Why does the doctor still say my diabetes isn't well controlled when my monthly blood sugar measurements are normal?

Every time they go for a follow-up visit at the hospital, diabetic patients are often asked to take a test—glycated hemoglobin. Many people with diabetes are puzzled: "I measure my blood sugar daily and it's always fine, so why do I need to check this?"

This seemingly ordinary indicator actually holds the core secret to diabetes management. Understanding it is the key to truly taking control of your health.

01 The Memory of Blood Glucose

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Fasting blood sugar and postprandial blood sugar are like "snapshots" of the blood sugar world, only reflecting the situation at the moment of measurement. In contrast, glycated hemoglobin (HbA1c) is a "long-term report card," recording the average blood sugar level over the past 2-3 months.

The principle is simple: hemoglobin in our blood combines with glucose in the bloodstream, and this binding is slow and irreversible.

The higher the blood sugar, the more of this binding occurs, resulting in a higher proportion of glycated hemoglobin. Since the average lifespan of red blood cells is about 120 days, this test can reflect blood sugar conditions over the past few months.

Doctors value this indicator precisely because it is not affected by short-term factors such as diet, emotions, or exercise. One patient, Mr. Wang, once shared in confusion: "After a gathering last week, my blood sugar was high, but I’ve been controlling it well these days. Why does the doctor still say my glycated hemoglobin is above the target?"

This is the key point – even with occasional good control, if blood sugar frequently "spikes" during regular times, glycated hemoglobin will "record this entry," honestly reflecting long-term control levels.

It can be said that glycated hemoglobin is the "gold standard" for diabetes control, helping doctors determine whether the treatment plan is truly effective, without being misled by daily blood sugar fluctuations.

02 Control Level Alerts

＜7.0%

To what level should glycated hemoglobin be controlled to minimize the risk of complications? According to the *Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes*, the control target for adult patients with type 2 diabetes should generally be <7.0%.

This number is not arbitrarily set. Extensive research has confirmed that when glycated hemoglobin remains below 7.0% for an extended period, the risk of microvascular complications (such as retinopathy, kidney disease) in diabetic patients is significantly reduced.

＜8.0%

For younger individuals with a shorter disease duration and no severe complications, more stringent control targets—6.5% or even lower—may be attempted under a doctor's guidance. Conversely, for elderly patients with multiple complications or a high risk of hypoglycemia, the target can be appropriately relaxed to <8.0%.

A 20-year follow-up study from Harvard University found: For every 1% reduction in HbA1c, the risk of microvascular complications in diabetic patients decreases by 37%, diabetes-related mortality decreases by 21%, and the risk of myocardial infarction decreases by 14%.

This means that lowering HbA1c from 9.0% to 8.0% can significantly reduce the risk of complications. The core goal of diabetes management is to keep these long-term risks at the lowest possible level.

Aunt Li, who has successfully managed her blood sugar for ten years, said: "I've always treated HbA1c as a health 'barometer,' keeping it below 7.0%. All these years, my eyes and kidneys have checked out normal, and even the doctor praised me for my excellent control."

03 Strategies for Addressing Elevated Levels

When discovering elevated HbA1c levels, there's no need for excessive panic; instead, consider it a health warning signal. Generally, an HbA1c level above 7.0% requires adjustments to the treatment plan. If it exceeds 8.0%, it indicates that blood sugar control is significantly inadequate.

When facing elevated HbA1c levels, individuals with diabetes can take the following steps to address the situation:

First, analyze the underlying causes with your doctor. Have dietary controls been relaxed? Has physical activity decreased? Or does medication require adjustment? Elevated HbA1c levels are typically not caused by a single factor.

Second, strengthen blood glucose monitoring, particularly focusing on postprandial and nighttime blood sugar levels, which are often overlooked. Many people only pay attention to fasting blood sugar, unaware that postprandial hyperglycemia contributes more significantly to HbA1c levels.

Then, review your dietary records. Is carbohydrate intake excessive? Are there irregular eating habits? Are there hidden "sugar traps"?

At the same time, evaluate physical activity levels. Regular physical exercise can improve insulin sensitivity and help lower blood glucose levels.

If necessary, adjust medication treatment plans under a doctor's guidance. Currently, there is a wide variety of antidiabetic drugs available, and doctors can select the most suitable medication or combination based on the patient's specific situation.

Finally, set reasonable phased goals. Do not expect glycated hemoglobin to drop from 9.0% to 7.0% all at once; instead, aim for gradual reduction of 0.5%–1.0% every three months.

"Three years ago, my glycated hemoglobin was as high as 9.8%," shared Mr. Zhang, a person with diabetes. "I didn’t lose heart; together with my doctor, I developed a plan for diet, exercise, and medication, and got tested every three months. Now it has stabilized around 6.7%. The key is consistent effort and regular monitoring."

"Auntie Li, your HbA1c this time is 6.5%, 0.2% lower than last time. Keep it up!" The doctor's affirmation brought a smile to Auntie Li's face. She understood that this figure reflected her daily efforts with reasonable diet, consistent exercise, and regular medication.

For people with diabetes, glycated hemoglobin isn't just a cold number—it's a compass for health management. It doesn't judge the past, it only points toward the future—guiding you to know if your management is on track and alerting you if you need to adjust your course.

Instead of fearing this number, it's better to learn to communicate with it, letting it become a faithful partner in guarding your health. After all, every test result lays the foundation for a longer and healthier life.