The Prediabetic Myth: Why A1C Misleads Athletes

"Your A1C is concerning. We should keep an eye on this."

I've heard this from doctors at every physical since 2017. Recent numbers:

2023: A1C 5.9% April 2024: A1C 6.0% December 2024: A1C 5.9%

Consistently "prediabetic" despite feeling great and staying active.

Most people would accept this pattern and prepare for eventual medication. I treated it like debugging a critical system failure.

For two years, I optimized everything I could:

• Continuous glucose monitoring for 3+ months
• Switched to high-protein, low-carb approach
• Tracked every meal, workout, and sleep metric

But my A1C stayed stubbornly in the "prediabetic" range.

Earlier this year, I wondered: Do I actually have signs of insulin resistance?

So I got DEXA scans and VO₂ max testing, primarily to check for visceral fat.

The results were shocking (in a good way):

• Body fat: 8% (elite athlete level)
• VO₂ max: 54.3 mL/kg/min (95th percentile)
• Visceral fat: 0 lbs
• Lean mass: 87% (21% above peer average)

Something didn't add up. How could I be "prediabetic" with these metrics?

This led me down a research rabbit hole, including Peter Attia's "Outlive." I learned you can test insulin sensitivity directly instead of using A1C as a proxy.

So I got an insulin resistance test:

• Insulin level: <3 uIU/mL (extremely low)
• Insulin Resistance Score: 2 (optimal is <33)

The revelation: I have elite insulin sensitivity despite the "prediabetic" A1C.

What I discovered is called the "Athlete's A1C Paradox":

• Athletes often have longer red blood cell lifespans (artificially elevates A1C)
• Exercise-induced glucose dynamics affect A1C without indicating dysfunction
• High-performance metabolism can "spare glucose" for performance needs

The real insight: Standard diagnostic categories don't always apply to high-performance individuals.

This changed how I approach all data - health or business. Context matters more than absolute values. Sometimes being an outlier means you're playing a different game entirely.

Have you ever had metrics that didn't match your reality?

Originally posted on LinkedIn on June 10, 2025