Question:  

I've heard that you shouldn't lower your A1C below 6% using diabetes medications because it can cause other health risks and possibly low blood sugar (known as hypoglycemia). Is diet the best way to get off diabetic drugs? 

Answer from Nebraska Medicine endocrinologist Gunjan Arora, MD, MBBS: 

Your A1C is a blood test that shows your average blood sugar level over the past three months. It’s one of the most important numbers your doctor uses to check how well your diabetes is being managed.

What is a good A1C goal?

There isn’t one perfect A1C goal for everyone. Your ideal number depends on things like your age, other medical conditions, your risk for low blood sugar and your overall health.

For most adults with diabetes, the American Diabetes Association recommends an A1C below 7%, as long as it can be done safely without causing low blood sugar. Some people might aim for a lower number, and some might aim for a higher one. Your doctor will help you decide what’s right for you.

Is an A1C of 6% safe?

For some people, aiming for an A1C as low as 6% may not be helpful. Studies show that very strict control with medications doesn’t always prevent complications and may even increase the risk of low blood sugar or other side effects.

Whether a 6% goal is right for you is something you and your doctor should decide together based on your full health history.

Can you reach a low A1C through diet alone?

Once you and your doctor decide on a target A1C, there are several ways to reach it:

• Lifestyle changes (like healthy eating and regular physical activity)

• Oral medications

• Injectable medications

• Insulin

If your doctor says it’s safe and appropriate, some people can lower their A1C to around 6% through diet and lifestyle alone. However, lowering your A1C below 6% with diabetes medications is usually not recommended because of the risk of dangerous low blood sugar episodes.

The bottom line

Whether you should aim for an A1C of 6% — and whether you should do so with or without diabetes medication — depends on your personal health needs. It’s a decision best made with your doctor.