At the age of 13, I was diagnosed with type 1 diabetes (I also have Celiac disease). Somewhere in my 20s—motivated by the promise of better health now, and in the long run—I started making changes to maintain a 6.0 A1C level.
I have to admit, maintaining this number wasn’t easy at first. So why go to such lengths to maintain an A1C of 6.0 when the American Diabetes Association says an A1C of 7 or less is desirable for people with type 1 and type diabetes? And the recommendation from the American Association of Clinical Endocrinologist (AACE) is less than 6.5?
That’s easy: I slept better, had fewer blood sugar highs and lows, required less insulin and felt much more energetic. When your blood sugars are running in the mid-to-high 100s every day (an A1C of 7) you might not realize just how sluggish you feel until you get them down. High blood sugars take HOURS to get back into range so if you’re working to prevent them from happening in the first place, you’re staving off a lot of stress on your body.
I also discovered that high blood sugars during sleep interfered with me getting truly restful sleep. I also felt my muscles’ ability to perform during exercise was worse. The list goes on and on.
Without becoming obsessive about my diabetes management, I’ve actually been able to maintain an average blood sugar of 125 mg/dL and an overall range of 100 to 152 mg/dL most of the time.
Periodic testing of A1C levels, which cannot be done at home, is important. Research shows that being in a healthy blood sugar range correlates with fewer complications from diabetes, such as kidney disease, diabetic neuropathy and high blood pressure later in life. In other words, better diabetes control translates into better health.
If you wind up having a high A1C level it may be surprising if your daily checks of blood glucose give you low numbers. But it’s important to remember that the A1C test measures blood glucose at all times over a 2- to 3-month period, rather than a sample of blood glucose control at the moment it is measured.
DiabeticLifestyle Editorial Board Member Amy Hess Fischl, MS, RD, LDN, BC-ADM, CDE, has a word of caution for anyone who’d like to attempt this admirable goal. “Blood glucose levels ebb and flow—I do have patients with A1C's in the 5s and 6s, but it can be a lot of work and frustration,” she says, adding that individualizing goals is the best approach because every person with diabetes is different. “To reach better A1C levels, it’s crucial to work with a diabetes educator/dietitian.”
In addition, there are some people with diabetes who should not aim for a 6.0 A1C. “This group includes anyone with hypoglycemic unawareness (the closer you are to 6.0, the higher the risk of more frequent hypoglycemia), children and senior citizens—especially those who live alone or have difficulty remembering if they took their insulin or not,” explains Hess Fischl, who practices at the Kovler Diabetes Center in Chicago.
Co-morbidities and medication also factor in/play a role in a individual’s ability to reach a 6.0. “A1C levels can be more lenient for those who have multiple co-morbidities, especially heart disease.” But regular exercise and individualized meal planning adjustments can make it easier to reduce A1C levels for many people. “For those with type 2 diabetes, not on medication with starting A1Cs in the 7s or 8s, increasing activity and working with a diabetes educator to adjust meal-planning can make it easier to reduce A1C levels,” advises Hess Fischl.
For me, it came down to some very basic and specific guidelines for managing blood sugars all day long. I’ve outlined my tried and true tips here so that you can work toward lowering your A1C.