It might seem confusing, but yes, you can have a normal A1C level and still be diabetic. The A1C test measures the average blood sugar levels over the past two to three months by looking at how much glucose is attached to hemoglobin in your red blood cells. Normally, an A1C below 5.7% is considered healthy, 5.7% to 6.4% indicates prediabetes, and 6.5% or higher usually means diabetes.
However, this test doesn’t catch every case perfectly because it reflects an average rather than daily fluctuations in blood sugar. Some people with diabetes may have normal or near-normal A1C levels if their blood sugar spikes are short-lived or if they experience frequent lows that balance out highs when averaged over time.
Also, certain conditions can affect the accuracy of the A1C test—like anemia, some hemoglobin variants, kidney disease, or recent blood loss—which might make your results look normal even if your actual glucose control isn’t good.
Moreover, early-stage diabetes or type 2 diabetes developing slowly might not immediately push your average glucose high enough to raise the A1C above the diagnostic threshold. In these cases, other tests like fasting blood sugar or oral glucose tolerance tests can reveal abnormal glucose metabolism before it shows up on an A1C test.
So while a normal A1C is generally a good sign for most people without diabetes symptoms or risk factors, it’s not foolproof for ruling out diabetes entirely. Doctors often use multiple tests and consider symptoms and risk factors together rather than relying solely on one number.
If you suspect you have diabetes despite a normal A1C—maybe due to symptoms like increased thirst or urination—or if you’re at high risk because of family history or weight issues—it’s important to discuss further testing with your healthcare provider rather than assuming everything is fine based on just one lab result alone.
