PreDiabetes

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A hemoglobin A1C at the high end of the range — 5.6%, for example — is an early warning worth taking seriously: the A1C test shows your average blood sugar over the past two to three months, and prediabetes is driven by insulin resistance that lifestyle changes can still reverse.

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What the A1C test measures

The A1C test — also known as glycated hemoglobin, glycosylated hemoglobin, hemoglobin A1C, or HbA1c — is a common blood test used to diagnose type 1 and type 2 diabetes and, later, to gauge how well you're managing your diabetes. Unlike usual measures of blood sugar, which capture your level at a single point in time, the A1C test reflects your average blood sugar level for the past two to three months.

Specifically, the test measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher your A1C level, the poorer your blood sugar control. And the higher the A1C level, the higher your risk of diabetes complications.

In June 2009, an international committee composed of experts from the American Diabetes Association, the European Association for the Study of Diabetes, and the International Diabetes Federation recommended that the A1C test be the primary test used to diagnose prediabetes, type 1, and type 2 diabetes. After a diabetes diagnosis, the A1C test is used to monitor your diabetes treatment plan — because it measures your average blood sugar over months rather than at a moment, it indicates how well your treatment plan is working overall.

What the numbers mean

For someone who doesn't have diabetes, a normal A1C level is about 5 percent, although it can range from 4.5 to 6 percent. Someone who has had uncontrolled diabetes for a long time might have an A1C level as high as 25 percent. When the A1C test is used to diagnose diabetes, an A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes.

An A1C at the high end of the range — 5.6%, for instance — comes in at less than 6, so technically you do not have prediabetes. But a fasting glucose level of 105 mg/dL indicates a high risk of developing diabetes, and that combination is a signal to act now rather than wait.

Prediabetes and insulin resistance

Prediabetes is linked to your body's metabolism and to a condition called insulin resistance. Insulin is a hormone made by your pancreas that helps control the amount of sugar in your bloodstream. Normally, your digestive system breaks down the foods you eat into sugar (glucose). Your blood carries the glucose to your body's tissues, where the cells use it as fuel — and glucose enters your cells with the help of insulin.

In people with insulin resistance, cells don't respond normally to insulin, and glucose can't enter the cells as easily. Your body reacts by churning out more and more insulin to help glucose get into your cells, and the result is higher-than-normal levels of insulin in your blood. This can eventually lead to diabetes, when your body is unable to make enough insulin to control the blood glucose to the normal range.

Increased insulin also raises your triglyceride level and other blood fat levels, and it interferes with how your kidneys work, leading to higher blood pressure. These combined effects of insulin resistance put you at risk of heart disease, stroke, diabetes, and other conditions.

Turning it around

The encouraging news is that prediabetes responds to action. Aggressive lifestyle changes, conditioning, exercise, hormone balance, and the use of certain supplements will improve all of your pre-diabetes syndrome components — before medication or a diabetes diagnosis enters the picture.

About the author

Allen Smolenski, M.D.

Emergency Medicine physician and founder of Coastal Medical Clinic in Surfside Beach (2009). After losing nearly 60 pounds himself — and placing third in his class at the 2008 NPC Natural Northern USA Bodybuilding Contest — he completed a fellowship in Anti-Aging and Regenerative Medicine through the A4M, and now helps patients across the Grand Strand optimize their hormones, metabolism, and long-term health.

Meet Dr. Smolenski →