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

If you’re doing everything right to manage your type 2 diabetes, but you’re still not hitting your A1C goal, it’s important to find out why.

“A lot of time, when A1C rises, a person might say, ‘What did I do wrong?’” says M. James Lenhard, MD, an endocrinologist at Lahey Hospital and Medical Center in Burlington, Massachusetts. “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, several factors that are beyond your control can increase your A1C.

1. Your Type 2 Diabetes Is Progressing

Type 2 diabetes can change over time, and your treatment plan may no longer work as well as it used to, Lenhard says.

“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 slow 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 says. Many people eat more overall but consume less healthy food when stressed, he adds.

While it’s impossible to test for stress, Lenhard says, pay attention to warning signs like poor sleep, increased heart rate, and higher blood pressure. Keep an eye out for these, particularly if you’re starting a new job, moving, getting married or divorced, or experiencing another major life event.

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

4. Your Exercise Plan Doesn’t Include Strength Training

Before adding strength training to your regimen or altering the workout you’re already doing, talk to your doctor about what exercises are safe for you.

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.”

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 the effects of other medications, 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 and progressive 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.

If your doctor currently has you managing your A1C with diet and exercise, it may be time to consider adding a prescription medication designed to lower A1C or improve how your body processes insulin, Lenhard says. If you’re on an oral medication and it’s not as effective as it once was, you may need to add another one or change your dose, says Lenhard.

Your doctor may also prescribe insulin or non-insulin injectables to help control your blood sugar. Once you’re on a new treatment, be sure to follow the doctor-prescribed regimen, as that’s the only way the medications will work to control your A1C, he says.

“I like to set an aggressively low A1C target for young, healthy people and a more lenient target as people age,” Lenhard says. “I am happy with an A1C between 7 and 8 percent for most people in their eighties, for example, but the target is individualized.”