The glycated hemoglobin A1C test (HBA1C) measures the average blood glucose level over the past 2-3 months.
But what constitutes a dangerous level of A1c? In this article, we investigate A1C levels that are considered too low or too high, and discuss strategies to improve the levels if considered dangerous.
What are the different A1C levels?
The American Diabetes Association classifies A1C levels to help identify diabetes management status.
- Normal (non-disaccharide): A1c less than 5.7%
- Prediabetes: 5.7% to 6.4% A1c
- Diabetes: A1c over 6.5%
Individual A1C goals may vary depending on the individual’s health situation. For example, higher A1C may be recommended for people living alone or who have difficulty detecting hypoglycemia (a condition known as recognition of hypoglycemia).
The ADA recommends that adults maintain A1c below 7% to prevent diabetes-related complications, but children should aim for A1c below 7.5%.
What is a dangerous A1C level?
Management at the A1C level is important. Because both high and low levels carry serious health risks. It is essential to work with your doctor to determine your ideal A1C goal. This depends on your lifestyle, health goals, and life stage.
A1c is less than 5%
Although it is rare for diabetic patients to have A1c below 5% and is admirable, levels below 5% can indicate frequent hypoglycemia.
This situation is especially concerning when you are older, live alone, or have difficulty detecting when your blood sugar levels are low.
In these scenarios, hypoglycemia results can be more dangerous and potentially lead to serious consequences such as coma and death of diabetes.
If you often experience hypoglycemia, it is important to discuss the possibility of adjusting your insulin dose with your doctor to maintain A1C at a safer level in a frequently low, low state.
It is important to note that newly diagnosed with type 1 diabetes may temporarily exhibit very low A1C levels while known as the “honeymoon stage.” This period occurs when the pancreas still produces some insulin.
A1c over 7%
The ADA recommends that most adults aim to keep A1c below 7% to prevent diabetes-related complications. For children, the goal is usually below 7-7.5% depending on the individual situation, reflecting the need to balance blood glucose control with the risk of hypoglycemia.
However, managing diabetes effectively can be difficult due to a variety of living factors. A1Cs of 7% to 8% are beyond the ideal target, but do not lead to complications anytime soon.
Nevertheless, it is important to aim for lower levels to reduce the long-term risk of diabetes-related health problems.
A1c over 9%
Levels above 9% significantly increase the risk of severe diabetic complications, including heart disease, nerve damage, and renal failure. Risk continues to escalate with an increase in each percentage of A1c.
How to make A1C safer
Whether increasing or decreasing A1c, adjusting is important when approaching dangerous levels. Here’s how to safely manage your A1c:
If A1c is too low:
- Talk to your healthcare provider: Discuss the possibility of reducing medication and insulin dosages to avoid frequent lows.
- Relax your exercise: If physical activity leads to hypoglycemia, consider reducing the intensity or duration of your training.
- Adjust your diet: Increases protein and fat intake. This helps stabilize blood sugar levels, especially overnight.
- Use a Continuous glucose monitor (CGM)): CGM helps detect hypoglycemia before it becomes critical, allowing timely intervention.
- Optimize your insulin pump settings: If you use an insulin pump, temporarily adjust the basal insulin rate for activities that lower blood sugar levels, such as exercise, to prevent hypoglycemia.
These strategies help maintain blood sugar at a safe level and minimize the risk of both high and low extremes.
If A1c is too high
- Talk to your doctor: Work with your healthcare provider to adjust your medication or insulin dosage to better manage your blood sugar levels.
- Increase physical activity: It helps to incorporate more physical activity into your daily life and lower your blood sugar levels.
- Eating a balanced diet: Focus on low-carb diets and include plenty of whole foods that are rich in fiber. Avoid processed foods and items with added sugar.
- Track carbs: If you find that carbohydrates are becoming more difficult, keep a food journal from your registered dietitian dietitian (RD/RDN) for your diet plan and seek guidance.
- Monitor your blood sugar levels: Check your blood glucose multiple times a day, or use CGM to detect hyperglycemia early.
- Optimize your insulin pump settings: If you use an insulin pump, adjust your basal speed day and night to prevent long-term hyperglycemia.
- Prioritize sleep: Aim for 7-9 hours of sleep per night to improve insulin sensitivity.
- management stress: To reduce insulin resistance, we practice stress-reducing activities such as yoga, meditation, and deep breathing exercises.
Home A1C Test
The A1C test kit can be used at home, purchased at a local pharmacy or online for convenient monitoring.
For more information on how to lower your A1C, check out this video from diabetes founder Christel Oerum. The video explains how to reduce A1c to 5.7% in 30 days following five simple steps.
