Is a 6.5% A1c Good Enough for You?

Originally published January 2019

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.