Understanding HbA1c: What Your Results Really Mean

Have you ever looked at your lab results and wondered, “What does this HbA1c number even mean?” You’re not alone. It’s one of those medical terms that gets thrown around a lot in diabetes care — but unless someone explains it in real-world language, it’s easy to feel lost.

Let’s break it down together — simply, clearly, and with a little dose of common sense.


What Is HbA1c and Why Is It Important?

HbA1c stands for glycated haemoglobin — but don’t let the fancy term scare you. In plain English, it’s a way to measure how much sugar has been sticking to your red blood cells over time. It’s like a three-month report card for your blood sugar levels.

Why does this matter? Because unlike a one-time glucose reading that can change depending on what you just ate, HbA1c gives a long-term view. It helps doctors understand whether your diabetes is under control — or quietly causing trouble.


How the HbA1c Test Works

Here’s a quick visual: imagine your red blood cells as little delivery trucks moving around your body. If there’s too much sugar in your blood, some of it sticks to those trucks. The more sugar that sticks, the higher your HbA1c.

The test is a simple blood draw — no fasting required. Once the sample is analysed, you’ll get a percentage that reflects how much glucose has been hanging around with your red blood cells for the past 8 to 12 weeks.


What Do HbA1c Results Mean?

Now let’s decode the numbers:

HbA1c (%)HbA1c (mmol/mol)What It Means
Below 5.7%Below 39 mmol/molNormal
5.7%–6.4%39–46 mmol/molPrediabetes (higher risk)
6.5% or more48 mmol/mol or moreDiabetes diagnosis likely

So, if your HbA1c is 7.2%, it means your average blood sugar has been running higher than it should — for a while.

But don’t panic. These numbers are not a judgment; they’re a starting point for action.


HbA1c vs Daily Glucose Testing: What’s the Difference?

You might ask: if I already check my blood sugar every day, why bother with an HbA1c test?

Great question.

Daily glucose checks give you snapshots — a single moment in time. But HbA1c? It’s the movie reel. It shows how your sugar has behaved over weeks and months.

  • Daily glucose: Good for adjusting meals or insulin on the go.
  • HbA1c: Good for tracking trends and long-term control.

Think of it like weighing yourself daily vs. looking at your average weight over 3 months. Both matter — but they serve different purposes.


Target HbA1c Levels: What Should You Aim For?

Here’s where it gets personal. The ideal HbA1c target can vary depending on your health, age, and lifestyle.

  • For most adults with diabetes: Under 7.0% (53 mmol/mol)
  • Older adults or those with other illnesses: Under 8.0% is often acceptable
  • Pregnancy: Usually under 6.0% to protect both mother and baby
  • Children with diabetes: The target may be a bit higher to avoid low blood sugars

Your doctor will work with you to find a target that fits your life, not just the textbook.


Why Your HbA1c Might Be High (Even If You Feel Fine)

Here’s the kicker: you might feel absolutely normal, but your HbA1c tells another story.

Why does this happen?

  • You’re used to high sugars and don’t feel symptoms anymore
  • You skip finger-prick tests and miss the highs
  • Stress, poor sleep, or hidden snacking is creeping in
  • Your medication isn’t working as well anymore

That’s why routine checks matter — they spot problems before you feel them.


Can HbA1c Be Too Low? Here’s What That Means

We often focus on high numbers, but low HbA1c can also raise red flags.

If it drops below 5.0% and you have diabetes, it could mean:

  • You’re overmedicated
  • You’re having frequent hypoglycaemia (low sugar episodes)
  • Your diet is too restricted

An unusually low HbA1c can actually be more dangerous than a slightly high one — especially in older adults.


Factors That Can Affect HbA1c Accuracy

Like most things in medicine, HbA1c isn’t perfect. Certain conditions can throw off the results:

  • Anaemia or iron deficiency
  • Kidney disease
  • Liver disorders
  • Pregnancy
  • Ethnic differences (some populations have slightly higher or lower levels even at same blood sugar)

Always interpret results in context. If your numbers don’t match how you’re feeling, ask your doctor to dig deeper.


How Often Should You Check Your HbA1c?

Generally, people with stable diabetes should test their HbA1c every 6 months. But in certain situations, more frequent testing — every 3 months — is better:

  • Starting a new treatment
  • Changing lifestyle habits
  • Struggling to reach goals
  • Pregnancy or planning for it

Bottom line? Don’t wait a whole year if things aren’t going well.


Tips to Lower Your HbA1c Naturally

The good news is, you can bring your HbA1c down — and it doesn’t have to be extreme. Small steps, done consistently, lead to real change.

Here’s what works:

  • Eat smart: Prioritise whole foods, lean protein, and fibre. Watch your carbs, but don’t fear them.
  • Get moving: Aim for at least 30 minutes of activity most days. Even walking helps.
  • Take your meds: As prescribed. No skipping, no guessing.
  • Manage stress: Deep breaths, short walks, or simply saying “no” when you need to
  • Sleep well: Poor sleep raises cortisol — which can push sugar up.

Is it easy? Not always. But is it possible? Absolutely.


Is HbA1c Enough on Its Own? When Other Tests Are Needed

HbA1c is a powerful tool — but it doesn’t tell the whole story. Sometimes, your doctor might suggest other tests:

  • Fasting blood glucose: Especially useful in early diagnosis
  • Fructosamine: Reflects sugar levels over 2–3 weeks instead of 3 months
  • Continuous Glucose Monitoring (CGM): For people who want real-time feedback
  • Oral glucose tolerance test (OGTT): Often used during pregnancy

If your HbA1c looks fine but you’re feeling “off,” don’t ignore it. Ask for a broader workup.


Talking to Your Doctor: Questions to Ask About Your HbA1c

Not sure what to say at your next appointment? Here are a few helpful questions:

  • What does my current HbA1c tell us?
  • Is my target range realistic?
  • What could be causing any changes in my results?
  • Should we adjust my medication or lifestyle?
  • Are there other tests I should consider?

Remember, your doctor is your teammate — not a judge. Bring your questions, your notes, and your honesty.


Final Thoughts

Understanding your HbA1c isn’t about numbers for the sake of numbers. It’s about living longer, feeling better, and staying in charge of your health. Whether you’re newly diagnosed or have lived with diabetes for years, taking time to understand what this test shows — and what it doesn’t — can make all the difference.

Because when you know better, you can do better.


References

  1. “Hemoglobin A1c (HbA1c) Test” – Mayo Clinic, 2024. https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643
  2. “Understanding A1C: A Guide for People with Diabetes” – American Diabetes Association, 2023. https://www.diabetes.org/a1c
  3. “A1C Test: Everything You Need to Know” – Cleveland Clinic, 2022. https://my.clevelandclinic.org/health/diagnostics/21760-a1c-test
  4. “Factors That Affect A1C Levels” – National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 2021. https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test
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