Why is My A1c High?

The A1c measures the average blood glucose level, so if your blood glucose is frequently high, the A1c number will be high. With type 2 diabetes two problems occur: 1) not enough insulin and 2) insulin resistance.

The A1c blood test is a measure of the average blood glucose level over a period of about 2-3 months.

This article will refer to the A1c. The A1c measures glucose levels in multiple types of diabetes, but this article is geared towards type 2 diabetes specifically.

With not enough insulin, the glucose stays in the bloodstream. There is not enough insulin to transport glucose into cells.

With insulin resistance, the body produces insulin; however, the cells are resistant to the insulin and bring glucose into the cells, but sluggishly.

In either case, there are strategies to help bring that A1c number right back down.

Sugar cubes and a donut and a measuring tape.
This sprinkles donut looks a little like a glycosylated red blood cell.
Photo by Nataliya Vaitkevich on Pexels.com

By the time someone gets type 2 diabetes, often their pancreas is producing only about half the amount of insulin that person would need.

Sometimes this occurs after an injury to the pancreas, such as surgery or trauma. Sometimes this occurs after an insult to the pancreas, such as an attack of pancreatitis.

Damage to the pancreas can occur when the body has a misdirected immune response. It attacks and kills some of its own pancreatic cells. This might sometimes occur after a viral infection.

And sometimes, the pancreas seems to have burned out or exhausted itself. A combination of processed carbohydrates in the diet and sedentary lifestyle may be to blame.

Person's hands holding their abdomen which has "out of order" written on it.
Not at all fun, for you or your abdomen.
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Sometimes fit and active people with a healthy lifestyle get diabetes. Diabetes has many causes. Not all of the causes are known or well understood. It is partly hereditary. A family history of diabetes increases the risk of becoming diabetic.

As far as insulin resistance, sedentary lifestyle is one factor. Obesity is a factor. But these are not the only factors. There are more complex hormone balances at play. Medical conditions such as Polycystic Ovarian Syndrome (PCOS) can also predispose an individual to insulin resistance.

Stress, including chronic stress and traumas, can also contribute by elevating the “stress hormone” cortisol and affecting other related hormones.

A stressful job, relationship, or caregiving role can affect your whole body. So can a history of trauma due to abuse, which is unfortunately all too common. Physical stresses include an excessively hot or cold environment, lack of sleep, or working the night shift.

This stress also affects the body and hormones.

The body can’t tell the difference between a bad grade on a test versus a bear. Both activate stress hormones. Being in a “fight or flight” state of stress for a long time is bad for the body.

Some people think artificial and low-calorie sweeteners “trick” the body into releasing insulin when no sugar has been eaten. When there are insulin spikes without glucose, the body adapts by becoming insulin resistant.

So, you had some routine lab work done and your A1c was elevated. Your doctor probably told you that you were pre-diabetic or diabetic. They might prescribe metformin. It is a medication to help with the insulin resistance side of the equation.

What you may or may not have been told is that some of these changes to the body can be reversed… With some significant caveats.

First off, what if we think of diabetes as carbohydrate intolerance.

We probably all know somebody with a food allergy. Perhaps it is a seafood allergy. Or a peanut allergy, and that person has to carry an epipen with them at all times. Someone else has celiac disease, and that person has to strictly avoid gluten.

On a less dangerous level, many people are lactose intolerant. They have some digestive upset after consuming dairy products. They may decide to indulge in ice cream or cheese once in a while and choose to suffer the consequences.

Diabetes is NOT a food allergy, but you might think of “pre-diabetes” or type 2 diabetes as similar to a food intolerance. Specifically, a carbohydrate intolerance.

Just as there are varying degrees of lactose intolerance, there are varying degrees of carbohydrate intolerance. With not enough insulin to process the usual amount of carbohydrates, it might be worth a try to eat fewer carbs.

It will also be helpful to make the most of the existing insulin. To decrease insulin resistance, increase the amount of exercise. Aerobic capacity and muscle mass are both relevant.

The main thing is to find exercise that you enjoy. That is the exercise that will stay part of your life over the years.

A very happy, smiling woman running up stairs.
This is not the author’s facial expression when running stairs.
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Increasing muscle mass increases the basal metabolic rate. It allows your body to use more calories even during times when you are not exercising. Generally accomplished by weight lifting and other focused methods of strength training.

While aerobic capacity less directly affects glucose metabolism, it is still very useful to include cardiovascular fitness in your regimen.

Walking, running, dancing, biking, and swimming are all examples of cardio activities that increase aerobic capacity.

Cardio can be a useful “cheat” strategy, too. If you have to have some sugar, going for a brisk walk right afterwards will bring down your blood glucose more quickly.

I am not going to cover intermittent fasting here, but it is certainly a hot topic. Right or wrong, some people use intermittent fasting in to manipulate their blood sugar.

It is all about finding what works for you.

Little habits can add up to drastic lifestyle changes. The key is to make incremental changes that feel good. This makes it easier to keep building up a better lifestyle.

Two students on a brick walkway walking their bikes together.
Pedestrians taking their bicycles out for some air.
Photo by Charlotte May on Pexels.com

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