A creeping HbA1c is a warning, not a sentence

Every few weeks someone forwards us a blood result with one number circled. Their HbA1c has drifted up — still under the diabetes line, but far enough that their GP used the word "pre-diabetes" and suggested they keep an eye on it. They are not sure what that means or what to do, and the internet has made them more frightened than informed. Here is the calm version.

What the number is

HbA1c is a three-month average of your blood sugar. It drifts up when your body is handling carbohydrate less well than it used to — often because there is a bit more fat around the middle and a bit less muscle doing the work of clearing sugar from the blood. That is the important part: it is largely about how much muscle you have and how you use it, which means it is largely something you can act on.

Pre-diabetes is not a diagnosis of disease. It is an early-warning light. The point of an early-warning light is that you still have time.

The number went up over years. It comes down over months. Both are slow, and both are real.

The three levers that move it

Muscle that gets used. Strength training builds the tissue that pulls sugar out of the blood, and a session leaves that tissue hungry for glucose for a day or more afterward. Two or three sessions a week is not a nice-to-have here; it is the mechanism.

A walk after meals. Ten minutes of easy walking after your largest meals blunts the sugar spike that follows them. It is almost absurdly simple, it costs nothing, and across a week it adds up on the three-month average. Most people can start this today.

Fewer liquid and snack sugars. Not a joyless overhaul — the specific, high-return swaps. The sweet drink, the grazing between meals, the "healthy" snack that is mostly sugar. You do not have to earn a sainthood; you have to remove the two or three biggest drips.

Why medication is not always the first stop

For many people in the pre-diabetes range, these levers move the number back down without ever needing a prescription. That is a conversation to have with your GP, not something to decide from a blog. But it is worth knowing that the early stage is the stage most responsive to training and food — the window where the least effort does the most.

How we approach it

We start with the screen — your bloods, your movement, your week. Then a written twelve-week plan: the strength sessions, the post-meal walks, the handful of food swaps that fit your life, not a stranger's. At twelve weeks we re-test the same panel and read the number together. If it moved, you know exactly what moved it.

None of this is medical advice, and we are not a substitute for your doctor. It is what an exercise physiologist does with the part of the problem that responds to training. If you want that part handled properly, that is the work.