A1C levels can fluctuate because of vitamin deficiencies, supplements, stress, lack of sleep, and more. If you've lived with type 2 diabetes for a while, you might be a pro at managing your blood sugar levels.
A1C levels can fluctuate because of vitamin deficiencies, supplements, stress, lack of sleep, and more.
If you’ve lived with type 2 diabetes for a while, you might be a pro at managing your blood sugar levels. You may know that it’s a good idea to limit carbs, exercise regularly, check other medications for possible interactions, and avoid drinking alcohol on an empty stomach.
By now, you may be well attuned to how your day-to-day activities impact your blood sugar. So, if you see a big shift in your hemoglobin A1c (HbA1c) levels that you can’t explain, you might be surprised or frustrated.
Sometimes, things you may not even think about can affect your blood sugar, which can lead to serious complications, such as heart attacks, kidney disease, blindness, or amputation.
Learning to recognize behaviors and circumstances that you don’t usually associate with blood glucose fluctuations may help you prevent more serious health concerns now and in the future.
Causes of falsely elevated A1C
1. Misdiagnosis
If your once-managed A1C spins out of control despite your best efforts, it’s possible you don’t have type 2 diabetes at all. In fact, according to one 2022 research review, between 4 percent to 12 percent of people diagnosed with type 2 diabetes actually have latent autoimmune diabetes (LADA).
In a 2015 report , doctors noted that you can manage LADA with the same regimen that people with type 1 diabetes use. The condition progresses slowly, but it ultimately does require insulin treatment.
If you’ve had treatments for type 2 diabetes for several years or more, a sudden change in your ability to manage your A1C levels might be a sign of LADA. You may want to consider taking the time to talk with your doctor about the issue.
2. Changes to your supplement regimen
Some vitamins, minerals, and supplements on the market can be good for your health. However, some nutritional supplements can affect your A1C test and lead to inaccurate test results.
For example, according to one 2013 research review , high levels of vitamin E can falsely elevate A1C levels.
On the other hand, vitamin B12 and folic acid can falsely lower them, and vitamin C can do either, depending on whether doctors measure your A1C with electrophoresis, which can show a false increase, or chromatography, which can return a false decrease.
Always consult with a doctor or dietitian before making any substantial changes to the supplements you take.
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It’s important to note that some prescription medications, such as interferon alfa-2b (Intron A) and ribavirin (Virazole), can impact A1C testing, too.
If you have a prescription medication that might affect your blood glucose levels or the accuracy of your A1C test, your doctor or pharmacist can discuss this with you.
3. Major life events
Stress, especially chronic stress, can raise blood sugar levels and increase insulin resistance.
You may be able to recognize when you’re under stress and may also know that it elevates levels of the hormones that, in turn, raise blood glucose. However, what you might not realize is that even the most positive life events can also be a source of stress.
You may not think to associate happy, exciting times in your life with fluctuations in A1C levels, but there could be a connection. Even the best life changes — a new romance, a big promotion, or buying your dream home — can lead to an increase in the hormones associated with stress.
If you experience major life changes — whether good or bad — it’s important to practice self-care. The American Diabetes Association suggests making time for stress-relieving practices, such as breathing exercises and physical activity.
Try to keep this in mind and stay on top of your blood sugar proactively when major changes are on the horizon.
4. Iron deficiency anemia
Insufficient iron in your diet can lead to iron deficiency anemia, a condition characterized by symptoms like weakness, fatigue, paler skin than usual, and shortness of breath.
Interestingly, one 2018 study suggested that iron deficiency is associated with increased A1C levels in people with diabetes.
Experts estimate that around 10 percent to 30 percent of individuals with diabetes have anemia, and approximately one-third of those people with anemia are deficient in iron.
Vegans and vegetarians, people with heavy menstrual cycles, and frequent blood donors tend to be at a higher risk of developing iron deficiency anemia.
If you don’t get enough iron in your diet, consider talking with a doctor about whether supplementation may be beneficial to increase iron levels and manage your blood sugar.
5. Lack of sleep
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Sleep deprivation can take a major toll on several aspects of health, causing issues like daytime sleepiness, mood changes, fatigue, and trouble concentrating, among others.
What’s more, one 2015 study found that sleep disturbances could link to higher levels of A1C and impaired blood sugar levels.
In fact, one small 2015 study involving people with diabetes and untreated sleep apnea found that each hour reduction in sleep duration was tied to a 4.8 percent increase in A1C levels.
Setting a regular sleep schedule, avoiding caffeine later in the day, and limiting screen time before bed may be beneficial to ensure you get enough sleep each night.
If you have any other health conditions that affect your sleep, such as sleep apnea or insomnia, talk with your doctor to determine the best course of treatment for you.
6. Medications
Many medications can affect A1C levels by altering insulin secretion, reducing insulin sensitivity, or increasing sugar production.
Some medications that may increase blood sugar levels include:
opioids
aspirin
steroids
antidepressants
anti-anxiety medications
cholesterol-lowering drugs
antiseizure medications
blood pressure medications
Several medications and supplements can also cause falsely low A1C levels, including vitamin C, vitamin E, antivirals, and certain medications used to treat cancer and some skin conditions.
If you take any of the medications listed above, talk with a doctor about the potential effects on blood sugar levels.
The takeaway
Under many circumstances, you can manage type 2 diabetes by eating a balanced diet, exercising regularly, and paying closer attention to your emotional well-being and medications.
When your best efforts don’t get the job done, look deeper, as there are often other factors that can throw your A1C levels out of balance.
Work with your doctor and registered dietitian to identify potential barriers to lowering blood sugar levels and discover changes you can make to improve your health.
Once recognized and addressed, you can regain your equilibrium and be on the road to maintaining steady blood sugar levels.
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