Is My Husband's A1C Too Low?
My husband has type 2 diabetes, and for years his endocrinologist urged him to keep his A1C under 7 percent. A few months ago we went on a low-carb diet, and my husband lost over 30 pounds. The doctor took him off a sulfonylurea, cut his metformin dose in half, and removed two blood pressure meds. When my husband’s A1C test came back at 6.1 percent, I thought his doctor would be thrilled. But he said 6.1 was too low. Why? Faith Goldman, Ladera Ranch, California
Sue Kirkman, MD, responds:
Although I don’t know all the details, I wouldn’t necessarily say that your husband’s A1C is “too low.”
What to Know:
The American Diabetes Association (ADA) recommends that many adults with diabetes strive to keep A1C less than 7 percent, but the goal can differ from person to person. Even tighter goals, such as less than 6.5 percent, might be reasonable for people with relatively recently diagnosed diabetes and many years to live. A bit looser goal (such as less than 8 percent) may be fine for those with advanced diabetes complications, other chronic illnesses, or shorter life expectancies. In all cases, hypoglycemia (low blood glucose, under 70 mg/dl) should be avoided as much as possible.
Find Out More:
The ADA recommendations do not specify a low end of the target range for A1C, because it matters how people get to lower A1Cs. People without prediabetes or diabetes have A1Cs in the mid-5 percent range or below. Many people with type 2 diabetes can lower their A1C with healthy changes in their diet and exercise, or with bariatric surgery. It would be hard to say that these A1Cs are “too low.”
When is someone’s A1C “too low”? It can be if it’s low due to frequent episodes of hypoglycemia, or if it’s lower than it needs to be to provide benefit but causing a lot of treatment burden (the expense of multiple medications, for example). It doesn’t sound as if that is the case here. Your husband’s weight loss and better glucose and blood pressure control on fewer medicines are commendable. I hope he’ll keep up the good work!