The primary measurement doctors use for testing blood sugar regulation is known as fasting glucose. Fasting in this case means the patient has not consumed any food or drink for the past 12 hours so we have a baseline, in between meals reading. Glucose, the simple carbohydrate that is the preferred source of fuel for nearly all cells in our body, is transported through the bloodstream in order to be distributed to all of those cells. A concentration of glucose between 65 and 99 mg per deciliter of blood is generally considered good and healthy, although I personally don’t like to see it rise above 90.
What if your glucose level is always within the normal range, but one time you were really stressed or scared while your blood was being drawn? Given that our glucose level tends to increase when we are stressed, your blood sugar would very likely be higher than normal. Maybe it would even be in the diabetic range, in other words 125 mg/dl or greater. Does that mean you should start medical treatment for diabetes? Probably not. But how can you know for sure if your glucose was just high at the time your blood was drawn, or if there really is a problem overall? This is one situation where a test known as A1c comes in handy.
(Hemoglobin) A1c is a measurement of the average blood sugar level over the past few months. While being stressed at the time of a blood draw can exert a major influence over your immediate glucose level, those 10 or 20 minutes of elevated glucose will not affect the average measurement over the past few months. If A1c was measured in the same blood draw and was in the appropriately low range, that would confirm that your unusually high glucose reading was indeed unusual, and therefore nothing to worry about. Without the A1c measurement, you are still left wondering.
I have seen this type of benefit by measuring A1c in my clinical practice. I have also seen it occur the other way around, where a patient had an appropriately low glucose reading, but elevated A1c. In that case we knew there was a problem, even though the glucose measurement did not indicate it. From there we began a discussion about which dietary changes are most favorable for blood sugar to be regulated most effectively in the body. That discussion centers around insulin resistance vs. insulin sensitivity, and how the fats we do and don’t consume affect that, in addition to exercise, sleep, stress, etc. It does NOT center around avoiding carbohydrates, although making the distinction between healthy sources of carbohydrates and unhealthy ones does come into play. One of my favorite parts of going over lab results with patients is looking at the usually excellent blood sugar numbers such as glucose and A1c in high fruit eaters, but that is another story…
The bottom line for this article is that A1c can often be a very useful test when analyzed by a clinician who knows how to utilize it appropriately. Fasting glucose is very useful as well, and in certain circumstances can take the lead over A1c. In our Mastering Raw Food Nutrition curriculum, we go into a great deal of depth about the ins and outs of glucose, A1c and how it can tell the average blood sugar level, insulin, insulin resistance vs. insulin sensitivity, insulin receptor function in the cell membrane, how the fats we eat affect this and which ones to include more of in your diet and which ones to include less of, fruit, vegetables, fiber, etc. Even though it is less important than many other factors, we even discuss the glycemic index within the appropriate perspective of plant based and raw food diets and all the other variables listed above.
We hope you have enjoyed this tidbit about the usefulness of the hemoglobin A1c test!
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4 thoughts on “Blood Sugar Regulation: What is A1c?”
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Interestingly, my fasting blood glucose was testing high month after month after month, usually at 99, but sometimes even higher, despite the fact that there was no good reason for me to have high blood glucose, considering my diet and lifestyle. Rather than testing A1c I ended up buying a $40 home blood glucose test kit (one that is marketed to people with diabetes), so that I could test my blood regularly and without the stress of being at the lab, and for much less money. Turns out that my fasting blood glucose is actually generally in the 70s! I simply get too stressed out when going to the lab, which elevates my blood glucose.
Hi Doug. You may have heard the term "white coat hypertension." It simply means the doctor makes the patient nervous and their blood pressure goes up, even though it is not normally high. It sounds like you have experienced "white coat hyperglycemia!" Your experience is a perfect example of what I discussed in the article. That was wise to do your own testing. As the article points out, your A1c would not have been affected by this few minutes of elevated glucose due to stress so when I see elevated fasting glucose but healthfully low A1c I know there was a situation such as yours at hand. That is one of A1c's real attributes. Testing on your own has many attributes as well, one of which you have pointed out here, so well done!
I enjoyed your article on A1c and sugar regulation. You discussed what you like to see for fasting blood sugar numbers, however, what do you like to see for an optimum A1c number?
Thank you Paula. I am very happy when I see A1c numbers in the 4's. Lower 5's is not quite ideal but not too unreasonable either. By the mid 5's I am starting to get concerned. Above that, there is some work to do! That's super general though, and every situation is a little different.