By Wil Dubois
We dFolk are bombarded with numbers, goals, and targets. We’re frequently told where we should be, but not how high our risk is when we can’t reach our targets. Here, we break down A1C numbers into a simple green-light, yellow-light, red-light format, to give you perspective on when (and how much) to worry, when to relax, when to call your doc, and when to call 911.
Green-light A1C score
For most people, the target for A1C, the green light, is between 6.0% and 6.9%. These numbers are commonly expressed simply as 6.0 and 6.9, without the % sign. If your A1C falls into this zone, you’re considered to be in control. For perspective, these numbers can be converted into “meter” numbers called estimated average glucose—eAG for short. The green light eAG range is 126 mg/dL (7 mmol/l) to 151 mg/dL (8.39 mmol/l). But what if your numbers are higher than target? Or lower than target? When are you actually in danger?
Yellow-light A1C score
If the light turns yellow as you approach the intersection, you need to either speed up or stop. Whichever is safe under the circumstances, right? If your A1C is between 7.0 and 8.9, you’ll be classified as “out of control.” But how much danger are you in? Frankly, it depends upon how close you are to either end of the spectrum. Yellow-light A1Cs are higher than is strictly healthy, but pose no immediate harm. However, the higher you are in this range, the closer you are to a red light. We’ll talk about just how serious that can be in a minute.
I should point out that there are some special cases. If you’re a very young type 1, a yellow-light A1C score may be considered in-target for you until you get older. Similarly, if you’re an elderly type 2, or have a history of severe hypoglycemia, you doctor may choose to “green light” you in the yellow zone. Don’t worry; it’s not the same as being “gaslighted.”
You’re also in yellow-light territory if you use insulin or pills called sulfonylureas, and your A1C is below six. Numbers in the low fives and below are considered non-diabetic, so at first glance, they might seem like an attractive place to be. The more highly controlled, the better, right? Uh, wrong. Sorry.
The simple fact of the matter is that if you have an A1C below six, it means you may be having low blood sugar, and lows are every bit as dangerous as highs. If too much medication is forcing you below 6.0, you’re staring at a yellow light. Put on the brakes, and talk to your doctor.
Red-light A1C score
An A1C score above 9.0 is considered critically high. Red light. Danger. But why? At an A1C of 9.0 (eAG 212 mg/dL, 11.78 mmol/l), your blood sugar is high enough to begin the slow process of destroying your kidneys and your eyes—and to light the fire of neuropathy. It’s cytotoxic, meaning lethal to cells. Or, as one dialysis nurse I know likes to say, “It’s incompatible with human life.”
You shouldn’t panic if your A1C is this high. Most people are above 9.0 when they’re diagnosed…but it’s a red light. Stop. In this case, back up and go the other direction. A high A1C for brand-new diabetes is just a problem that needs to be fixed. Often, minor changes in lifestyle and/or some meds will whip it into shape in no time. On the other hand, if you’ve been lower than 9.0 for a long time, and have now crossed the red-light Rubicon, it tells us your diabetes has advanced beyond your therapy. This is no fault of your own. It’s what diabetes does. It changes. It advances. No guilt. But you do need to stay one step ahead of it. You’ll need a change of therapy.
- The A1C green-light score is between 6.0% and 6.9%.
- The A1C yellow-light score is between 7.0% and 8.9% on the high end, or below 5.9% on the low end.
- The A1C red-light score is more than 9.0%.
American Association of Clinical Endocrinologists. AACE Diabetes Resource Center. “Type 2 Diabetes Glucose Management Goals.” Accessed September 1, 2017. http://outpatient.aace.com/type-2-diabetes/management
American Diabetes Association. “Standards of Medical Care in Diabetes — 2017.” Diabetes Care. January 2017. Accessed September 1, 2017. http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
National Institute of Diabetes and Digestive and Kidney Diseases. “The A1C Test and Diabetes.” September 2014. Accessed September 1, 2017. https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test#15