7 Reasons You’re Not Hitting Your A1C Goal For Type 2 Diabetes

You’re doing everything right to manage your type 2 diabetes. You’re watching your carb intake, exercising regularly, and following your treatment plan. You’re avoiding bad habits — such as smoking — and taking steps to maintain your overall health. And yet, you’re not hitting your A1C goal. Why?

“A lot of time, when A1C rises, a person might say, ‘What did I do wrong?’” says M. James Lenhard, MD, an endocrinologist and the medical director of Christiana Care Health System’s Diabetes & Metabolic Research Center in Newark, Delaware. “Diabetes 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 diabetes.”

It’s not necessarily your fault, Dr. Lenhard says. While it’s important to do everything you can to manage your type 2 diabetes, there are several factors that can up your A1C that are beyond your control.

1. Your Type 2 Diabetes Is Progressing

“I try and remind all of my patients with type 2 diabetes that it’s a progressive disorder,” Lenhard says. “Over time, the pancreas makes less insulin. Maintaining a healthy weight and staying active slows the process but don’t stop it.” That’s why it’s vital to work with your doctor to regularly monitor your blood sugar and A1C levels and, if needed, adjust treatment.

2. You’re Stressed Out

Stress can make it difficult to control your A1C, says Alyssa Gallagher, RD, a certified diabetes care and education specialist (CDCES) at St. Luke’s Humphreys Diabetes Center in Boise, Idaho. “Stress can absolutely play a role in diabetes progression,” she says. “It impacts your body’s ability to utilize insulin properly and contributes to insulin resistance.” It can also raise your epinephrine (aka adrenaline) and cortisol levels, causing an increase in A1C, Lenhard notes. Many people also eat more as a whole but consume less healthy food when stressed, he adds.

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

4. Your Exercise Plan Doesn’t Include Strength Training

5. You Have a Diabetes-Related Health Condition

“Glucose is sticky, and one of the things it sticks to is red blood cells,” he says. “Disorders that affect the amount or life span of red blood cells, like anemia or kidney disease, can affect A1C levels.” In fact, rising A1C may be a sign that you’ve developed one of these complications, he says, so talk to your doctor to see if you’re at risk.

6. You’re Taking Medications for Another Health Condition

If prescription medications you’re taking for other health conditions are affecting your blood sugar levels (or even the way you manage your type 2 diabetes), talk to your doctor about making changes to your treatment plan. You may need to take a more aggressive approach to compensate for how other medications are affecting you, Lenhard says. Don’t stop taking any medications — for diabetes or any other health condition — without first talking to your doctor.

7. Your Treatment May No Longer Be Effective

Because type 2 diabetes is a chronic disease, it’s likely that your treatment will need to change over time to effectively manage it, Lenhard says. An A1C that’s higher than your target may be a sign that your current treatment plan isn’t working as well as it should.

“High A1C is not healthy for anybody, but it’s particularly dangerous for the elderly and people with preexisting comorbidities, such as heart disease,” Lenhard explains. “I like to set an aggressively low A1C target for young, healthy people and a more lenient target as people age. I am happy with an A1C between 7 and 8 percent for most people in their 80s, for example, but the target is individualized.”