A1C Numbers and Diagnoses

I know the fasting numbers that qualify for a diagnosis of pre-diabetes and diabetes, but with many doctors beginning to use the A1C for diagnosis, does anyone know the official cutoffs? (I’m asking because my brother was recently tested with 5.9 A1C and I’m thinking that is pre-diabetes and 6.0 the cutoff for diabetes?? Since I’ve discovered there are three different conversion rates used from blood glucose to A1C I didn’t want to just convert myself, but to know the official A1C cutoffs.

Risk for all kinds of diseases starts going up with A1Cs higher than 4.6%. Official A1C cutoffs are helpful to insurance companies that want to avoid paying for treatment. If I was your brother I would reduce my carb intake and try to get as much life out of my pancreas as possible. I am a T1 and I would not be happy with 5.9% A1C.

Gotta go along with Helmut. I am T2 and would not be happy with an A1c of 5.9. After all, given accuracy and precision, it might as well be that 6.0.

The paperwork I got from the lab from my diagnosis said less than 6.0 would be “normal” but it also says that the ‘flag reference range’ is considered high if it exceeds 5.7. I think that means if you hit 5.7, you would be a candidate for a fasting glucose test. There are a lot of variables, and I think, too many medical opinions and ‘standards’ such that I would be concerned with anything out of the 4’s as an A1c and would want a test. I wish that A1c numbers were tested whenever blood work is done, and that it would be included in an annual checkup as a matter of course. I still believe that once your system begins to fail, you can call it pre, you can call it abnormal,or whatever you like, but in the end, its going to keep failing and the rate is totally dependent upon how you deal with it, and how much of a load you can take off of your pancreas and other parts of your system, so to try and split hairs and hope a 5.9 is not diabetes, takes an awful risk, since its not that high, and could be easily controlled now, rather than waiting, taxing your system, and being in bigger trouble somewhere down the road.

I think that is kind of high, and I will go out on a limb and risk the wrath of many, and say that there is really no such thing as pre-diabetes any more than one can be a little bit pregnant. Its time for your brother to hit the low carb method and see if he can get that down, but not I am a doctor or anything, but I think he should get a fasting tolerance test and find out. Failing to do that, get a meter and take some daily readings for a week, mornings, before and after meals. If he is diabetic, and an A1c of 5.9, that is no too bad to get down to 5.0 or less without meds, just exercise and careful diet. Sometimes, even tho diabetes is hardly anything to be happy about, catching it early, can make a lot of difference in how you can live your life. Beats finding out with an A1c of 11, and having to do meds, and risk the need for insulin sooner, than later.

Oh my brother has definitely reduced his carb intake and lost 40 pounds, so he is doing everything right. I was just curious as to diagnosis cutoffs. I’m a LADA and getting under 6.0 is my current goal actually. (I’m 6.5) We’re all different. I would question risks for complications going up over 4.6! Even with the most conservative conversion that is a blood glucose of 86 and my understanding is the majority of studies show complications begin over 140.


I am an amateur and I don’t do my own studies. I came across the 4.6% number several times. For example,

“In nondiabetic adults, HbA1c level was not related to CHD risk below a level of 4.6% but was significantly related to risk above that level (P<.001).”


I have no intention of defending this number. To me accepting the 4.6% threshold is the diabetic’s version of Pascal’s wager.

I just wanted to make sure he takes the numbers seriously and was wondering about the official diagnosis. Me, I never paused at pre-diabetes but just went right to a fasting of 326 and the diagnosis was clear…well, actully not…I was misdiagnosed as Type II, but that’s a different story.

Ah, I see we were talking apples and oranges; I was referring to the risk of diabetic complications which I believe is generally assumed to be over 140 and you were referring to increased risk of heart attack; both important things but two different issues. I certainly don’t do my own studies either, and don’t have a clue who this Pascal dude is, but I do tend to give less credance to one study or person than to consensus tried and trues. I know on here I could be considered backward for taking Lipitor! I guess after a lifetime of hearing one thing after another proclaimed the “absolute new truth” I don’t jump on bandwagons all that quickly.

Sorry for being a smart ■■■. Maybe tomorrow will be a better day.


Ah, thanks for the explanation; can’t argue much with the guy’s reasoning! I don’t know that this diabetic will ever see 4.6 but more power to those who can do it!!

Ahh, miscommunication :slight_smile:

I think the point would be that people who hang around the 4.6 area, or sub 5.0 are “normal” or “healthy” to the medical profession, and if it starts to rise from there, then trouble is a brewing. My last A1c was 5.0, but I doubt that will hold up based on my choices and lifestyle anymore. You are most correct when you say we are all different, and to me, that is where the medical "professionals’ fall flat on their face. So many still have the “one size fits all” approach to controlling, and even diagnosing diabetes, and I think most of us have learned that just ain’t the way of it.

140 does seem to be the consensus point at which complications begin to occur, but in my short time as part of the ‘community’ I think that number came from us, not the world of medicine, since so many “experts” will say they find hitting 180 to be acceptable. Likely, the best thing is to just stay as low as you can, and avoid the big spikes, without making ourselves miserable, and without compromising our health in other ways. Lower has to be better. Its just good logic (till you go into the sub 60’s, of course )

I believe the issue of “numbers” may contribute to a lot of diabetics just giving up as it can become an obsession that many refuse to cope with. I also have an unprovable theory that research and test results given to us are no longer valid, as most of the people they did 20 year studies on, didn’t have access to the meters, meds, and other testing methods for most of their lives, as well as support groups like this, and information at our bruised fingertips, so if “grandma” died from complications, I wouldn’t stress about dying from it if I was dx’d because we have so much the advantage over her generation, and for some of us, even over our parents. Still have to control it, but our fate can and should be much better than hers.

How’s that for hijacking a thread? :slight_smile:


John, I stand in awe of your hijacking skilz.

Hijacking or not, I think you make some good points about the value (or lack thereof) of numbers. As well the idea of staying as low as you can “without making ourselves miserable.” Ah, balance!

What I’ve read says an A1c of 4.6 is considered normal. I believe in Dr. Bernstein’s book he gives a range of 4.3-4.6. There are people who suffer from chronic hypoglycemia, so lower than 4.3 would be abnormal on the other end of the spectrum.

My feeling is that most doctors allow too much leeway regarding acceptable BG. Since damage occurs with BG 140 & over, I can’t understand their lax attitude. Too many have the attitude that it’s “good enough for a diabetic.”