Getting your A1C checked is an important part of managing diabetes. The A1C test, also called the hemoglobin A1C or glycohemoglobin test, provides valuable information about your average blood sugar levels over the past 2-3 months. This helps you and your healthcare provider determine how well your treatment plan is working.
One common question that comes up is whether you need to fast before getting your A1C tested. The short answer is no – fasting is not required prior to A1C testing.
What is A1C?
The A1C test measures the amount of glycated hemoglobin (hemoglobin bound to glucose) in your red blood cells. Since red blood cells survive for around 3 months before being replaced, this test gives an overview of your average blood sugar over that time period.
A normal A1C level is below 5.7%. An A1C between 5.7-6.4% indicates prediabetes. A level of 6.5% or higher means you have diabetes:
- Normal: Less than 5.7%
- Prediabetes: 5.7% – 6.4%
- Diabetes: 6.5% or higher
The higher your A1C level, the higher your blood sugar has been over the past 2-3 months. Bringing your A1C down towards normal can help reduce the risk of diabetes complications.
Why fasting is not needed
Fasting is not required before A1C testing because this test does not measure your blood sugar level at a single point in time. Instead, it provides an average over a longer period.
This is different from tests like the fasting plasma glucose test or random blood sugar test. These directly measure the amount of glucose circulating in your blood right then and there. They require fasting because food intake can impact the results.
But for the A1C test, fasting or timing of your last meal does not make a significant difference. The A1C measurement remains the same regardless of food intake because it reflects your average blood sugar over months rather than hours.
When to get your A1C tested
Experts recommend that people with diabetes have their A1C checked at least twice per year. Those with very controlled diabetes who are meeting treatment goals may only need the test once or twice per year.
Testing your A1C about every 3-6 months allows you and your healthcare provider to see how well your treatment plan is working and make adjustments as needed. More frequent testing, such as every 1-2 months, may be recommended when you are first diagnosed or changing medications.
Make sure you follow your doctor’s advice on how often you should test your A1C based on your individual situation.
Key times to test A1C
- At diabetes diagnosis
- 3-6 months after starting a new medication or changing dosage
- At least twice per year when blood sugar is well-controlled
- Every 1-3 months if blood sugar is poorly controlled or you are adjusting treatment
Tips for A1C testing
Here are some tips to get the most accurate results from your A1C test:
- Have the test in the morning. A1C levels tend to be most stable after waking up.
- Use the same lab each time you test. Different labs may have slightly varied results.
- Know your average blood sugar. Tracking with a glucose meter helps interpret your A1C.
- Stay hydrated. Severe dehydration can raise A1C results.
- Avoid alcohol and certain medications. These can impact the test.
What impacts A1C results?
Certain factors unrelated to your average blood sugar can slightly impact A1C results. Your healthcare provider takes these into account when interpreting the test.
Things that can increase A1C:
- Age
- African, Hispanic, or Asian heritage
- Anemia
- Vitamin deficiencies
- Kidney disease
- Alcohol use
- Some medications
Things that can decrease A1C:
- Pregnancy
- Blood loss
- Red blood cell defects
- Hemolytic anemia
- Hypertriglyceridemia
- Uremia
- Hepatitis
Let your doctor know if you have any of these conditions so they can take them into account.
What A1C results mean
Once you get your A1C results, it’s useful to understand what they mean for your diabetes management. Here is an overview of target levels:
| A1C Level | Average Blood Sugar | Action |
|---|---|---|
| Below 5.7% | Below 117 mg/dL | Normal. Maintain treatment plan. |
| 5.7 – 6.4% | 117 – 140 mg/dL | Prediabetes. Add lifestyle changes. |
| 6.5 – 7% | 140 – 154 mg/dL | Diabetes. Start/adjust treatment plan. |
| 7 – 8% | 154 – 183 mg/dL | Moderate control. Enhance treatment. |
| 8 – 9% | 183 – 212 mg/dL | Poor control. Change treatment approach. |
| Over 9% | Over 212 mg/dL | Very poor control. Immediate treatment change. |
These ranges are general guidelines. Your target A1C may be different based on your individual medical profile and diabetes management plan. Work with your healthcare team to determine your optimal A1C goal.
How to lower A1C
If your A1C is above your target level, there are steps you can take to help improve it:
- Follow prescribed medication dosages carefully.
- Check blood sugar regularly and keep logs for your doctor.
- Attend diabetes education programs to sharpen skills.
- Eat healthy, balanced meals focusing on low GI foods.
- Increase physical activity with daily exercise.
- Lose excess weight if BMI is 25 or higher.
- Quit smoking and limit alcohol intake.
- Manage stress levels through yoga, meditation, etc.
- Get enough sleep with 7-8 hours per night.
Making lifestyle changes and optimizing medications takes time to bring down A1C levels. But sticking to your treatment plan can help get your blood sugar into a healthier range.
Risks of high A1C
Keeping your A1C in check is important because elevated levels (over 6.5-7%) increase the risk of diabetes complications:
- Nerve damage (neuropathy): Numbness, pain, tingling in hands/feet
- Kidney disease (nephropathy): Damage to blood-filtering system
- Eye disease (retinopathy): Blurred vision, blindness
- Foot damage: Ulcers, infections, bone/joint problems
- Skin conditions: Necrobiosis lipoidica diabeticorum (NLD)
- Hearing impairment: Hearing loss
- Heart disease: Increased plaque buildup, stroke, heart attack
That’s why keeping your A1C in check through diabetes management is so important – it helps reduce the likelihood of developing these serious health issues.
Other diabetes tests
In addition to the A1C test, people with diabetes need regular assessments including:
Blood sugar monitoring
Checking blood glucose levels multiple times per day helps you understand how food, exercise, stress and medication are impacting your blood sugar. This data allows you to make daily management adjustments to stay in range.
Urine protein
Microalbuminuria testing detects small amounts of protein in urine, which may indicate early kidney damage. This test is done annually in people with type 1 diabetes after 5 years duration and type 2 diabetes at diagnosis.
Eye exams
Annual dilated eye exams by an ophthalmologist check for signs of diabetic retinopathy. Early detection allows timely treatment to prevent vision loss.
Foot exams
Neurological assessment and inspection of feet/footwear is done 4 times per year to identify foot problems before they worsen.
Blood fat profile
Testing blood cholesterol and triglyceride levels can identify cardiac risk factors requiring medication management.
Key takeaways
- The A1C test measures your average blood sugar over the past 2-3 months.
- Fasting is not required for A1C testing.
- Get your A1C checked by your doctor every 3-6 months.
- An A1C of 6.5% or above indicates diabetes.
- Work to keep your A1C in your target range by following your treatment plan.
- Higher A1C levels increase the risk of diabetes complications.
The bottom line
Checking your A1C on a regular basis is important for monitoring diabetes and guiding treatment decisions. Fortunately, fasting is not required for A1C testing – so you can have this important blood test done at any time of day without skipping meals.
Work with your healthcare provider on the optimal timing and frequency of A1C checks based on your health profile and blood sugar control. Keeping your A1C within your personalized target range reduces the risk of diabetes complications and keeps you feeling your best.