by Jennifer Douglas
(Spain)
Question: My HbA1c is 6.6%, but my fasting, random, and 2-hour after-meal finger-prick glucose readings are usually normal. I have no classic diabetes symptoms, lost 19 kg, eat low carb, walk daily, and feel well. In one country I am told I have diabetes, while in another I may be called prediabetic. Why can this happen?
Written by: Dr. Albana Greca Sejdini
Medically reviewed: July 2026
Dear Jenny, your frustration is understandable. An HbA1c of 6.6% is just above the diabetes diagnostic threshold used in many countries. However, when HbA1c and home finger-prick readings do not match, the result should be reviewed carefully, not used only as a label.
Your fasting glucose around 95 mg/dL and 2-hour after-meal glucose around 92 mg/dL are reassuring. But finger-prick testing shows only one moment in time. HbA1c reflects a longer period, and sometimes it can also be affected by anemia, vitamin deficiencies, kidney disease, liver disease, hemoglobin variants, or laboratory error.
My advice: do not panic, but do confirm. Ask your doctor about repeating HbA1c, checking fasting plasma glucose, considering an oral glucose tolerance test or short-term continuous glucose monitoring, and looking for causes of a falsely high HbA1c.
Losing 19 kg in 11 months, walking daily, improving food choices, and feeling healthier are excellent achievements. A drop from a much higher HbA1c toward 6.6% without medication suggests that your lifestyle changes have made a real difference.
At the same time, type 2 diabetes and prediabetes often have no obvious symptoms. Feeling well is good news, but it does not always prove that glucose metabolism is completely normal.
Shows an estimated average blood sugar over about 2 to 3 months.
Shows your blood sugar at the exact moment you test.
If you test only fasting or after low-carbohydrate meals, you may miss glucose rises after other meals, during the night, early morning, illness, stress, poor sleep, or less active days.
But your repeated normal readings also raise a fair question: is the HbA1c truly reflecting your glucose? That is why confirmation is important.
An HbA1c of 6.6% is approximately equal to an estimated average glucose of about 143 mg/dL. This feels very different from finger-prick readings in the 80s and 90s mg/dL, so the mismatch deserves a proper medical explanation.
Doctor’s note: A borderline HbA1c should guide a careful review, not create fear. The goal is to understand your real glucose pattern and protect your heart, kidneys, eyes, nerves, and blood vessels.
Many international guidelines use HbA1c 6.5% or higher as a diabetes-range result, especially when confirmed by repeat testing. Some countries have used slightly different thresholds or have updated their criteria over time.
This can feel unfair because the same person may hear different words: normal, prediabetes, or diabetes. But the safest approach is to look beyond the label and confirm the diagnosis with the right tests.
Jenny, yes, I have seen patients with a similar situation. Sometimes the HbA1c is correct and home testing is missing glucose peaks. Sometimes the HbA1c is higher than expected because of another medical factor. Your question is valid and deserves a calm, structured review.
Please continue the healthy lifestyle that helped you lose weight and feel better. But do not rely only on yearly HbA1c if the diagnosis is uncertain. A short period of continuous glucose monitoring or an oral glucose tolerance test may give you much clearer answers.
Contact your doctor if you develop increased thirst, frequent urination, unexplained weight loss, blurry vision, repeated infections, numbness or tingling in the feet, or glucose readings that are repeatedly high.
Seek urgent medical help for confusion, severe weakness, chest pain, shortness of breath, vomiting with very high blood sugar, dehydration, or loss of consciousness.
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