Is a 6.5% A1c Good Enough for You?

The premise that a 6.5% A1c is great for a type 1 diabetic is based on the widespread belief that we simply cannot expect better results than that and still maintain safety from low blood sugars. The truth is that a 6.5% A1c in a non-type 1 diabetic is medically diagnostic criteria for type 2 diabetes. It is well established that type 2 diabetes is detrimental to one’s health, especially in the long term, though probably also in the short-term, though that is more difficult to quantify due to comorbidities.

It’s possible that a type 1 with a 6.5% A1c is different from a type 2 with a 6.5% A1c because the type 1 might be having more blood sugar variability, which the body doesn’t like. The type 2 in many cases has additional metabolic distress in the form of insulin resistance, obesity, high blood pressure, and fatty liver disease which would also make a difference when comparing their 6.5% A1c to that same A1c in type 1. Therefore, there are factors making this a nuanced issue.

However, if you look at cardiovascular outcomes of people with A1c averaging in the lower normal A1c range and compare them with those whose A1c averages in the upper normal range, you’ll find that the former does much better than the latter. Many people with type 2 diabetes experience complications and most likely their diabetes started after they became adults. So imagine what may happen to the type 1 child who experiences an additional two or more decades of harmful blood sugar by the time they’re 50? If you’re thinking that’s not fair, I agree.

If you have type 1 diabetes and have a healthy weight (which is increasingly less common) and you have low blood sugar variability and you feel good and all other vitals are in optimal normal range and you’re not making visits to the emergency room, then you may be completely content with your management. Or you simply may not be willing to make certain changes for what you may deem a very minor improvement in the quality of your life. Or maybe you were diagnosed much later in life so you have a long and protective history of excellent blood sugar. Or perhaps you aren’t willing or ready to aim higher right now. We all have this freedom to choose what is right for us and I wouldn’t want it any other way.

As for children, ethics would dictate that our choices must reflect much higher standards on their behalf.

For those who want better than diabetic blood sugars and are willing to do what it takes, there is a way to manage diabetes so that you can achieve normal or near-normal blood sugars and see less severe hypoglycemia. I don’t know of another way to do this than to eat a diet that is comprised of very low carb, high protein, and fat to the degree you require. There is more to it than that, though. You may be tired of hearing this but if you read Dr. Bernstein’s Diabetes Solution, you’ll learn what you need to know to get on the road to optimally healthy blood sugar management.

Ultimately, I want you to know that if you want it, it’s possible. Regardless, I wish all diabetics the very best of health.

6 thoughts on “Is a 6.5% A1c Good Enough for You?

  1. Rick Phillips

    It is not for me, but I cannot fault people who like maintaining this level. I am far more comfortable in the 5.6 to 5.9 range, even though my doctor would like it in the 6.0 to 6.3 range.

    Ahh the tenths.

  2. Kenny

    My last A1C was 6.4% and I’ve been feeling good. I have type 1 diabetes for 25 years and my A1C was always around the 6.9% level. But about a year ago I started a Keto diet (low carbs high healthy fats) and lowered my A1C to 6.4%. My goal is to exercise more and get it down to 6.0%.

  3. Julz

    My nine year old has been diagnosed nearly 3 years Hba1cs have ranged from 4.9-5.3 over those years.
    Our time in target is around 85 % -90%and SD 1.5 which means we are not have lows and wide variations of levels .
    We are not low carb so yes there is another way to achieve these levels although I’m sure Dr Bertstein would believe you think that there isn’t.
    Accurate carb counting , bolusing for fat and protein and proactive CGM management is the key . He eats a healthy well balanced diet and is very active with sports . We started on a insulin pump on diagnosis .
    Low carb is certainly one way to achieve non diabetic levels but it’s not the only way .

  4. Sysy Post author

    Those are fabulous numbers, Julz, you should be proud. Your results are extremely atypical, though. Research shows most people can’t even get below 7% and most are way above that with a standard deviation that is dangerous and exhausting to live with. There’s always a rare exception to everything. It doesn’t mean I’m wrong.

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