What the HbA1c test is all about

Measuring HbA1C gives an overall picture of what the average blood sugar levels have been over a period of eight to 12 weeks. — 123rf

I recently had a blood test. One of the tests was HbA1c. What is that?

HbA1c is your average blood sugar levels for the past two or three months.

It is glycated haemoglobin, which is made when glucose or sugar in your body sticks to your red blood cells.

If your body cannot utilise all the sugar floating around in your bloodstream, then more and more of it will adhere to your red blood cells.

The higher your HbA1c is, the more sugar there was in your blood to stick to those red blood cells – it’s a build-up.

You mean my sugar builds up for months and years?

HbA1c is the reading of what is happening in your body for the last two or three months only.

This is as your red blood cells, which are produced by your bone marrow, are only active for 120 days.

HbA1c is a very accurate reading of your past three months’ worth of sugar content.

A high HbA1c means you have too much sugar in your blood and are likely to have impaired glucose tolerance, or diabetes and its complications.

When I took my blood test, my HbA1c came back high. Does this mean I have diabetes? My fasting blood glucose result was OK.

Different levels of HbA1c mean different things.

These are some levels:

• Normal: less than 5.7% ( less than 39-41 mmol/mol).
• Prediabetes: 5.7% to 6.4% (39-47 mmol/mol).
• Diabetes: 6.5% or more (48 or more mmol/mol).

This test is not only used to diagnose you, but is also a good measure of how well you are controlling your blood sugar by diet, exercise and/or medications, if you have been diagnosed to have prediabetes or diabetes.

My range is in prediabetes. I am scared.

You don’t have to be scared. Prediabetes can be reversed.

It is all up to you.

Prediabetes means you have a higher than normal blood glucose.

But it is not high enough to be diagnosed as diabetes.

Nevertheless, you should watch out for it because the long-term complications of high blood sugar to your blood vessels, kidneys and heart may already be starting.

Prediabetes is very common. It affects one out of three adults under age 65.

It is caused by insulin resistance.

Isn’t insulin resistance the same thing that causes type 2 diabetes?

Yes. The cells in your body don’t respond as well as they used to towards insulin any more.

Hence, insulin is not as effective in helping your body store sugar and you end up having high blood sugar levels, which in turn get attached to your red blood cells.

Many factors can cause insulin resistance, like:

• Genes
• Too much body fat, especially around your belly (visceral fat)
• Not enough exercise
• Eating too much unhealthy carbohydrates, highly-processed food and saturated fats
• Lack of good quality sleep
• Stress
• Certain medicines like steroids.

Can I reverse prediabetes and my HbA1c levels?

Yes. The good thing is that you can do so right now.

You should exercise regularly and move constantly throughout the day so that you can reduce your weight and increase your insulin sensitivity.

A lot of prediabetes in Malaysia is caused by us being overweight.

Exercise uses the sugar in your bloodstream to fuel your muscles.

Even if you cannot find time to exercise for long periods, you can try doing short sessions lasting 10 to 15 minutes each.

ALSO READ: Always busy? Try stacking short workouts throughout your day

The advocated amount of moderate activity exercise needed per week is 150 minutes.

You can divide this into 30 minutes each day for five days.

Take a brisk walk, cycle, lift weights, hike, run, swim, dance – whatever you like.

Even if you find it difficult to allocate the time to exercise, you can do plenty of movement and activities throughout the day.

This is called N.E.A.T. or non-exercise activity thermogenesis, which means you are burning calories without a scheduled exercise activity.

You can incorporate N.E.A.T. into your daily lifestyle.

For example, instead of sitting down watching Netflix, you can stand or balance on one leg.

Do your own housework and gardening.

You will find that you will sweat plenty.

Take the stairs instead of escalators and elevators.

At work, if you have an ergonomic desk, stand up instead of sitting down.

Walk to talk to your colleagues face to face instead of sending an email.

Importantly, after every meal, take a little walk.

Even as little as two minutes can do wonders for your digestion and sugar levels.

ALSO READ: Take a short walk after your meal for your blood sugar

Is it only activity? What about my diet?

Your carbohydrate intake in a strong influencer of your sugar levels.

You need to reduce it.

The trouble with Asian diets is that it contains a lot of white rice.

But you can have your white rice and eat it too.

Simply cook your rice, then store it for at least 12 hours in the refrigerator.

This breaks down the starch into resistant starch.

This process is called retrogradation.

Your body finds it difficult to digest this resistant starch.

ALSO READ: A good reason to eat leftover carbs

See StarLifestyle on March 30 (2026) for more practical ways to lower your HbA1c level.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.