How to Lower Your A1c Without Medication (Type 2 Diabetes)

You can lower your A1c through lifestyle changes.

There are two ways to lower your A1c without medication:

1) Decrease carbohydrate intake.

2) Increase activity.

Keep in mind that all of these strategies are truly lifestyle based. You are committing to changing your habits in the long-term in an effort to avoid the medical complications of full-blown diabetes and to delay, or even avoid altogether, formal treatment with medications.

Your diabetes might not be cured, but if it is in remission for the rest of your life, it might as well be, right?

Your natural insulin can more easily handle a smaller amount of carbohydrate, especially simple sugars like grain flours, baked goods, and pasta, regardless of the specific diet followed.

It might be helpful to think of the natural insulin as a sponge and the glucose as water. If the sponge is cut in half, it only “soaks up” half as much water.

What is insulin?

Insulin is a hormone produced by the pancreas. Insulin facilitates entry of glucose into the cells of the body. The cells burn glucose for fuel.

A healthy meal. Dishes containing white rice, vegetables, avocado, and lime slices.
This looks healthy, but I spy white rice.
Photo by Ella Olsson on Pexels.com

There are also unprocessed foods that are still starchy. Examples include rice, bananas, potatoes. To identify these simple carbs the rule of thumb is, avoid white foods. For example, an orange sweet potato has more nutrients for the calories than a regular potato.

Learn to recognize sneaky carbohydrates.

Complex carbohydrates such as whole grains differ from the simple carbohydrates in more processed grain-based foods. This how whole wheat bread differs from white bread.

But at the end of the day, bread is bread. There are more nutrients in the whole-grain based bread. If you are serious about controlling your blood sugar levels with diet alone (or diet and exercise), then complex carbohydrates are still carbs.

Eat fewer total carbohydrates.

Whether you follow a ketogenic diet that relies heavily on fat and almost no carbohydrates; a low-carb, high-protein diet (such as Atkins); cut back on carbohydrates most of the time with an occasional “splurge” meal; or practice intermittent fasting, such as cutting out one meal per day, or not eating at all one day per week; what matters most is finding a strategy that works well for you, so that you can commit to it.

Carbohydrates are not “bad food,” they are just food. But, just like some people are lactose intolerant and cannot tolerate a milkshake, some of use are carbohydrate intolerant.

Charcuterie board with a cheese wheel topped with nuts, sliced salami, and green grapes on the side.
Meat, cheese, and nuts are low carb. Grapes are not.
Photo by Rachel Claire on Pexels.com

Keep in mind that you are seeking to modify how your body functions.

When the blood glucose level is high, your body will try to compensate by flushing out some of the extra sugar via your kidneys.

This causes glucosuria, or glucose in the urine. Glucosuria led to the sweet-tasting urine–yes, tasting–for which diabetes mellitus is named. Mellitus translates to sweet.

Thank goodness for modern lab tests.

For this reason, stay well hydrated. Be more mindful of hydration if you are embarking on a new journey that involves a high-protein diet or weight lifting.

A pitcher of water with lemon slices.
Mmm, water.
Photo by Nadi Lindsay on Pexels.com

Increase activity. Decrease insulin resistance.

Increased activity uses up more blood glucose, either actively through aerobic exercise (cardio) or “passively” with increased muscle mass.

Strength training (weights) builds muscle mass and the increased amount of muscle burns glucose faster even during times when you are not being active.

High Intensity Interval Training (HIIT) workouts combine both. Crossfit is a popular brand of HIIT exercise. High intensity exercise is not necessary for health, although it can be a very efficient way to improve both aerobic capacity and muscle mass.

Don’t underestimate classics such as yoga and tai chi, which are safe and beneficial for the entire body. They also lower stress.

Ladies in gym clothes sitting on yoga mats in a gym.
Preparing for some stock photo yoga.
Photo by Andrea Piacquadio on Pexels.com

The A1c is high for two reasons with type 2 diabetes:

1) not enough insulin

2) insulin resistance.

A1c (see also, hemoglobin A1c or HgbA1c): A numerical value determined by a laboratory blood test, used as a measurement of glycosylated hemoglobin over the last, approximately, three months. Often used as a measure of an individual’s average serum glucose over that timeframe.

Hemoglobin: a large and complex protein molecule contained in red blood cells, that enables those cells to perform their job of distributing oxygen in the body

The average lifespan of a red blood cell is about 120 days, or about 4 months. Bone marrow produces the red blood cell, which then enters the bloodstream. It cycles round and round, from the heart, to the lungs, through the body, and back to the heart.

Unlike many cells of the body, the red blood cell does not have a nucleus and does not repair itself. Instead, once it has become damaged or aged, the red blood cell is taken up by the spleen and its components are broken down or recycled by the spleen and liver.

Depiction of red blood cells.
An artist’s conception of red blood cells.
Photo by artist on Pexels.com.

As red blood cells travel around and around, they travel alongside glucose molecules.

Of course, glucose levels are constantly changing as the body takes in sugar from food, burns sugar during exertion, or breaks down glycogen to make stored sugar available (such as during exercise).

Part of the normal aging process of a red blood cell is that some of this glucose sticks to it. The hemoglobin protein becomes “glycosylated” as glucose molecules attach to it.

So, the A1c is very useful. While blood sugar levels change constantly, persistently high levels cause damage.

The A1c lets us detect blood sugar levels that are frequently too high, by providing an average measurement that is a good estimate of what most days have been like over approximately 2.5 to 3 months prior.

Scientist holding up a test tube containing red liquid.
Eureka! I call it a “test tube.”
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The other big advantage of the A1c?

A single blood sample that is drawn and sent to the lab.

Other measurements are less convenient, such as the Oral Glucose Tolerance Test (OGTT). For the OGTT, you drink a sugar solution and then wait for a period of hours without eating or drinking anything (even water) and only then give the blood sample.

The OGTT is commonly used in pregnancy. It is more accurate than the A1c during pregnancy due to hormonal and dilutional circulatory changes, and it tells us more about the real-time metabolism of a set amount of glucose, so it is worth it during the physiological upheaval of pregnancy; but is not worth the hassle in most other instances.

Family gathering around a table in the backyard.
Unless one of these persons is pregnant, they’d probably rather skip the OGTT.
Photo by Askar Abayev on Pexels.com

In summary…

The foundations of type 2 diabetes management in your lifestyle are, as discussed:

1) Decreasing the carbohydrate load that needs to be managed by the existing insulin. Be kind to whatever pancreas you have left. This does not repair a damaged pancreas, but rather decreases the need for insulin in the first place.

2) Increasing activity level. All activity is good. The key is finding activity you enjoy, so that you will keep doing it. Becoming more physically fit will help your body to process glucose more efficiently, and to burn more glucose, more of the time; even during times when your body is at rest.

3) Tracking the Hemoglobin A1c. It is a lab test that estimates your average blood sugar over the last 2-3 months. In type 2 diabetes, this number can be pushed lower by lifestyle changes. Lifestyle changes help to keep the blood sugar controlled and the A1c low.

Teammates in a huddle. Several people putting their fists together about to cheer for their team.
Go forth and conquer!
Photo by Andrea Piacquadio on Pexels.com

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