The glycated hemoglobin A1c (HbA1c) test, or the A1c test for short, is a blood test that gives you the average blood glucose level over the past 2-3 months.
This is a standard test that people with diabetes routinely have to assess their overall blood sugar management and adjust their treatment plans.
But what is a dangerous level of A1c? In this article, we’ll explore A1c levels, which are considered both low and high, and what to do to improve your level if it’s at dangerous levels.
What is A1c?
A1c is a blood test that is usually done in a laboratory and measures the amount of hemoglobin in the blood.
Hemoglobin is a protein found in red blood cells and gives blood its red color. It carries oxygen throughout the body and is critical to good health.
This test measures the average amount of blood glucose bound to hemoglobin in red blood cells over the last few months. Red blood cells regenerate every 3 months, so the test will only show the average blood glucose level for the last 2-3 months.
It is usually leaning toward the weeks before the test.
What is the meaning of A1c?
The A1c test helps diagnose diabetes
A1c is an important tool for diagnosing type 1 and type 2 diabetes, pre-diabetes and sometimes even gestational diabetes.
If your results show pre-diabetes, your doctor will probably recommend repeating the A1c test annually or semi-annually. Additionally, for people age 45 and older, the Centers for Disease Control and Prevention (CDC) recommends an A1c test every 3 years.
If you have prediabetes, you should talk to your doctor about steps you can take to reduce your risk of developing diabetes.
Your doctor may recommend an A1c test if you are under 45 but have certain risk factors for diabetes, including:
- Overweight or obese
- Having a family history of diabetes
- Having hypertension (high blood pressure)
- She previously had gestational diabetes
- They are an ethnic minority
- Heart diseases
- Be sedentary/lack of physical activity
Contact your doctor immediately if you experience the following symptoms, as these are symptoms of diabetes:
Your doctor may recommend taking an A1c test or seeking emergency medical attention, depending on the severity of your symptoms.
You can also test your HbA1c at home with a test kit that you can buy at your local pharmacy or online.
The A1c test determines overall diabetes control
For people with existing diabetes, a quarterly A1c test is usually ordered to determine average blood sugar levels and overall diabetes control over the past 3 months.
A1c tests are great at detecting whether your blood sugar is consistently high or low and can help you change your diabetes treatment to prevent complications such as heart disease, retinopathy, neuropathy, kidney disease and premature death.
However, since the A1c test is only an average of blood sugar over the last 3 months, it will average all high blood sugar levels with all low blood sugar levels. This can potentially give you a false sense of accomplishment if you’re actually riding a blood sugar rollercoaster most days!
However, if your blood sugar is moderately stable, it can give you a good sense of how well you are doing at keeping your blood sugar in the right range.
What are the different levels of A1c?
The American Diabetes Association uses the following definition to determine if you have diabetes or prediabetes:
- Normal, without diabetes: HbA1c below 5.7%
- Prediabetes: HbA1c between 5.7% and 6.4%
- Diabetes: A1c 6.5% or more
Individual A1c targets will vary from person to person. For example, for someone who doesn’t detect low blood sugar, or for someone with diabetes who lives alone, their doctor may recommend a slightly higher A1c value.
On the other hand, for a person with existing diabetes who is pregnant, an HbA1c of or less than 6% is ideal as long as he or she is not experiencing blood sugar levels that are too low.
The American Diabetes Association (ADA) recommends that HbA1c be kept below 7% to prevent diabetes complications in adults and below 7.5% in children.
What is a dangerous level of A1c?
Both too high and too low levels of A1c carry dangers. Always work with your doctor to determine what level of A1c you should be aiming for based on your lifestyle, health goals, and life stage. However, some dangerous ranges would be best avoided.
A1c below 5%
As diabetes management becomes more precise with faster insulins, closed-loop insulin pumps, continuous glucose monitoring (CGM) systems, and better access to diabetes self-management education (DSME), people with diabetes are achieving lower A1c values than ever before .
This is a great achievement if you don’t experience too many low blood sugar levels.
Remember that A1c is simply your average blood sugar over the past three months, so if your A1c is below 5%, you may be having too many lows.
Even if you don’t experience severe low blood sugar, which is common if you’re older, live alone, have trouble detecting low blood sugar (hypo-unconscious), or don’t have a continuous glucose monitor (CGM) with low-level alerts turned on, HbA1c levels that low can be dangerous.
5% A1c indicates that the average blood sugar level is only 97 mg/dl.
This means that even a moderate walk or a hot shower can cause your blood sugar to drop sharply at any time, which can be risky.
Low blood sugar can lead to serious complications of diabetes, including diabetic coma and death, so it’s important to prevent severe low blood sugar and have access to fast-acting glucose or glucagon for emergencies.
If you live alone, are elderly, suffer from hypo-unconsciousness, do not have a CGM, or are simply experiencing too many lows, talk to your doctor about lowering your insulin doses to prevent dangerous drops and increase your HbA1c.
Note: Pregnant women may have A1c below 5%, and if they are not experiencing too low blood sugar, this may be fine.
Also, at the onset of a type 1 diabetes diagnosis, many people experience what is known as the “honeymoon phase” where their pancreas is still secreting some insulin and they may have very low A1c values for the first few months to a year after diagnosis.
This is normal, but if you are on your honeymoon with blood sugar levels that are too low, talk to your doctor.
A1c higher than 7%
While the ADA recommends that most adults maintain an HbA1c of 7% or less (and children maintain an HbA1c of 7.5% or less), this is not always possible.
Competing priorities, money, time, energy, hormones, work, school, stress, and everyday life make managing diabetes really hard, and sometimes we struggle with higher than ideal blood sugar levels, and that’s okay!
A1c is 7%, which means an average blood sugar of 154 mg/dL, and A1c0f is 7.5% if the average blood sugar is 169 mg/dL. does not always finish meals, or an adult who has difficulty detecting dangerously low blood sugar).
In most cases, especially during busy or stressful periods of life, an HbA1c of 7-8% is not dangerous and does not cause any health problems.
A1c higher than 9%
However, numbers much higher than 9% may start to put you at risk for diabetes complications later in life.
According to the American Diabetes Association’s 2022 Standards of Medical Care for Diabetes, an A1c of 9% increases the risk of blindness, heart attack, nerve damage, and kidney failure.
A1c is 9%, which corresponds to an average blood sugar level of 212 mg/dl.
The higher the HbA1c level, the more dangerous it is and the more likely you are to suffer from diabetes complications.
Below are the levels of A1c to average blood sugar:
10% = 240 mg/dl
11% = 269 mg/dL
12% = 298 mg/dL
13% = 326 mg/dL
14% = 355 mg/dL
For more detailed information, read on How to translate A1c into blood sugar.
Prolonged high blood sugar levels over time can lead to serious diabetes complications such as retinopathy, neuropathy, heart disease, kidney disease, lower limb amputations, stroke, and even premature death.
If you have difficulty getting your A1c down, talk to your doctor about increasing or changing your medication regimen, diet, physical activity level, addressing any mental health issues, or suggesting other ways to help you better control your blood sugar.
Note: At diagnosis, especially with type 1 diabetes, the person usually has a very high A1c level.
This does not automatically mean that you will suffer from the long-term complications of diabetes. Usually, after a few months of insulin therapy and treatment, the A1c level drops extremely quickly and there is no risk of serious complications in the future.
Ways to increase A1c security
There are ways to both increase and decrease A1c if you fall into the danger zone.
If the A1c concentration is too low
- Work with your doctor to reduce your medication and/or insulin doses
- Reduce the amount of exercise you do if you are struggling with post-exercise lows
- Increase the amount of protein and fat in your diet to prevent low blood sugar levels overnight
- If you don’t already have one, use CGM to catch low blood sugar before they become dangerous
- Use an insulin pump and use temporary base settings during exercise and other physical activities to help prevent low blood sugar
If the A1c value is too high
- Work with your doctor to increase your medication and/or insulin dose
- Increase the amount of physical activity you do each day
- Eat lower carb meals and eat plenty of whole foods with fiber
- If you have trouble counting carbs, keep a food diary and work with a Registered Dietitian (RD) to help you plan your meals
- Avoid processed foods and foods and drinks with added sugar
- Check your blood sugar several times a day or use CGM to catch high blood sugar more quickly
- Utilize an insulin pump that can use different basal rates throughout the day and night to prevent prolonged high blood sugar
- Get enough sleep (try to sleep 7 to 9 hours a night for better insulin sensitivity)
- Manage stress with yoga, meditation and breathing to reduce insulin resistance
summary
While there is a lot of talk about the dangers of high HbA1c, little is said about the dangers of low HbA1c, and there is much confusion about what is really dangerous and what to do about it.
For most people, a good and safe level of A1c is between 5-8%, although this can vary from person to person.
If you are pregnant your HbA1c should be lower, and if you live alone or struggle with low blood sugar your doctor may want your HbA1c higher.
However, A1c, which is routinely below 5%, can pose the danger of having too many and too severely low blood sugar levels, which can cause diabetic coma and death.
An A1c of 9% or higher increases the risk of diabetes complications, including heart disease and heart attack, stroke, retinopathy and blindness, nerve damage and amputations, kidney disease and kidney failure, and ultimately premature death.
Work with your doctor to adjust your medications, increase or decrease your physical activity, change your diet, and better regulate sleep and stress to help you reach your A1c goal.
While there is no “perfect” HbA1c, no one should live with HbA1c at dangerous levels that are detrimental to health and well-being.
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