Know Your Numbers | HbA1c

Michelle Shyam
2 days ago
3 min read

If you’ve ever looked at your blood reports and felt either relieved or anxious because of one number — it’s probably HbA1c. It’s one of the most commonly used markers to assess blood sugar health. Doctors use it. Coaches talk about it. Social media glorifies it. And clients often obsess over it. But after years of working with real bodies, real lives, real stress, real hormones, and real habits — I can confidently say this:

HbA1c is useful. But it is not a complete picture of metabolic health.

The HbA1c test (hemoglobin A1c) measures the average level of glucose in your blood over the past 2–3 months. When sugar circulates in your bloodstream, it attaches to hemoglobin — the protein in red blood cells that carries oxygen. The more glucose present, the more hemoglobin becomes “glycated” (coated with sugar). Since red blood cells live for roughly 2–3 months, HbA1c gives us a long-term average — not daily spikes, not weekly fluctuations, but a broader metabolic snapshot. I often explain it to clients like this: It’s not your daily spending — it’s your bank statement average over three months.

The result comes as a percentage. For example, an HbA1c of 6% means roughly 6% of your hemoglobin is coated with glucose.

The Ranges I Personally Work With

From a coaching and metabolic health lens, these are the ranges I use:

5–5.2% → Healthy regulation
Up to 5.6–5.7% → Still optimal
5.7–6.3% → Pre-diabetes range
6.4% and above → Diabetes

But numbers don’t live in isolation. People do.

And this is where lived experience as a coach changes how you interpret data.

Why I Don’t Rely on HbA1c Alone

For many of my diabetic, pre-diabetic, and insulin-resistant clients, I also use the Fructosamine test. While HbA1c reflects the last 2–3 months, fructosamine shows blood sugar patterns over the last 2–3 weeks. It measures glycated proteins (mainly albumin), giving a short-term metabolic picture. This matters in real coaching because:

It helps track rapid changes
It shows whether interventions are working
It gives feedback during nutrition changes, lifestyle shifts, medication adjustments, and recovery phases
It reflects real-time metabolic response, not delayed averages

In simple terms: HbA1c = long-term lens, Fructosamine = short-term lens

Both matter. Both tell different stories.

The Uncomfortable Truth About “Perfect” HbA1c

Here’s something that surprises many people: A very low HbA1c is not always a sign of health.

In real-world coaching, I’ve seen this pattern repeatedly:

HbA1c below 5%
High cholesterol
Elevated TSH
Chronic fatigue
Poor sleep
High training load
Undereating
Nervous system dysregulation
Chronic stress physiology

On paper, sugar looks “perfect.” In the body, the system is stressed.

So when I see very low HbA1c, I don’t celebrate automatically. I ask better questions:

Are you eating enough?
Are you sleeping enough?
Are you overtraining?
Is your nervous system constantly activated?
Is cortisol running your metabolism?

Because metabolic health is not just low sugar —It’s energy stability, hormonal balance, recovery capacity, and nervous system safety.

How Chronic Low Blood Sugar Can Create Insulin Resistance

When blood sugar drops too low repeatedly, the body enters a stress response:

The brain detects glucose deficiency
The hypothalamus activates the adrenals
Cortisol is released
The liver produces glucose to survive

Cortisol does several things:

Blocks insulin action
Reduces glucose uptake into muscle and fat
Increases fat breakdown → free fatty acids → inflammation
Disrupts insulin signaling over time

This creates a loop: Low blood sugar → cortisol → insulin resistance → metabolic dysfunction → weight gain → hormonal imbalance → more stress response

This is why it’s entirely possible to have: Low HbA1c + insulin resistance at the same time. Especially in early-stage metabolic dysfunction.

The Markers I Actually Trust for Detecting Insulin Resistance

When HbA1c looks “normal” but the body doesn’t function normally, I look deeper:

Fasting insulin >15 µU/mL = red flag
HOMA-IR (glucose + insulin calculation)
When accessible:
- Adiponectin
- Leptin
- C-peptide

These markers tell me what HbA1c alone cannot: How hard the body is working to maintain “normal” sugar levels. Because sometimes normal glucose is maintained by a stressed, overcompensating system — and that is not health.

My Coaching Lens on Metabolic Health

Here’s my honest philosophy:

Health is not about chasing perfect numbers. It’s about building stable systems.

Blood sugar, hormones, sleep, stress, nutrition, training, inflammation, nervous system regulation — they all talk to each other. You cannot isolate one without affecting the others.

So I don’t treat HbA1c as a trophy metric. I treat it as a data point in a larger story.

Because real health looks like: