A1C Is Not the Goal: Rethinking Metabolic Health

By Dr. Steven Long, DO, MHA, CPT

When most people (and unfortunately, most providers) talk about metabolic health, the conversation almost always circles back to one number: hemoglobin A1C.

The logic seems simple: if your A1C is “in range,” your metabolic health must be good. But this is an overly narrow—and often misleading—view. A normal A1C does not necessarily mean your metabolism is healthy. In fact, many people maintain a “normal” A1C at the expense of chronically elevated insulin levels, which can quietly drive long-term damage long before diabetes ever appears on a chart.

Let’s talk about why A1C is just one small piece of the puzzle—and why Beyond Health looks far beyond that single number when evaluating your metabolic health.

What A1C Actually Tells Us

A1C reflects the percentage of hemoglobin molecules in your blood that are glycated—bound to glucose. Because red blood cells live about 90–120 days, A1C offers a 3-month average of blood glucose levels.

It’s a useful marker for assessing diabetes control, but it’s far from perfect:

• It’s an average, which means spikes and dips can be hidden. A patient with frequent 200 mg/dL glucose spikes and frequent lows can average out to a “normal” A1C.
• It doesn’t tell us anything about insulin levels, insulin sensitivity, or underlying metabolic strain.
• It can be influenced by factors like anemia, kidney disease, or altered red blood cell turnover.

A1C is like a rearview mirror—it shows where your glucose has been, but it doesn’t show the full terrain of your metabolic health.

The Problem With “Normal” A1C and High Insulin

It’s entirely possible to have a normal A1C while living with chronically elevated insulin levels (hyperinsulinemia).

This happens because the body, in early insulin resistance, can keep glucose in check by producing more and more insulin. The pancreas works overtime to push glucose into cells despite resistance at the tissue level. Your A1C stays “normal” … until one day, it doesn’t.

But long before that tipping point, excess insulin is quietly harmful:

• Promotes fat storage—particularly visceral (organ) fat, which is strongly associated with cardiovascular risk and worsening metabolic dysfunction.
• Raises blood pressure by promoting sodium retention and sympathetic nervous system activity.
• Lowers HDL and raises triglycerides, driving an atherogenic lipid profile (even when LDL is “normal”).
• Increases inflammation by activating pro-inflammatory pathways in vascular and adipose tissue.
• Drives endothelial dysfunction, which sets the stage for atherosclerosis.
• Can promote cancer cell growth, as insulin is a growth factor that signals proliferation.

In other words, high insulin is not benign just because blood sugar looks okay.

Metabolic Health Is Bigger Than Glucose

At Beyond Health, we define metabolic health in broader—and more meaningful—terms than just blood sugar control.

Key pillars of metabolic health include:

1. Insulin Sensitivity
   • Fasting insulin levels in an optimal range
   • Favorable HOMA-IR
   • No excessive post-meal insulin spikes
2. Glucose Control
   • Normal fasting glucose
   • Minimal glucose variability on continuous glucose monitoring (CGM)
   • Absence of significant postprandial spikes
3. Lipid Health
   • Low triglycerides
   • High HDL
   • Favorable LDL particle size and count
4. Body Composition
   • Low visceral fat
   • Healthy lean muscle mass
5. Blood Pressure
   • Consistently in an optimal range without medication excess
6. Inflammation & Vascular Health
   • Low hs-CRP and other inflammatory markers
   • Healthy endothelial function

Why We Care About the Bigger Picture

Traditional diabetes care often waits for blood glucose to deteriorate before acting. But metabolic disease begins years—sometimes decades—earlier, in the silent phase of insulin resistance.

At Beyond Health, we don’t wait for a “pre-diabetes” or “diabetes” label. We focus on early detection—through fasting insulin, CGM, body composition analysis, lipid particle testing, and inflammatory markers—to address the root cause before it manifests as overt disease.

This is not just about avoiding diabetes. Optimizing metabolic health reduces the risk of:

• Cardiovascular disease
• Fatty liver disease
• Cognitive decline
• Certain cancers
• Sarcopenia and frailty with aging

Bottom Line

A1C is a useful tool, but it’s not the gold standard for metabolic health. A “good” A1C can hide early metabolic dysfunction if it comes at the cost of chronically elevated insulin and poor metabolic resilience.

At Beyond Health, we aim for more than “normal labs.” We aim for optimal metabolic health—glucose stability, insulin sensitivity, favorable body composition, and low inflammation—because this is what truly moves the needle on long-term healthspan.