Dealing with insulin resistance? Here’s what you should know about glucose vs A1c

If you’re living with insulin resistance (IR), PCOS, or another metabolic condition, you’ve probably heard the terms “blood sugar” and “A1c” at least in passing at the doctor’s office. But what do these numbers really mean? Are they the same? How do they relate to insulin sensitivity, and most importantly, should you track these numbers?

In short, all of these are related to how well your body regulates and uses insulin and glucose, which is critical for your long-term health. In this explainer, we’ll break down glucose and A1c in plain language. You’ll learn what each test measures, what healthy levels look like for women, how to read them together, and evidence-based strategies to bring your numbers into a healthier range.

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What Is Glucose?

Glucose, AKA blood sugar, is the main form of sugar circulating in your blood. It comes from the food you eat and serves as the body’s primary energy source. When you eat, your blood sugar levels rise, prompting your pancreas to release insulin, which helps move glucose into your cells for energy or storage.

When you have insulin resistance, your body cannot properly use glucose, which can lead to prediabetes or Type II Diabetes (that’s why we say IR elevates your risk of prediabetes and diabetes!). Some people choose to monitor their glucose levels to help determine foods that cause glucose spikes or to learn their fasting glucose levels. 

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What Does a Glucose Blood Test Measure?

A glucose blood test uses a tiny amount of blood to measure your blood sugar level at that moment. It can either be a lab or an in-home test, and doctors tend to look at:

• Fasting blood glucose (after at least 8 hours without food)
• Post-meal (postprandial) glucose (usually 1–2 hours after eating)
• Random glucose (any time of day) 

For most non-pregnant adults, the Mayo Clinic suggests a fasting/pre-meal glucose level of <100mg/dL. A fasting glucose level of 100-125 mg/dL can indicate prediabetes and insulin resistance.

Glucose testing only provides a moment-in-time snapshot; great for spotting spikes, but it won’t reveal your long-term averages or provide a full picture of your metabolic health. For that, you may want to ask about metabolic syndrome testing. 

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A1c Testing

A1c (or Hemoglobin A1c test) is a blood test that measures your average blood glucose levels over the past 3 months. It is an essential metric for people with prediabetes and type 2 diabetes; doctors use the test to both diagnose and manage the conditions. 

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What Does the A1c Test Measure?

The test looks at how much sugar has attached to your red blood cells over time. Since red blood cells live about 120 days, your A1c reflects your average blood sugar over roughly three months. Think of it as a “memory” of your glucose levels, not just a single point in time, like with glucose testing.

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Healthy A1c Levels

A1c test results are expressed as a percentage; the higher your average glucose level, the higher your A1c. For most adults:

• Normal A1c: Below 5.7%
• Prediabetes: 5.7–6.4%
• Diabetes: 6.5% or higher

The above are general guidelines; you should always consult with a healthcare provider on any testing and management of conditions. Something to note is that some women-specific factors, i.e., PCOS, pregnancy, perimenopause, and iron deficiency, can impact both your A1c readings and overall risk profile.

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A1c vs Blood Sugar

While both tests measure glucose, they aren’t the same. The main difference is that glucose testing measures one moment in time (like a snapshot), while the A1c test measures your average levels over ~3 months. 

Additionally, the numbers won’t always match. You can have “good” fasting glucose levels, but a high A1c or high glucose spikes, but ‘ok’ A1c levels. That’s why consistent monitoring and support are necessary to achieve and maintain your health.

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Special Considerations for Women With IR

Metabolic health, AKA how your body converts food into energy, depends on several interconnected systems operating smoothly to work. Imagine an assembly line; if one piece is out of whack, that can cause problems for the whole system. 

At the cornerstone of these systems are insulin, blood sugar, and fat. Problems arise when your body cannot efficiently utilize or regulate those three. It can lead to insulin resistance, high cholesterol, high blood pressure, metabolic syndrome or type II diabetes.

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PCOS and Insulin Resistance

Polycystic ovary syndrome (PCOS) and insulin resistance are closely linked, and because of that, women with PCOS can have issues managing their blood sugar levels. That leads to an increased risk of metabolic syndrome, prediabetes, and type II diabetes. 

A chronically elevated fasting glucose level (like we see with IR) is precisely what can drive your A1c up over time. Depending on what your healthcare provider recommends, you may monitor both to track glucose spikes throughout the day and the overall trend over a 3-month period.

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Pregnancy

Doctors closely monitor A1c levels during pregnancy, regardless of your family health history or prior risk. That’s because gestational diabetes, a type of diabetes that people can develop during pregnancy, can affect any pregnant person and can cause neonatal complications. Elevated A1c levels in early pregnancy, and preexisting metabolic conditions increase the risk of those complications. 

Additionally, women with PCOS are more likely to be diagnosed with gestational diabetes.

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Perimenopause 

Fluctuating estrogen and progesterone levels can worsen insulin resistance and blood sugar swings. On top of that, stress, a slower metabolism, and poor sleep, all common during midlife, all add fuel to the fire. Tracking both glucose and A1c can provide a more comprehensive picture of your metabolic health during this transition.

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Everyday Ways to Stabilize Blood Sugar

Improving insulin sensitivity and stabilizing blood sugar benefit both your daily glucose and your A1c levels over time. Evidence-based strategies include:

• Build balanced meals: Prioritize 25–35 grams of protein per meal and at least 25–30 grams of fiber per day to slow glucose absorption.
• Eat your food in a strategic order: Eating protein, fat, or fiber before carbs can blunt post-meal spikes.
• Move your body regularly: Aim for at least 150 minutes of moderate activity per week plus 2–3 strength sessions. Resistance training is particularly effective in combating insulin resistance.
• Get adequate sleep: You need 7-9 hours of shut-eye every night. Poor sleep increases cortisol and blood sugar levels. In fact, a lack of sleep can lower your basal metabolic rate (BMR), which is the amount of calories your body needs to function. The lower your BMR, the harder it is to maintain a healthy weight. 
• Manage stress: Mindfulness, breathing exercises, or even brief walks can help lower stress hormones that contribute to insulin resistance.
• Consider supplements: Research shows that Inositol increases insulin sensitivity (Allara’s supplement features the clinically proven formulation). Alternatively, a popular medication called Metformin can help with insulin as part of an overall plan. Coordinate with your healthcare team.

Because A1c reflects approximately three months of blood sugar exposure, improvements are gradual. But those small wins yield big results; even a 0.5% drop in A1c significantly reduces your risk of diabetes complications.

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With The Right Support, You CAN Get Control of Your Glucose

Glucose and A1c can be helpful pieces to the larger metabolic health puzzle, and if you have IR, you may benefit from tracking one or both, under the guidance of a healthcare professional. Uncontrolled blood sugar can have large effects on your health. Weight gain, fatigue, and brain fog, to name a few. And just “eating healthy” often isn’t enough to deal with the problem. That doesn’t mean it’s impossible; you may just need a helping hand.

Small, consistent changes in diet, movement, sleep, and stress can lower both daily glucose spikes and A1c over time. The first step is working with a specialist, like our team at Allara. We can help create a sustainable plan that addresses your needs and enables you to achieve your goals. Discover the Allara care model today.