Ep. 101 Your Teen's A1C Is Normal—But Are They Healthy?

A normal A1C result feels like good news. And I completely understand why parents feel relieved when they hear it. But as a pediatric endocrinologist, this is one of the biggest misunderstandings I see in families, and I want to clear it up today.

In this episode I explain what A1C actually measures, why it misses early insulin resistance in teenagers, and the other lab values and physical signs that pediatric endocrinologists look for when they want to catch metabolic problems before they become prediabetes or diabetes.

Do you worry your teen is gaining weight quickly or seems hungry all the time?
Are you afraid this could lead to prediabetes or diabetes later in life?

That’s why I created the “Healthy Weight Starts with Healthy Habits": A 7-Day Hormone Reset Program for Teens.

ONLY $25 - Learn more here !

I’m Dr. Jenny Gourgari—pediatric endocrinologist, certified in obesity medicine and a health coach. 
After helping hundreds of teens struggling with their weight and hormones, I’ve created a whole new path by doing what most programs miss: balance puberty hormones naturally and create habits that actually last.

Here's what makes this different:
✅ No dieting. No calorie counting. No shame.
✅ No more food fights between parents and teens.
✅ No weight obsession—just healthy habits
✅ Real science behind how puberty hormones affect weight
✅ A safe, supportive approach that prevents eating disorders

Because when teens understand their hormones and get the right support, they don’t just lose weight—they gain strength, energy, confidence, and freedom!

📲 Subscribe to my newsletter for weekly emails packed with easy tips, clinical insights, and practical tools

🎁 Grab your FREE high-protein recipe guide with 30 meals teens will love.
Links
30 Healthy Recipes for teens
lifestyleforteens.com/recipes

Smoothies Recipes for teens
lifestyleforteens.com/smoothies

Subscribe to my newsletter
lifestyleforteens.com/newsletter

I’m Dr. Jenny Gourgari—pediatric endocrinologist, certified in obesity medicine and a health coach. 
After helping hundreds of teens struggling with their weight and hormones, I’ve created a whole new path by doing what most programs miss: balance puberty hormones naturally and create habits that actually last.

Here's what makes this different:
✅ No dieting. No calorie counting. No shame.
✅ No more food fights between parents and teens.
✅ No weight obsession—just healthy habits
✅ Real science behind how puberty hormones affect weight
✅ A safe, supportive approach that prevents eating disorders

Because when teens understand their hormones and get the right support, they don’t just lose weight—they gain strength, energy, confidence, and freedom!

📲 Subscribe to my newsletter for weekly emails packed with easy tips, clinical insights, and practical tools

🎁 Grab your FREE high-protein recipe guide with 30 meals teens will love.
Links
30 Healthy Recipes for teens
lifestyleforteens.com/recipes

Smoothies Recipes for teens
lifestyleforteens.com/smoothies

Subscribe to my newsletter
lifestyleforteens.com/newsletter

Transcript

 Welcome to another episode of the Lifestyle and Weight Loss For Teens podcast. This is Dr. Jenny Gourgari, and today I'll be talking about A1C. Parents hear normal A1C and feel relieved. " Okay, that's good. My teen is not at risk for diabetes." But as a pediatric endocrinologist, I can tell you that in teenagers, metabolic problems begins years before the A1C becomes abnormal. 

A teenager can have insulin resistance developing, high insulin levels, cravings, rapid weight gain, darkening around the neck and the axilla. They can have polycystic ovary syndrome, and the A1C can still look completely normal. 

Today, I want to explain why that happens, what A1C actually measures, what it misses in the teenagers, and other lab clues pediatric endocrinologists sometimes look when they're trying to catch metabolic problems early, because early identification is very important you can prevent the future pre-diabetes, the future diabetes, and future complications. 

So that's what I help teenagers with. I help them improve their metabolic health through health habits, sleep, movement, nutrition, stress management, hormone education, without shame, without dieting, without restriction. And honestly, this topic today is one of the biggest misunderstandings I see in families because many parents feel falsely reassured by one single lab value, the A1C. We call this hemoglobin A1c. I know most parents refer to it as A1C.

So let me explain what A1C is. A1C, or hemoglobin A1C or glycosylated hemoglobin hemoglobin is the protein inside  the red blood cells in the body that carries oxygen. When there's a lot of glucose or sugar in the blood, the sugar attach to hemoglobin, and the more sugar there is over time in the blood, the more the glucose sticks to the hemoglobin, It's called glycosylated hemoglobin, red blood cells have a lifespan of around three months, that's why the A1C represents the average sugar in the body in the last three months.  

Is this, the absolute test that, cannot miss anything? No. A1C is, one of the tools that, can be used for screening for prediabetes in teenagers, along with fasting glucose and oral glucose tolerance test. Oftentimes the A1C can miss teenagers that have prediabetes. The A1C can underestimate the percentage of teenagers that have prediabetes and abnormal sugar. That's why when we have high concern that there are teenagers at high risk to develop, prediabetes, we as pediatric endocrinologists may take one step further, and we can do more tests. 

Puberty itself naturally increases insulin resistance. During puberty, insulin sensitivity can decrease by about 25 to 30%, and that means the teenage years are particularly vulnerable. if a teenager is overweight, their body is already stressed because of the extra weight, and then they go into puberty, they have more insulin resistance because of puberty. That can tip them off and become, an A1C abnormal. Or A1C looks okay, however, there could be other signs of insulin resistance and, early signs of prediabetes before it becomes diabetes. A1C is kind of a late sign. There are other earlier signs that you can see before you get to see a high A1C. Because the first thing that happens is you start by having insulin resistance. You have high insulin levels to control the sugar, to control whatever carbohydrates when you're eating. So that's like a compensatory hyperinsulinemia, and sometimes fasting insulin can help us, get that additional piece of information.However it's not routinely recommended to do, a fasting insulin, level. 

What are other, clinical signs that are important when we have high suspicion? So if you have a teenager that  they're gaining weight rapidly, they're, always tired even though they're sleeping okay, they have a lot of, stress in their life. You start to see that they have dark skin around the neck. Under the axillary. Or if it is a girl, you start to see acne and irregular periods. Or if you have teenagers that have family history of type 2 diabetes, or that you have a teenager that also has fatty liver disease or, a teenager that has PCOS, those are the teenagers that may be at higher risk for prediabetes. 

A pediatric endocrinologist may consider doing additional testing even though the A1C, may be normal. What are those additional tests, one is the fasting glucose, and then the other test is, the two-hour oral glucose tolerance test. If you're a mom and you've, had that, when you were pregnant, it's a test where we give, teenagers to drink sugar, and then we measure the amount of sugar after, One hour and two hours, and we look at the two-hour sugar to see if there is abnormalities that indicate, abnormal glucose, tolerance. The problem with the oral glucose tolerance test is, that drink does not taste good, 'cause I did had that myself. Besides that, it is a time commitment. It's not an easy thing to do. It often requires that there is  a nurse, somebody to supervise the test. It takes, about two hours. It can be time-consuming it does not have the best, reproducibility, so you can go and do the test, it can be normal, and then you can go and do the test again after three months, it can be abnormal, and that's why typically it's not like one of those tests that, we do, and that's, a discussion that, you can have with a pediatric endocrinologist, and we decide on a one-to-one basis whether to do it. High suspicion cases in patients that have high risk for prediabetes where there is a normal A1C, a pediatric endocrinologist may elect to do a, glucose test, along with a fasting glucose level. Now, I also wanna mention sometimes I see teenagers that are not at high risk for prediabetes, and they may have, slightly higher A1C.

 This A1C can, give you falsely, elevated results. One very common reason why A1C can be abnormal is iron deficiency. If you have  iron deficiency anemia, that can, sometimes, elevate, the A1C without, necessarily meaning that there is risk for prediabetes. Iron deficiency, is very common, particularly among teenage girls that have  heavy menstrual cycles and they're having rapid growth, or they're not  eating enough, food with enough iron. A1C can potentially miss, early insulin resistance in prediabetes. Iron deficiency can falsely elevate a little bit the, A1C. That's another thing you can have a discussion with your pediatric endocrinologist. Another thing we look at is if there is a lot of triglycerides. We can do a  fasting lipid profile. Triglycerides is another thing we get besides the cholesterol.  HDL is the good cholesterol,  LDL is the bad cholesterol. So if you have, a higher triglyceride and a low HDL cholesterol, then that is also associated with insulin resistance. Now, this ratio, is not diagnostic by itself, but it's a clue, clues that, the doctor can put together and see if there is, metabolic dysregulation before you see the A1C.

The  labs by themselves are not determining whether a child has prediabetes or whether a child is at risk for prediabetes or not. That's why the role of pediatric endocrinologist, the role of pediatrician is very important. That your pediatrician can ask you all the questions, assess the risk factors, do the physical exam and examine your teenagers. 

They can see whether they have other, clinical signs of metabolic derangement. They can have other risk factors, and they can test those tests, and depending on those, they can decide what to do next. So, the biggest takeaway that I want you to remember from this is a normal A1C does not always mean normal metabolic health in teenagers, particularly during puberty and particularly the teenagers that are at high risk to have prediabetes, if you don't know if your teenager is at high risk, I have created a quiz. You can go to lifestyleforteens.com/quiz and get the quiz and see if your teenager is at high risk for, diabetes. that's all I had for you today.

I hope this was helpful, and I will talk to you next week. Take care. Bye.