It’s not uncommon to walk away from a doctor’s appointment feeling confused after receiving a diagnosis of type 2 diabetes—especially if the numbers don’t seem to line up.
One of the most frequently asked questions we get is: “How can I have a normal A1c but still be diagnosed with diabetes?”
That’s exactly the situation Amanda found herself in.
Recently, Amanda shared her story:
“I suffer from health anxiety and get nervous before blood tests. My fasting blood glucose was 7.0 (126 mg/dL), but my A1c was 5.6%. My GP said I have type 2 diabetes, but it didn’t make sense to me. I thought A1c was the more accurate measure.”
Amanda is not alone in this experience, and it raises an important point: while all tests provide valuable information, they reflect different aspects of your glucose metabolism.
In Amanda’s case, her A1c of 5.6% is technically in the normal range, below the cut-off for both diabetes and prediabetes. Yet, her fasting glucose of 7.0 mmol/L meets the threshold for a type 2 diabetes diagnosis.
So how do we make sense of this?
The fasting blood glucose (FBG) test measures your blood sugar after at least 8 hours without food and is just a snapshot of that moment in time. However, this snapshot can be influenced by short-term factors like stress, poor sleep, or even a bad night’s meal, especially in people prone to health anxiety, like Amanda.
On the other hand, the hemoglobin A1c (HbA1c) reflects your average blood sugar levels over roughly the past three months. It’s less impacted by daily blood sugar fluctuations and acute stress, which is why many consider it a more stable marker.
According to clinical guidelines, either an A1c ≥ 6.5% or an FBG ≥ 7.0 mmol/L (126 mg/dL) can be used to confirm a diagnosis of type 2 diabetes.
If someone is symptomatic (with signs like excessive thirst, urination, or fatigue), just one abnormal result may be enough to confirm diagnosis. If they’re asymptomatic (no symptoms), the guidelines recommend confirming the result on a separate day or with a second abnormal test.
In Amanda’s case, unless her doctor saw other symptoms or contributing health risks that confirmed a pattern, it would be good practice to repeat the fasting glucose test or use a different test, like an oral glucose tolerance test, to confirm the diagnosis.
The key takeaway? A single elevated fasting glucose test can indicate early insulin resistance or liver glucose overproduction, often one of the first signs of impaired glucose metabolism.
So even if a formal diagnosis feels premature, Amanda’s result is a clear signal that something is shifting. And catching this early provides the best chance to take action and prevent progression of prediabetes to type 2 diabetes.
If you’ve ever been in Amanda’s shoes, remember this: you are allowed to ask questions, request repeat testing, and seek clarity. Diagnosis should never feel like a mystery, it should feel like a guidepost.
Although medical doctors can sometimes seem intimidating, you must advocate for yourself and should never be afraid to stand up and ask questions!
👉 Listen to episode 87 of the Type 2 Diabetes Talk podcast where we talked about Amanda’s case study in more detail.
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