A patient sat across from me last month, a little defensive, and said, "But I ate well the morning of my blood draw." I smiled, because I hear this often. And it's exactly why the HbA1c test exists. One careful breakfast can't fool it. This test doesn't care what you had this morning — it reflects your average blood sugar over the past two to three months.
That's its quiet superpower. A finger-stick glucose check is a snapshot. The HbA1c test is the whole movie.
What does the HbA1c test actually measure?
The HbA1c test measures the percentage of your red blood cells that have sugar attached to them. Glucose in your bloodstream binds to hemoglobin, the protein that carries oxygen. The more sugar floating around over time, the higher the percentage.
Because red blood cells live about three months, the result gives us a rolling average. No fasting required. No need to time it around a meal. You can have it drawn at any point during your day.
What is a normal HbA1c level?
A normal HbA1c is below 5.7%. Between 5.7% and 6.4% suggests prediabetes, and 6.5% or higher on two occasions generally points to diabetes. These are the standard ranges I use, though your personal target may differ.
I want to be careful here. A single number is a starting point, not a verdict. I look at the whole person — symptoms, weight, family history, other labs. Someone with anemia or certain blood conditions can get a skewed reading, which is one reason I rarely rely on a lone result to make a big decision.
Why does my doctor keep ordering this test?
If you have type 2 diabetes or prediabetes, I usually recheck your HbA1c a few times a year to see how your management is actually working. It tells me whether your current plan — food, movement, medication — is moving the needle in the right direction.
For patients without diabetes, it's a screening tool. Many people walking around Los Angeles feel completely fine while their blood sugar creeps upward for years. The HbA1c test catches that drift early, while there's still plenty of room to change course.
I think of it less as a grade and more as a conversation starter.
What should I do if my HbA1c is high?
Don't panic, and don't disappear. A high number is information, not a sentence. Most of the time, my first conversation isn't about medication at all — it's about the everyday things that move this number.
- What a typical day of eating looks like, honestly
- How much you're moving, and what gets in the way
- Sleep, stress, and whether either has gone sideways lately
- Any other labs worth checking at the same time, like a lipid panel
From there we build a plan that fits your life, not someone else's. For some patients that's a focused lifestyle modification plan. For others, a medication makes sense. The point is that the HbA1c gives us a clear, fair way to measure whether what we're doing is working — and to adjust without guessing.
How often should I get an HbA1c test?
It depends on where you stand. If your blood sugar is well-controlled and stable, once or twice a year is often enough. If we've recently changed your treatment or your numbers are moving, I'll check it more frequently — usually every three months, which matches the lifespan of those red blood cells.
If you've never had it tested and you're over 35, or younger with risk factors like extra weight or a family history, it's worth asking about. The test itself is simple. We coordinate the blood draw, and you're done in a few minutes.
One small caution: an HbA1c is best read alongside your story, not in isolation. I've seen patients fixate on a decimal point and miss the bigger picture of how they actually feel.
If you're wondering about your own numbers — or you got a result that left you with more questions than answers — I'd genuinely like to talk it through with you. In my membership practice, that conversation isn't rushed. Reach out anytime, and we'll figure out your next step together.