The Normal A1C Level

You want to control your diabetes as much as possible. You wouldn't be reading this if you didn't.

So you regularly check your A1C level. This is the best measurement of our blood glucose control that we have now. It tells us what percentage of our hemoglobin -- the protein in our red blood cells that carry oxygen -- has glucose sticking to it. The less glucose that remains in our bloodstream rather than going to work in the cells that need it the better we feel now and the better our health will continue to be.

As we are able to control our diabetes better and better, the reasonable goal is to bring our A1C levels down to normal -- the A1C level that people who don't have diabetes have. But before we can even set that goal, we have to know what the target is.

The trouble with setting that target is that different experts tell us that quite different A1C levels are "normal." They tell us that different levels are normal -- but I have never heard of actual studies of normal A1C levels among people without diabetes -- until now.

The major laboratories that test our levels often say that the normal range is 4.0 to 6.0. They base that range on an old standard chemistry text, Tietz Fundamentals of Clinical Chemistry.

The Diabetes Control and Complications Trial or DCCT, one of the two largest and most important studies of people with diabetes, said that 6.0 was a normal level. But the other key study, the United Kingdom Prospective Diabetes Study or UKPDS, which compared conventional and intensive therapy in more than 5,000 newly diagnosed people with type 2 diabetes, said that 6.2 is the normal level.

Those levels, while unsubstantiated, are close. But then comes along one of my heroes, Dr. Richard K. Bernstein, the author of the key text of very low-carb eating for people with diabetes, Dr. Bernstein's Diabetes Solution. Dr. Bernstein himself developed type 1 diabetes in 1946 at the age of 12.

"For my patients...a truly normal HgbA1C ranges from 4.2 percent to 4.6 percent," he writes on page 54 of the third edition of that book. "Mine is consistently 4.5 percent." Then in his July 30, 2008, telecast he reiterated that as far as he has been able to determine, a normal A1C is 4.2 to 4.6.

What Dr. Bernstein says is normal is so at odds with the other experts that at least a year ago I determined to find scientific proof of what a normal A1C level actually is. It turned out to be a lot more difficult to find than I ever imagined.

My personal quest for a normal A1C level and that of my favorite Certified Diabetes Educator drove that search.

When I learned in 1994 that I had diabetes and that my A1C level was 14.4, I was gradually able to bring it way down. Lately I have been doing everything I can think of to try to get my A1C down to normal. But in 2008 my level in nine separate A1C tests always ranged from 5.2 to 5.6. That's far from normal, according to Dr. Bernstein.

My favorite Certified Diabetes Educator is also doing everything she can to get a normal A1C level. And she doesn't even have diabetes -- which she double-checked by taking a glucose tolerance test -- but her most recent A1C was 5.4.