David's Guide to Getting Our A1C Under 6.0

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells.

The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year.

If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don't control our condition.

But what do we mean by a "high" A1C level? Here the experts disagree.

The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent.

The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define "normal."
 
People who don't have diabetes have A1C levels below 6.0 percent. That's the gist of what I wrote here recently in "The Normal A1C Level." The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That's what Dr. Richard K. Bernstein wrote in Dr. Bernstein's Diabetes Solution.

No matter what our level is, we can be sure that lower is better. Unless we drive it so low with diabetes drugs that we run risks of hypos or heart problems. Concerns with these risks are the main reasons why our diabetes organizations set a goal that is higher than a normal level -- even though they know from clinical trials, like the UKPDS and the DCCT, that with higher levels we will probably suffer from the serious complications that result from high levels.

Then the question becomes what is our best strategy to bring our A1C level down to normal. Not surprisingly, the experts disagree here too.

The key has to be the level of carbohydrates in our diet. After all, like Dr. Bernstein says, diabetes is a disturbance of carbohydrate metabolism where our blood glucose rises above normal.

But for years the ADA has told us that "The recommended dietary allowance for digestible carbohydrate is 130 grams per day." On the other hand, Dr. Bernstein's diet allows no more than a grand total of 42 grams carbohydrate each day. While his books don't say, he has told me directly that he's talking total carbs, not digestible carbs.

I know from my personal experience that Dr. Bernstein's restrictions on carbohydrate do indeed bring our A1C levels down to normal. My most recent test was 4.8 percent -- without drugs.