High A1C? Why Your Levels Stay High and the Medical Steps to Take Now

If your A1C is higher than it should be, you're not alone. Millions of people live with elevated A1C levels, often without realizing what it means or what to do next. The good news: there are clear, medically proven steps you can take to bring it down and protect your long-term health.

Let's walk through what A1C means, why it may stay high, and what to do now.

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What Is A1C?

The A1C test (also called hemoglobin A1C or HbA1c) measures your average blood sugar levels over the past 2 to 3 months. Unlike a single fingerstick glucose test, A1C shows your long-term blood sugar pattern.

General A1C ranges:

• Below 5.7%: Normal
• 5.7% to 6.4%: Prediabetes
• 6.5% or higher: Diabetes

For many people with diabetes, the usual target is below 7%, though your doctor may set a different goal based on age, other health conditions, and risk factors.

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Why Is My A1C Still High?

A high A1C means your blood sugar has been elevated over time. If it's not improving despite your efforts, here are the most common reasons:

1. Undiagnosed or Progressing Diabetes

Sometimes blood sugar levels rise gradually. Type 2 diabetes can develop over years. If your A1C keeps climbing, your body may not be producing enough insulin — or may not be using it effectively.

2. Medication Issues

• Missing doses
• Incorrect timing
• Dose too low
• Medication no longer effective
• Need for combination therapy or insulin

Diabetes is often progressive. It's not a personal failure if medications need adjusting.

3. Hidden Carbohydrates

Many people underestimate how many carbohydrates they eat. Foods that can spike blood sugar include:

• Bread, rice, pasta
• Sweet drinks (including juice)
• Flavored coffee drinks
• Snack foods
• "Healthy" granola or smoothies

Even portion sizes of healthy carbs matter.

4. Weight Gain or Insulin Resistance

Excess body fat — especially around the abdomen — increases insulin resistance. This makes it harder for your body to lower blood sugar.

5. Lack of Physical Activity

Muscles use glucose for energy. Without regular movement, blood sugar remains elevated longer.

6. Stress and Poor Sleep

Chronic stress increases cortisol, a hormone that raises blood sugar. Poor sleep can worsen insulin resistance.

7. Other Medical Conditions

Certain conditions can push A1C higher:

• Thyroid disorders
• Polycystic ovary syndrome (PCOS)
• Cushing's syndrome
• Chronic infections
• Liver disease

8. Certain Medications

Steroids (like prednisone), some psychiatric medications, and certain blood pressure drugs can raise blood sugar.

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Why High A1C Matters

It's important not to panic — but it's also important not to ignore it.

Over time, a high A1C increases the risk of:

• Heart disease
• Stroke
• Kidney damage
• Nerve damage (neuropathy)
• Vision loss
• Slow wound healing

The higher the A1C — and the longer it stays elevated — the greater the risk. The good news is that lowering your A1C even by 1% significantly reduces complications, according to major long-term diabetes studies.

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Medical Steps to Take Now

If your A1C is high, here's what to do.

1. Speak to a Doctor Promptly

Do not self-manage a high A1C alone. A doctor can:

• Confirm the diagnosis
• Repeat the test if needed
• Check fasting glucose
• Order additional labs (kidney function, cholesterol)
• Review medications
• Screen for complications

If your A1C is very high (such as above 9% or 10%), you may need more aggressive treatment, including insulin.

Always speak to a doctor about anything that could be serious or life-threatening.

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2. Confirm Your Diagnosis

If you haven't been formally diagnosed with diabetes yet and want to better understand whether your symptoms align with the condition, you can use Ubie's free AI-powered Diabetes Mellitus symptom checker to get personalized insights in just a few minutes before your doctor's visit.

Common symptoms include:

• Increased thirst
• Frequent urination
• Blurred vision
• Fatigue
• Slow-healing wounds
• Unexplained weight loss

Even if you feel fine, high A1C still needs medical attention.

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3. Review and Adjust Medications

There are several evidence-based medication options:

• Metformin (often first-line)
• GLP-1 receptor agonists
• SGLT2 inhibitors
• DPP-4 inhibitors
• Sulfonylureas
• Insulin therapy

Modern diabetes treatment is personalized. If one medication isn't enough, combination therapy is common and effective.

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4. Improve Nutrition Strategically

You don't need a "perfect" diet — just a consistent one.

Focus on:

• Non-starchy vegetables
• Lean proteins
• High-fiber foods
• Healthy fats (olive oil, nuts)
• Whole grains in controlled portions

Limit:

• Sugary drinks
• Refined carbohydrates
• Large portions
• Frequent snacking

Even modest weight loss (5–10% of body weight) can significantly improve A1C.

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5. Increase Physical Activity

Aim for:

• 150 minutes per week of moderate exercise (like brisk walking)
• Strength training 2–3 times weekly

Exercise lowers blood sugar both immediately and long term. Even walking 10–15 minutes after meals can help.

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6. Monitor Blood Sugar

If recommended by your doctor:

• Check fasting glucose
• Check post-meal readings
• Use a continuous glucose monitor (CGM) if appropriate

Monitoring helps you see patterns and adjust behavior or medications.

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7. Address Sleep and Stress

• Aim for 7–9 hours of sleep
• Practice stress reduction (deep breathing, walking, meditation)
• Treat sleep apnea if present

Sleep apnea is common in people with high A1C and often goes undiagnosed.

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When High A1C Is Urgent

Seek medical attention immediately if you have:

• Extreme thirst
• Confusion
• Rapid breathing
• Severe abdominal pain
• Fruity-smelling breath
• Blood sugar over 300 mg/dL consistently

These could signal dangerous conditions like diabetic ketoacidosis or hyperosmolar hyperglycemic state.

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Can A1C Be Reversed?

If you have prediabetes, yes — lifestyle changes can often return A1C to normal.

If you have type 2 diabetes, remission is sometimes possible, especially with:

• Significant weight loss
• Bariatric surgery (in select cases)
• Intensive lifestyle intervention

Even if full remission isn't achieved, lowering A1C reduces risk dramatically.

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A Balanced Perspective

A high A1C is a warning sign — not a verdict. It tells you something needs attention.

The key steps are:

• Confirm the diagnosis
• Work with a doctor
• Adjust medications if needed
• Improve diet and activity
• Monitor progress

You don't need to solve everything at once. Small, consistent changes can lower A1C over months.

If you're experiencing symptoms but haven't been diagnosed yet, checking your symptoms with Ubie's free Diabetes Mellitus assessment tool can help you understand what to discuss with your healthcare provider at your next appointment.

Most importantly, do not delay care. Elevated A1C is manageable — but only if you take action. Speak to a doctor about any serious symptoms or concerns. Early treatment protects your heart, kidneys, nerves, and vision for the long term.

Your A1C is a number — but it's also an opportunity to take control of your health starting today.