A glycated hemoglobin A1c test (HbA1c), or simply an A1c test, measures your average blood glucose levels over the past 2 to 3 months.
It’s a standard test that people with diabetes routinely undergo to assess how well they’re managing their blood sugar levels and to make necessary adjustments to their treatment plans.
But what constitutes a dangerous level of A1c? In this article, we will explore the A1c levels that are considered too low or too high, and discuss strategies to improve your levels if they are deemed dangerous.
What is an A1c?
The A1c measures the average amount of glucose that has attached to the hemoglobin in your red blood cells over the past 2 to 3 months.
Hemoglobin, a protein that gives blood its red color, carries oxygen throughout your body and is essential for maintaining good health.
Red blood cells regenerate approximately every 3 months, which is why the A1c test reflects your average blood glucose levels for this period.
The results are typically more influenced by glucose levels in the several weeks immediately preceding the test.
Read more in: How to Lower Your A1c: The Complete Guide and How to Lower A1c Naturally.
What are the different A1c levels?
The American Diabetes Association categorizes A1c levels to help identify diabetes management status:
- Normal (No Diabetes): A1c below 5.7 percent
- Prediabetes: A1c between 5.7 percent and 6.4 percent
- Diabetes: A1c of 6.5 percent or higher
Individual A1c goals can vary depending on personal health circumstances. For instance, a higher A1c may be recommended for people who live alone or have difficulty detecting low blood sugars (a condition known as hypoglycemia unawareness).
For pregnant women with diabetes, it is often recommended to maintain an A1c as close to 6 percent as is safely achievable to minimize the risk of complications during pregnancy, as long as tight control does not lead to frequent hypoglycemia (low blood sugar).
The ADA recommends that adults maintain an A1c below 7 percent to prevent complications associated with diabetes, while children should aim for an A1c below 7.5 percent.
What is a dangerous A1c level?
Managing A1c levels is important, as both high and low levels carry significant health risks. It’s essential to work with your doctor to determine your ideal A1c target, which will vary based on your lifestyle, health goals, and life stage.
Learn more in: Blood Sugar Chart: Blood Sugar and A1c Targets.
An A1c lower than 5 percent
An A1c lower than 5 percent in people with diabetes is uncommon and, while commendable, levels under 5 percent could indicate frequent hypoglycemia.
This situation becomes particularly concerning if you are older, live alone, or have difficulty detecting when your blood sugar levels are low.
In these scenarios, the consequences of hypoglycemia can be more dangerous, potentially leading to severe outcomes such as diabetic coma or death.
If you often experience low blood sugars, it is crucial to discuss the possibility of adjusting your insulin doses with your doctor to maintain your A1c at a safer level without frequent lows.
It’s important to note that people newly diagnosed with type 1 diabetes may temporarily exhibit very low A1c levels during what is known as the “honeymoon phase.” This period occurs when the pancreas still produces some insulin.
An A1c higher than 7 percent
The ADA recommends that most adults aim to keep their A1c below 7 percent to prevent diabetes-related complications. For children, the goal is typically set below 7 to 7.5 percent, depending on the individual situation, reflecting the need to balance blood sugar management with the risk of hypoglycemia.
However, managing diabetes effectively can be challenging due to various life factors. While an A1c between 7 percent and 8 percent exceeds the ideal target, it may not immediately lead to complications.
Nonetheless, it is important to aim for lower levels to reduce the long-term risk of diabetes-related health issues.
An A1c higher than 9 percent
Levels higher than 9 percent significantly increase the risk of severe diabetes complications, such as heart disease, nerve damage, and kidney failure. The risk continues to escalate with each percentage increase in A1c.
A1c to eAG chart
The following are A1c levels to estimated average glucose (eAG) levels:
| A1c | eAG |
| 9 percent | 212 mg/dL (11.77 mmol/L) |
| 10 percent | 240 mg/dL (13.32 mmol/L) |
| 11 percent | 269 mg/dL (14.93 mmol/L) |
| 12 percent | 298 mg/dL (16.54 mmol/L) |
| 13 percent | 326 mg/dL (18.09 mmol/L) |
| 14 percent | 355 mg/dL (19.70 mmol/L) |
Learn more in: How to Translate Your A1c to a Blood Sugar Level.
Managing A1c fluctuations
If you’re dealing with high A1c levels, consider discussing with your healthcare provider strategies to adjust your medication, diet, and exercise regimen. Addressing any underlying mental health issues may also be beneficial.
Note: At diagnosis, especially with type 1 diabetes, A1c levels can be very high. However, these levels typically decrease rapidly with effective insulin therapy, decreasing the risk of long-term complications.
Ways to make your A1c safer
Adjusting your A1c, whether increasing or decreasing it, is crucial if you’re nearing dangerous levels. Here’s how you can safely manage your A1c:
If your A1c is too low:
- Speak with your healthcare provider: Discuss the possibility of reducing your medications or insulin dosages to avoid frequent lows.
- Moderate your exercise: If physical activity leads to hypoglycemia, consider reducing the intensity or duration of your workouts.
- Adjust your diet: Increase your intake of proteins and fats, which can help stabilize blood sugar levels, particularly overnight.
- Use a continuous glucose monitor (CGM): A CGM can help you detect low blood sugars before they become critical, allowing for timely intervention.
- Optimize insulin pump settings: If you use an insulin pump, adjust your basal insulin rates temporarily for activities that lower blood glucose, like exercise, to prevent hypoglycemia.
These strategies can help maintain your blood glucose at a safe level, minimizing the risk of both high and low extremes.
If your A1c is too high
- Speak with your doctor: Work with your healthcare provider to adjust your medications or insulin dosages to better manage your blood sugar levels.
- Increase physical activity: Incorporate more physical activity into your daily routine to help lower blood glucose levels.
- Eat a balanced diet: Focus on lower-carbohydrate meals and include plenty of whole foods rich in fiber. Avoid processed foods and items with added sugars.
- Track carbohydrates: If you find counting carbohydrates challenging, keep a food journal and seek guidance from a registered dietitian nutritionist (RD/RDN) for meal planning.
- Monitor blood sugar: Check your blood sugar multiple times a day or use a CGM to detect high blood sugars early.
- Optimize insulin pump settings: If you use an insulin pump, adjust the basal rates throughout the day and night to prevent prolonged high blood sugars.
- Prioritize sleep: Aim for 7 to 9 hours of sleep per night to improve insulin sensitivity.
- Manage stress: Practice stress-reducing activities like yoga, meditation, and deep breathing exercises to decrease insulin resistance.
For more in-depth information on how to lower your A1c, watch this video by Christel Oerum, founder of Diabetes Strong. In the video, she explains how she successfully lowered her A1c to 5.7 percent in 30 days by following five simple steps:
What is the importance of an A1c?
An A1c test helps diagnose diabetes
The A1c test is crucial for diagnosing type 1 and type 2 diabetes, prediabetes, and occasionally, gestational diabetes.
Diagnosis and monitoring
If your results indicate prediabetes, your doctor may recommend that you have the A1c test repeated annually or semi-annually. For those 45 and older, the U.S. Centers for Disease Control and Prevention (CDC) advises regular screening.
If the results are normal, your doctor will set a testing schedule based on your age and risk factors. If the test indicates prediabetes, it is likely you’ll need an A1c test every one to two years.
Risk factor identification
For people under 45 with certain risk factors for diabetes, an A1c test is recommended. These risk factors include:
- Being overweight
- Having a family history of diabetes
- Hypertension (high blood pressure)
- Past gestational diabetes
- Belonging to an ethnic minority
- Having heart disease
- Leading a sedentary lifestyle
Symptoms of diabetes
You should contact your doctor immediately if you are not diagnosed with diabetes but experience any of the following symptoms:
- Extreme thirst
- Frequent urination
- Unexplained weight loss
- Blurry vision/changes in vision
- Extreme hunger
- Fruity-smelling breath
- Lethargy
- Body aches and/or headache
Depending on the severity, you might need an A1c test or emergency medical care.
Home testing
A1c test kits are also available for home use and can be purchased at local pharmacies or online, allowing for convenient monitoring.
See more in: How to Measure Your A1c at Home.
An A1c test determines general diabetes control
For people with diabetes, a quarterly A1c test is commonly administered to monitor average blood sugar levels and overall diabetes management over the previous 3 months.
The A1c test is effective at identifying whether blood sugar levels are consistently high or low, helping with the adjustment of diabetes therapies to prevent complications such as heart disease, retinopathy, neuropathy (nerve damage), kidney disease, and premature death.
However, it’s important to remember that the A1c test provides an average of your blood sugar levels from the past 3 months.
This averaging can mask variations, potentially giving a false sense of control if your blood sugar levels frequently fluctuate between highs and lows.
That said, if your blood sugar levels are relatively stable, the A1c test can accurately reflect how well you are maintaining your blood sugar within the desired range.
Key takeaways for managing your A1c safely
While there is a lot of emphasis on the dangers of high A1c levels, the risks of low A1c levels are often overlooked. A safe A1c range for most people is typically between 5 and 8 percent, though this can vary based on individual circumstances.
Pregnant women may need a lower A1c, while those who live alone or struggle with low blood sugars may need a higher target.
An A1c below 5 percent can indicate frequent and severe hypoglycemia. Conversely, an A1c of 9 percent or above significantly increases the risk of diabetes complications.
To achieve a safe A1c, work with your healthcare provider to adjust medications, diet, and physical activity, and manage sleep and stress. While there is no “perfect” A1c, maintaining your levels within a safe range is crucial for your health and well-being.
Learn more about maintaining a healthy A1c level in How to Lower Your A1c: The Complete Guide and How to Lower A1c Naturally. Did you find this article helpful? Click Yes or No below to let us know!
