What Is HbA1c and A Normal HbA1c Range? Explained In Plain English

HbA1c Explained in Plain English

HbA1c is a marker used to measure long-term blood sugar (glucose) levels.

Those with type 1 or type 2 diabetes may have seen it before, but what is a normal HbA1c range?

This article explores what your HbA1c reading should be and how you can improve it.

What is HbA1c (Hemoglobin A1c)?

What is HbA1cHbA1c is a marker that can determine your average blood sugar (glucose) levels over the previous 3-months (1).

That means it can be used to assess the quality of your diabetes management, as well as to diagnose pre-diabetes and diabetes.

Sometimes HbA1c is also called glycated hemoglobin, hemoglobin A1c or just A1c.

The ‘Hb’ refers to hemoglobin, a part of red blood cells that carry oxygen throughout your body.

‘A1c’ refers to a minor part of hemoglobin that sugar molecules attach to.

The amount of sugar attached is directly proportional to the amount of sugar in your blood at a given time, so this reading is used to accurately reflect average blood sugar levels.

If you’ve had high blood sugar levels in the past month or so, your HbA1c levels will be higher too.

Summary: HbA1c is a marker that reflects your average blood sugar levels in the previous 3 months. It’s also called glycated hemoglobin, hemoglobin A1c or just A1c.

Normal HbA1c Range

Normal Hba1c rangeThe HbA1c test is measured as either a percentage or in mmol/mol.

Below I’ve listed what is considered a normal HbA1c range, and what values would be considered outside of normal (pre-diabetic or diabetic):

HbA1c range for normal (non-diabetic) adults:

  • Below 6.0%, or below 42 mmol/mol

HbA1c range for pre-diabetes:

  • 6.0% to 6.4%, or 42 to 47 mmol/mol

HbA1c range for diabetes:

  • 6.5% or above, or 48 mmol/mol or above.

Target ranges are also shown below in this table:

HbA1c

%

mmol/mol

Normal Below 6.0% Below 42 mmol/mol
Pre-diabetes 6.0% to 6.4% 42 to 47 mmol/mol
Diabetes 6.5% or above 48 mmol/mol or above

 

Normal HbA1c Range For Diabetes

Those with diabetes are advised to aim for a HbA1c level of:

  • 6.5% or 48 mmol/mol.

A value lower than this 6.5% target indicates great blood sugar control, a value higher indicates the need for improvement.

Now this range is 0.5% higher than the normal range given for those without diabetes, as it’s unlikely that diabetes patients can match that exact same blood sugar control.

In fact, some experts believe a more realistic healthy range for diabetics should be 7-7.5%.

Summary: The normal HbA1c range is below 6.0% for the average adult, and 6.5% or less for those with diabetes. Some argue the the normal range should be slightly higher for diabetics.

Testing HbA1c Levels vs Blood Glucose Finger Prick

Blood glucose finger prick testThe typical fasting blood glucose finger prick shows your blood sugar levels right at that moment.

These are (confusingly) measured in mmol/L or mg/dL.

Measuring HbA1c levels instantly provides a bigger picture view, kind of like an average of your blood sugar levels over the past 3 months.

It’s usually taken from your regular arm blood test rather than the finger prick.

This HbA1c chart shows how the different tests correlate with one another. HbA1c levels are shown at the top, and blood glucose (the finger prick test) is shown below:

hba1c diabetes control chart

Click to enlarge. Image source.

As an example, if your average blood glucose (sugar) reading in the finger prick tests is around 10.0 mmol/L, then your HbA1c level will be about 8%.

Said another way, if you get a HbA1c of 9% then we know your average blood glucose level is about 11.8 mmol/L for the past few months.

Here’s another HbA1c chart that shows those comparisons side-by-side:

HbA1c levels (%)

HbA1c levels (mmol/mol) Blood Glucose (mmol/L)

13

119

18

12

108

17

11

97

15

10

86

13

9

75 12

8

64

10

7

53

8

6

42

7

Summary: The blood glucose finger prick shows your current blood sugar levels, whereas HbA1c is representative of your previous 3-month average.

Risks of a High HbA1c Levels

HbA1c is an important marker because it can estimate the health risks associated with high blood sugar levels.

risks of HbA1c and diabetes complications

Studies show those who can lower their HbA1c by just 1% (11 mmol/mol) will (2, 3):

  • reduce their risk of neuropathy (damage to nerve endings) by 25%
  • reduce their risk of retinopathy (damage to eye retina) by 25%
  • reduce their risk of diabetic nephropathy (kidney disease) by 25%
  • reduce their risk of heart failure by 15% for every 1% drop in HbA1c
  • reduce their risk amputations and vascular disease by 43%
  • reduce their risk of cataracts by 19%.

These numbers are based on observational data and therefore would vary somewhat between people. But they paint a powerful picture.

For example, reducing your HbA1c from 9% to 7% will cut your risk of neuropathy, retinopathy, nephropathy by half and almost all chance of vascular disease. Risk of heart failure and cataracts is also slashed by up to 38%.

Summary: HbA1c is a strong predictor of various major health issues related to diabetes.

Improving HbA1c and Diabetes Management

If you’re showing signs of high blood sugars or have a high HbA1c level then there are many things you can try (other than medications like metformin).

Regular exercise is very important, as is maintaining a healthy weight.

But I’d argue that diet changes should be your first priority. Consider:

HbA1c Explained in Plain English (1)

Comments

  1. To convert blood glucose in mmol/L to mg/dL multiply by 18.
    Leave it up to the “scientists” to come up with a method of expressing a value so that it is meaningless to the average person.

  2. Don’t you know that Type 2 Diabetes (diabetes) is merely a side effect of insulin resistance? In fact, I’ve read that most diabetics -at least in the early stages – have above normal insulin levels that cause as much or more damage to the body than high blood glucose (bg) levels.

    You recommend “reducing your carbohydrate intake (after speaking with your doctor)”. Well “your doctor” is going to be against carb restriction. He has succumbed to the American Diabetes Assn’s high-carb, low fat diet and he’s never seen anyone with diabetes get anything but worse over time. He thinks that’s all that can be done. Everything else is dangerous.

    The reason the recommended target A1c level is well into the diabetic range is that trying to force bg down by giving insulin stimulating drugs or giving insulin to people with insulin resistance who already have insulin levels in the harmful range will only make them sicker sooner. It’s not the A1c <6.0 that is harmful, it’s the method used to get there. After all, there are many people walking around with A1c <5 who are perfectly healthy.

    In my opinion, you only need the doctor to help you reduce your carb intake without suffering dangerous hypos. If you have to, test your blood sugar after every meal for a week and show him which specific foods spike your bg. Tell him you are going to eliminate those foods from your diet. If he won’t help you reduce your medications to keep from having hypos tell him you will go find a doctor who will.

    Or perhaps the patient could acquaint the doctor with the scientific studies linked on the LCHF website, The Diet Doctor.

    Well, dinner’s ready. Gotta go.
    Regards,
    Bill

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