Head nurse: Diabetes doesn’t have to control your life, if you control your diabetes
Valeria Boitsova, head nurse at Meliva's Rävala clinic, discusses measuring haemoglobin A1c levels.
Living with diabetes means constant monitoring — what to eat, when to move, what your blood sugar level is. But while a glucometer reading gives a good picture of the current moment, it’s the glycated haemoglobin, or HbA1c, level that allows you to sum up a longer stretch of time. This measure shows the average blood sugar level over the past 2-3 months, making it one of the most important indicators for monitoring diabetes.
How is this different from regular blood sugar testing?
“Unlike regular blood sugar testing, HbA1c shows how well blood sugar has been controlled over a longer period,” explains Valeria Boitsova, head nurse at Meliva’s Rävala clinic. She notes that this allows both doctor and patient to draw conclusions about how effective treatment has been and, where necessary, plan changes.
For diabetes that’s stably controlled, HbA1c testing is recommended twice a year. If treatment has recently changed or blood sugar levels are fluctuating, testing every three months is advised. “This frequency helps ensure that any potential problems are caught early and the treatment plan can be adjusted accordingly,” Boitsova notes.
Regular blood sugar, often measured with a glucometer, reflects a single moment in time — for example, before or after a meal. HbA1c, by contrast, reflects glucose bound to red blood cells, offering a picture of the average level over the past 8-12 weeks. This is what makes HbA1c so valuable for assessing long-term control.
What counts as a “good” HbA1c level?
According to Boitsova, the general target is to keep HbA1c below 7.0% (53 mmol/mol). “This significantly reduces the risk of diabetes-related complications,” she stresses.
In some cases, the target may be below 6.5% — for example, in younger or recently diagnosed patients. On the other hand, in older patients or those with chronic conditions, the target may be set as high as 8.0%, to avoid hypoglycaemia caused by overly aggressive treatment.
If HbA1c is above the normal range, it suggests blood sugar has been too high over a longer period. This may point to a need to adjust the treatment plan — for example, increasing medication doses or adjusting insulin.
An HbA1c that’s too low (below 6%), particularly in older patients, can indicate overly aggressive treatment and an increased risk of hypoglycaemia. In that case, treatment needs to be rebalanced based on the patient’s overall condition and lifestyle.
Can lifestyle affect HbA1c levels?
Valeria Boitsova confirms that lifestyle can indeed influence HbA1c levels. This is often a highly effective way to gain control, particularly with type 2 diabetes. Evidence shows the following steps can lower HbA1c by 0.5-2.0%:
- Healthy eating – favouring foods with a lower glycaemic load.
- Regular physical activity – at least 150 minutes of moderate-intensity aerobic exercise per week.
- Weight loss – even a 5-10% reduction in body weight significantly improves glucose balance.
- Reducing stress and quitting smoking – both positively affect blood sugar control.
It’s worth knowing, though, that HbA1c may not be a reliable indicator for certain groups of patients. For example, with iron-deficiency anaemia, chronic kidney disease, blood disorders, or after a blood transfusion, results can be skewed. In such cases, Boitsova recommends using other methods instead.
Today, options such as continuous glucose monitoring (CGM) are available, offering a detailed picture of blood sugar levels around the clock. Keeping a blood sugar diary, noting readings before and after meals, is also useful — it helps the doctor spot patterns and fine-tune treatment more precisely.
Overall, though, glycated haemoglobin, or HbA1c, remains an indispensable tool for monitoring diabetes. It reflects blood sugar levels over a longer stretch of time and helps assess how well the condition is being managed.
Regular monitoring, an appropriate treatment plan, and healthy lifestyle habits all help keep HbA1c within the recommended range and reduce the risk of diabetes-related complications. “Diabetes doesn’t have to control your life, if you control your diabetes,” Valeria Boitsova reminds us, warmly.
This article was first published on the Tervisegeenius portal on 28.05.2025.
