How to lower your HbA1c
Your HbA1c is the number that tells you whether what you're doing day to day is working. It's also the one that can make your heart sink when the practice nurse reads it out.
I've had good results and bad results over the years, so I know both feelings. Here's what the number means and what actually brings it down.
What HbA1c measures
HbA1c shows your average blood sugar over the last two to three months. So it isn't affected much by one good day or one bad day. It's a picture of how things have been going overall.
That's also why three months is the natural time to see a change. What you do from today will show up properly at your next test, not next week.
What number should I aim for?
In the UK, HbA1c is given in mmol/mol. The usual targets are:
- 48 if your diabetes is managed by food and activity, or by tablets that don't cause hypos (when your sugar goes too low).
- 53 if you take something that can cause hypos, like gliclazide or insulin.
Your diabetes team might agree a different target with you, and that's fine. If you've been reading American websites, they use percentages: 48 is about 6.5%, and 53 is about 7%.
What brings it down
These are the things that make the most difference for most people. You don't need all of them at once.
- Losing some weight, if you're carrying extra. For many people this has the biggest effect of anything.
- Cutting sugary drinks. Fizzy drinks, juice, smoothies and sweet coffees can add a lot of sugar without you noticing.
- Fewer refined carbs. White bread, white rice, pastries, crackers and cereals go into your blood fast. Wholegrain versions and smaller portions help.
- Walking, especially after meals. Regular activity helps your body use sugar better, and a short walk after eating stops some of the spike.
- Sorting out the evenings. For a lot of us, the day goes fine and then the evening falls apart. That's often where the HbA1c is really decided.
- Sleep and stress. Both push blood sugar up. They're harder to fix than food, but they count.
- Taking your tablets as prescribed. If they give you side effects or you keep forgetting, tell your GP. There are usually other options.
Can I lower my HbA1c without medication?
Many people can, especially in the first few years after diagnosis. But for plenty of others, tablets are part of the answer, and that isn't a failure. Type 2 tends to change over time, and needing medication doesn't mean you haven't tried.
Please don't stop or cut down your tablets or insulin because you're making changes. Talk to your GP or diabetes team first, as some medication can make your sugar drop too low if you eat less.
A simple three-month plan
Month one. Swap any sugary drinks and start a short walk after your evening meal. That's it. Get those two things feeling normal.
Month two. Work on your plate: half veg, a quarter protein, a quarter carbs. Have a plan for the evenings, whether that's an earlier tea, a cup of tea instead of the biscuits, or simply not keeping the biscuits in.
Month three. Keep going. Ask your surgery when your next HbA1c test is due, and go to it.
If you have a finger-prick meter or a Libre, use it to learn. There's more on that in Blood sugar after eating and High blood sugar in the morning.
What to do if your HbA1c is high
Don't panic and don't hide from it. Ask your GP what your target is and what the plan is. Ask about a free diabetes course if you haven't been on one.
It's also worth knowing that some things, like anaemia, can affect the HbA1c reading. If your number doesn't match your finger-prick readings at all, ask about it.
And if you've been at this a while and keep going round in circles, you might want some support. That's why I run SODIT: 12 weeks of coaching with me, then a year of support. If you're curious about going further, read Type 2 remission: what it really takes.
Start with my free guide if you want your numbers, your plate and your bad days explained in plain English.
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Questions people ask
How much can HbA1c drop in 3 months?
It varies a lot from person to person. Some people see a big drop, especially soon after diagnosis. Others see smaller changes. Every mmol/mol down counts, so compare yourself with your last test, not with someone else.
Can walking lower HbA1c?
Yes. Regular walking helps your body use sugar better, and a 10 to 15 minute walk after meals helps with spikes. Over time that can help bring your HbA1c down.
What's the best breakfast to lower HbA1c?
There isn't one perfect breakfast, but something with protein and fewer refined carbs usually works better than sugary cereal or white toast. Eggs, Greek yoghurt with berries, or wholegrain toast with peanut butter are good places to start.
Keep reading
Auriel isn't a doctor or a lawyer. This is general information from her own experience and UK guidance. Always follow your GP and diabetes team.