What is the A1c blood test?

Medically reviewed by Neka Miller, PhD on March 25, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Understanding your blood sugar level is important, especially if you have diabetes or are at risk of developing it. But how does one actually go about measuring and monitoring this? One effective way: the hemoglobin A1c test—or HbA1c test—which tells you your average blood sugar level over the past 3 months. (You can test your HbA1c at home with the Everlywell HbA1c Test.)

Read on to learn what you need to know about this type of lab test, including how it works and who should take it.

But first, let’s start with an overview of diabetes.

What is diabetes?

Diabetes is a chronic condition that occurs when your pancreas can’t make insulin or your body can’t properly use it. Insulin plays an important role in energy production. It allows the glucose, or sugar, from your food to pass through the bloodstream to reach your body’s cells and produce energy.

When your body has trouble making or using insulin, it can cause your blood glucose level to increase. Over time, this can contribute to the development of prediabetes or diabetes (type 1 or type 2 diabetes).

  • Prediabetes means you have a higher-than-average blood glucose level, but it’s not quite high enough to be indicative of diabetes. But having prediabetes does mean you’re at a significantly higher risk of developing diabetes.
  • Type 1 diabetes means your body doesn’t produce enough or any insulin on its own. This condition typically appears when you’re a child, teen, or young adult.
  • Type 2 diabetes means your body does produce insulin but it can’t use it properly. This type of diabetes more commonly develops in adults.

Gestational diabetes also exists as a specific type of diabetes that develops during pregnancy. While this condition typically goes away after giving birth, it is associated with a higher risk of you or your child developing type 2 diabetes later in life.

What are the symptoms of diabetes?

There are many different possible symptoms of diabetes, and many of them can seem unrelated at first. If you have the following symptoms, you may want to consider visiting your healthcare provider for further evaluation.

  • Excessive thirst and hunger
  • Frequent urination
  • Unexplained weight loss
  • Blurry vision
  • Fatigue
  • Very dry skin
  • Infections and slow-healing wounds
  • Numbness or tingling in the hands or feet

If you have type 1 diabetes, you may also have symptoms like stomach pains, nausea, and vomiting.

Also, it’s worth pointing out that over time, untreated or unmanaged diabetes can lead to other health issues and complications, including heart disease, kidney disease, and nerve problems.

What is an A1c blood test, and what does A1c stand for?

A1c stands for glycated hemoglobin. The A1c blood test, also known as the HbA1c test, can help with monitoring and diagnosing diabetes. It does so by measuring how much blood sugar is attached to your hemoglobin. Here’s how it works.

As sugar circulates in your bloodstream, some sugar molecules stick to your red blood cells. Specifically, they bind to a red blood cell protein called hemoglobin (hemoglobin is responsible for transporting oxygen molecules from the lungs to other parts of the body). These sugar molecules stay there for the rest of the red blood cell’s lifespan, which is usually about 3 months (your body keeps making new red blood cells as old ones die off). If there’s a lot of sugar in your bloodstream, then a lot of your red blood cells will be covered with sugar molecules.

An HbA1c test measures the percentage of the hemoglobin in your red blood cells that’s covered in sugar—giving you a good idea of your average blood sugar level over the past 3 months.

This way of measuring blood sugar is the key difference between an HbA1c test and a blood glucose meter (commonly called a glucometer). A blood glucose meter can tell you what your blood sugar levels are at the specific moment you take the measurement—in milligrams per deciliter, or mg/dL.

However, blood sugar levels can change quite a lot throughout the day in response to the meals you eat and your physical activity. Since an HbA1c test gives you a 90-day average of your blood sugar, it’s useful for tracking long-term changes and trends in your blood sugar levels.

Related: What is HbA1c?

What does the A1c test diagnose?

In a clinical context in which a healthcare provider considers one’s medical history, symptoms, and risk factors, an A1c test can be a helpful tool for diagnosing prediabetes, type 1 diabetes, and type 2 diabetes. If you already have a diabetes diagnosis, the hemoglobin A1c test can help with monitoring your average blood sugar level and tracking your progress towards improved glycemic control.

While the HbA1c test is valuable in the diagnosis of some forms of diabetes, it can’t diagnose the following types of diabetes:

  • Gestational diabetes
  • Childhood diabetes

Additionally, it’s important to know that the A1c test is not a replacement for regular blood glucose monitoring (using a glucose meter) in diabetic patients.

How does HbA1c testing work?

The process of getting an A1c blood glucose test is simple. In fact, you don’t even need to fast beforehand (unlike various other kinds of blood sugar tests). You can either make an appointment with your healthcare provider for this test or you can take an at-home test.

  • HbA1c testing at your healthcare provider’s office: You’ll provide a blood sample by either undergoing a blood draw or a finger prick. With a blood draw, you’ll have a needle placed in a vein in your arm. Then, your sample will be sent to a lab for testing. With a finger prick, you’ll have your finger pricked with a small lancet.
  • At-home HbA1c testing: With options like the Everlywell at-home HbA1c Test, you’ll collect a blood sample—from the convenience and privacy of home—using a quick and easy finger prick. Then, you’ll mail your sample to a laboratory using a prepaid shipping label that’s included with the kit.

What does your A1c test result mean?

Once you receive your HbA1c level, either your healthcare provider or at-home test summary can help you understand your test result.

When you receive your HbA1c test results, you’ll notice that it’s reported as a percentage. Below are the typical HbA1c ranges:

  • Normal is below 5.7%.
  • Prediabetes is between 5.7% and 6.4%
  • Diabetes is 6.5% or higher

Note, however, that because these are typical ranges that don’t always reflect a person’s unique health context, it’s best to discuss your A1c test results with your healthcare provider to have a better understanding of what your results mean for you personally.

You can use your A1c number to help you take next steps:

  • A normal A1c result usually means you can keep doing what you’ve been doing with regards to blood sugar management—unless your healthcare provider tells you otherwise.
  • If your A1c test result suggests that you may have prediabetes or diabetes, you’ll want to visit your healthcare provider for an official diagnosis. In general, you’ll receive a diabetes diagnosis if you have an A1c level of 6.5% or higher on two different tests.

What are the treatment options for diabetes?

The type of diabetes that you have and your A1c levels will help determine your diabetes treatment plan. Most diabetes treatment plans will include frequent blood sugar monitoring, insulin, and oral medications.

Routine blood sugar monitoring using a blood glucose monitor is the only way to ensure your average glucose level stays in your target range on a daily basis. Typically, you will monitor your blood sugar more times throughout the day if you’re taking insulin. Your healthcare provider will also likely recommend regular A1c testing as part of your monitoring plan. (Learn more about the Everlywell HbA1c testing option for only $24.99/month.)

Insulin is critical for people with type 1 diabetes because the body can’t make its own. Additionally, many people with type 2 diabetes or gestational diabetes need insulin therapy. Insulin is typically taken as an injection using a fine needle and syringe or insulin pen. In some cases, an insulin pump is also an option.

Oral medications can often be part of a diabetes treatment plan. Metformin is one of the most common medications for type 2 diabetes. It works by reducing how much sugar your liver releases into your bloodstream. This medication also improves your body’s response to insulin.

In addition to these medical interventions, it’s important to manage one’s weight through diet and exercise.

Diet: While there is no specific “diabetes diet,” your healthcare provider may advise you to focus on loading up your plate with fruits, vegetables, whole grains, and lean proteins. These foods tend to be high in fiber and nutrients while being low in fat and calories. They may also recommend cutting back on saturated fats, sugary foods, and refined carbohydrates. You can work with a dietitian to help you design a healthy and balanced diet that can meet your needs.

Exercise: Physical activity helps lower your blood sugar level because exercise moves sugar into your cells to be used for energy. Exercise also improves how your body responds to insulin. To make sure you’re getting enough exercise, aim for at least 150 minutes of moderate physical activity each week (this can be broken down into a routine that works well for you, such as 30 minutes of exercise 5 days a week).

Is the Everlywell HbA1c Test right for you?

If you’re looking for an easy and effective way to test your A1c, our HbA1c Test can be a great choice. With just a tiny blood sample from a finger prick—collected from the convenience of your home—the Everlywell HbA1c test can help you learn how well your blood sugar has been controlled over the last 90 days.

Plus, you’ll be able to view your personalized results on a secure digital platform just days after sending your sample to the lab for testing. You can then easily share your results with your healthcare provider or diabetes care team to inform your next steps to protect your health.


References

1. About Diabetes. International Diabetes Federation. URL. Accessed March 25, 2021.

2. Diabetes Symptoms. Centers for Disease Control and Prevention. URL. Accessed March 25, 2021.

3. Prediabetes. Mayo Clinic. URL. Accessed March 25, 2021.

4. Diabetes. Mayo Clinic. URL. Accessed March 25, 2021.

5. Hemoglobin A1C (HbA1c) Medline Plus. Source. URL. Accessed March 25, 2021.

6. Bonora E, Tuomilehto J. The pros and cons of diagnosing diabetes with A1C. Diabetes Care. 2011;34 Suppl 2(Suppl 2):S184-S190.

7. Katwal PC, Jirjees S, Htun ZM, Aldawudi I, Khan S. The Effect of Anemia and the Goal of Optimal HbA1c Control in Diabetes and Non-Diabetes. Cureus. 2020;12(6):e8431. Published 2020 Jun 3.

8. A1C test. Mayo Clinic. URL. Accessed March 25, 2021.

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