If you live with diabetes, you are likely familiar with having your A1C checked – the common blood test that is used both to diagnose type 1 or type 2 diabetes and also to gauge how well a person is managing their diabetes. You may have also experienced that “Yikes!” feeling with an A1C that is higher than expected. So what can a person do to avoid the potentially negative feelings that may come with an A1C result that is different from what was anticipated?
As a diabetes educator, I’ve seen this happen with my clients. I advise them that, instead of taking on any guilt or feelings of failure, it may be helpful to step back from the numbers game. This is data. One’s A1C is a number that, along with other information, may help a person living with diabetes and their healthcare provider make necessary adjustments to their diabetes treatment plan. As I tell my clients: you are not your A1C number, but you can use the information it provides to better focus on your health.
The basics of A1C
The A1C test, also called hemoglobin A1C, is an indicator of a person’s average blood glucose level over the previous 3 months. (Learn more about the A1C test and why it’s important for people living with type 1 or type 2 diabetes.) A higher A1C suggests a higher average blood sugar level. Target A1C goals vary among people with diabetes. Your healthcare provider will work with you to identify your goal based on your age, health conditions, type of medical treatment and other factors.
When an A1C surprises
Many things that are outside a person’s control may affect an A1C result. For example, the stress of having a cold, the flu or a sprained ankle may boost blood sugar. So might swings in hormone levels.
For my clients living with type 2 diabetes, I remind them to keep in mind that T2 diabetes is a progressive disease. That means that it’s possible that one’s treatment plan may need to be adjusted over time. In other words, the plan that works today may need to be tweaked as time goes on. I reassure these clients that this is not their fault; rather it’s the fault of the beta cells of their pancreas. These insulin-producing cells may continue to fail and secrete less and less insulin. The result: rising blood glucose levels. This is why many people living with type 2 diabetes may require treatment adjustments to manage their disease. Additionally, an A1C test may not give accurate results if you have various types of anemia, liver disease or kidney disease.
There may be additional causes of an elevated A1C level.
- Are you taking your medications properly? If you have any doubt, ask your healthcare provider to review your medications with you. I’ve often discovered clients taking their dinnertime pills before bed instead of with dinner or taking their meal-time insulin injections 20 minutes too soon or too late. These are easy mistakes to make and correct. Don’t make guesses as to how you should take your medications. Talk to a member of your healthcare team.
- Has your routine changed? Are you less physically active? Getting less sleep? Have your food portions grown? Are you eating in different restaurants or nibbling mindlessly? There are many factors that may impact blood sugar levels. (Talk with your doctor before making any changes to your exercise routine or meal plan.)
- Are you always checking your blood glucose at the same time? Remember that A1C represents an average of blood sugar levels all day, every day, for about 3 months. Many people monitor their blood glucose levels only when they first get up in the morning or only when they are about to eat dinner or go to bed. These few data points may not give a picture of any other time of day. It’s possible that a person’s blood sugar level after meals is driving up their A1C.
Please remember that you are not your A1C, and you are not your diabetes. Dealing with diabetes day in and day out may sometimes feel tiring, frustrating, and even depressing. So how are you to keep your motivation? Here are a few suggestions.
- Reflect on your personal reasons to live a healthful life. My clients find that writing this down is very motivating. Create a quiet space to journal about why you want to live healthfully. Include everything from feeling proud of yourself to being able to travel or do important volunteer work to being a role model and more.
- Gather more data. Knowledge is power, so start collecting more blood glucose data, and keep some food and activity records. On a schedule that works for you, measure your blood glucose in pairs – right before a meal and about 2 hours later. Take several paired measurements for each of your meals. Take periodic fasting and bedtime readings too.
- Ask for a referral. A diabetes expert may empower you to meet your A1C goals. A registered dietitian nutritionist may help you make some lasting lifestyle changes. A Certified Diabetes Educator (CDE*) may help you tie all the pieces together: learning how your medications work, getting tips for monitoring your blood sugar and more.
Jill Weisenberger, MS, RDN, CDE*, FAND, is the author of Diabetes Weight Loss Week by Week, The Overworked Person’s Guide to Better Nutrition and 21 Things You Need to Know about Diabetes and Your Heart. She is contributing editor for Environmental Nutrition, and has written for many publications including EatingWell, Diabetic Living, Diabetes Forecast and Kids Eat Right. She has a private practice in Newport News, VA. Weisenberger is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewees, and not of Sanofi US, its employees, agencies, or affiliates.
*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.
© 2016 The DX: The Diabetes Experience