Hemoglobin A1C — abbreviated HbA1C or just A1C — is the single most important benchmark of blood sugar management success. It’s the first number that your doctor or endocrinologist wants to see to help evaluate the success of your treatment, and possibly the number that was used to diagnose your diabetes in the first place.
A lot more goes into A1C than just the techniques we usually call “diabetes management.” In some ways, it’s almost a holistic measure of overall health. Diet, exercise, mental health, and sleep quality all play a role in pushing your A1C towards (or away from) your target.
Struggling with a high A1C? We’ve got some ideas, some less obvious than others, that might be helpful:
Eat Fewer Carbs
Let’s get the big one out of the way, shall we? No element of our food causes blood sugar spikes like carbohydrates do. Experts universally believe that highly-refined carbs, like those found in like added sugar, high-fructose corn syrup, and white flour, are especially bad for our health. You already know this, but it’s worth repeating: the less junk food, the better.
If you test your blood sugar frequently, you might also learn that even healthier carbs from fruit and whole grains can make your glucose level skyrocket. There’s still some debate over how appropriate a low-carb diet is for people with diabetes, but there’s relatively little doubt that it is among the best ways to get your blood sugar under control, and perhaps the very best.
The bottom line is that carbs and blood sugar are inextricably linked. It’s something to be mindful of every time you eat. We recommend eating, testing your blood sugar, and seeing what happens. You might be surprised by what foods you decide to cut out.
Stop Accepting High Stress
Stress means high blood sugars. Stress hormones can directly increase glucose levels — many people in the Diabetes Daily community know that their blood sugar reliably spikes up when faced with stressful situations at work, school, athletics, or elsewhere. The same hormones can also drive insulin resistance. In fact, these connections run so deep that some experts have implicated stress in the development of both type 1 and type 2 diabetes.
And then there are the secondary effects: Stress can easily cause us to neglect our self-care. When we’re feeling overwhelmed we might cut corners, less actively monitor our blood sugar, or reach for junk food. In more extreme cases of diabetes burnout, patients find themselves neglecting the most important elements of diabetes care, and risking real health consequences as a result.
Getting rid of stress is easier said than done, but we encourage you to stop thinking of stress as a necessary part of modern life. High stress should not be something you have to live with. Check out our list of mental health resources for people with diabetes.
Move Your Body
The science is absolutely clear: the more time you spend sitting, the worse it is for diabetes control. Many studies have shown that people with both type 1 and type 2 diabetes benefit from exercise of any intensity. A workout can both bring your blood sugar down immediately and boost your insulin sensitivity to help keep your blood sugar low in the future.
Even the lowest-impact exercises, like walking and doing household chores, have serious health benefits, including lower A1C. Getting up off the couch is likely to help you improve your physical fitness, your cardiometabolic risk factors, and your state of mind. If you can commit to more intense exercise, that’s even better.
Make Good Sleep a Priority
Good sleep is surprisingly important for diabetes management. Poor sleep is associated with higher blood sugar, and the relationship was even stronger for those with sleep apnea.
Experts agree that proper sleep — for most, that means 7-9 hours of sleep per night — has comprehensive health benefits. And if you’re not getting enough sleep, it’s tough to count the many ways it can negatively impact diabetes management by putting you in a weaker place, both physically and mentally, to confront the rigors of daily life.
Take sleep seriously! There’s so much new stuff out there to help people sleep, from weighted blankets and white noise machines to ASMR videos on Youtube. And if your problems require medical intervention, like sleep apnea, please get them addressed by a professional. Don’t accept poor sleep.
Solve Dawn Phenomenon
It’s one of the trickiest glucose management challenges, and it strikes more than half of people with both type 1 and type 2 diabetes: dawn phenomenon, when your blood sugars rise in the morning for no apparent reason.
There are actually a few reasons this might be happening, and luckily, they’re all solvable. We’ve got an article devoted to the topic: How to Fix High Morning Blood Sugars (Dawn Phenomenon).
Start Tracking Fat & Protein
Everyone with diabetes knows that carbohydrates cause blood sugar spikes. Fewer are aware, however, of the effects of fat and protein on blood sugar. Have you ever noticed your blood sugar rise hours after a fatty meal like pizza? There’s a reason that happens.
Protein causes a delayed blood sugar rise that is sneakier than the effect that carbs have. Fat has only a very minor direct impact on blood sugar, but it can substantially change how carbs are absorbed by the body, boosting their blood sugar impact.
You can take your blood sugar management to the next level by understanding the way these two macronutrients.
Change Your Insulin Dosing
When’s the last time you adjusted your basal rate, your correction factor, or your insulin-to-carbohydrate ratio? If you use insulin to treat your diabetes, you should realize that these doses and ratios are moving targets; they will change as your body changes with age and you experience shifts in your metabolic health.
Some people with diabetes feel comfortable adjusting all of these moving parts by themselves, while others prefer to trust the guiding hand of a diabetes specialist. Either way, it’s important to track your data as well as you can — whether that’s with a CGM, a diabetes management app, or an old-fashioned journal — so you and your doctor understand what changes will work best.
It’s important to use the right amount of insulin to keep your blood sugar in a safe range. With that said, insulin is a bit of a double-edged sword — it brings your blood sugar down, but also contributes to rising insulin resistance. In the long term, you’ll benefit more from the good habits that improve insulin sensitivity and let you use less insulin to stay in your target blood sugar range.
Fight Back Against Insulin Resistance
Insulin resistance is a defining feature of type 2 diabetes. It’s also a frustratingly common complication in type 1 diabetes. Insulin resistance makes it tougher to keep your blood sugar in a safe range — you need more and more insulin and medication to get the same glucose results — and it tends to increase as we get older. Even if you seem to be doing everything right, your A1C might keep trending up.
Talk to your doctor. There are several ways to supercharge your insulin sensitivity. You can fight against insulin resistance with both medications and lifestyle choices.
Get Serious about Pre-Bolusing
If you take rapid-acting insulin before meals, try and remember this one technique that can have a major beneficial effect on blood sugar levels: take your bolus before you begin to eat.
When you eat, your blood sugar rises quickly, much faster than injected insulin can keep up with. In other words, your insulin needs a head start. Pre-bolusing can greatly enhance postprandial glucose control, reducing both blood sugar peaks and valleys (hypoglycemia).
Experts recommend administering your mealtime bolus 15 minutes before you begin to eat. The exact timing of a perfect pre-bolus, though, may vary depending on the precise insulin you’re using, the meal, your starting blood glucose level, and your own unique physiognomy.
Get Your Thyroid Checked
Many people with diabetes — both type 1 and type 2 — also have thyroid issues. Thyroid problems can be difficult to identify and can mess with your metabolism, making diabetes management more confusing and frustrating than it already is.
Hypothyroidism can also make your A1C results deceptively high.
The most common cause of hypothyroidism is an autoimmune disorder named Hashimoto’s disease. Other symptoms include fatigue, cold intolerance, weight gain, and sleep dysfunction. Luckily, thyroid issues are generally easy to diagnose with a test, and are easy to treat.
Misdiagnosis
Finally, does your A1C keep going up, no matter what you do? It’s possible that you’ve been misdiagnosed!
Misdiagnosis is a real problem in the diabetes community. As many as 38 percent of older adults that develop type 1 diabetes are misdiagnosed with type 2, for example, but misdiagnoses can happen in the opposite direction as well, and some patients won’t find out the truth for years. Meanwhile, those with less common forms of diabetes, such as latent autoimmune diabetes in adults (LADA) and maturity-onset diabetes of the young (MODY), may have an even more difficult time identifying the nature of their conditions.
We know that many members of our community have had to push for more testing before finally landing on an accurate diagnosis. If you suspect that your own condition has been misdiagnosed, please share your doubts with your doctor or endocrinologist.