7 Unbelievable Reasons You’re Not Hitting Your A1C Goal

A high A1C could indicate that it’s time to revisit your type 2 high blood sugar management plan.

You’re diligently managing your type 2 high blood sugar by watching your carb intake, exercising regularly, and following your treatment plan. You avoid harmful habits like smoking and take steps to maintain your overall health. Yet, your A1C is still not where you want it to be. Why?

The A1C test measures your average blood sugar over the past two to three months. According to the American Diabetes Association (ADA), the target A1C for most adults with type 2 high blood sugar is below 7 percent. Your doctor uses this number to evaluate how well your high blood sugar management plan is working. A high A1C might signal the need for adjustments to your treatment plan.

“A lot of time, when A1C rises, a person might say, ‘What did I do wrong?’” says Dr. M. James Lenhard, an endocrinologist and medical director of Christiana Care Health System’s Diabetes & Metabolic Research Center in Newark, Delaware. “High blood sugar can be frustrating, and it’s hard work to control it. Unfortunately, a lot of people feel like they have failed when they see their A1C on the rise, when the cause is often due to progression of their type 2 high blood sugar.”

Dr. Lenhard emphasizes that it’s not always your fault. While you should do everything you can to manage your high blood sugar, several factors affecting your A1C are beyond your control.

Here are a few reasons why your A1C might be high and what you can do about it:

1.Your Type 2 High Blood Sugar is Progressing

Type 2 high blood sugar can evolve over time, potentially making your current treatment less effective. In type 2 high blood sugar, your pancreas may produce insulin, but your cells might not respond to it effectively. Over time, this can damage the insulin-producing cells in the pancreas, reducing its ability to meet your body’s insulin needs. “I remind my patients that type 2 high blood sugar is a progressive disorder,” Lenhard explains. “Maintaining a healthy weight and staying active can slow the process but won’t stop it.” Regular monitoring of your blood sugar and A1C levels with your doctor is crucial for adjusting your treatment as needed.

2. You’re Stressed Out

Stress can significantly impact your A1C levels, says Alyssa Gallagher, RD, a certified high blood sugar care and education specialist at St. Luke’s Humphreys Diabetes Center in Boise, Idaho. Stress can affect your body’s insulin utilization, contribute to insulin resistance, and increase levels of epinephrine and cortisol, which raise A1C. People often eat more and less healthy foods when stressed. Pay attention to signs of stress like poor sleep, increased heart rate, and high blood pressure, especially during major life events. Discuss stress management techniques with your doctor, such as exercise, yoga, mindfulness meditation, or cognitive behavioral therapy.

3. You’re Eating Healthy Foods, But You’re Eating Too Much

Portion control is vital for managing your A1C. Monitoring how much you eat helps manage your carb intake, which significantly affects blood sugar levels. The Centers for Disease Control and Prevention (CDC) suggest measuring portions of snacks and asking for half of your meal to be wrapped when dining out. A registered dietitian can help create a meal plan to keep your blood sugar in check.

4. Your Exercise Plan Doesn’t Include Strength Training

Strength or resistance training, such as using free weights or resistance bands, c an improve your body’s response to insulin and increase muscle glucose storage. It also helps maintain a healthy weight, reduce body fat, control blood pressure, and improve strength. The ADA recommends adults with type 2 high blood sugar engage in resistance training two or three times a week. A study published in Medicine & Science in Sports & Exercise found that increasing aerobic and resistance exercise reduced A1C by 0.15 percent in one month. Consult your doctor before adding strength training to your routine.

5. You Have a High Blood Sugar-Related Health Condition

High blood sugar can damage your heart, blood vessels, nerves, eyes, and kidneys, potentially leading to conditions like kidney failure, liver disease, and anemia, all of which can affect your A1C. “Glucose is sticky, and one of the things it sticks to is red blood cells,” says Lenhard. Disorders affecting red blood cells can influence A1C levels. Rising A1C may indicate complications, so consult your doctor about your risk and strategies to mitigate it.

6. You’re Taking Medications for Another Health Condition

Certain prescription drugs, such as opioid pain medications and HIV therapies, can raise A1C levels. If your medications for other conditions are affecting your blood sugar, discuss potential changes to your treatment plan with your doctor. You might need a more aggressive approach to manage your high blood sugar. Always consult your doctor before stopping any medications.

7. Your Treatment May No Longer Be Effective

Since type 2 high blood sugar is chronic, your treatment may need to change over time. A higher-than-target A1C might indicate your current plan isn’t working effectively. If diet and exercise aren’t enough, you might need prescription medications to lower A1C or improve insulin processing. If oral medications are less effective, you may need to try a different one or change the dose. Your doctor may also recommend insulin or non-insulin injectables. Follow your prescribed regimen for the best results.

“High A1C is particularly dangerous for the elderly and those with preexisting conditions like heart disease,” Lenhard explains. “I set lower A1C targets for young, healthy individuals and more lenient ones as people age. An A1C between 7 and 8 percent is acceptable for most people in their 80s, but the target is individualized.”