5 ways to lower A1C and manage your blood-sugar levels
- To lower A1C levels, you may need to lose weight, get regular exercise, regulate your carbohydrate intake, take insulin, or use medication like metformin.
- A1C levels measure your blood sugar over a period of about 12 weeks and are an important indicator for people with type 1 or type 2
diabetes, as well as those at risk.
- This article was reviewed by Jason R. McKnight, MD, MS, a family-medicine physician and clinical assistant professor at Texas A&M College of Medicine.
An A1C test measures the amount of glucose in your blood over the previous 12 weeks. This is important because it provides a long-term measure of blood-sugar levels, which are used to diagnose and manage diabetes or prediabetes.
Those with type 1 or type 2 diabetes should have their A1C levels measured about every three months. If you're at an increased risk, you should have A1C measured twice a year, says Dr. Charles Richardson, the CEO of Cleveland Diabetes Care.
Through an A1C test, early detection of elevated blood-sugar levels can help reduce the risk of
What is A1C?
A1C represents the amount of glycosylated hemoglobin in your blood. This is the amount of glucose that becomes attached to hemoglobin, a protein in red blood cells.
Over the normal 90-day life cycle of a red blood cell, glucose attaches faster in people with higher blood-sugar levels, Richardson explains. A1C measures the percentage of red blood cells that have hemoglobin that is coated with sugar, and it is an important marker of blood sugar.
Otherwise-healthy adults who are overweight — a risk factor for type 2 diabetes — should have their A1C measured every three years by having the doctor order blood work to test A1C. People who have no risk factors for diabetes and are not overweight do not need to check their A1C unless they or their doctor have cause for concern.
People with diabetes should have A1C measured about every three months, and more often if they have trouble controlling their blood sugars or if they are changing diabetes treatments.
Normal A1C levels
Your A1C levels can indicate the following:
- Normal: 5.6% or lower
- Prediabetes: 5.7% to 6.4%
- Diabetes: 6.5% or higher
If you receive a diagnosis of diabetes or prediabetes, your doctor will work with you to set an individual target for your A1C levels. Most people with diabetes have a target A1C level of less than 7%. Doctors might set a higher goal for people with other health conditions like heart disease.
If you have diabetes or prediabetes, lowering your A1C is important. In fact, each percentage-point decrease in A1C levels can reduce risk of long-term complications from diabetes by 40%, according to the American Diabetes Association.
Richardson says the amount considered a significant reduction varies from individual to individual, so you should work with your doctor to set a personal goal. Dropping your A1C by even half a percentage point can have significant benefits, he says.
How to lower A1C
Your A1C levels are lowered when you reduce your average blood-glucose levels. This can be done through lifestyle changes and medication.
"With a multidisciplinary approach including optimal nutrition, implementing an exercise regimen, and diabetic medication, most patients can lower the hemoglobin A1C," Richardson says.
Here are a few of the most effective ways to lower your A1C levels:
1. Lose weight
Losing weight can help you better control your blood sugars and lower your A1C levels.
A 2012 study published in the journal Diabetes Education found that losing 10% of body weight was linked to a 0.81% decrease in A1C levels for patients with type 2 diabetes.
2. Exercise regularly
"Exercising helps the body absorb glucose from the bloodstream and can help to make the body more efficient at accessing and utilizing glucose," says Claudia Hleap, a registered dietitian based in Philadelphia who regularly works with patients to lower their A1C levels.
A 2017 study published in BMJ Open Diabetes Research and Care followed 65 patients with type 2 diabetes over eight years. One group completed 90-minute exercise sessions three times a week. Their A1C levels decreased by as much as 1.84%, and researchers concluded that people who exercised reduced their A1C more consistently than those who did not.
3. Count carbohydrates
Working with a dietitian to create an eating plan can help you lower A1C levels. In particular, people with diabetes and prediabetes need to monitor the amount of carbohydrates they eat, since carbs have the greatest effect on blood sugar.
"It is essential to undergo diet education in order to understand how eating certain foods will affect your blood sugars," Hleap says. "Using this knowledge, it is important to move towards a consistent and controlled carbohydrate diet, in order to create lifelong sustainable dietary changes."
A 2014 scientific review published in The Lancet Diabetes and Endocrinology found that people with type 1 diabetes who counted carbohydrates reduced their A1C levels 0.64% more than people who did not count carbs.
For more information, read about how many carbs you should have a day if you're diabetic.
4. Take oral diabetes medication
Oral diabetes medications, like metformin, can reduce your A1C levels. A widely cited 2012 scientific review in Diabetes Care found that metformin reduced A1C by an average of 1.12% for people with type 2 diabetes.
In addition, a 2019 study published in the Pakistan Journal of Medical Sciences followed 200 patients with type 2 diabetes. All of them saw their A1C levels drop within three months of taking metformin at the dose prescribed by their doctors, with the biggest decreases for people with higher starting A1C levels.
5. Use insulin
If your initial A1C levels are higher than 9% — most commonly for people with previously undiagnosed diabetes — your doctor might recommend starting insulin right away.
A 2010 scientific review published in Diabetes Technology and Therapeutics found that insulin regimens reduced A1C by an average of 1.4% for type 2 diabetics.
Measuring A1C levels is an important way to monitor prediabetes and reduce your risk for diabetes complications. Working with a dietitian and your doctor can help you develop a plan to lower your A1C levels, but having patience is also important, Hleap says.
"Your hemoglobin A1C will not change overnight," she says. "It is essential to make small and realistic changes one step at a time to ensure that the modifications you're making to your diet and exercise regimen will be sustainable for the long term. These suggestions take time to implement. Mindset is important in making and sustaining these changes for the long haul."
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