HbA1c blood sugar level

How to improve your blood sugar levels

422 million people worldwide are suffering from diabetes. The majority of them struggle with severe blood sugar fluctuations and associated effects on the neurological and cardiovascular systems. With exercise, the right food and fasting, you can get your values under control!

Be it gummy bears, licorice or chocolate - sweets have long been suspected of triggering diabetes. But it is not necessarily the sugar that results in diabetes. As research has now revealed, a generally unhealthy diet and obesity increase blood sugar levels and cause type 2 diabetes mellitus. Even healthy, athletic children and adults can develop type 1 diabetes, which is usually caused by genetic factors.

Increased blood sugar and diabetes risk can be measured with the long-term blood sugar value HbA1c. In this article, we will explain what this value is all about and what you can do about hypoglycemia or hypoglycemia.

Diabetes mellitus

The long-term blood sugar value HbA1c is particularly relevant for people who suffer from diabetes. According to the World Health Organization (WHO), diabetes mellitus is one of the most common diseases, with around 422 million people living with diabetes worldwide in 2014. Type 2 diabetes is particularly prevalent among older people.

In order to really understand the clinical picture of the widespread disease diabetes, it is important to be able to classify the most important terms around the disease: pancreas, insulin, blood sugar, type 1 diabetes and type 2 diabetes.

What is insulin?

The pancreas produces the hormone insulin. It regulates blood sugar, i.e. the glucose content in the blood, and serves as a key. It opens the cell membrane from the outside so that the sugar from the blood can enter the cell and supply it with energy. Once the sugar has arrived in the cell, the sugar content in the blood drops[1].

Generally, insulin allows the sugar to enter the cells. In the case of diabetes mellitus, the body cannot transport the sugar in the blood into the cells. The sugar (glucose) continues to circulate in the blood, causing the blood sugar to increase. Diabetes is caused by insulin deficiency or unusable insulin. There are three different forms:

  • Diabetes mellitus type 1 - absolute insulin deficiency
  • Diabetes mellitus type 2 - relative insulin deficiency
  • Gestational diabetes - relative insulin deficiency in pregnancy

The difference between diabetes mellitus type 1 and type 2

In the case of type 1 diabetes, the pancreas no longer produces insulin because it is impaired by viral infections or genetic predispositions. Type 1 diabetes affects children and adolescents Type 2 diabetes, on the other hand, is more likely to be the result of an unhealthy diet and obesity: In this disease, the pancreas produces insulin but cannot open the cell membrane. Fat cells stand in the way of insulin. This is why glucose remains in the blood and blood sugar rises [2].

Diabetes risk due to vitamin D deficiency

That's good to know:ÊThere is a north-south divide in Europe with regard to diabetes mellitus type 1. In Scandinavia, significantly more people are affected than in southern Europe. Researchers assume that genetic causes are responsible and a vitamin D deficiency, which is widespread in northern Europe. The sun vitamin D is supposed to protect the pancreas from infections that weaken its function[3].

Gestational diabetes

Gestational diabetes is a relatively common clinical picture. In most cases, elevated blood sugar levels occur in the second half of pregnancy. The following factors increase the risk of developing type 2 diabetes during pregnancy[4]:

  • The pregnant woman suffers from severe obesity.
  • The woman had already developed diabetes in a previous pregnancy.
  • Type 2 diabetes is common in the woman's family.

Therefore, you should undergo regular medical examinations. If you are diagnosed with gestational diabetes, check your blood sugar levels. Worst case scenario, poorly adjusted gestational diabetes can lead to miscarriage. After the birth of the child, this form of diabetes usually resolves itself[5].

Current knowledge - Breastfeeding protects against diabetes mellitus type 2

The German Institute of Nutrition Research investigated the risk of developing type 2 diabetes in breastfeeding mothers. The study found that non-breast-feeding participants exhibited a stronger tendency[6]. Researchers at the German Center for Diabetes Research suspect that breastfeeding protects women from type 2 diabetes when they have had gestational diabetes.[7].

Blood sugar and HbA1c

Sugar is like fuel for the body. Our brain, muscles and organs work at full speed when insulin feeds them with this energy source. Bread, potatoes, rice, fruit and sweets contain carbohydrates, chemical sugar chains. They are made up of glucose or fructose, which is converted into glucose in the body. Even in the mouth, substances in saliva break down long-chain carbohydrates into glucose molecules Only in this form can the body introduce carbohydrates into the bloodstream via the mucous membrane of the small intestine - blood sugar increases and the pancreas releases insulin.

Which blood sugar levels are considered normal?

Physicians usually measure blood sugar in the international unit millimol per liter (mmol/L). In Germany, the unit milligramm per deciliter (mg/dl) is often used. Whether your blood sugar is within a healthy range depends on whether you are fasting or have eaten[8, 9].

State of health/ target values at specific times

After getting up (fasting)

Before eating

At least 90 minutes after eating



72-108 mg/dl

< 140 mg/dl

Diabetes mellitus Type 2


72-126 mg/dl

< 153 mg/dl

Diabetes mellitus Type 1

90-126 mg/dl

72-126 mg/dl

90-162 mg/dl

Children with diabetes

72-126 mg/dl

72-126 mg/dl

90-162 mg/dl

Modified by: National Institute for Health and Care Excellence

Good to know:ÊTo convert the blood sugar value from mg/dl to mmol/L to, you must divide the value by 18. 72 mg/dl therefore results in 4 mmol/L.

Blood sugar imbalances and their consequences

It is difficult for a diabetic to maintain consistently good blood sugar levels. However, with the right therapy and lifestyle, you can aim for healthy blood sugar levels to avoid the consequences of blood sugar fluctuations. Both hypoglycemia and hyperglycemia have a negative effect on your body.

If your blood sugar drops to a very low level, this can lead to seizures in addition to the usual symptoms. In the worst case, severe hypoglycemia can cause you to lose consciousness [15].

Hyperglycemia for an extended period of time is associated with long-term damage. Damage to the nerve cells causes numbness, especially in the feet. Saccharified molecules are increasingly deposited in the eye, which can lead to impaired vision. High blood sugar levels also make it difficult for the kidneys and heart vessels to cope. The risk of developing kidney problems or even suffering a stroke increases [16].

Current knowledge: High blood sugar and HbA1c impair the brain

According to the latest research, your brain ages faster if you are suffering from diabetes with continuous hyperglycemia. In the study, the brain of a diabetic was five years older than that of a healthy volunteer. Similarly, diabetes can promote the onset of dementia . In order to reduce the risk, patients should try to achieve a continuously optimal HbA1c value with the right treatment[19].

What constitutes an elevated blood sugar level?

Physicians consider elevated blood sugar to be present when fasting blood sugar exceeds 126 milligrams per deciliter. Since the body releases considerable amounts of the stress hormone cortisol in the morning, the fasting blood sugar can be greater than 126 mg/dl in the morning. Cortisol increases the amount of glucose in the blood[10, 11].

The boy with the highest blood sugar in the world: The American Michael Buonocore was hospitalized in 2008 with a blood sugar level of 2656 mg/dl. He was diagnosed with diabetes mellitus type 1[12].

What is the HbA1c value?

The long-term blood sugar HbA1c indicates your average blood sugar level over the three months. Sugar attaches itself to the blood pigment hemoglobin in the blood, causing it to "saccharify". We call the sugared blood pigment "glycohemoglobin", "hemoglobin A1c" or "HbA1c".

The higher the HbA1c value, the more saccharified hemoglobin particles in the blood. This means that you have had increased blood sugar levels during this period. In German-speaking countries, the HbA1c value is usually indicated as a percentage value it describes the proportion of HbA1c in the total hemoglobin. Physicians can use this value to diagnose diabetes mellitus[13].

Which HbA1c values are normal? - An overview



< 5,7 percent

Normal range

5,7percent < 6,5 percent

Grey area ( pre-diabetes ) - please clarify

= 6,5 percent

Increased (possible diabetes) - must be clarified

6,5 - 7 percent as target range for diabetics

If your HbA1c value lies within the so-called grey range, physicians speak of pre-diabetes. In this blood sugar range, the risk of developing diabetes increases. Especially people who are overweight and have an unbalanced diet fall into this category. A healthy diet and sufficient exercise can minimize this risk. If your value is greater than or equal to 6.5 percent, physicians will assume that you have diabetes. A comprehensive blood test enables physicians to confirm the diagnosis.

In short – Blood sugar and HbA1c:
The blood sugar value indicates how much glucose there is in the blood. The HbA1c value serves as a long-term memory for our sugar content in the blood. It provides information about the blood sugar level of the last three months. Both parameters are important in the diagnosis of diabetes mellitus and are particularly relevant for diabetics.

Causes of hyperglycemia and hypoglycemia

Various factors cause blood sugar to increase or decrease. Normally, hormones restore balance to these fluctuations. However, this only works to a limited extent in diabetics. As a result, their blood sugar balance fluctuates more, causing them to suffer more frequent hypoglycemiaand hyperglycemia.

What causes hypoglycemia?

If the amount of insulin is too high the blood sugar level drops rapidly. Too much sugar enters the cells. The following conditions reduce your blood sugar level considerably[14]:

  • Use of more insulin and medication than necessary
  • Extensive physical activity
  • High stress load
  • Heavy alcohol consumption
  • Fasting and omitting meals (especially in type 1 diabetes)

You should not underestimate hypoglycemia - the decreasing blood sugar level must be counteracted. Always carry your glucose meter and dextrose with you to avoid the dangerous consequences of hypoglycemia.

Good to know: In rare cases, benign tumors can also lead to hypoglycemia. The so-called insulinomas produce excess insulin, which causes the blood sugar level to drop. In Germany, every 200th person is at risk of developing an insulinoma. Especially people over 50 years of age are affected[15].

What increases blood sugar levels?

Hyperglycemia mainly affects diabetics. Glucose remains in the blood due to lack of insultin Blood sugar levels can also increase due to[16]:

  • high stress load
  • use of cortisone preparations
  • Infections
  • lack of exercise

Symptoms of hypoglycemia and hypoglycemia

Fluctuations in blood sugar levels don't go unnoticed. Your heart races, confusion sets in and your emotional state fluctuates between anxiety and anger. Hypoglycemia and hypoglycemia can be dangerous if you fail to act promptly. The problem with blood sugar imbalances: The more often you suffer from them, the worse you may feel them over time. People with frequent hypoglycemia notice that their blood sugar is low either too late or not at all, which can have life-threatening consequences[17, 18].

How can I tell if my blood sugar is low or too high?



Heart races

increased urination

Ravenous appetite

increased thirst

difficulty concentrating, fatigue, confusion, anxiety attacks, emotional outbursts


increased sweating, chills, weak knees


Treatment - Optimize blood sugar and HbA1c

6 tips for improved long-time blood sugar values

Regular examinations by family doctors and diabetologists are important for a well adjusted HbA1c value.ÊHowever, a great deal ofresponsibility also lies with those affected.ÊThe right insulin and medication therapy can be used to adjust blood sugar levels very well. However, in the event of fluctuations in blood sugar levels, patients must act correctly to prevent health problems. Ideally, not only the diabetic, but also family members, friends and partners should be informed.

What do I do in case of hypoglycemia?

You need to act fast! Hypoglycemia is best treated with quickly absorbed sugars: dextrose, sweets, Coca Cola and juices. Depending on the value, it is recommended to use the following remedies. After 15 minutes you should check whether the value has increased[20].

Blood sugar


Coca Cola



< 80 mg / dl

1 tablet

50 ml

1 tsp diluted in water

100 ml

< 70 mg / dl

1. 5 tablets

75 ml

1.5 tsp diluted in water

150 ml

< 60 mg / dl

2 tablets

100 ml

1 Tbsp diluted in water

200 ml

< 50 mg / dl

2.5 tabelts

125 ml

1.5 Tbsp diluted in water

250 ml

What should I do if my blood sugar does not increase?

You cannot be alone in a situation like this! The following must be considered[21]:

  • Get help. Tell your partner, neighbor or a person in your immediate vicinity.
  • Continue to consume quickly absorbable carbohydrates and check your values every 15 minutes.li>
  • If the value drops significantly, contact 911.
  • Always have a glucagon syringe handy. Glucagon is the antagonist of insulin and increases blood sugar.li>

How can I lower high blood sugar?

You can counteract high blood sugar with insulin. Your diabetologist will discuss the amount of insulin that is needed in case of hyperglycemia with you. Exercise can lower your blood sugar, but if you develop hyperglycemia your blood sugar will increase considerably as a result of exercise[22].

What is the best way to lower a high HbA1c value?

With the right medication and lifestyle, you can improve your HbA1c value and keep it at an optimal level. This is especially important for people who suffer from diabetes. As a diabetic you should check your HbA1c every three months and your blood sugar levels several times a day. Continue to eat a healthy diet. In many cases, type 2 diabetics are able to control their illness so well by changing their diet and losing weight that they only take few or no medications at all[23, 24, 25].



Adjust insulin therapy correctly

Adjust insulin and medication therapy correctly

Exercise regularly

Exercise regularly, lose weight

Avoid foods with a high glycemic index

Avoid foods with a high glycemic index, eat healthyp>

Check blood sugar regularly

Discuss continuous blood sugar monitoring with your physician

Check blood sugar regularly

Check HbA1c value every three months

Check HbA1c value every three months

Magnesium - An aid in type 2 diabetes?

Magnesium supplements can help type 2 diabetics get their blood sugar under control. The mineral promotes the effectiveness of insulin. This allows the body to transport more sugar into the cells [26].

What is the glycemic index?

The glycemic index indicates, how quickly and how strongly blood sugar rises when you consume a certain foodstuff. The higher and faster your blood sugar increases, the more insulin your body needs. For example, white flour products, white rice, pumpkins and sweets are foods with a high glycemic index. Whole grain products and most fruits do not cause blood sugar levels to increase as drastically[27].

Current knowledge: Intermittent fasting in diabetes mellitus type 2

Intermittent fasting is becoming increasingly important. During the day you should have a fasting period of 16 hours, during which you may only drink water and tea. You can only eat for the remaining eight hours. The most popular method is to eat two meals between 12:00 bis 8:00 p.m. and then fast. According to a study in the World Journal of Diabetes intermittent fasting can help type 2 diabetics improve their blood sugar levels and lose weight. The long phases of not eating will immobilize your blood sugar and your metabolism will go to your fat reserves. Remember one thing: As soon as your pancreas releases insulin, your fat metabolism is stopped[28, 29].

What does a diabetic need to consider before exercising??

If you are exercising, you should check your blood sugar one hour prior. If the value is less than 100 milligrams per deciliter, you should eat two tablets of dextrose or a banana. If the value is above 200 milligrams per deciliter or below 80 milligrams per deciliter, you will need to wait for the value to normalize. It is also best to check your blood sugar level after exercise, as you usually do not notice hypoglycemia during exercise[22].

Important: You should not only check your blood sugar before exercising, but also before driving a vehicle!


The HbA1c value is the most important parameter , to examine the current blood sugar control of a diabetic. In addition to diabetics, people at high risk of diabetes should have their blood sugar levels checked. If you are overweight with a family history of diabetes, it is also a good idea to monitor them.

An HbA1c test is beneficial for the following reasons[30]:

  • You don't have to administer it on an empty stomach.
  • It can be checked at any time.li>
  • It provides information about your blood sugar over the last three monhts.
  • It only requires a small amount of blood.li>

Who checks your HbA1c value?

long-term blood sugar test Family doctors, diabetologists and some pharmacists are able to check your long-term blood sugar levels - but you can also do a self-test at home. For the cerascreen® Long-Term Blood Sugar Test (HbA1c) test, take a small amount of blood from your fingertip. A specialist laboratory analyzes the blood sample to determine your long-term blood sugar and uses it to determine the average blood sugar of the last three months.




HbA1c blood sugar value - At a glance

What is the HbA1c value?

The HbA1c value is also referred to as long-term blood sugar. It provides information on the average blood sugar level over the last three months.ÊIn German-speaking countries, the HbA1c value is usually indicated as a percentage value internationally also in millimoles per mole (mmol/mol).

What does the HbA1c value indicate?

If the HbA1c value is above 6.5 percent, your blood sugar is too high. You may suffer from diabetes. With a value of 5.7 to 6.5 percent, your risk of diabetes is increased. Diabetes mellitus is a condition that is associated with imbalances in the blood sugar. This is caused by a lack of insulin.

How can I lower my HbA1c value?

In order to optimize your HbA1c value, we recommend: regular physical activity, a balanced diet, a well-adjusted medication therapy and regular blood sugar and HbA1c monitoring. Intermittent fasting is supposed to help type 2 diabetics with the optimization according to the newest studies.

What happens in the case of hypoglycemia and hypoglycemia?

Hypoglycemia occurs when an excess of insulin causes the glucose level to drop. Extreme physical activity can also decrease blood sugar. Hyperglycemia occurs when there is not enough insulin in the body or when you are stressed. If you are hypoglycemic, you will be less likely be able to concentrate, your knees will become weak and you notice increased sweating. Hyperglycemia is manifested by an increased urge to urinate and a strong feeling of thirst.


  1. Pschyrembel Online | Insulin, https://www.pschyrembel.de/Insulin/H07H2/doc/
  2. Pschyrembel Online | Diabetes mellitus, https://www.pschyrembel.de/Diabetes%20mellitus/K05U4
  3. Bundeszentrum für Ernährung. Typ-1-Diabetes, https://www.bzfe.de/inhalt/pressemeldung-6214.html
  4. Helmholtz Zentrum München. Schwangerschaftsdiabetes tritt bei ca. 4,5 % auf, https://www.diabetesinformationsdienst-muenchen.de/erkrankungsformen/schwangerschaftsdiabetes/verbreitung/index.html
  5. National Health Service. Gestational diabetes, https://www.nhs.uk/conditions/gestational-diabetes/
  6. Bundeszentrum für Ernährung. Typ-2-Diabetes, https://www.bzfe.de/inhalt/pressemeldung-6994.html
  7. Bundeszentrum für Ernährung. Wie Stillen vor Diabetes schützt: Der Stoffwechsel verändert sich, https://www.bzfe.de/inhalt/wie-stillen-vor-diabetes-schuetzt-27778.html
  8. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Therapie des Typ-2-Diabetes – Langfassung, 1. Auflage. Version 4. 2013, zuletzt geändert: November 2014. Available from: www.dm-therapie.versorgungsleitlinien.de; [cited: 02.11.2018]; DOI: 10.6101/AZQ/000213
  9. pmhdev: Blood Glucose Monitoring - National Library of Medicine, https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024698/
  10. WHO | Diabetes programme, http://www.who.int/diabetes/en/
  11. Freckmann, G., Hagenlocher, S., Baumstark, A., Jendrike, N., Gillen, R.C., Rössner, K., Haug, C.: Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals. J. Diabetes Sci. Technol. Online. 1, 695–703 (2007)
  12. Guinness World Records. Highest blood sugar level, http://www.guinnessworldrecords.com/world-records/highest-blood-sugar-level
  13. Neal, B., Perkovic, V., Mahaffey, K.W., de Zeeuw, D., Fulcher, G., Erondu, N., Shaw, W., Law, G., Desai, M., Matthews, D.R.: Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N. Engl. J. Med. 377, 644–657 (2017). doi:10.1056/nejmoa1611925
  14. Mayo Clinic. Hypoglycemia - Symptoms and causes, http://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685
  15. Informationen für Patienten und Fachleute aus erster Hand - Schwerpunkt: Endokrinologie / Diabetologie, http://www.diabetes-deutschland.de/insulinom/
  16. Mayo Clinic. Hyperglycemia in diabetes - Symptoms and causes, http://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
  17. Spero, D., BSN, RN: Low Blood Sugar Symptoms But Normal Levels, https://www.diabetesselfmanagement.com/blog/low-blood-sugar-symptoms-but-normal-levels/
  18. American Diabetes Assiciation. Hypoglycemia (Low Blood Glucose), http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html
  19. Blutzucker versus Denkleistung, https://www.bzfe.de/inhalt/pressemeldung-7371.html
  20. National Institute of Diabetes and Digestive and Kidney DIseases (NIDDK). Low Blood Glucose (Hypoglycemia), https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia
  21. Blauw, H., Wendl, I., DeVries, J.H., Heise, T., Jax, T., PCDIAB consortium: Pharmacokinetics and pharmacodynamics of various glucagon dosages at different blood glucose levels. Diabetes Obes. Metab. 18, 34–39 (2016). doi:10.1111/dom.12571
  22. Shugart, C., Jackson, J., Fields, K.B.: Diabetes in Sports. Sports Health. 2, 29–38 (2010). doi:10.1177/1941738109347974
  23. Pettus, J., Stenger, P., Schachner, H.C., Dunne, N., Parkes, J.L., Pardo, S., Edelman, S.V.: Testing versus guessing blood glucose values: impact on self-care behaviors in type 2 diabetes. Curr. Med. Res. Opin. 30, 1795–1802 (2014). doi:10.1185/03007995.2014.929097
  24. Pan, B., Ge, L., Xun, Y.-Q., Chen, Y.-J., Gao, C.-Y., Han, X., Zuo, L.-Q., Shan, H.-Q., Yang, K.-H., Ding, G.-W., Tian, J.-H.: Exercise training modalities in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis. Int. J. Behav. Nutr. Phys. Act. 15, 72 (2018). doi:10.1186/s12966-018-0703-3
  25. Hermanns, N., Schumann, B., Kulzer, B., Haak, T.: The impact of continuous glucose monitoring on low interstitial glucose values and low blood glucose values assessed by point-of-care blood glucose meters: results of a crossover trial. J. Diabetes Sci. Technol. 8, 516–522 (2014). doi:10.1177/1932296814524105
  26. Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. Magnesium intake and risk of type 2 diabetes: a meta-analysis. - PubMed - NCBI, https://www.ncbi.nlm.nih.gov/pubmed/17645588
  27. American Diabetes Association. Glycemic Index and Diabetes, http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html
  28. Barnosky, A.R., Hoddy, K.K., Unterman, T.G., Varady, K.A.: Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Transl. Res. J. Lab. Clin. Med. 164, 302–311 (2014). doi:10.1016/j.trsl.2014.05.013
  29. Arnason, T.G., Bowen, M.W., Mansell, K.D.: Effects of intermittent fasting on health markers in those with type 2 diabetes: A pilot study. World J. Diabetes. 8, 154–164 (2017). doi:10.4239/wjd.v8.i4.154
  30. Saudek, C.D., Brick, J.C.: The Clinical Use of Hemoglobin A1c. J. Diabetes Sci. Technol. Online. 3, 629–634 (2009)


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