The Cooper Institute

Founded in 1970 by the "Father of Aerobics"
Kenneth H. Cooper MD, MPH


You Know Your ABC’s; Do You Know Your A1C?

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Live well

Wednesday, Nov 08, 2017

When we have a physical exam that includes blood work, our physician will typically include our blood glucose level in the report. A normal fasting blood glucose level is between 70-99 mg/dL. Individuals with fasting glucose levels between 100-125 mg/dL on two separate occasions have prediabetes, while individuals with fasting glucose levels >125 mg/dL on two separate occasions have diabetes.   

According to the American Diabetes Association, the prevalence of diabetes in the U.S. is estimated to be 30 million; with a prevalence of type 2 diabetes that is 10-20 times that of type 1 diabetes. Additionally, there are an estimated 90 million Americans with prediabetes. Both prediabetes and type 2 diabetes are more likely to occur in middle-aged to older adults who are sedentary and overweight, although they can both occur at any age. Diabetes and prediabetes significantly increase the risk of cardiovascular disease, nerve and capillary damage, as well as damage to the retina of the eye. You may be wondering exactly what it is about diabetes that would cause these serious health problems.

As mentioned above, people with prediabetes and diabetes have higher than normal levels of blood glucose. When blood glucose levels remain elevated over an extended period of time, some of the glucose molecules become permanently attached to various components such as nerves, capillaries, and hemoglobin. This attachment process is called glycation, and is undesirable because it can cause damage to these vital body components.  

Because a fasting blood glucose test only provides a snapshot of glucose values at one specific point in time, people with prediabetes and diabetes are advised to have a special blood test called Hemoglobin A1C at least twice a year. Hemoglobin is a protein that is found inside red blood cells; its job is to carry oxygen. Some of the glucose in your blood can penetrate red blood cells and permanently attach to hemoglobin.  The Hemoglobin A1C test measures what percentage of hemoglobin molecules are glycated, and provides an excellent measure of average blood glucose levels over the past 2-3 months. This in turn gives the physician a much better idea than a snapshot of how well (or not so well) the patient has been controlling their condition. Here’s an example: If the Hemoglobin A1C test comes back with a result of 7%, it means that the patient’s average blood glucose level over the past 2-3 months was 154 mg/dl. As a point of reference, an average Hemoglobin A1C in someone who does not have prediabetes or diabetes is about 5%. This equates to an average blood glucose level of 97 mg/dl over the past 2-3 months. Table 1 below provides a comparison between Hemoglobin A1C levels and average blood glucose levels over the past 2-3 months. People with diabetes are advised to keep their A1C level <7% by controlling their weight, making dietary changes, being more physically active, managing stress, and by taking medication such as insulin and/or an oral diabetes pill.

A few years ago, the American Diabetes Association approved the use of the Hemoglobin A1C test for diagnosing prediabetes and diabetes. The advantage of this method is that it doesn’t require fasting beforehand, so it’s a lot more convenient than having to repeat a fasting blood glucose test if the first reading is elevated. Prediabetes is now be diagnosed when the hemoglobin A1C is between 5.7-6.4%, while diabetes is now diagnosed when the value is >6.5%. So, the next time you are due for a physical exam, you should ask your physician if it would be possible to measure your Hemoglobin A1C level if he/she was not planning to do so. This test is definitely becoming more mainstream; but it may be a year or two before it becomes a routine part of a physical examination for middle-aged and older adults as well as others who are at risk for developing prediabetes or diabetes.

Knowledge is power; but putting that knowledge into action is the key for preventing disease. Knowing your blood cholesterol, triglyceride and glucose values, as well as your resting blood pressure numbers is a great start. It is also beneficial for you to know your Hemoglobin A1C number. Check with your doctor to see if he/she thinks it would be a good idea to have this test done the next time you are scheduled for a physical exam.       

Table 1. Comparison of Hemoglobin A1C Test Result and Average Blood Glucose Level over the Past 2-3 Months.    

Hemoglobin A1C Result

Average Blood Glucose Level over the Past 2-3 Months


97 mg/dl


111 mg/dl


126 mg/dl


140 mg/dl


154 mg/dl


169 mg/dl


183 mg/dl


197 mg/dl


212 mg/dl


226 mg/dl


240 mg/dl


Note: The Cooper Institute has recently published a state of the art textbook titled Principles of Health and Fitness for Fitness Professionals. This book is an absolute must for fitness leaders or anyone in the general population who wants to learn more about health and physical fitness. The book is also a great resource for anyone who is seeking to earn a nationally accredited personal trainer certification! Click on the links above to learn more.