including 0.78 grams of fiber (44Trusted Source)

pretzels: 22.5 grams of carbs, including 0.95 grams of fiber (45Trusted Source)

graham crackers: 21.7 grams of carbs, including 0.95 grams of fiber (46Trusted Source)

In fact, some of these foods may contain even more carbs than stated on their nutrition label. One study found that snack foods provide 7.7% more carbs, on average, than the label states (47Trusted Source).

If you get hungry in between meals, it’s better to eat nuts or a few low carb vegetables with an ounce of cheese.

SUMMARY

Packaged snacks are typically highly processed foods made from refined flour, which can quickly raise your blood sugar levels.

10. Fruit juice

Although fruit juice is often considered a healthy beverage, its effects on blood sugar are similar to those of sodas and other sugary drinks.

This goes for unsweetened 100% fruit juice, as well as types that contain added sugar. In some cases, fruit juice is even higher in sugar and carbs than soda.

For example, 8 ounces (250 mL) of soda and apple juice contain 22 and 24 grams of sugar, respectively. An equivalent serving of grape juice provides 35 grams of sugar (48Trusted Source, 49Trusted Source, 50Trusted Source).

Similarly to sugar-sweetened beverages, fruit juice is loaded with fructose. Fructose drives insulin resistance, obesity, and heart disease (51Trusted Source).

A much better alternative is to enjoy water with a wedge of lemon, which provides less than 1 gram of carbs and is virtually calorie-free (52Trusted Source).

SUMMARY

Fruit juices contain at least as much sugar as sodas. Their high fructose content can worsen insulin resistance, promote weight gain, and increase the risk of heart disease.

11. French fries

French fries are a food you may want to steer clear of, especially if you have diabetes.

Potatoes themselves are relatively high in carbs. One medium potato contains 34.8 grams of carbs, 2.4 of which come from fiber (53Trusted Source).

However, once they’ve been peeled and fried in vegetable oil, potatoes may do more than spike your blood sugar.

Deep-frying foods has been shown to produce high amounts of toxic compounds, such as advanced glycation end products (AGEs) and aldehydes. These compounds may promote inflammation and increase the risk of disease (54Trusted Source, 55Trusted Source).

Indeed, several studies have linked frequently consuming french fries and other fried foods to heart disease and cancer (56Trusted Source, 57Trusted Source, 58Trusted Source, 59Trusted Source).

If you don’t want to avoid potatoes altogether, eating a small serving of sweet potatoes is your best option.

SUMMARY

In addition to being high in carbs that raise blood sugar levels, french fries are fried in unhealthy oils that may promote inflammation and increase the risk of heart disease and cancer.

The bottom line

Knowing which foods to avoid when you have diabetes can sometimes seem tough. However, following a few guidelines can make it easier.

Take Apple Cider Vinegar to Lower Blood Sugar Levels ❓

Your main goals should include staying away from unhealthy fats, liquid sugars, processed grains, and other foods that contain refined carbs.

Avoiding foods that increase your blood sugar levels and drive insulin resistance can help keep you healthy and reduce your risk of future diabetes complications.

It might likewise help to reach out to others for support. Healthline’s free app, T2D Healthline, connects you with people living with type 2 diabetes. Ask diet-related questions and seek advice from others who get it. Download the app for iPhone or Android.

Can turmeric lower A1C?

The history of the Curcuma longa plant is quite prestigious. Dating back thousands of years to its roots in Southeast Asia, this member of the ginger family served numerous medicinal purposes.

The constituent of Curcuma longa known for its health benefits is curcumin, extracted from turmeric root. This powerful antioxidant is the poster child for modern natural medicine, as it’s both safe and nearly side effect free. But, is turmeric good for diabetes and lowering blood sugar?

Turmeric and Diabetes

We know that turmeric is capable of benefiting a wide variety of diseases and illnesses. These conditions range from arthritis and joint pain, all the way up to Alzheimer’s disease and cancer. Curcumin can even help with blood-thinning and depression and anxiety.

Today, research suggests that curcumin may also have a positive impact on diabetes. Specifically, it may lower and stabilize blood sugar levels in type 1 and type 2 diabetics. To fully understand how turmeric can help, let’s explore diabetes in more detail. (1)

What is Diabetes?

Diabetes occurs when your blood sugar (glucose) is too high. Blood glucose is the body’s primary energy source derived from the food we eat. In an otherwise healthy person, the pancreas secretes insulin, the hormone used to help glucose into your cells for energy conversion.

Sometimes, the body doesn’t produce enough insulin or any insulin at all. This inefficiency causes glucose to stay in your blood without reaching the cells. Over time, high blood sugar can cause severe health problems if not properly managed.

There are a few types of diabetes to keep in mind as we proceed through the article:

Type 1 Diabetes: The body cannot efficiently produce insulin. The immune system attacks the cells in your pancreas responsible for insulin production.

Type 2 Diabetes: The body cannot manufacture insulin or use it efficiently.

Gestational Diabetes: Often diagnosed in women during pregnancy. Usually, this condition disappears following childbirth but may increase the odds of developing type 2 diabetes in the future.

There also appears to be an apparent link between chronic inflammation and metabolic disorders. Thus, it’s thought that obesity-induced inflammation may further contribute to the development and worsening of the diabetic condition. (2)

Diabetes can impact anyone from any walk of life, and it’s not necessarily dependent on age. Though, people over the age of 65 tend to have a higher risk. While it’s possible to live a completely healthy life with the condition, others have more severe cases and are not quite as fortunate. (3)

Why Turmeric Curcumin?

Turmeric is famous for its ability to reduce inflammation and boost immunity by acting as a powerful antioxidant in the body. Curcumin also appears to benefit hyperlipidemia and glycemia in various studies.

Glycemia: The existence of sugar (glucose) in the blood.

Hyperlipidemia: Excessive lipids (cholesterol and triglycerides) in the blood.

Lipid accumulation from obesity may cause insulin resistance that inhibits glycolysis (the breakdown of glucose). This problem is a key feature of type 2 diabetes. The thought is, if curcumin can lower blood sugar and influence lipid levels, then it should be able to help manage diabetes and aid weight loss. (4)

In this article, we’ll dissect the research surrounding curcumin’s ability to help lower blood sugar and stabilize type 1 and type 2 diabetes.

Does Turmeric Lower Blood Sugar?

The first study we’ll look at examined curcumin’s effects on total cholesterol, HDL, LDL, and triglycerides in 75 patients with acute coronary syndrome (ACS). The results showed a trend indicating that a lower dose of curcumin yielded higher cholesterol reduction. However, the study did not show any decrease in triglycerides. (5)

A second study sought to uncover one of curcumin’s potential anti-diabetic mechanisms of action. The research team used a curcumin C3 complex on a rat model. Researchers observed an apparent suppression of gluconeogenesis (the opposite of glycolysis).

In other words, turmeric reduced glucose creation from non-carbohydrate carbon substrates such as the breaking down of proteins and lipids. The result showed a promising glucose-lowering effect through the use of curcuminoids. (6)

Further research assessed the potential of turmeric to delay the onset of type 2 diabetes mellitus (T2DM) in a prediabetic condition. This trial contained 240 subjects in a double-blinded, placebo-controlled, and randomized environment.

All subjects were split and assigned to curcumin capsules or a placebo for a 9-month treatment period. The results showed that 16.4% of the placebo group developed type 2 diabetes mellitus after nine months. Impressively, none of the curcumin group progressed from a prediabetic state into T2DM.

The curcumin group also saw an improvement in the function of Beta cells (β-cells) within the pancreas. β-cells are responsible for the synthesizing and secretion of insulin and amylin (helps glycemic regulation), both of which are deficient in people with diabetes. (7, 8)

Similarly, in patients who have already developed type 2 diabetes mellitus, the addition of 150 mg of curcumin twice daily exhibited positive benefits. In total, 67 subjects completed the 8-week study.

The results showed enhanced endothelial (blood vessel) function, with notable reductions in oxidative stress and inflammation over the placebo group. These benefits can help stabilize the diabetic condition. (9)

Obesity can be a major obstacle in the management of chronic diseases such as hypertension, heart disease, and type 2 diabetes. When looking at obesity-related metabolic disorders, curcumin has demonstrated several mechanisms of action.

Turmeric can interact with pancreatic cells, white blood cells, beta cells, and downregulate inflammatory cytokines. These various benefits allow curcumin to potentially reverse insulin resistance, hyperlipidemia, and hyperglycemia (heightened blood glucose levels). (10, 11)

Curcumin may also lower the risk of developing atherosclerosis, a common cardiovascular condition among people with diabetes. One 6-month double-blind, placebo-controlled, and randomized trial assessed turmeric’s effects on atherogenic risk factors. The results showed that turmeric administration significantly improved metabolic profiles in this high-risk population. (12)

Since diabetes also puts you at a higher risk of developing nonalcoholic fatty liver disease (NAFLD), turmeric can be of further use. Studies show that curcumin is an excellent way to detox and cleanse the liver. In other words, it helps support the body’s primary filtration processes.

Our last study of note used a 300 mg dosage of curcumin per day on a group of overweight type 2 diabetic patients for a 3-month treatment period. The study also contained a placebo group. The results showed that curcumin supplementation drastically reduced fasting blood glucose and insulin resistance in the patients. (13)

It’s important to mention that turmeric is also good for thyroid function. Thyroid disease can worsen glycemic control and rapidly alter the body’s insulin requirements, creating dangerous situations for diabetics. Therefore, turmeric can help diabetes and blood sugar in more ways than one.

How to Take Turmeric for Diabetes

The best way to take turmeric for blood sugar is with an encapsulated turmeric supplement.

Many health sites recommend adding turmeric powder to a smoothie, using more of it in your food, or drinking turmeric tea. The issue with these methods is that you’re highly unlikely to get the required amount of curcumin to realize any benefits.

This is because turmeric powder is only 3.14% curcumin, on average. This means that a 100 mg dose of turmeric contains roughly 3.14 mg of curcumin. In other words, almost nothing.

The second issue is that turmeric and curcumin have poor absorption and bioavailability in the body without the help of additional substances.

Research shows that when you consume turmeric with piperine (black pepper extract), you’ll see a 20x improvement in overall absorption. If your product also contains AstraGin, you’ll see an additional 92% increase in absorption, with the added benefit of supporting gut health.

Therefore, look for a product with both of those ingredients for the best results.

Dosage Recommendations

How much turmeric should a diabetic take daily? We’ve seen that lower doses of curcumin may yield greater cholesterol reduction than higher dosages. Also, doses as high as 300 mg of curcumin per day have shown substantial improvements in the diabetic condition.

In general, turmeric is very well tolerated in most individuals. In past articles, some studies used as much as 8,000 mg of curcumin per day with no treatment-related toxicity to report. Though, this is a ridiculously high amount that we don’t recommend.

For managing diabetes, a dosing range of 150 mg to 250 mg of curcumin per day should suffice. You’ll want to start small when using turmeric supplements and assess your results over time, increasing the turmeric dosage only when required.

How quickly does turmeric lower blood sugar?

Most of the meaningful studies above were conducted over an extended period, comparing key biomarkers to placebo groups. There currently is not enough research to suggest that turmeric can lower your blood sugar immediately.

Results depend on the individual and the severity of their condition. However, for most people, you can expect some improvement with 4-8 weeks of continuous use.

Remember, turmeric and curcumin are not a replacement for insulin or any other traditionally prescribed medications. If you have been diagnosed with diabetes, only use turmeric under the supervision of a medical professional.

Potential Side Effects

What are the negative effects of turmeric? The side effects of turmeric are very rare and usually mild. Still, it’s important to be aware of the following potential adverse reactions:

Turmeric is known to have anticoagulant properties and may be able to thin the blood.

Turmeric has shown an ability to lower blood sugar. Diabetics should use extra caution.

Excessive dosages may lead to mild headaches, nausea, or digestive discomfort.

Who should not take turmeric? Do not take turmeric while you are pregnant or nursing. While it may be safe in the small quantities found in food, medicinal amounts of curcumin are not recommended. You should also avoid turmeric if it is just before or after a scheduled surgery. Turmeric has shown that it can thin the blood, which may cause complications with blood clotting.

Learn: What Medications Should Not Be Taken With Turmeric

Final Thoughts on Turmeric for Diabetes and Blood Sugar

Is turmeric good for diabetes and lowering blood sugar? The answer appears to be, yes. Remember, there is no cure for type 1 or type 2 diabetes, and curcumin should not be viewed as such. However, several animal and human studies show definitive glucose-lowering and insulin-sensitizing effects that people with diabetes or prediabetes can appreciate. (14, 15)

Turmeric’s anti-diabetic activities may help lower A1C levels, reduce insulin resistance, lower cholesterol levels, and prevent other metabolic and obesity-related complications. As always, please consult with a certified medical professional to see if curcumin can be beneficial for your situation.

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What are symptoms of high A1C?

Prediabetes means you have a higher than normal blood sugar level. It's not high enough to be considered type 2 diabetes yet. But without lifestyle changes, adults and children with prediabetes are at high risk to develop type 2 diabetes.

If you have prediabetes, the long-term damage of diabetes — especially to your heart, blood vessels and kidneys — may already be starting. There's good news, however. Progression from prediabetes to type 2 diabetes isn't inevitable.

Eating healthy foods, making physical activity part of your daily routine and staying at a healthy weight can help bring your blood sugar level back to normal. The same lifestyle changes that can help prevent type 2 diabetes in adults might also help bring children's blood sugar levels back to normal.

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Symptoms

Prediabetes doesn't usually have any signs or symptoms.

One possible sign of prediabetes is darkened skin on certain parts of the body. Affected areas can include the neck, armpits and groin.

Classic signs and symptoms that suggest you've moved from prediabetes to type 2 diabetes include:

Increased thirst

Frequent urination

Increased hunger

Fatigue

Blurred vision

Numbness or tingling in the feet or hands

Frequent infections

Slow-healing sores

Unintended weight loss

When to see a doctor

See your health care provider if you're concerned about diabetes or if you notice any type 2 diabetes signs or symptoms. Ask your health care provider about blood sugar screening if you have any risk factors for diabetes.

 

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Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

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Causes

The exact cause of prediabetes is unknown. But family history and genetics appear to play an important role. What is clear is that people with prediabetes don't process sugar (glucose) properly anymore.

Most of the glucose in your body comes from the food you eat. When food is digested, sugar enters your bloodstream. Insulin allows sugar to enter your cells — and lowers the amount of sugar in your blood.

Insulin is produced by a gland located behind the stomach called the pancreas. Your pancreas sends insulin to your blood when you eat. When your blood sugar level starts to drop, the pancreas slows down the secretion of insulin into the blood.

When you have prediabetes, this process doesn't work as well. As a result, instead of fueling your cells, sugar builds up in your bloodstream. This can happen because:

Your pancreas may not make enough insulin

Your cells become resistant to insulin and don't allow as much sugar in

Risk factors

The same factors that increase the odds of getting type 2 diabetes also increase the risk of prediabetes. These factors include:

Weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.

Waist size. A large waist size can indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.

Diet. Eating red meat and processed meat, and drinking sugar-sweetened beverages, is associated with a higher risk of prediabetes.

Inactivity. The less active you are, the greater your risk of prediabetes.

Age. Although diabetes can develop at any age, the risk of prediabetes increases after age 45.

Family history. Your risk of prediabetes increases if you have a parent or sibling with type 2 diabetes.

Race or ethnicity. Although it's unclear why, certain people — including Black, Hispanic, American Indian and Asian American people — are more likely to develop prediabetes.

Gestational diabetes. If you had diabetes while pregnant (gestational diabetes), you and your child are at higher risk of developing prediabetes.

Polycystic ovary syndrome. Women with this common condition — characterized by irregular menstrual periods, excess hair growth and obesity — have a higher risk of prediabetes.

Sleep. People with obstructive sleep apnea — a condition that disrupts sleep repeatedly — have an increased risk of insulin resistance. People who are overweight or obese have a higher risk of developing obstructive sleep apnea.

Tobacco smoke. Smoking may increase insulin resistance and can increase the risk of type 2 diabetes in people with prediabetes. Smoking also increases your risk of complications from diabetes.

Other conditions associated with an increased risk of prediabetes include:

High blood pressure

Low levels of high-density lipoprotein (HDL) cholesterol, the "good" cholesterol

High levels of triglycerides — a type of fat in your blood

Metabolic syndrome

When certain conditions occur with obesity, they are associated with insulin resistance, and can increase your risk for diabetes ⸺ and heart disease and stroke. A combination of three or more of these conditions is often called metabolic syndrome:

High blood pressure

Low levels of HDL

High triglycerides

High blood sugar levels

Large waist size

Complications

Prediabetes has been linked with long-term damage, including to your heart, blood vessels and kidneys, even if you haven't progressed to type 2 diabetes. Prediabetes is also linked to unrecognized (silent) heart attacks.

Prediabetes can progress to type 2 diabetes, which can lead to:

High blood pressure

High cholesterol

Heart disease

Stroke

Kidney disease

Nerve damage

Fatty liver disease

Eye damage, including loss of vision

Amputations

Prevention

Healthy lifestyle choices can help you prevent prediabetes and its progression to type 2 diabetes — even if diabetes runs in your family. These include:

Eating healthy foods

Getting active

Losing excess weight

Controlling your blood pressure and cholesterol

Not smoking

Why is my A1C going up?

By Adithi Gandhi and Jeemin Kwon

Why we use A1c, what values are recommended, and what impacts A1c – everything from anemia to vitamins

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Hemoglobin A1c (“HbA1c” or just “A1c”) is the standard for measuring blood sugar management in people with diabetes. A1c reflects average blood sugars over 2 to 3 months, and through studies like DCCT and UKPDS, higher A1c levels have been shown to be associated with the risk of certain diabetes complications (eye, kidney, and nerve disease). For every 1% decrease in A1c, there is significant pretection against those complications.

However, as an average over a period of months, A1c cannot capture critical information such as time spent in a target range (70-180 mg/dl) and hypoglycemia (less than 70 mg/dl).

This article describes why A1c is used in the first place, as well as factors that can lead to misleadingly high or low values. In a follow-up piece, we will discuss time-in-range, hypoglycemia, hyperglycemia, blood sugar variability, and how to measure and interpret them.

Click to jump down to a section:

What is A1c and why is it used?

What are “normal” A1c levels for people who don't have diabetes?

What is an A1c goal for those with diabetes?

How does age affect A1c?

Where is A1c misleading or potentially inaccurate?

What tools are available if an A1c test is not accurate or sufficient?

What’s important to keep in mind about A1c?

Conditions and factors that impact A1c

What is A1c and why is it used?

A1c estimates a person’s average blood sugar levels over a 2 to 3-month span. It is the best measure we have of how well blood glucose is controlled and an indicator of diabetes management.

Though A1c doesn’t provide day-to-day information, keeping A1c low has been proven to lower the risk of “microvascular” complications like kidney disease (nephropathy), vision loss (retinopathy), and nerve damage (neuropathy). The relationship between A1c and “macrovascular” complications like heart disease is harder to show in clinical trials, but having high blood sugar is a major risk factor for heart disease.

A1c is usually measured in a lab with routine blood work, or with a countertop machine in a doctor’s office (and some pharmacies) using a fingerstick.

A1c measures the quantity of “glycated hemoglobin,” which refers to sugar attached to a red blood cell protein called hemoglobin. The number is reported as a percentage of the total hemoglobin in the blood. If a person consistently has higher blood glucose levels over time, A1c levels go up because more red blood cells are coated with sugar. The test is representative of a 2 to 3-month average because once a red blood cell becomes coated with sugar, the link is irreversible. It is only when the red blood cell is "recycled" (happens every 2 to 3 months) that the sugar coating disappears. 

What are “normal” A1c levels for people who don't have diabetes?

Generally, high A1c values indicate high average blood sugar levels and that a person might be at risk for or may have diabetes. The American Diabetes Association (ADA) has established the following cutoffs: 

A1c Level

What It Means

Less than 5.7%

Normal (minimal Risk for Type 2 Diabetes)

5.7% to 6.4%

“Prediabetes,” meaning at risk for developing type 2 diabetes

6.5% or greater

Diagnosed diabetes

Make sure you get a regular A1c test, especially if you think you might be at risk for diabetes.

What is an A1c goal for those with diagnosed diabetes?

An A1c of less than 6.5% or 7% is the goal for many people with diabetes. Since each person with diabetes is unique, however, healthcare providers are recommended to set individual A1c goals. For instance, goals may differ depending on age and other health conditions.  

How does age affect A1c?

A1c is a measure of diabetes management, so your A1c won't naturally shift as you get older. However, as you age your diabetes management strategies and A1c goals may change – for example, younger people may be more focused on reducing long-term health complications, while older people may concentrate on avoiding severe lows. Talk with your healthcare professional if you're curious about how your age may affect your A1c levels.

Where is A1c misleading or potentially inaccurate?

Much progress has been made in standardizing and improving the accuracy of the A1c test thanks to the National Glycohemoglobin Standardization Program (NGSP). Results from a non-NGSP certified lab may not be as reliable. Depending on the machine, a single A1c test can have up to a 0.5% margin of error, which means the “true” value might be 0.5% higher or lower than the measured A1c. For example, if a lab report shows an A1c value of 7.0%, the actual A1c value might range from 6.5% and 7.5%.

A1c is based on a person’s red blood cell turnover (the lifespan of a red blood cell) and the quantity of sugar attached to each cell. Certain conditions, such as kidney disease, hemoglobin variants, certain types of anemia, and certain drugs and vitamins, impact red blood cell turnover, leading to misleading A1c values. Click here to jump down to a list of factors that impact A1c. 

According to Dr. Irl Hirsch, in a typical diabetes practice, an estimated 14%-25% of A1c measurements are misleading.

The relationship between A1c values and average blood sugar levels can also vary markedly from person to person. In studies using continuous glucose monitoring (CGM), 24/7 blood sugar levels can be compared to a measured A1c. These studies reveal considerable variation from person to person. For instance, an 8% A1c value in one person could reflect an average blood sugar of 140 mg/dl, while in another it could be 220 mg/dl. This variation relates to individual differences in how red blood cells and blood sugars bind or the lifespan of red blood cells.

"An A1c of 8% can correspond to an average blood sugar of 140 mg/dl in one person, while in another it could be 220 mg/dl."

For looking at an individual’s glucose values, CGM is a better tool for measuring average sugar levels, time-in-range, and hypoglycemia. Learn more in our previous beyond A1c article here. 

What tools are available if an A1c test is not accurate or sufficient?

Besides A1c tests, the most common measures of blood sugar are the oral glucose tolerance test (OGTT), CGM, and self-monitored blood glucose tests.

The OGTT is a diagnostic tool diabetes and prediabetes, assessing a person’s response to consuming a fixed amount of sugar. After taking the sugar drink, blood sugar levels are measured two hours later. Below 140 mg/dl is considered “normal,” between 140 mg/dl and 200 mg/dl points to prediabetes or impaired glucose tolerance, and above 200 mg/dl indicates diabetes. It is not useful for tracking diabetes management.

For those with established diabetes, CGM has the advantage of monitoring blood sugar levels consistently throughout the day (every 5-15 minutes), providing more detailed insight into time spent in-range, low blood sugars, and high blood sugars. Examples of CGM include:

Abbott FreeStyle Libre (real-time) and Freestyle Libre Pro (blinded)

Dexcom G5 (real-time)

Medtronic Enlite (real-time) and Guardian Sensor 3 (real-time) and iPro2 (blinded)

Senseonics implantable Eversense CGM (real-time)

If CGM is not available, taking frequent fingersticks with a blood glucose meter – when waking up, before and after meals, and before bed – can also indicate when blood sugar levels are going low, high, and staying in range. 

What’s important to keep in mind about A1c?

If you have diabetes, it’s also important to take the perspective that A1c is not a “grade” on diabetes management, but rather a helpful measurement tool that you and your healthcare providers can use to guide decisions and assess the risk of complications.

Non-glycemic factors that can affect A1c:

While there are many unsuspecting factors that can impact A1c, the information in the table below is not meant to invalidate the A1c test. Rather, knowing how certain conditions and factors can change A1c levels is a key part of using A1c as one measure of diabetes management.

Many of the conditions that affect A1c results are related to changes in the turnover of red blood cells, and thus notably, types of anemia.  Correction of anemia by treatment can also affect A1c results.

Condition

What is the impact on A1c?

How to test for this condition

Untreated anemia due to:

Iron deficiency

Vitamin B-12 deficiency

Untreated anemia can misleadingly increase A1c values due to decreased production of red blood cells.

(If anemia is treated, A1c can go down.)

To test for anemia, ask your healthcare provider about taking a complete blood count (CBC) test.

Asplenia: decreased spleen function

The spleen is involved in the production and removal of red blood cells. Decreased spleen function, which may be caused by surgical removal, congenital disorders, or other blood disorders such as sickle cell disease.

This may lead to misleadingly increased A1c.

Asplenia can be identified by MRI, echocardiogram, chest X-ray, or a screening test.

 

Blood loss and blood transfusions

The body’s response to recent blood loss (create more blood cells) or blood transfusion can misleadingly lower A1c, but the next A1c test should return to a more representative reading.

Let your healthcare provider know if you have recently received a blood transfusion.

Cirrhosis of the liver: chronic liver damage that leads to scarring

Cirrhosis, in addition to affecting response to glucose-lowering medications – including insulin – may misleadingly lower A1c values.

Ask your healthcare provider about a liver examination.

Genetic blood disorders

Hemoglobinopathy (results in abnormal hemoglobin)

Thalassemia (lower production of functional hemoglobin)

Depending on the abnormal form of hemoglobin, hemoglobinopathy can result in either increased or decreased A1c values.

Thalassemia can misleadingly lower A1c values due to early destruction of red blood cells.

Tell your healthcare provider if you have any known family members that have had thalassemia, and ask for a Complete Blood Count test.

Hemolysis: rapid destruction of red blood cells

 

Hemolysis may misleadingly lower A1c values due to the shortened red blood cell lifespan.

This condition may be caused by an inappropriate immune response and artificial heart valves.

Ask your healthcare provider about taking a Complete Blood Count (CBC) test.

Untreated hypothyroidism: low levels of thyroid hormone

Hypothyroidism may misleadingly increase A1c, while treatment with thyroid hormone can lower A1c.

 

Ask your healthcare provider about taking blood tests that measure the level of thyroid-stimulating hormone, which helps determine if there are thyroid gland problems.

Pregnancy

Decreased red blood cell lifespan and increase in red blood cell production may misleadingly lower A1c values in both early and late pregnancy.

Ask about taking an oral glucose tolerance test, which is used to diagnose gestational diabetes.

A common practice for pregnant people with diabetes is to use CGM. To learn more about managing diabetes during pregnancy, click here.

Uremia: high levels of waste (normally filtered by kidneys) in the blood

Untreated uremia may misleadingly increase A1c values.

Dialysis is used to treat uremia – in this case, A1c is not a suitable test.

Ask your healthcare provider about taking a blood test to detect uremia or abnormal kidney function.

Medications

Medications that may misleadingly increase A1c include:

Opioids (pain relievers): Duragesic (fentanyl), Norco/Vicodin (hydrocodone), Dilaudid (hydromorphone), Astramorph/Avinza (morphine), or OxyContin/Percocet (oxycodone)

Long-term use of over 500 mg of aspirin a day or more

Medications that may misleadingly lower A1c include:

Erythropoietin (EPO)

Azcone (dapsone)

Virazole/Rebetol/Copegus (ribavirin)

HIV medications (NRTIs): Emtriva, Epivir, Retrovir, Videx-EC, Viread, Zerit, or Ziagen

Always discuss appropriate use of opioids for pain and their possible effect on A1c as well.

Tell your healthcare provider if you are taking any of these medications prior to 

How can I lower my prediabetes A1C naturally?

Prediabetes is where your blood sugar is higher than normal but not high enough to be diagnosed as type 2 diabetes.

A1C Test for Diabetes, Animation

The exact cause of prediabetes is unknown, but it’s associated with insulin resistance. This is when your cells stop responding to the hormone insulin.

The pancreas produces insulin, which allows sugar (glucose) to enter your cells. When your body doesn’t use insulin properly, sugar can accumulate in your bloodstream.

Prediabetes doesn’t always cause symptoms, although some people develop darkening of the skin around the armpits, neck, and elbows.

A simple blood test can diagnose prediabetes. This includes a fasting plasma glucose (FPG) test. Results between 100 and 125 can indicate prediabetes.

Your doctor can also use an A1C test, which monitors your blood sugar over 3 months. Test results between 5.7 and 6.4 percent can also indicate prediabetes.

A prediabetes diagnosis, however, doesn’t mean that you’ll develop type 2 diabetes. Some people have successfully reversed prediabetes by modifying their diet and lifestyle.

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1. Eat a “clean” diet

One risk factor for prediabetes is a diet high in processed foods, which have added fats, calories, and sugar without nutritional value. A diet high in red meat also heightens your risk.

Eating a “clean” diet, which consists of healthier choices, can help restore normal blood sugar levels. This can reverse prediabetes and help prevent type 2 diabetes.

Incorporate low fat and low calorie foods into your diet. These include:

fruits with complex carbs

vegetables

lean meats

whole grains

healthy fats, like avocado and fish

2. Exercise regularly

Lack of physical activity is another risk factor for prediabetes.

Exercise is not only great for energy and mental health, it can also lower your blood sugar by increasing insulin sensitivity. This allows the cells in your body to use insulin more efficiently.

According to the American Diabetes Association (ADA), exercise can reduce blood sugar for up to 24 hours after a workout.

If you’re beginning a new exercise routine, start slow. Engage in light physical activity for 15 or 20 minutes, and then gradually increase the intensity and length of the workouts after a few days.

Ideally, you’ll want to have 30 to 60 minutes of moderate physical activity at least 5 days a week. Exercises can include:

walking

biking

jogging

swimming

aerobics

playing sports

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3. Lose excess weight

One benefit of a regular exercise routine is that it helps you shed excess weight.

In fact, losing as little as 5 to 10 percent of body fat can improve your blood sugar level and help reverse prediabetes. For some people, this is about 10 to 20 pounds.

Insulin resistance increases when you have a larger waist size, too. This is 35 inches or more for women and 40 inches or more for men.

Healthy eating and a regular exercise routine are both keys to losing weight. You can take other steps, too. This might include getting a gym membership, working with a personal trainer, or having an accountability buddy, such as a friend or family member.

Also, it might help to eat five or six smaller meals throughout the day, rather than three large meals.

4. Stop smoking

Many people know that smoking increases the risk for heart disease and lung cancer. But smoking is also a risk factor for insulin resistance, prediabetes, and type 2 diabetes.

You can get help to quit smoking. Use over-the-counter products such as nicotine patches or nicotine gum. Or, ask your doctor about smoking cessation programs or prescription medications to help curb nicotine cravings.

5. Eat fewer carbs

Even if you’re committed to healthy eating, it’s important to choose your carbohydrates carefully. You’ll also want to eat fewer of certain carbs to help reverse prediabetes.

For the most part, you want to eat complex carbohydrates, which are unprocessed carbs. These include:

vegetables

whole grains

beans

These carbs are rich in fiber and keep you full longer. They also take longer to break down, so they absorb into your body at a slower rate. This helps prevent blood sugar spikes.

Avoid or limit simple carbohydrates, which absorb quickly and cause an immediate spike in blood sugar. Simple carbohydrates include:

candy

yogurt

honey

juices

certain fruits

Refined carbohydrates are also fast-acting and should be limited or avoided. These include:

white rice

white bread

pizza dough

breakfast cereals

pastries

pasta

6. Treat sleep apnea

Keep in mind, too, that sleep apnea has been associated with insulin resistance.

With this condition, breathing stops repeatedly throughout the night due to relaxation of the throat muscles.

Signs of sleep apnea include:

loud snoring

gasping for air during sleep

choking during sleep

waking up with a headache

daytime sleepiness

Treatment usually involves use of an oral appliance while asleep to keep the throat open.

You can also use a continuous positive airway pressure (CPAP) machine. This keeps the upper airway passage open throughout the night.

7. Drink more water

Drinking water is another excellent way to help reverse prediabetes and prevent type 2 diabetes.

Water helps control blood glucose levels, and it’s also a healthy substitute for sodas and fruit juices. Those beverages are typically high in sugar.

8. Work with a dietitian nutritionist

Knowing what to eat with prediabetes can be tricky. Even if your doctor makes dietary suggestions, it’s helpful to consult a registered dietitian nutritionist (RDN).

An RDN can provide nutritional guidance and advice on which foods to eat and which to avoid.

They can help you develop a meal plan specific to your condition and offer other practical strategies to maintain a healthy diet. The goal is to stabilize your blood sugar.

Can medications help if you have prediabetes?

Even though some people reverse prediabetes with lifestyle changes, this isn’t enough for everyone.

If your blood sugar doesn’t improve and you’re at high risk for developing diabetes, your doctor might prescribe medication.

Medications to help lower blood sugar and reverse prediabetes include metformin (Glucophage, Fortamet) or a similar drug.

Metformin has been shown to reduce the risk of diabetes by up to 30 percentTrusted Source. It may also reduce your appetite, which can help you lose weight, too.

When to see your doctor

Prediabetes can progress to type 2 diabetes. So it’s important to monitor your symptoms and speak with your doctor if you develop any early signs of diabetes.

These signs vary from person to person but might include:

increased urination

unusual hunger

blurry vision

fatigue

increased thirst

The bottom line

A prediabetes diagnosis doesn’t mean that you’ll develop type 2 diabetes. But you’ll need to take quick action to reverse the condition.

Getting your blood sugar to a healthy range is key. You’ll not only avoid type 2 diabetes, but also complications associated with this condition like heart disease, stroke, nerve damage, and others.

What foods reduce HbA1c?

An A1C blood test measures average blood sugar levels over the past 2 to 3 months.

The American Diabetes Association (ADA) recommend using A1C tests to help diagnose prediabetes, type 1, and type 2 diabetes. Doctors also use A1C tests to monitor diabetes treatment plans.

A1C refers to hemoglobin A1C, a protein that sugar attaches itself to in your red blood cells. A1C tests measure the percentage of sugar-coated hemoglobin in your red blood cells.

If a person’s A1C levels are too high, this means their blood sugar levels are too high. Lowering blood sugar levels will reduce a person’s A1C percentage.

Why is this important? Read on to find out.

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What is an A1C test?

A doctor or nurse will take a blood test to assess a person’s A1C levels.

An A1C test measures how well the body is maintaining blood glucose levels. It shows the average percentage of sugar-bound hemoglobin in a blood sample.

When glucose enters the blood, it binds to a red blood cell protein called hemoglobin. Hemoglobin carries oxygen around the body.

The higher blood glucose levels are, the more hemoglobin it binds.

Red blood cells live for around 4 months, so A1C results reflect long-term blood glucose levels.

A1C tests use blood from a finger prick or blood draw.

Physicians will usually do more than one A1C test before diagnosing diabetes.

The first test will help a physician work out an individual’s baseline A1C level for later comparison.

How often a person with a diagnosis of diabetes needs to do an A1C test will vary, depending on the type of diabetes and management factors.

Why reduce levels?

Many studies have shown that lowering A1C levels can help slow the progression of diabetes and reduce the risk of complications — such as nerve damage and cardiovascular disease — in both type 1 and type 2 diabetes.

Even small changes in A1C levels can have significant effects.

The American Diabetes Association recommend maintaining A1C levels below 7 percentTrusted Source for most people.

A doctor will diagnose diabetes if a person’s A1C level is 6.5 percent or higher on two separate occasions.

Physical activity, diet, and possibly medication, can help manage blood glucose levels, and therefore also A1C levels.

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Lifestyle tips

Regular exercise can help manage glucose levels and boost overall wellbeing.

Exercise and lifestyle tips to help lower A1C levels include:

Physical activity: Current guidelines recommend that adults should do 150–300 minutesTrusted Source of moderate physical exercise each week. People who use insulin should talk to their doctor about a suitable plan.

Routine activities: Housework, gardening, and other routine activities can all help keep a person moving.

Monitoring blood glucose: This is crucial to ensure the person meets their targets and makes any necessary changes.

Following the treatment plan: This includes the use of medications and lifestyle therapies.

Target weight: The person should work on setting and achieving any weight loss goals.

Tracking progress: This is useful for self-motivation, for monitoring changes, and for identifying which strategies work for an individual.

Getting others involved: Lifestyle changes are often easier to adopt if other people can encourage and monitor progress.

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Dietary tips

Everyone, especially people with diabetes, can benefit from a healthful diet that includes plenty of fresh fruit and vegetables and whole foods and is low in sugar, salt, and fat.

Monitoring carbohydrate intake can help a person manage their glucose levels.

General diet tips to lower A1C levels include:

being mindful of portion sizes

eating regularly, every 3-5 hours

eating similar sized portions at meals and snacks

planning meals ahead of time

keeping a journal of food, medication, and exercise

spreading out carbohydrate-rich foods throughout the day

choosing less processed or whole foods like whole grains, fruits, vegetables, legumes, and nuts

eating a balanced diet complete with healthy proteins, fats, and carbohydrates

seeking out the help of a registered dietitian

A healthcare professional will advise each person on their dietary needs, including the number of carbs they should consume. This will depend on individual factors, including the person’s exercise levels and treatment plan.

Nutrition

Food that takes longer to digest, such as whole grains, will have a slower and less significant impact on blood sugar levels.

What is A Normal Blood Glucose?

A person will digest simple sugars — present in candies and white bread — more quickly. This can trigger a blood sugar spike.

Frequent glucose spikes can speed up the development of diabetes and increase the risk of complications.

Carbohydrates

A person with diabetes needs to manage their carb intake, but they do not need to avoid carbs altogether. Carbohydrates are the body and brain’s main fuel source and contain important nutrients.

Tips for a healthful carb intake include:

spreading carb intake throughout the day

choosing the right kinds of carb

There are three types of carbohydrate:

Sugars: The body absorbs these quickly, causing blood glucose level to spike.

Starch: These take longer to absorb, and are less likely to cause a glucose spike.

Fiber: This is essential for health. Its benefits include reducing the risk of high blood sugar levels.

Fiber

Fiber is complex and takes longer to break down, so it provides more sustainable energy and decreases the risk of a spike in blood sugar. Fiber also helps keep the digestive tract healthy.

Research has found that when women consume at least 25 grams (g) of fiber a day and men 38 g or more, the chance of developing type 2 diabetes can fall by 20–30 percentTrusted Source.

Sources of fiber include whole grains, nuts, and whole fruits and vegetables. Fresh, whole fruit contains more fiber than fruit juice made with fresh fruits.

Natural sugar

The body absorbs refined sugars, such as candies, quickly, and this can lead to dangerous rises in blood glucose.

Fruits, vegetables, and low-fat dairy products contain less processed sugars that are more healthful than refined sugars.

Whole fruits, vegetables, and dairy products all contain far higher levels of vital nutrients than most processed foods and less sugar.

All whole fruits and vegetables contain natural sugars, but they also tend to be rich in other nutrients, including fiber.

Low-sugar options

Low-sugar fruit and vegetable options include:

Many berries are considered to be relatively low in sugar.

lemon

rhubarb

lime

guava

kiwifruit

tangerines, nectarines, and plums

olives

avocados

grapefruit

broccoli and cauliflower

kale, cabbage, bok choy, and Brussels sprouts

lettuce

spinaches, collard greens, and Swiss chard

cucumbers and zucchini

tomatoes

mushrooms

celery

cranberries, raspberries, blackberries, and strawberries

People with diabetes do not need to avoid fruits, but they should account for the carbohydrates and sugars they contain. They should also eat fruits in moderation.

Dried fruits contain more sugar than fresh fruits.

Lactose

Lactose is the sugar that occurs in dairy products. One cup of 1-percent fortified milk contains 12.8 gramsTrusted Source of carbohydrate, which is mostly lactose.

Low-sugar, dairy-free options include unflavored, fortified soy, rice, almond, flax, and coconut milk or products

Lactose levels are similar in full-fat, reduced-fat, and non-fat milk, but people with type 2 diabetes often need to take care of their weight. For this reason, a low-fat version may be a better option.

Whole grains

Starches or complex carbohydrates include:

grains

starchy vegetables

legumes

Most of a person’s carbohydrate consumption should consist of these. For most grains and starches, half a cup contains one 15 gram serving of carbohydrates.

Starches are better carbohydrate choices than simple sugars, but the body can absorb highly processed starches rapidly, leading to increases in blood sugar levels.

Whole-grain breads, cereals, pastas, and rices contain B and E vitamins, minerals, essential fatty acids, and fiber.

Bleached or processed grains and cereals generally contain fewer nutrients and higher levels of sugar than whole-grain products.

Some products that claim to contain whole wheat still have high levels of refined grains, and they may contain added sugar.

The best whole-grain options include:

whole-wheat flour

buckwheat or buckwheat flour

cracked wheat

whole-grain barley

whole rye

millet

sorghum

whole oats

brown rice

wild rice

quinoa

whole faro

popcorn

whole-grain corn or corn meal

triticale

amaranth

A healthcare professional will advise on how much carbohydrate a person should consume each day.

Starchy vegetables and legumes

Vegetables are a good source of fiber and other nutrients.

Plenty of starchy vegetables and legumes also contain high levels of nutrients and fiber in their skins or pods.

Some vegetables have higher concentrations of starch than others. These include root vegetables like potatoes. People should monitor their consumption of these vegetables more closely than others.

Healthful, starchy vegetable and legume options include:

corn

green peas

black, lima, and pinto beans

butternut, acorn, and spring squash

pumpkin

parsnip

plantain

dried black-eyed or split peas

lentils

low-fat refried beans or baked beans

yams or sweet potatoes

taro

palm hearts

garlic

Understanding A1C levels

A1C test results appear as a percentage. A higher A1C level means a greater risk of diabetes and its complications.

Physicians may also refer to average glucose, or eAG, when they talk about A1C levels. The eAG corresponds to A1C, but it appears as milligrams per deciliter (mg/dl), like blood sugar.

Both A1C results and eAG refer to a person’s average 3-month blood glucose levels.

A1C value eAG value ADA diagnosis

5.6% or less 117 mg/dl or less Normal

5.7-6.4% 117–137 mg/dl Prediabetes

6.5% or more 137 mg/dl Diabetes

A person with prediabetes has a good chance of reversing their high blood sugar levels and preventing diabetes from developing. Get some tips and strategies for managing prediabetes here.

A1C level recommendations vary between individuals. People with more advanced diabetes will have higher A1C targets than healthy adults without diabetes. Factors like life expectancy, treatment response, and medical history also have an impact.

A1C value eAG value ADA recommended goal for

5.6% or below 117 mg/dl or below Healthy, adults without diabetes

6.5% 140 mg/dl People with short-term diabetes, managed type 2 diabetes, no cardiovascular disease, long life expectancy

7% or less 154 mg/dl or less Most non-pregnant adults with diabetes

8% or less 183 mg/dl or less People with long-standing or severe diabetes, limited life expectancy, extensive additional health complications, or poor treatment response

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Takeaway

A1C levels are a measure of blood glucose over 2–3 months. A person whose A1C level is 6.5 percent or more will need to take steps to lower their levels.

Strategies include healthful dietary choices, exercise, and medication, for some people.

Can Walking lower my A1C?

by Adam Brown

If you’re like me, you might have a health-focused New Year’s resolution posted on your wall: "lose weight," "exercise more, "be less stressed."

Unfortunately, making resolutions is easy, but sticking to them is hard. A 15,000-person survey found that four out of five people who make New Year’s resolutions eventually break them. And it gets worse: a sizeable percentage of people (11%) in one survey actually broke their resolution one week in!

As I pondered this depressing data, I thought about scientifically testing the simplest, most fundamental exercise possible: walking. It can be done anywhere, does not cost anything, and requires no equipment. And because the barriers to doing it are so low, it also helps address that very basic New Year’s Resolution conundrum outlined above. What follows is my personal diabetes experience testing the blood sugar benefits of walking, a brief review of studies on diabetes and walking, and five tips to incorporate walking into your daily routine.

If you find this article useful, check out my upcoming book, Bright Spots & Landmines!

Walking with diabetes – my own experience

As a fitness fiend my whole life, I tend to think of “exercise” with a very intense, all-or-nothing frame of reference: cycling, strength training, and playing basketball. So when I approached the question of how much walking could really drop my blood sugars, I was skeptical. In an effort to test it objectively, I performed a dozen periods of walking, and measured my blood glucose immediately before and immediately after finishing. I timed each walk with a stopwatch, always made sure I had less than one unit of insulin-on-board, and tried to go at a normal speed.

On average, walking dropped my blood sugar by approximately one mg/dl per minute. The largest drop I saw was 46 mg/dl in 20 minutes, more than two mg/dl per minute. Walking was also surprisingly effective: my blood sugar dropped in 83% of my tests. There were only two times where I did not see a drop in blood sugar; in these instances, I suspect it was either blood glucose meter inaccuracy or a delayed blood glucose rise from meals (e.g., fiber, fat) that contributed to the increase. Those interested can see the complete table of my walking endeavors at the end of this article.

Some might argue that one mg/dl per minute is not very impressive, but the key for me is reducing my insulin intake. One unit of insulin tends to drop my blood glucose by 25 mg/dl (morning) and 35 mg/dl (afternoon and evening). My rapid-acting insulin (Novolog) takes about 60-90 minutes to peak and three hours to completely finish working, meaning any drop in blood glucose takes a while. With a blood sugar of 170 mg/dl, I could either take two units of insulin and wait well over an hour for my blood glucose to really drop, or I could walk for a little more than 30-40 minutes. I found it liberating that something as simple and easy as walking could be a replacement for (or augment to) taking insulin.

I originally had hoped to test the effects of walking after meals but found it hard to do a thoroughly scientific job of it. What I can say, however, is that walking after meals definitely lowered my insulin requirements. Generally, planning a post-meal walk of around 20 minutes meant I needed about half as much insulin as normal, and in some cases no insulin at all. The caveat is that I do tend to eat pretty low carbohydrate meals, so those eating higher carb meals may find their needs differ. The best way to see how walking affects your blood sugar it to try it for yourself.

What does the research say about walking with diabetes?

I found many published studies on walking with diabetes, and most showed a benefit. I’ve categorized them below into type 1 diabetes, type 2 diabetes, and prediabetes/overweight/obese. The list below is not exhaustive by any stretch, but I hope it gives a broad sense of some of the scientific research supporting the benefits of walking.

Type 2 Diabetes: A 2012 study of 201 people with type 2 diabetes found that every additional 2,600 steps of walking each day was associated with a 0.2% lower A1c. For reference, 2,600 steps is a little over a mile (about 20 minutes walking at a normal pace). In an interesting 2005 study of 179 patients with type 2 diabetes, medication costs, insulin usage, and physical activity were tracked over a two-year period. Over that time, taking a three-mile daily walk (about an hour per day) was estimated to reduce drug costs by $550 and other medical costs by $700. The number of patients on insulin therapy also fell by a compelling 25%. And a small 2012 study examined the emotional effects of walking in individuals with type 2 diabetes – in the 16 patients that participated in the study, 20 minute walks were associated with significant positive influences on psychological well-being.

Type 1 Diabetes: Though few studies have tested walking in people with type 1 diabetes, the results do seem positive, particularly after meals. A 2012 study examined 12 patients with type 1 diabetes over 88 hours. Those who walked after meals had approximately one half the glucose excursion compared to those who did not walk after meals. Interestingly, the same study found a similar glycemic benefit in those without diabetes. The researchers concluded, “Walking significantly impacts postprandial [after meal] glucose excursions in healthy populations and in those with type 1 diabetes.”

Prediabetes/Overweight/Obese: A 2007 analysis, which included five studies examining walking and the risk of type 2 diabetes (data from a staggering 301,221 people), found that those who walked regularly (about 20 minutes per day) had a 30% lower risk of developing type 2 diabetes compared to those who did almost no walking at all. A 1999 analysis of the Nurses Health Study also examined the risk of developing type 2 diabetes, this time in over 70,000 female nurses over an eight-year period. Walking was strongly associated with a lower risk of type 2 diabetes, and the speed was important – compared to those who walked at an “easy pace” (longer than 30 minutes to walk one mile), those who walked at a “normal” pace (20-30 minutes per mile) had a 14% lower risk of developing type 2 diabetes. Walking at a brisk pace (faster than 20 minutes per mile) was linked with a 41% lower risk of type 2 diabetes.

How can I incorporate walking and other types of exercise into my daily routine?

1. Take it one step at a time: A good way to start something new is to take it slow, set achievable goals, and then make them more ambitious over time. If you don’t walk at all right now, make a goal to walk one minute per day. Next week, walk two minutes per day. Starting small and building up over time makes starting a new goal less daunting. Plus, the gains you make will give you a sense of satisfaction and encourage you to keep going.

2. Make a schedule: One easy way to remind yourself to walk or exercise is to schedule it on your calendar – this can serve as a daily reminder, as well as a way to protect that time and avoid overscheduling yourself. And if your goal is 100 minutes of walking per week, a calendar can make it seem manageable: just 15 minutes per day.

3. Involve friends and family: Having someone join you in an exercise program can help keep you accountable (i.e., you may be less likely to skip out on a session if you know you’d be letting your partner down), make the time pass more quickly, and even help foster some healthy competition.

4. Make it fun: To pass the time while walking, I’ve become a huge fan of listening to audiobooks, music, or calling family members. There are also a variety of smartphone apps that are designed to make walking more fun, trackable over time, and even more competitive. I'm a big fan of activity trackers like Fitbit, which can be very motivating for increasing daily steps.

5. Sneak it in: If you’re not into planning exercise, there are still cool and easy ways to get more walking in. You can park farther away when you go to the store, take the stairs instead of the elevator or escalator, and take walking breaks with colleagues at work – the latter is a diaTribe staff favorite to enjoy the beautiful Lower Haight neighborhood here in San Francisco.

How can I lower my A1C in a week?

Diabetes is a serious, chronic condition that can lead to many complications. But there are ways to manage your condition.

A1C Levels

Getting your A1C level tested, especially if you’re at risk for developing type 2 diabetes, is a good way of taking care of yourself. An early diagnosis helpsTrusted Source you get treatment before complications can occur.

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Tips for lowering A1C level

You can lower your A1C by making changes to your:

exercise regimen

diet

medication

If you already have diabetes and are taking medications that can cause low blood sugar levels, find out your optimal levels.

Here are nine ways to lower your A1C:

1. Make a food plan

Eating the right foods is essential to lowering your A1C, so you want to make a plan and stick to it. There are a few important strategies for this:

Make a grocery list. When you’re trying to fill your basket with nutrient-dense foods while minimizing sweets, having and following a list can help you avoid impulse purchases. And if you’re trying out new recipes, your list can help make sure you get home with all the right ingredients.

Meal prep ahead of time. When you’re fixing a nutritious meal, you can save time by doubling the recipe, so you have another meal readily available later in the week.

Build in flexibility. Plan to give yourself options before you need them, so you’re not scrounging for a fallback when the cupboards are bare and your stomach is rumbling.

2. Measure portion sizes

It’s important to choose not just the right foods to lower your A1C but also the right amount. Here are a few tips to avoid overdoing it:

Get familiar with the appropriate portion sizes. You don’t have to measure every food you eat by the gram to learn to recognize and make a habit of thinking about what’s a right-size portion and what’s too much.

Use smaller plates at home. It’s not uncommon to want to fill your plate in the kitchen, but for portioning purposes, it might help for the plate to be smaller.

Avoid eating from a bag. In the interest of mindful munching, if you’re having a few crackers, pull out a reasonable serving, then put the rest back in the cupboard for later.

Be mindful when going out to eat. Rather than order an entrée that’s more food than you need, you may want to ask a friend if they’ll split something with you. Or you can plan to take half home to eat later in the week.

3. Track carbs

The appropriate amount of carbohydrates varies from person to person and is worth discussing with your doctor, but in general, carbs are easy to overdo if you’re not keeping track. It can be helpful to maintain a food diary or use an app to keep track of your carb intake.

Starting out, you may have to take some time looking at nutrition labels, but with practice, this will become a quick and easy process and will help you get a sense of which foods are most carb-heavy so you can adjust accordingly.

4. Plate method

Also called the Diabetes Plate Method, the idea here is to simplify your mealtime calculations while eating the right foods in the right proportions. Picture a plate that’s less than a foot in diameter and divide it up into quarters:

Half of what’s on the plate — that is, two quarters — should be low carb vegetables. There are many to choose from, including broccoli, cauliflower, carrots, peppers, mushrooms, cucumber, and anything leafy, like lettuce, cabbage, spinach, and so on.

The next quarter of the plate should be lean proteins, which include fish, chicken, eggs, shellfish, cheese, tofu, and lean cuts of pork or beef.

The last quarter of the plate goes to carbs, including grains like rice and whole grain bread, as well as fruit and starchy vegetables like potatoes.

With practice, you can apply the same proportions and ideas behind the plate method to foods that don’t lend themselves to being divided across a plate like sandwiches, for instance.

5. Have a realistic weight loss goal

Set yourself up for success. It’s important to be practical because a slow, steady approach to weight loss (a pound or two a weekTrusted Source, at most) tends to get the best results when it comes to keeping weight off.

It’s also worth noting the results don’t have to be drastic to meaningfully improve your health. Experts say even 5 percentTrusted Source can make a difference. This means if someone at 180 pounds adjusts their exercise and food habits and works their way down to 170 over a few months, the resulting health benefits can be worthwhile.

Talk with your doctor about what weight loss goal makes sense for you and how best to work toward it.

6. Exercise plan

Increase your activity levelTrusted Source to get your A1C level down for good. Start with a 20-minute walk after lunch. Build up to 150 minutes of extra activity a week.

Get confirmation from your doctor first before you increase your activity level. Being active is a key part of reducing the risk of developing diabetes.

Remember: Any exercise is better than no exercise. Even getting up for 2 minutes every hour has been shown to help reduce the risk of diabetes.

7. Take medications

The medications that lower fasting blood sugars will also lower your A1C level. Some medications primarily affect your blood sugars after a meal, which are also called postprandial blood sugars.

These medications include sitagliptin (Januvia), repaglinide (Prandin), and others. While these medications don’t significantly improve fasting glucose values, they still help lower your A1C level because of the decrease in post-meal glucose spikes.

8. Supplements and vitamins

It’s worth talking with your doctor about supplements you might take to improve your A1C level. Some of those to consider include aloe vera and chromium. Aloe vera is a succulent that may inhibit the body’s absorption of carbohydrates. A 2016 review of studies found that it may lower A1C levels by around 1 percentTrusted Source.

A 2014 analysis of prior studies suggests chromium, a mineral found in vegetables like potatoes and mushrooms, as well as oysters, can lower A1C by more than half a percentTrusted Source in people with type 2 diabetes.

However, a 2002 review of previous research found that chromium had no impact on glycemic control in those who do not have diabetes.

9. Stay consistent

Lowering your A1C levels depends on making changes that become habits. The best way to make something second nature is to keep doing it consistently, so your week-long streak turns into a month and so on.

Particularly where eating patterns and exercise are concerned, slow, steady progress tends to deliver the best long-term results.

A1C level

Sugar from food makes its way into your bloodstream and attaches to your red blood cells — specifically to a protein called hemoglobin.

Your A1C levelTrusted Source is a measure of how much sugar is attached to your red blood cells. This can help determine if you have diabetes or prediabetes and can help inform how best to manage it.

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What is the A1C test?

The A1C test is a blood testTrusted Source that screens for diabetes. If you have diabetes, it shows whether treatment is working and how well you’re managing the condition. The test provides information about a person’s average levels of blood sugar over a 2- to 3-month period before the test.

The number is reported as a percentage. If the percentage is higher, so are your average blood glucose levels. This means your riskTrusted Source for either diabetes or related complications is higher.

Although A1C is the gold standard of diabetes diagnosis, keep in mind that it’s not always accurate. Many clinical conditions can affect A1C, including iron deficiency anemia and other blood disorders that affect red blood cells.

WERBUNG

What does the A1C test measure?

A1C is one of the primary tests used for diabetes diagnosis and management. It can test for type 1 and type 2 diabetes, but not for gestational diabetes. The A1C test can also predict the likelihood that someone will develop diabetes.

The A1C test measures how much glucose (sugar) is attached to hemoglobin. This is the protein in red blood cells. The more glucose attached, the higher the A1C.

The A1C test is groundbreaking becauseTrusted Source:

It doesn’t require fasting.

It gives a picture of blood sugar levels over a period of weeks to months instead of at just one time, like fasting sugars.

It can be done at any time of day. This makes it easier for doctors to give and make accurate diagnoses.

What do the scores mean?

According to the National Institute of Diabetes and Digestive and Kidney Diseases, an optimal A1C is below 5.7 percentTrusted Source. If your score is between 5.7 and 6.4 percent, the diagnosis is prediabetes.

Having prediabetes puts you at risk for developing type 2 diabetes within 10 years. But you can take steps to prevent or delay developing diabetes. If you test positive for prediabetes, it’s best to get retested every year.

There’s an increased chance of prediabetes developing into type 2 diabetes if your A1C is 6.5 percent or higher.

If you have been diagnosed with diabetes, keeping your A1C levels below 7 percent can help reduce the risk of complications.

If you receive a diagnosis of prediabetes or diabetes, your doctor may prescribe a home monitor to allow you to test your blood sugar. Be sure to talk with your doctor to learn what to do if the results are too high or too low for you.

Talking with your doctor

It’s important to talk with your doctor about what steps you can take to help lower your A1C levels. They can help you set and monitor practical goals and may also prescribe medication.

Additionally, your doctor may connect you with a dietician who can help you better understand the nutrition component of lowering your A1C levels, as well as determine the best ways to adjust your diet and habits around food in health-promoting, practical ways.

How fast can A1C drop?

Call it what you will: hemoglobin A1C, glycosylated hemoglobin, HbA1c or just “A1C,” these numbers, known as A1C levels, play a huge role in how your diabetes is managed. It’s also used to diagnose diabetes, as well as prediabetes. Your A1C is a blood test that provides information about your average blood sugar levels over the past three months. Your provider and diabetes care team use this number to gauge how things are going and if and how to tweak your diabetes treatment plan. For most people who have diabetes, the American Diabetes Association (ADA) recommends an A1C of less than 7%. The American Association of Clinical Endocrinologists (AACE) advises a tighter goal of 6.5% or lower. Your goal may be completely different, and that’s OK (just make sure you know what it is!).

Why lower your A1C?

A1C goals aren’t decided upon out of thin air. The targets that the ADA, AACE or your provider advise for you are based on clinical research, as well as other factors, such as your age, your overall health and your risk of hypoglycemia. Landmark clinical trials, such as the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC), for example, have correlated lowering A1C with a decrease in diabetes-related complications. So, for every one point that you lower your A1C, you’ll lower your complication risk as follows:

• Eye disease by 76%

• Nerve damage by 60%

• Heart attack or stroke by 57%

• Kidney disease by 50%

It’s important to realize that your A1C levels reflects an average of your blood sugar numbers. Your A1C levels might be 6.7%, but that may be because you’re having a lot of low blood sugars, for example. For this reason, your A1C levels should be viewed as part of the picture, and not in isolation. Your blood sugar readings, frequency of highs and lows, and quality of life need to be considered as part of your overall diabetes management plan.

How long does it take to lower your A1C levels?

Is it possible to lower A1C levels overnight? Well, the short answer is no. Unlike your blood sugars, which can go up or down in a matter of minutes, your A1C will take some time to change. Remember what your A1C measures: your average blood sugars over the past three months. The good news is that if your A1C is on the high side, say, 10% or higher, it will likely start to drop within two to three months (in other words, the higher it is, the faster it comes down). On the other hand, if your A1C is 7.5%, it may take a little longer to lower A1C levels. 

Seven ways to lower your A1C levels

There are a number of ways to get your A1C down. Taking medication is one way (and the reality is that many people with diabetes need to take medication), but lifestyle measures are effective, too. Here’s a rundown of what can work.

Diet

What and how much you eat factors in to your blood sugar control and, in turn, affects your A1C. There’s so much controversy about the best “diet” for diabetes and there’s no shortage of arguments on this topic. However, realize that there is no one “diet” that will work for everyone. And despite popular belief, the American Diabetes Association does not prescribe any one type of eating plan. In actuality, they state that many different types of eating patterns, including lower carb, vegetarian, DASH and Mediterranean can be beneficial. One of the best ways to figure this all out is to meet with a registered dietitian, preferably one who has experience in working with people who have diabetes. Your doctor can provide you with a referral to meet with a dietitian. In the meantime, consider the following for lowering A1C levels:

1. Come up with a plan

Getting into the habit of eating three meals a day, and possibly some snacks, is a great way to get started on controlling A1C levels. In addition, aiming to eat your meals at about the same times each day will make it easier to stabilize your blood sugars. Try not to skip meals or delay eating your meals as much as possible.

2. Be carb choosey

Carb naysayers will proclaim that carb foods are evil and should be avoided as much as possible. But reality and research shows otherwise. It’s difficult for most people to cut out carbs and it’s not the smartest thing to do from a nutrition standpoint, as carb foods can and do provide important nutrients that you won’t get from eating just protein and fat. However, you do need to consider the types of carbs you eat. Refined carbs, such as white bread, white rice, chips, soda, cookies and other sweets have been stripped of their fiber and most of their vitamins and minerals; contain “empty” calories; and can cause “spikes” in blood sugars. Eating refined and processed carbs has been linked to an increase risk of diabetes, heart disease, inflammation and obesity. The carbs to focus on are unrefined, meaning, they retain their fiber, vitamins, minerals and other plant compounds that promote health. These carbs include whole grains, whole fruits and vegetables and legumes (beans and peas).

3. Be carb consistent

Along with eating healthy carb foods comes the concept of carb control for controlling A1C levels. Eating too much carb from any food source can mean higher blood sugars and a higher A1C. Aim to eat the same amount of carb at your meals and snacks each day. Many people count grams of carb and aim for a range at their meals — for example, 30–45 grams per meal. Doing so helps you keep your blood sugars steady, whether you take diabetes medicine or not. Because people do need different amounts of carb, it’s best to check with a dietitian as to what your carb goals should be.

4. Watch portions

Eating too much carb is one thing; eating too much protein or fat is another. Keep an eye on your portions of all of the foods that you eat, especially if you are trying to lose weight (losing weight, if you need to, can help lower your blood sugars and A1C). Using the plate method or sample menus are a couple of ways to help you get on track with an eating plan.

Being active

We’re all bombarded with messages to exercise or be physically active, and after a while, it’s easy to tune them out. But if your goal is to lower your A1C, it’s time to pay attention. Yes, carb counting and losing weight helps, but don’t overlook the power of physical activity, too. Exercise provides numerous health benefits, including a lower risk of heart disease, weight loss, increased energy and a lower risk of depression and stress. Add lower blood sugars to the list.

A1c - What You Need To Know

5. Come up with a plan

If you haven’t been active for a while, you might be wondering how to get started. The first step is to think about what you might like to do. One of the best ways to get moving is to start walking. All you need is a good pair of sneakers. However, bicycling, swimming, using an exercise video or taking a Zumba class, for example, are all great ways to be active.

6. Commit to 150 minutes each week

One reason why people don’t exercise is because they think they need to spend hours at the gym, huffing and puffing away. Not true. The goal is to aim for doing at least 150 minutes of physical activity each week, or 30 minutes, five days a week. And the good news is that you can break those 30 minutes into 10-minute segments, three times a day. If you haven’t been exercising, start slowly and build up, five minutes at a time. By the way, don’t forget to check with your doctor before starting any new exercise program.

7. Combine cardio and resistance

Exercises that strengthen your heart and lungs and that use large muscle groups are often called aerobic or cardio exercises. These include walking, swimming and bicycling. Ideally, your exercise routine should also include resistance, or strengthening, exercises, such as using hand weights, resistance bands, calisthenics or weight machines. Both types of exercise work in different ways to promote health, but they both lower blood sugars and A1C.

More on how to lower your A1C next week!

Want to learn more about A1C? Read “How to Lower Your A1C: More Steps You Can Take,” “What Does A1C Stand For?” and “H-B-A-1-C: What It Is and Why It Matters.”

How do I lower my A1C without medication?

For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not a full picture of what’s happened in the long term, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City.

For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides another lens on how well your type 2 diabetes management plan is working.

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How often do you get your A1C tested?

Once a year

Twice a year

Three to four times a year

Once every few years

I've never had my A1C tested

How Often Do You Need to Take an A1C Test?

If your blood sugar levels have remained stable, the American Diabetes Association (ADA) recommends getting the A1C test two times each year. If your therapy has changed or you are not meeting your glycemic (blood sugar) targets, the ADA recommends getting the test four times per year. This simple blood draw can be done in your doctor's office.

The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Often your blood sample is sent out to a lab for your results; though some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. Such an in-office test can be used to monitor your condition.

Nonetheless, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) notes that point-of-care tests should not be used for diagnosis, which can only be done by lab tests certified by the NGSP. Any results pointing to a change in your health should be confirmed by conventional lab tests.

RELATED: 9 Signs Your Blood Sugar Is Out of Control

What Do Your A1C Results Mean?

The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says.

According to the ADA, A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes, according to the ADA. Type 2 diabetes is diagnosed when the A1C is at or over 6.5 percent. For many people with type 2 diabetes, the goal is to lower A1C levels to a healthier percentage.

Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and any other heath conditions you have. A common A1C goal for people with diabetes is less than 7 percent, Dodell says. If you can keep your A1C number below your goal, you help to reduce the risk of diabetes complications, such as nerve damage and eye problems.

RELATED: A1C May Fall Short in Diagnosing Some People With Diabetes

What Are the Top Tips for Lowering A1C?

Your A1C score is a valuable part of the diabetes control picture, Dodell says, but it is not the only indicator of your health. Someone who has wide fluctuations in blood sugar levels (which is more common among patients who are taking insulin) may have an A1C at goal because the average over two to three months is good. But the day-to-day fluctuations can lower your quality of life and increase your risk of complications, he cautions.

Diabetes can be a tough condition to manage, Dodell says. He tells his patients to view diabetes management like a job. It takes work, but the time and effort you put into it can result in good control and an improved quality of life. “The key to reaching your A1C goal is trying to follow a healthy lifestyle,” he says.

Making these healthy changes can help you improve your day-to-day blood sugar management and lower your A1C:

1. Start an Exercise Plan You Enjoy and Do It Regularly

Find something you enjoy doing that gets your body moving — take your dog for a walk, play a sport with a friend, or ride a stationary bike indoors or a regular bike outdoors.

A good goal is to get 150 minutes of moderate exercise per week, recommends Jordana Turkel, a registered dietitian and certified diabetes educator at Park Avenue Endocrinology and Nutrition in New York City. This is also what the ADA recommends. Different types of exercise (both strength training or resistance training and aerobic exercise) can lower your A1C by making the body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising, and to aim for two days of strength training.

Be sure to check with your healthcare provider before embarking on an exercise plan, though. He or she can come up with an individualized plan for you.

And if you monitor your blood sugar daily, check it before and after exercise. As the Joslin Diabetes Center at Harvard Medical School explains, exercise can cause your blood sugar to rise, as more is released from the liver, and blood sugar to fall, due to increase insulin sensitivity. Fluctuations in your blood sugar levels can result if you aren’t careful. This is particularly important if you are on insulin or another diabetes medication that causes insulin secretion, such as include sulfonylureas, such as Amaryl (glimepiride), and glinides, such as Prandin (repaglinide) and Starlix (nateglinide). 

2. Eat a Balanced Diet With Proper Portion Sizes

It’s best to check with a certified diabetes care and education specialist or a registered dietitian-nutritionist to determine what a balanced diet and appropriate portions mean for you. But a great rule of thumb is to visualize your plate for every meal and aim to fill one-half of it with veggies, one-quarter with protein, and one-quarter with whole grains, says Turkel. If you like fruit, limit your portions to a small cup, eaten with a little protein or lean fat to help you digest the fruit carbohydrates in a manner that is less likely to spike your blood sugar level.

Also, avoid processed foods as much as possible, and say no to sugary sodas and fruit juice, which are high in carbs and calories, and thus can lead to spikes in blood sugar and contribute to weight gain, according to the ADA.

RELATED: The Best and Worst Drinks for People With Type 2 Diabetes 

3. Stick to a Regular Schedule, So You Can More Easily Follow Your Healthy Diet and Lifestyle

Skipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much, the ADA points out. This is especially true if you are taking insulin or certain diabetes drugs. Your doctor can help you determine the best meal schedule for your lifestyle.

4. Follow the Diabetes Treatment Plan Your Healthcare Team Recommends

Diabetes treatment is very individualized, noted an article published in May 2014 in Diabetes Spectrum. After all, factors including how long you’ve lived with the disease, your socioeconomic status, and any other conditions you’re living with can play a role in the best treatment approach for you.

Your healthcare team will help you determine the steps you need to take to successfully manage diabetes. Always talk to your doctor before making any changes, such as starting a very-low-carbohydrate diet or beginning a new exercise regimen, and especially before making any medication or insulin changes.

RELATED: 6 Top Diabetes Exercise Mistakes and How to Avoid Them

5. Check Your Blood Sugar Levels as Your Doctor Has Directed

Work with your doctor to determine if, and how often, you should check your blood sugar. You may be tempted to pick up an A1C home testing kit, but Dowdell does not recommend doing that. As he mentions, day-to-day fluctuations in your blood sugar can be masked by an A1C result that is at your goal level. Instead, if you have a personal continuous glucose monitor, such as a Dexcom G6 or a Freestyle Libre (or can get one from your healthcare provider), Dowdell recommends checking your “time in range” to see if you are at the optimal level. For many people that is 70 to 180 milligrams per decilter (mg/dL) (3.9 to 10 mmol/L), according to ADA guidelines. Having your A1C checked by your healthcare provider every three to six months is sufficient, he adds.

Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C levels or what they mean, don’t hesitate to ask your doctor.

How can I lower my A1c quickly?

When you have diabetes, you probably know you should check your blood sugar regularly. Your doctor will also recommend that you take an A1c blood test a few times a year, with a goal of lowering the results to help protect your health. And there’s a lot you can do to move toward meeting that goal.

Unlike a regular blood sugar test, the A1c test measures the amount of sugar that clings to a protein, called hemoglobin, in your red blood cells. The test shows your average blood sugar levels over the past few months, so you know how well your diabetes is under control.

In general, the goal for your A1c is to be lower than 7%. Exactly how much lower will depend on your individual treatment plan. When you take steps to get your A1c in a healthy range, you lower your risk of complications such as nerve damage, eye problems, and heart disease.

Your doctor will let you know the best target for your A1c. How do you get there? Here are a few tactics to try, in addition to taking any medications your doctor prescribes.

Get some new kitchen gear. You’ll want to get a set of measuring cups and a kitchen scale if you don’t already have them. These will help you with your portion sizes. Your blood sugar will go up if you eat more food than your body needs. Keeping servings in check is a good way to reduce your A1c level.

At first, it’s a good idea to measure your food to give you an idea of what healthy portion sizes look like for different foods. That’s where the measuring cups and scale come in handy. You may be surprised at first to see what one serving looks like, especially of high-carb items like cereal, rice, and pasta. But this will help ensure you don’t eat more than you intend to.

Be carb smart. It’s true that carbohydrates affect your blood sugar more than other nutrients you eat. Chances are that if you overdo starchy carbs on a regular basis, your A1c number will start to creep up. But remember, all carbs aren’t a problem. You want ones that have a lot of fiber and nutrients, more than those that just serve up starch.

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Tweak your plate. Experts advise filling about half your plate with vegetables that are low in starch, such as carrots, greens, zucchini, or tomatoes. One-quarter of your plate should be a lean protein like chicken or tofu, and the last quarter should be whole grains like brown rice or quinoa.

Make a plan. The guidelines for what to put on your plate give you a lot of flexibility. But even though it sounds simple, you’ll probably be better off if you plan your meals. Why? If you skip set menus and eat on the fly, it’s easy to end up with calorie-dense, high-carbohydrate food choices -- like fast food, bagels, and frozen pizza -- that will cause your blood sugar and A1c numbers to soar.

Instead, at the start of each week, pencil in a rough plan for what foods you’ll eat at each meal and what groceries you’ll need. This way, you’ll be prepared with plenty of choices that limit post-meal blood sugar spikes. A Mediterranean diet, which is low in saturated fat and high in vegetables and fruit, reliably lowers A1c numbers.

Maybe downsize your weight loss goal. Not everyone with type 2 diabetes is overweight. But if you are, you may not need to drop as much as you think to make a difference in your A1c level.

If you’re overweight, diabetes doctors will often recommend you try to lose just 5% to 10% of your current weight. Here’s why: As you shed extra pounds, the insulin in your body lowers your blood sugar levels more efficiently, which will cause your A1c levels to drop over time. In one study, people with type 2 diabetes who lost 5% to 10% of their body weight were three times as likely to lower their A1c by 0.5%.

You may have a different goal for your weight or other health considerations on your mind. Ask your doctor to help you make a weight loss plan that matches your overall goals.

Rethink your exercise plan. Other than upgrading your nutrition, exercise is one of the most important habit changes you can make to lower your A1c. But don’t just grind it out on the treadmill, or you’ll miss another effective workout: strength training.

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No offense to the elliptical machine or your cycling class. You can choose whatever type of exercise you prefer as long as it’s a challenging workout. Both aerobic exercise and resistance (weight) training lower A1c levels if they’re part of a regular routine.

There’s solid science to support how much working out helps you whittle down your A1c level. Since exercise prompts your muscles to take up sugar from your bloodstream, it helps your blood sugar levels drop more quickly after you eat a meal. As you make exercise a regular habit, you’ll see a downward trend in your A1c numbers.

Never miss your meds. You can reliably lower your A1c through diet and exercise. But if your doctor has prescribed medication, such as metformin, miglitol, or insulin, it’s important to take them exactly as prescribed. If you miss doses regularly, your blood sugar numbers may creep up and cause your A1c to rise. But if you follow the medication plan that your doctor recommends and go to every appointment, your blood sugar should stay under control -- and your lower A1c number will reflect that. If your goal is to cut down on, or even stop needing, your meds, tell your doctor that you want to work toward that. But don’t stop them on your own.

Be savvy about supplements. Many dietary supplements say they’ll lower your A1c. But there’s not always much research to back that up. Still, some may have promise. These include berberine, made up of extracts from a variety of plants, and coenzyme Q10 (CoQ10), an antioxidant that reduces inflammation in your body. Cinnamon may also lower A1c levels over time. As with any supplement, it’s best to check with your doctor first.

Put your plan on repeat. Stick with it and give it time. Since your A1c level reflects your average blood sugar over several months, it’s going to take that long for your A1c to drop. You won’t do everything perfectly, and that’s OK. Just keep moving in the direction you want to go in. And rest assured: Your A1c number will come down, and it’ll be worth it.

What is the fastest way to reduce HbA1C?

Blood sugar changes measured by HbA1C levels are directly associated with inflammation in the body. Inflammation is the main player in the diseases we all want to avoid- heart disease, dementia, diabetes and many more. In this post, you will learn about lifestyle, diet, and supplement strategies that can improve your levels.

However, remember that the most important thing is to work with your doctor to find out what’s causing your high HbA1c levels and to treat any underlying conditions.

Discuss the strategies listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

Lifestyle to Lower Hemoglobin A1c (HbA1C)

1) Lose Weight

One of the best things you can do to decrease your blood glucose and HbA1c it to lose weight if you are overweight [1, 2].

This will enable your cells and tissues to use and respond to glucose more efficiently [3, 4]!

2) Exercise

There are a plethora of studies showing exercise helps lower HbA1c in both healthy people and those who have diabetes. Studies, in general, suggest that engaging in moderate to vigorous exercise for at least 30 minutes on more than 3 days per week is most beneficial [5, 6, 7].

Aerobic exercise, resistance training, and both combined were each associated with declines in HbA1c levels in several studies with type 2 diabetics [8, 9, 10].

One study of 2.7k people found that physical activity was more beneficial in shorter bouts of ≥10min with higher intensity [11].

A systematic review of 47 trials with over 8.5 diabetics showed that exercising for more than 150 minutes per week reduced HbA1c more than 2 times as efficiently compared to 150 minutes or less of exercise per week [9].

3) Quit Smoking

Studies show that smoking increases HbA1c levels [12, 13].

In a meta-analysis of over 35 men and women without diabetes, HbA1c was 0.1% higher in current smokers and 0.03% higher in ex-smokers, compared with those who never smoked [12].

Smoking is also associated with unsatisfactory blood sugar levels in diabetics. Both type 1 and type 2 diabetes patients who smoked had higher HbA1c values than non-smokers [14].

Among 2.3k women with gestational diabetes, HbA1c was higher than expected in women who smoked at the beginning of the pregnancy [13].

4) Get More Sleep

Sleep duration and the number of sleep segments are associated with HbA1c in type 2 diabetes patients. A one-hour longer sleep duration was associated with a 0.174% (1.4 mmol/mol) decrease in HbA1c in a study of 118 diabetics. Moreover, those who napped had lower HbA1c [15].

In 210 type 2 diabetics, later bedtime on weekends was significantly associated with poorer glycemic control [16].

In another study, in 2.5k type 2 diabetics, sleep compensation during weekends (sleep duration of about 1h more during weekends compared to weekdays) had a beneficial effect on HbA1c [17].

A meta-analysis of 22 studies has found that adults with type 1 diabetes who reported sleeping >6 hours had lower HbA1c levels than those sleeping ≤6 hours. Similarly, those reporting good sleep quality had lower HbA1c than those with poor sleep quality [18].

A1C test for Diabetes (HbA1c) - What is a Good A1C Test Result? SUGARMD

Another meta-analysis of 15 studies showed that both short (<5h) and long (>9h) sleep durations were associated with an increased HbA1c in type 2 diabetes patients. So was poor sleep quality [19].

In 80 people with type 1 diabetes, social jetlag, a small but recurrent circadian misalignment between biological and social time, was associated with higher HbA1c [20].

5) De-Stress

Stress impacts many aspects of your body, including your blood sugar and HbA1c. Studies suggest we shouldn’t neglect our emotional health and should instead find healthy ways to avoid or cope with stress [21, 22, 23, 24, 25, 26, 27].

Mood difficulties are common among patients with diabetes and have been linked to poor blood glucose control and increased diabetes complications [25, 26]. In one study of 100 diabetics, lower HbA1c levels were significantly associated with less affect intensity and with higher emotional intelligence [24].

Studies indicate there is an association between behavior problems (internalizing, externalizing) and HbA1c levels in youth with type 1 diabetes. Increased problematic behaviors in youth with type 1 diabetes have been associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement [27].

A study of 312 type 2 diabetics has shown that lower life satisfaction was associated with higher HbA1c [23].

In a study of 938 non-diabetic people, weight discrimination has been associated with higher HbA1c in obese people, in addition to the effects of obesity on HbA1c itself. The study suggests that psychological and social factors can increase vulnerability to diabetes in nondiabetic obese people [22].

Higher socioeconomic status or high levels of parental education were found to be associated with lower HbA1c in children and adolescents with type 1 diabetes [28].

Caucasian, higher socioeconomic status, two-parent household, more frequent self-monitoring of blood glucose and low insulin requirements were associated with lower HbA1c concentration one year after the onset of type 1 diabetes in children [29]. These factors probably translate into HbA1c levels through increased diet quality, less stress, and more exercise.

Evidence is in favor of mind-body wellness techniques for emotional regulation and mindfulness-based cognitive therapy. Mindful self-compassion training significantly reduced depression, diabetes distress, and HbA1c in a randomized controlled trial [25].

6) Oral Hygiene

Improve your oral hygiene. It may come as a surprise, but studies suggest that proper and regular tooth brushing may help decrease your blood glucose and HbA1c levels. Also, address any existing periodontal (gum) issues such as inflammation, as these can increase HbA1c [30, 31, 32, 33, 34, 35].

7) Avoid Air Pollution

Long (1-year) and intermediate (3 months) term exposure to higher levels of air pollution was associated with increases in HbA1c [36, 37, 38, 39].

Air pollution was associated with higher HbA1c levels in 9.1k newly diagnosed type 2 diabetes patients [40].

Air pollution may result in increased low-level chronic inflammation in the body that, in turn, can have an adverse effect on blood sugar control.

8) Get More Sun

Getting more sun increases Vitamin D levels.

An association was found between higher HbA1c levels and lower Vitamin D in 160 pregnant women [41].

Vitamin D administration decreased HbA1c levels in a study of 65 children and adolescents with type 1 diabetes [42].

Enhanced vitamin D supplementation also improved HbA1c in a study of type 2 diabetes overweight and obese patients [43].

However, other studies in healthy subjects found no correlation between vitamin D and HbA1c [44, 45].

Dietary Changes that May Lower Hemoglobin A1c (HbA1C)

1) Avoid Sugar and Processed Carbs

Avoid sugary foods and processed carbs [46, 47]. They cause spikes in blood sugar levels.

A loose restriction of carbohydrate intake in a study of 133 type 2 diabetes patients improved HbA1c levels significantly during the 2-year follow-up period [48].

A low carbohydrate diet reduced HbA1c and BMI in a study of 66 Japanese patients with poorly controlled type 2 diabetes [49].

When an energy-restricted, protein-rich meal was used to replace certain meals in15 obese type 2 diabetes patients, over a period of 12 weeks, HbA1c decreased from 8.8% to 8.1%. Participants who continued with the practice further reduced their HbA1c [50].

2) Increase Fruits, Vegetables, and Fiber

Increase your fiber intake. Fruits and vegetables are generally rich in fiber, and studies show they can help keep your blood sugar levels under control. Beans, chickpeas, broccoli, berries, pears, avocado, and nuts are all great fiber sources [51, 52, 53, 54].

Higher total fiber intake was associated with lower HbA1c in a study of over 2k people with type 1 diabetes [53].

Similarly, HbA1c levels were lower in both people with and without type 2 diabetes when they consumed more fiber. Increasing fiber intake may be an effective approach to improve blood sugar levels in type 2 diabetic patients [51, 52].

Oats are a great source of fiber and can help decrease HbA1c and fasting glucose. The intake of oats and beta-glucan extracted from oats tends to lower HbA1c. Higher consumption of whole oats and oat bran, but not oat or barley beta-glucan extracts, were associated with lower HbA1c, fasting glucose and fasting insulin, in a meta-analysis of 18 studies [55].

A study showed in over 3k people showed that in nondiabetics, for every extra 80 g vegetable portion consumed, HbA1c reduced by 0.01% [46].

3) Mediterranean Diet

A Mediterranean diet includes many healthy components, such as fruits, vegetables, nuts, legumes, whole grains, and fish. There is lots of research showing that this type of diet has beneficial effects on diabetes and lowers HbA1c [56, 57, 58, 59, 60].

The essential nutrients and health-promoting properties of the diet, including high fibers, high magnesium, high antioxidant flavonoids, and high monounsaturated fatty acids (MUFA) are all powerful ways to decrease inflammation in the body [57].

In a meta-analysis of 9 studies with 1178 diabetics, a Mediterranean diet improved blood sugar control, body weight, and heart disease risk factors.

In a study of 27 diabetics, compared with the usual diet, a traditional Cretan Mediterranean diet lowered HbA1c from 7.1% to 6.8% [58].

In a study with over 200 overweight middle-aged men and women with newly diagnosed type 2 diabetes, a low-carbohydrate Mediterranean diet resulted in a greater reduction of HbA1c levels, a higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet [59].

A meta-analysis of 8 studies found that the Mediterranean diet reduced HbA1c significantly compared to the usual diet, but so did the Paleo diet [60].

4) Paleo Diet

Several initial studies suggest that a paleo diet, consisting of lean meat, fruits, vegetables, and nuts, can also help improve blood sugar and HbA1c levels [61, 62, 60].

5) Drink More Water

A study showed that 1 cup of plain water per day was associated with a -0.04% lower HbA1c in men. Men had a 22% reduced odds of having HbA1c≥5.5% for each cup per day of plain water. There was no such association in women, however [63].

6) Moderate Alcohol Consumption

Studies suggest that moderate alcohol consumption (1 serving per day) can reduce HbA1c in both non-diabetics and diabetics [64, 65].

In Japanese women, HbA1c levels were lower in occasional, regular light and regular heavy drinkers than in nondrinkers. HbA1c was further significantly lower in regular light and heavy drinkers than in occasional drinkers [66].

Higher alcohol consumption was associated with lower HbA1c in diabetes patients [65].

Higher alcohol intake was associated with lower HbA1c levels in Korean adults [67].

However, it’s very important to remember that alcohol consumption is associated with other health issues and diseases so always talk with your physician about the optimal amount of alcohol you should be taking.

7) Probiotic Yogurt

Multistrain probiotics and probiotic yogurt decrease HbA1c in several studies of people with type 2 diabetes [68, 69, 70, 71].

A probiotic strain, L. fermentum reduced HbA1c in a study of 45 volunteers with borderline-high values [72].

Some studies, however, failed to find improvement associated with probiotics [73, 74].

8) Dark Chocolate

Among type 1 diabetes patients, those who consumed dark chocolate (25 g/day 2 – 5 times/week) showed a significantly lower HbA1c than both patients who consumed the same amount of milk chocolate or neither dark nor milk chocolate [75].

In another study of 7.8k people, those who ate up to 2 – 6 servings (28.5 g) of dark chocolate per week had a 34% lower risk of being diagnosed with diabetes [76].

Supplements that May Lower Hemoglobin A1c (HbA1C)

Talk to your doctor about the following foods and supplements. Initial studies suggest they may help decrease blood sugar levels and HbA1c:

Aloe [77, 78, 79, 80]

Alpha-lipoic acid [81, 82]

Berberine [83, 84, 85, 86]

Caffeine/Coffee [87, 88, 89, 90, 91, 92]

Chromium [93, 94]

Curcumin [95, 96, 97, 98]

Dark chocolate [76, 99, 100]

Fiber, such as glucomannan or beta-glucans [101, 102, 103, 104, 105]

Garlic [106, 107]

Green tea [108, 109, 110]

Milk thistle [111, 112]

 How long before vinegar lowers blood sugar?

Does vinegar really lower blood sugar?

Why would a shot of vinegar blunt the glucose spike from a carb-heavy meal? Here's what the research shows, and tips for working vinegar into your diet.

WRITTEN BY

Meghan Rabbitt

REVIEWED BY

Casey Means, MD

UPDATED: 04/21/2022

PUBLISHED: 02/05/2021

5 MIN READ

Eating a metabolically healthy diet isn’t just about eliminating foods that cause a blood sugar spike, it’s also about incorporating foods that can help aid glucose control. Vinegar is often cited as a food that can have a positive effect on blood sugar, but is it true?

The answer is a solid: probably. Several studies examine the effects of vinegar on glucose processing, and many show positive results. However, much of the research uses very small sample sizes—between 5 and 12 study participants. 

What’s more, the high-carb meals those study participants consume aren’t exactly typical—especially for people trying to eat healthily—often consisting of white bread and juice. How vinegar affects more complex carbs is hard to say. And the studies mostly focus on glucose processing and insulin sensitivity; there’s little evidence it affects weight loss.

7 Small Changes To Lower Your A1C (T1D Edition!)

Still, the evidence across several studies suggests that this may be more than folklore, so let’s look at the mechanisms involved and how you can take advantage of it in your own diet.

First, What Exactly is Vinegar?

At its most basic, this kitchen staple results from a two-step fermentation process that converts a carbohydrate (usually fruit, rice, potatoes, or whole grains) into alcohol, which is then fermented to vinegar. First, yeast feed on liquid sugar or starch,  fermenting it into alcohol. When the alcohol is exposed to oxygen, naturally-occurring bacteria called Acetobacter create acetic acid—the stuff that gives vinegar its tart, sharp taste, and what’s likely at work when it comes to blunting a post-meal blood-sugar spike.

You’ll find many different types of vinegar at the grocery store, and the differences result from the kind of carbohydrate used to start the fermentation process. The most common varieties include:

White distilled vinegar comes from a grain alcohol similar to vodka, which gives it a neutral color and flavor profile.

Rice vinegar is made with fermented rice, this type of vinegar tends to have a milder, less acidic taste than the other varieties.

Balsamic vinegar is often thicker, darker, and sweeter than the others; it starts with fermented grapes.

Apple cider vinegar comes from the liquid of crushed apples and retains a faint apple flavor.

Wine vinegar can be either red and white, and the flavor depends on the type of wine used to make it.

Malt vinegar comes from fermenting unhopped beer; it displays the same nutty, caramel, sometimes lemony flavor profile as a malted ale.

So How Does Vinegar Impact Blood Sugar?

There isn’t a clear consensus on a precise mechanism behind vinegar’s effect on glucose, but there are a few research-backed theories:

The acetic acid in vinegar slows down the rate at which the stomach empties the food you’ve eaten into the small intestine, which in turn slows the breakdown of carbohydrates and gives the body more time to remove glucose from the blood. This ultimately reduces the spike in blood sugar you’d typically see after eating. In one small study of 10 healthy, regular weight volunteers, researchers found that the ingestion of acetic acid as vinegar significantly reduced both blood glucose concentrations and insulin responses after a starchy meal. The study authors wrote: “The mechanism is probably a delayed gastric emptying rate.”

Vinegar may act on the body’s cells, increasing their ability to take in glucose, so there’s less of it circulating in the bloodstream. One group of researchers found increased glucose uptake in the forearm muscle cells of people with diabetes who had consumed vinegar compared to those who hadn’t. A study in rats found that balsamic vinegar improves the function of beta cells, which secrete insulin in response to glucose. 

Vinegar may also work to balance blood sugar by interfering with disaccharidases—enzymes in the small intestine that break down carbohydrates, says Ashley Koff, RD, a Columbus, Ohio-based dietitian. Anything that acts “to block or subdue the capabilities of the enzymes that break down the carb [curbs the] rapid absorption of the carb as glucose,”  says Koff, blunting the blood sugar rise you might typically see after eating.

Five Ways to Incorporate Vinegar into Your Meals

Have a vinegar-based salad dressing before you eat. This may be especially helpful if you’re planning on having a carbohydrate-rich meal. One study showed that when people consumed 1 ounce of white vinegar with a meal of bread containing 50 grams of carbohydrates, it lowered post-meal glucose spikes and insulin levels. (The researchers soaked the bread in vinegar to distribute its intake, but that may not be the most delicious way to go.)

Another study of healthy people found that eating 100 grams (about a cup and a half) of sliced lettuce dressed with olive oil and vinegar before consuming 50g of white bread carbs experienced significantly lower blood sugar compared to those who ate the same amount of salad dressed with olive oil but no vinegar.

Interestingly, the study authors also compared the vinegar group to a second vinegar group in which they added sodium bicarbonate to the vinegar to neutralize its pH. The scientists found that the neutralized vinegar did not affect blood sugar, suggesting that vinegar’s acidic nature plays a crucial role in its ability to modulate blood sugar.   

Drizzle vinegar over steamed or roasted veggies. It turns out even a small amount of vinegar consumed with meals can help control blood sugar, too. One study found consuming two teaspoons of vinegar with carbs may reduce post-meal blood glucose levels as much as 20 percent. Bonus: the study also found that consuming vinegar with a high-carb meal also increases satiety.

Dilute four teaspoons of apple cider vinegar in water and drink right before you eat. In one study, participants consumed a buttered bagel with orange juice two minutes after drinking either 20 grams of apple cider vinegar or a placebo. When the researchers checked blood glucose levels at 30 and 60 minutes after the meal, they found significantly lower post-meal blood glucose levels in the apple cider vinegar group.

Take six teaspoons of apple cider vinegar before bed. In one small but intriguing study, researchers looked at people with well-controlled Type 2 diabetes and found that drinking two tablespoons of ACV with an ounce of cheese before bed could positively impact blood sugar. Compared to study participants who had water and cheese at bedtime, those who downed the apple cider vinegar reduced their fasting blood sugar levels by up to 6 percent over two days.

Eat more fermented foods. They’re good for your gut and your blood glucose. When researchers in Sweden added fermented milk (a.k.a. yogurt) and pickles (cucumbers preserved in vinegar) to a breakfast of high-carb white bread, they found that the combination reduced blood sugar and insulin levels compared to study participants who just ate the bread. What’s more, the scientists found that adding regular milk and fresh cukes had little impact on blood sugar response.

Related article: 12 glucose-lowering strategies to improve metabolic fitness

Any Downsides to Vinegar Consumption?

According to the American Dental Association, frequent consumption of foods and beverages with high acidity can damage tooth enamel. There’s also a chance you could experience some gastrointestinal woes: According to one study, people who drank vinegar with breakfast reported feeling nauseated. To combat these possible side effects, experts recommend diluting vinegar with water and using it as an ingredient in your meals rather than taking it as a shot.

What can I drink to lower A1c?

Having diabetes means that you have to be aware of everything you eat or drink. Knowing the number of carbohydrates that you ingest and how they may affect your blood sugar is crucial.

The American Diabetes Association (ADA) recommends zero-calorie or low-calorie drinks. The main reason is to prevent a spike in blood sugar.

Choosing the right drinks can help you:

avoid unpleasant side effects like blood sugar spikes

manage your symptoms

maintain a healthy weight

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The 11 best drinks

Better beverage choices:

water

seltzer water

unsweetened tea

herbal tea

unsweetened coffee

vegetable juice

low fat milk

milk alternatives

green smoothies

sugar-free lemonade

kombucha

Zero- or low-calorie drinks are typically your best bet when choosing something to quench your thirst. Squeeze some fresh lemon or lime juice into your drink for a refreshing, low-calorie kick.

Keep in mind that even low sugar options, such as vegetable juice, should be consumed in moderation.

Reduced fat dairy contains the naturally occurring milk sugar, lactose, so this beverage must be considered in your total carbohydrate allowance for the day.

Dairy options are also not considered a low-sugar beverage.

Whether you’re at home or at a restaurant, here are the most diabetes-friendly beverage options.

1. Water

When it comes to hydration, water is the best option for people with diabetes. That’s because it won’t raise your blood sugar levels. High blood sugar levels can cause dehydration.

Drinking enough water can help your body eliminate excess glucose through urine. The Institute of Medicine recommends adult men drink about 13 cups (3.08 liters) of day and women drink about 9 cups (2.13 liters).

If plain water doesn’t appeal to you, create some variety by:

adding slices of lemon, lime, or orange

adding sprigs of flavorful herbs, such as mint, basil, or lemon balm

crushing a couple of fresh or frozen raspberries into your drink

2. Seltzer water

Seltzer water is a great fizzy, sugar-free alternative to other carbonated beverages, such as soda.

Like regular water, seltzer water is free of calories, carbs, and sugar. Carbonated water is a great way to stay hydrated and support healthy blood sugar levels.

There are many different flavors and varieties to choose from, or you can try adding some fresh fruit and herbs to give your drink a delicious twist.

3. Tea

ResearchTrusted Source has shown that green tea has a positive effect on your general health.

A large 2021 cohort study of more than a half million people suggestsTrusted Source that daily consumption of green tea may lower your risk of type 2 diabetes. However, more research is needed.

Whether you choose green, black, white, or oolong tea, avoid those with added sugars. For a refreshing taste, make your own iced tea and add a few slices of lemon.

4. Herbal tea

Herbal tea varieties like chamomile, hibiscus, ginger, and peppermint tea are all excellent options for people with diabetes.

Not only is herbal tea free of carbs, calories, and sugar, but it’s also rich in disease-fighting antioxidant compounds, including carotenoids, flavonoids, and phenolic acids.

5. Unsweetened coffee

Drinking coffee might help lower your risk of developing type 2 diabetes by improving sugar metabolism, according to a 2019 review of studiesTrusted Source.

As with tea, it’s important that your coffee remain unsweetened. Adding milk, cream, or sugar to your coffee increases the overall calorie count and may affect your blood sugar levels.

Many no- or low-calorie sweeteners are available if you choose to use them.

6. Vegetable juice

While most 100 percent fruit juice is 100 percent sugar, you can try tomato juice or a vegetable juice alternative.

Make your own blend of green leafy vegetables, celery, or cucumbers with a handful of berries for a flavorful supply of vitamins and minerals. Remember to count the berries as part of your carbohydrate total for the day.

7. Low fat milk

Milk contains important vitamins and minerals, but it does add carbohydrates to your diet. Always choose unsweetened, low fat, or skim versions of your preferred milk and stick to no more than two to three 8-ounce glasses a day.

8. Milk alternatives

Milk alternatives like almond, oat, rice, soy, rice, or coconut milk are dairy-free and low in carbs.

They are also sometimes fortified with important nutrients like calcium and vitamin D, both of which play a key role in bone health.

Be aware that soy and rice milk contain carbohydrates, and many nut milks contain a minimal amount of protein, so check the packaging carefully to pick the right product for you.

9. Green smoothie

Green smoothies can be an excellent way to squeeze some extra fiber and nutrients into your diet while staying hydrated.

Try making your own using green vegetables like spinach, kale, or celery and pair with some protein powder and a bit of fruit for a healthy, homemade smoothie.

Keep in mind that fruits contain carbohydrates, so remember to count them toward your daily carb intake.

10. Sugar-free lemonade

You can easily whip up your own sugar-free lemonade at home using just a few simple ingredients for a refreshing and delicious low carb beverage.

To get started, combine sparkling water with a bit of freshly squeezed lemon juice. Top it off with some ice and your choice of sugar-free sweetener, such as stevia.

11. Kombucha

Kombucha is a fermented beverage typically made from black or green tea.

It’s a great source of probiotics, which are a type of beneficial bacteria found in the gut that have been well studied for their ability to improve blood sugar controlTrusted Source for people with type 2 diabetes.

Although the exact nutritional content can vary depending on the specific type, brand, and flavor, a 1-cup serving of kombucha typically contains about 7 grams of carbs, making it a great choice on a low carb diet.

The 3 worst drinks

Drinks to avoid

regular soda

energy drinks that contain sugar

fruit juices

Avoid sugary drinks whenever possible. Not only can they raise your blood sugar levels, but they can also account for a significant portion of your daily recommended caloric intake.

Sugary drinks add little if any nutritional value to your diet. However, fruit juices do provide some nutrients.

1. Regular soda

Soda takes the top spot on the list of drinks to avoid. On average, one can has a whopping 40 grams of sugar and 150 calories, notes the ADA.

This sugary drink has also been linked to weight gain and tooth decay, so it’s best to leave it on the store shelf. Instead, reach for sugar-free, fruit-infused water or tea.

2. Energy drinks

Energy drinks can be high in both caffeine and carbohydrates. A 2018 studyTrusted Source showed that energy drinks can cause a spike in blood sugar.

Too much caffeine can:

cause nervousness

increase your blood pressure

lead to insomnia

All of these can affect your overall health.

How to Check Your A1c at Home (Or in a Clinic)

3. Sweetened or unsweetened fruit juices

Although 100 percent fruit juice is fine in moderation, and is a source of nutrients like vitamin C, all fruit juices can add a high amount of carbohydrates to your diet and are pure (natural) sugar. This combination can wreak havoc on your blood sugar and increase your risk for weight gain.

If you have a fruit juice craving that won’t fade, be sure you pick up a juice that’s 100 percent pure and contains no added sugars.

Also, limit your portion size to 4 ounces (0.12 liters), which will reduce your sugar intake to only 3.6 teaspoons (15 grams).

You might consider adding a splash or two of your favorite juice to sparkling water instead.

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Exercise caution with these two

Drinks to be aware of

diet soda

alcoholic beverages

1. Diet soda

A 2015 studyTrusted Source linked increased diet soda intake with a risk for metabolic syndrome. This syndrome refers to a cluster of conditions, including:

high blood pressure

high levels of cholesterol

high levels of triglycerides

increased weight gain

high blood sugar levels

Upon further analysis, the study participants who had overweight or obesity, which are risk factors for metabolic syndrome, had likely been swapping no-calorie soda for the full-sugar versions.

They likely took this step to cut their calorie intake. This was an association, but it wasn’t considered cause and effect.

A 2016 study seemed to show that those drinking diet sodas had increased blood sugar levels and waist circumference.

However, this study did not control for meals or physical activity or other variables before each round of testing was done.

Further, the authors stated that individuals with higher insulin levels at the beginning of the study may have already had metabolic issues not related to their intake of sugar-free sodas.

For most people living with diabetes, sugar-free sodas are safe in moderation.

Resist the urge to pair something sweet or high in calories with that no-calorie beverage. No, the diet beverage doesn’t cancel out the calories in a candy bar!

2. Alcoholic beverages

If you have high blood pressure or nerve damage from your diabetes, drinking alcohol may worsen these conditions.

You should check with your healthcare professional to determine whether alcoholic beverages are safe for you to drink.

Alcohol can cause a drop in blood sugar during the next several hours after ingestion. This is especially important for those who take insulin or other medications that can cause hypoglycemia or low blood sugars.

Some distilled spirits are typically mixed with sugar-containing sodas or juices which can raise blood sugars.

One 2016 studyTrusted Source in more than 383,000 people found that alcohol intake was associated with a higher risk of prediabetes. However, mild to moderate consumption of alcohol was actually linked to a lower risk of developing type 2 diabetes.

Some studies have shown a beneficial effectTrusted Source of red wine on diabetes, though the evidence remains uncertain.

If you’re planning to drink an alcoholic beverage, red wine may be a good choice as it has some antioxidant properties and can be lower in carbohydrates. Sweeter tasting wines do have more sugar content.

ADA guidelines recommend that those with diabetes limit consumption to one drink or less per day for women and two drinks or less per day for men. One drink is considered 5 ounces (0.15 liters) of wine, 1 1/2 ounces (.04 liters) of distilled spirits, or a 12-ounce beer.

More research is needed to understand the potential relationship between diabetes risk and alcohol consumption.

WERBUNG

The bottom line

When it comes to selecting a drink, keep it simple. Choose water whenever possible. Unsweetened tea and all sugar-free beverages are also good options. Natural juices and low fat milk are generally fine in moderation.

If you’re craving a little sweetness in your drinks, try adding natural sources like:

fragrant herbs

slices of citrus fruit

a couple of crushed berries

Does drinking apple cider vinegar help lower your A1c?

Apple cider vinegar — also known as “ACV” — is a trendy ingredient these days. Personally, I love pouring a big splash of it into an ice-cold glass of fruit-flavored seltzer!

But recently, apple cider vinegar is also being touted as a home remedy for people living with diabetes, with claims that it can help control blood sugars and lower A1c levels.

In this article, we’ll discuss the general benefits of apple cider vinegar, what research has determined about its impact on blood sugar levels, precautions to take when adding it to your diet, and who shouldn’t consume apple cider vinegar regularly at all.

Glass bottle of apple cider vinegar in front of basket with apples

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First, make sure you buy the right apple cider vinegar

Made by crushing, distilling, and fermenting apples, apple cider vinegar does offer a few generally accepted health benefits.

Those benefits come mostly from “the mother” which is the beneficial bacteria that cause the fermentation process.

“First, yeast is added to apple juice to break down the sugars and turn them into alcohol,” explains Enzymedica. “Then, bacteria is added, which converts the alcohol into acetic acid. This bacteria is what is known as the “mother” because it is the catalyst that gives rise to the vinegar. Many store-bought apple cider vinegars have the mother removed because it gives the vinegar a cloudy appearance, which can lead some customers to believe that the product has gone bad. But this is not the case. In fact, the mother is the healthiest part.”

When purchasing ACV, you should be looking for a product that’s raw, unfiltered, and “comes from the mother.”  All three of these details should be clearly printed on the packaging of your ACV contained in a glass container versus a plastic container.

You can find high-quality ACV in most grocery stores in the baking aisle or online at Trader Joe’s and on Amazon.

*Please note: You should not drink ACV without diluting it in water or another beverage. The high acidity content can damage your teeth, mouth, and throat if consumed regularly without diluting.

General health benefits of drinking apple cider vinegar

Before we discuss how ACV affects blood sugar and A1c for people living with diabetes, let’s look at some of the claims regarding general health benefits.

ACV has been around for a long time

Mentioned several times in the Bible as an “antibiotic,” the problem is that ACV is not actually the cure-all it’s often reported to be — and it’s definitely not going to help you if what you actually need is a legitimate antibiotic.

Again, to be clear, ACV is not an antibiotic.

Instead, there are some basic and generally accepted benefits to drinking a little ACV every day.

Let’s take a look at the facts:

ACV is antimicrobial

ACV is “antimicrobial” which means it’s very similar to alcohol-based hand sanitizers. It helps to prevent the spreading of bacteria, fungi, and some viruses. However, that is not the same as “antibacterial,” which prevents the growth of bacteria.

How to Lower A1C Levels Naturally in 4 EASY Ways | Manage Diabetes Naturally

Extensive research has also found that ACV has a significant direct effect on three specific types of bacteria: E-coli, Staphylococcus aureus, and Candida albicans. However, do not use ACV to treat any of these types of bacteria without consulting your healthcare team.

You can even mix ACV (or standard white vinegar) with a much larger ratio of water to use as an all-natural household cleaning product for your floors, counters, and bathrooms.

ACV contains probiotics…which support healthy digestion

You’ll get the probiotic benefits of ACV is you’re drinking the raw, unfiltered, and “from the mother” version. Like kombucha, ACV contains dozens of beneficial bacteria that support a healthy gut.

When your gut-health is “out of whack” because there is too little of the healthy bacteria and too much of unhealthy bacteria, it can actually affect many parts of your entire well-being.

Gut health has been linked to a variety of health conditions, including:

Depression

Anxiety

Insulin resistance

Diabetes (type 1 and type 2)

Obesity

Cancer

Inflammatory bowel disease

Acne

…and more!

Apple cider vinegar and diabetes: Can ACV lower blood sugar levels in people with diabetes?

Let’s cut right to the chase: apple cider vinegar has shown to reduce blood sugar levels slightly in people with type 2 diabetes and type 1 diabetes, but the results aren’t going to have a tremendous impact on your A1c from ACV alone.

Instead, the research seems to imply that adding ACV to your many other diabetes management habits can help a little bit. And there’s no question that it could benefit your health in ways unrelated to your blood sugar, too, as explained earlier.

Let’s take a look at some of the most significant research.

In well-managed type 2 diabetes, drinking ACV before bed helps manage morning blood sugars.

In this 2007 study from Arizona, patients with well-managed type 2 diabetes who did not take insulin drank 2 tablespoons of apple cider vinegar with 1 ounce of cheese every night.

The study also included a placebo group of patients with well-managed type 2 diabetes, who drank water instead of ACV.

In the placebo group, morning fasting blood sugar levels were 2 percent lower by the end of the study. In the ACV group, morning fasting blood sugar levels were 4 to 6 percent lower.

The study concluded that ACV can help lower blood sugar levels in those who are engaged in other diabetes management habits.

12 weeks of drinking ACV showed relatively insignificant reductions in A1c levels

This 2018 study from Singapore — involving patients with type 1 and type 2 diabetes — found that while drinking 2 tablespoons of ACV after a meal did demonstrate a slight reduction in post-meal blood sugar levels, the results weren’t remarkably significant.

That being said, blood sugar levels were slightly lower which suggests it can help but it likely can’t replace diabetes medications nor compensate for unhealthy lifestyle habits.

ACV improves insulin sensitivity after high-carbohydrate meals

This 2004 study from Arizona gave patients with type 2 diabetes 20 grams (about 1.5 tablespoons) of ACV with high-carbohydrate meals.

Researchers concluded that consuming vinegar with high-starch meals lowered post-meal blood sugars by increasing a patient’s sensitivity to insulin.

ACV delays gastric emptying and reduces post-meal blood sugar levels

This 2007 study from Sweden focused on patients with type 1 diabetes and gastroparesis.

The results determined that consuming 2 tablespoons of ACV with meals reduced the rate at which the body empties digested food (including glucose) into the bloodstream.

For patients with gastroparesis, this is actually a disadvantage because they already struggle with significantly delayed and unpredictable digestion — which makes it harder to time and dose insulin.

For patients without gastroparesis, however, this might be helpful. By reducing the rate of gastric emptying, it reduces the post-meal blood sugar spike.

If you decide to add ACV to your diet (and who shouldn’t)

While the results of recent research imply that ACV will have a very modest impact on your blood sugar, there are still plenty of reasons to incorporate it into your daily or weekly diet.

The probiotics alone are remarkably important for the maintenance of your gut’s balance of healthy bacteria.

Remember these three crucial details when consuming ACV:

Always dilute it with another beverage (water, seltzer, tea) or by mixing it into your food.

Only consume approximately 2 tablespoons per day.

Consuming too much ACV can wreak havoc on your teeth, throat, and stomach because of its high-acidity content.

However, in addition to always diluting your ACV with another liquid, there are a few people who shouldn’t drink it all.

You shouldn’t drink ACV if…

If you have any of the following health concerns, talk to your doctor before consuming ACV.

Reverse Type 2 Diabetes — How Tina Dropped Her A1c from 10.6% to 5.4% in 90 Days

You have a history of stomach ulcers

You have low potassium levels

You have a history of bulimia

You have any health or dental conditions in your mouth or throat (discuss with your doctor or dentist first!)

ACV has a lot of subtle but legitimate benefits to offer anyone — including those of us with diabetes. Give it a whirl! And enjoy!

Apple cider vinegar has links to an array of health benefits, such as aiding weight loss to relieving cold symptoms. But does taking it help people with diabetes?

Scientists have yet to back up the majority of the health claims around apple cider vinegar with significant clinical research. However, some evidence has emerged to suggest that apple cider vinegar may have particular benefits for the management of diabetes.

Diabetes is a chronic condition that leads to an inability to manage blood sugar levels properly. According to the World Health Organization (WHO), in 1980, around 108 million people had diabetes. Its prevalence has significantly increased over the past few decades to an estimated 422 million in 2014.

This article looks at the research that links apple cider vinegar and diabetes, as well as ways to take apple cider vinegar effectively.

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Apple cider vinegar and diabetes

Apple cider vinegar may have many benefits for people with diabetes.

According to scientists, apple cider vinegar has the potential to impact different types of diabetes in a variety of ways.

Some research, such as this review from 2018Trusted Source, draws a connection between apple cider vinegar and reduced blood glucose. This leads some people to believe that apple cider vinegar could provide benefits for people with diabetes who need to manage their blood glucose levels.

There are two primary forms of diabetes: type 1 and type 2. In type 1, the pancreas does not produce insulin because the body’s immune system attacks the cells that make it. A person with type 1 diabetes will need to take additional insulin.

Type 2 occurs when the body’s cells become less sensitive to the glucose-reducing effects of insulin. This means that the body absorbs less glucose, which leaves more circulating in the bloodstream.

Diet has a controlling influence on type 2 diabetes and is an essential consideration for people with type 1.

However, while apple cider vinegar is a low-risk addition to a diabetes diet, many studies on the vinegar are small and have reached mixed conclusions concerning its effects on blood sugar levels.

Research

Studies of apple cider vinegar’s impact on blood sugar levels tend to be small and have mixed results.

Most studies on apple cider vinegar have examined its potential to reduce blood sugar. A 2018 reviewTrusted Source examined both its long- and short-term effects and found that many results favored the groups using vinegar, although often not by a significant margin. Groups had both main types of diabetes.

The review reports that apple cider vinegar caused a small, significant reduction in HbA1c results after 8–12 weeks. HbA1c levels reflect a person’s blood glucose levels over many weeks or months.

On a short-term basis, groups taking apple cider vinegar saw significant improvement in blood glucose levels 30 minutes after consuming the vinegar. However, the differences between the vinegar and control groups reduced after this time frame.

Other studies looked to identify the mechanisms behind this reduction in blood sugar level. One crossover, randomized study from 2015Trusted Source suggested that apple cider vinegar may improve the way that the body absorbs blood sugar and increase insulin sensitivity in the skeletal muscle.

Apple cider vinegar contains acetic acid, which some researchers claim has effects on reducing obesity. However, the source of the vinegar, such as apple cider, affects its impact on the body.

One 2017 studyTrusted Source on mice showed that the mice who received a dose of vinegar experienced reduced inflammation, body weight, and fat distribution.

Obesity can trigger the development of type 2 diabetes.

While this research does not indicate that the same results would occur in humans, it does highlight the mechanisms that might lead to a drop in blood glucose after taking apple cider vinegar.

Apple cider vinegar’s effects on people with type 1 diabetes are the subject of fewer specific studies. The last study that looked into this took place in 2010 and showed that 2 tablespoons (tbs) of vinegar could help reduce hyperglycemia, or high glucose levels, after meals.

An even older study from 2007, however, suggested that apple cider vinegar might make symptoms worseTrusted Source. It might slow the process through which the stomach empties, affecting glucose management in people who regularly take insulin.

The mixed nature of research and the lack of recent studies into apple cider vinegar and type 1 diabetes make it difficult for doctors to recommend it as a complementary intervention for people with this type of diabetes.

However, taking apple cider vinegar is unlikely to cause serious harm. Always monitor levels to measure whether it works and make dietary adjustments accordingly.

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Tips

Drinking a glass of water containing 1–2 spoonfuls of apple cider vinegar before meals or bedtime can reduce blood sugar.

People who wish to consume apple cider vinegar should dilute 1–2 tbs of apple cider vinegar in a large glass of water.

Drink it before meals or just before bedtime, when it has the greatest reducing impact on blood sugar.

As with most kinds of vinegar, a person should not consume undiluted apple cider vinegar. On its own, the vinegar can cause stomach irritation or damage tooth enamel.

Apple cider vinegar is also a versatile cooking ingredient. People can use it in salad dressings, marinades, sauces, and soups, and it works well with many types of meat and fish.

People are most likely to see the distilled varieties of apple cider vinegar on sale. This type of apple cider vinegar is clear and has no color.

There is a range of apple cider vinegar products available for purchase online.

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Risks

Apple cider vinegar has high acidity levels and some research has demonstrated its corrosive effects on enamel, the protective covering on the surface of teeth.

The authors of a 2014 lab study Trusted Sourceimmersed tooth enamel in a range of vinegars of acidities that varied between 2.7–3.95 PH. The enamel in apple cider vinegar saw a loss of 1–20 percent over 4 hours.

However, despite suggesting that large amounts of apple cider vinegar may lead to dental decay, the study did not account for the protective action of saliva.

Consuming moderate amounts of apple cider vinegar has an extremely low risk of damaging the teeth.

Takeaway

People with type 2 diabetes may want to consider consuming diluted apple vinegar cider, as scientists believe it safe to drink. It may also provide some benefit in terms of helping to control blood sugar levels. However, there is little scientific evidence to support its benefits.

People should not consider apple cider vinegar or any other isolated dietary change to be a quick fix for diabetes.

Eating a high-fiber diet that contains the right amount of carbohydrates, protein, and healthful fat, alongside regular physical exercise, are the most effective methods of controlling diabetes.

What is the Difference Between Blood Glucose & A1C?

Q:

Is apple cider vinegar better than other types for blood sugar control?

A:

The type of vinegar that scientists have studied most often for reducing blood glucose levels is apple cider vinegar. However, researchers believe that other kinds of vinegar have the potential to act similarly in the body.

Acetic acid is present in all vinegar, and this is the component that researchers believe influences weight, lipids, and blood sugar management. Some studies use vinegar solutions without stating apple cider vinegar specifically. For example, one studyTrusted Source showed that a 30 milliliter (ml) vinegar solution that contained 6 percent acetic acid had positive effects on glucose and lipid metabolism.

Theoretically, any vinegar should help improve these levels based on acetic acid concentrations and the impact of that specific component on blood sugar. Most varieties of food vinegar contain 4-7 percent acetic acid. However, scientists need to carry out more research to confirm the benefits and effects of different types of vinegar.