Post Time: 2025-07-18

5 Reasons Why Your A1C May Be High If You Are Not Diabetic

You've just received your lab results, and your A1C level is higher than normal, yet you've been told you're not diabetic. This can be confusing and concerning. A1C, or glycated hemoglobin, is a blood test that reflects your average blood sugar levels over the past two to three months. While often associated with diabetes, elevated A1C can sometimes occur in individuals without the condition. This article aims to clarify why your A1C might be high even if you are not diagnosed with diabetes, delving into the possible reasons and what it means for you. We'll break down five common reasons, backed by insights, examples, and actionable information.

Understanding A1C: Beyond the Diabetes Diagnosis

Before we delve into why your A1C might be elevated, let's briefly review what this test measures and its significance. Glycated hemoglobin (A1C) forms when glucose in your blood binds to hemoglobin, the protein in red blood cells that carries oxygen. The higher your average blood glucose levels over a period of time, the more hemoglobin gets glycated. Because red blood cells have a lifespan of roughly three months, the A1C test gives an average of blood sugar levels over this duration. While a normal A1C level is typically below 5.7%, levels between 5.7% and 6.4% are categorized as pre-diabetes, and 6.5% or higher indicates diabetes. However, what happens if your results show high A1C levels but you're officially not diabetic? This is a common question, and understanding the nuances is crucial.

Reason #1: Pre-diabetes or "Impaired Glucose Tolerance"

Perhaps the most common reason for a high A1C in someone not considered fully diabetic is pre-diabetes, also known as impaired glucose tolerance (IGT). This condition lies in between normal glucose regulation and full-blown diabetes. In IGT, your body isn't processing glucose as efficiently as it should, leading to higher-than-normal blood sugar levels. Even though you don't meet the criteria for a diabetes diagnosis (often defined by other tests like fasting blood sugar or a glucose tolerance test in addition to A1C), your A1C could be higher than normal. It signals that your body is showing signs of struggling with glucose metabolism. It’s a warning sign to take proactive measures to prevent the development of diabetes.

A1C Category	A1C Level	Condition
Normal	Below 5.7%	Healthy Glucose Control
Pre-diabetes	5.7% - 6.4%	Impaired Glucose Tolerance
Diabetes	6.5% or Higher	Diagnosed Diabetes

Example: Imagine Sarah, 45 years old, goes for a routine check-up and finds her A1C is 6.2%. She does not have a fasting blood sugar level in the diabetic range. Based on A1C alone, she falls into the pre-diabetic category. Although Sarah doesn’t have diabetes yet, the increased glycation of hemoglobin signifies a clear warning sign.

Actionable Steps for IGT

If your A1C results place you in the pre-diabetic range, steps can be taken to reverse or slow progression to diabetes:

1. Dietary Changes: Focus on whole foods, and foods low in the Glycemic Index. Limit processed foods, refined carbohydrates, and sugary drinks.
2. Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
3. Weight Management: Losing even a modest amount of weight (5-10% of body weight) can significantly impact blood sugar regulation.
4. Regular Monitoring: Periodic A1C testing (every 6 to 12 months as directed by your healthcare provider) is essential to track progress and ensure effective management.

Reason #2: Certain Medications

Another reason for unexpectedly elevated A1C levels could be the side effects of certain medications. Although this might be a less common cause, certain classes of drugs can directly or indirectly affect blood glucose and consequently increase A1C results, making interpretation more complex.

Medication Type	Effect on Glucose	Impact on A1C
Corticosteroids	Increase blood sugar	Can significantly elevate A1C
Thiazide Diuretics	May impair glucose	Potential for increased A1C, particularly if high doses
Some Antidepressants	May affect insulin secretion	Possible minor elevation in A1C

Example: Suppose John has an autoimmune condition requiring long-term treatment with corticosteroids. These medications are known to elevate blood sugar levels by increasing hepatic gluconeogenesis (sugar formation) and causing insulin resistance. John’s A1C might be high even though he is not, technically, a diabetic, due to the effects of the medication.

Actionable Steps

If medication use is suspected to contribute to increased A1C levels:

1. Discuss with your doctor: Work with your doctor to understand if your current medications could be impacting glucose levels and if alternatives exist.
2. Regular blood sugar checks: Monitor blood glucose more often, especially around periods when you adjust the dose or start using the medication.
3. Lifestyle adjustments: Diet and exercise become even more important in managing blood glucose if your medication is influencing sugar levels.

Reason #3: Underlying Health Conditions (Non-Diabetes)

Beyond medications, certain medical conditions that aren’t directly related to diabetes can impact your A1C levels. These conditions can affect your metabolic processes and how your body regulates blood glucose. Conditions like Cushing’s Syndrome, Polycystic Ovary Syndrome (PCOS) and pancreatic diseases can alter glucose metabolism and lead to an increase in blood glucose levels.

Condition	Impact on Glucose	Potential Effect on A1C
Cushing’s Syndrome	Overproduction of cortisol can increase blood glucose	Can cause A1C elevation
PCOS	Insulin resistance can lead to higher glucose	High risk for elevated A1C
Pancreatic Diseases	Can affect insulin production	May impact A1C results

Example: Consider Susan, who has Polycystic Ovary Syndrome (PCOS). This condition is frequently associated with insulin resistance, meaning that her body doesn’t use insulin efficiently, resulting in higher blood sugar levels. Even without a full diabetes diagnosis, Susan could have a high A1C because her insulin is not working properly, leading to consistently higher blood glucose.

Actionable Steps for Associated Health Conditions

If an underlying health condition may be affecting A1C:

1. Get a Thorough Evaluation: If you’re concerned about an underlying condition, seek a detailed evaluation and diagnostic tests from your healthcare provider.
2. Treatment of the underlying issue: Addressing the primary health concern is often the most direct route to resolving the associated impacts on glucose regulation.
3. Integrated Health Approach: Lifestyle interventions, such as diet and exercise, may need to be combined with the medical treatment of the underlying condition to manage A1C effectively.

Reason #4: Temporary Stress and Illness

Stress, both physical and emotional, can cause transient elevations in your blood sugar levels. When your body experiences stress, it releases hormones such as cortisol and adrenaline. These hormones trigger the liver to release stored glucose into the bloodstream, which can raise your blood sugar levels. This is a temporary effect, but it is possible that in the weeks and months before the A1C test, these temporary spikes could contribute to an overall higher reading. An acute illness can similarly trigger higher blood glucose levels due to these stress related hormone secretions.

Example: Think of Alex, who experienced a very stressful month at work with multiple intense deadlines, compounded by being unwell with a flu the week prior to the A1C blood draw. While these issues aren’t reflective of a long-term glucose imbalance, the overall effect of sustained stress might temporarily elevate his A1C result.

Actionable Steps

1. Stress Management: Utilize relaxation methods such as mindfulness, yoga, meditation or deep breathing exercises to lower stress levels.
2. Address Underlying illness: Seek proper and timely treatment when you feel unwell or ill. Monitor for resolution of elevated glucose level post recovery.
3. Repeat Testing: Consider retesting your A1C at a different time to see if any external stressors may be a factor impacting the first result.

Reason #5: Less Common Physiological Conditions

Rare conditions or variations in physiology can sometimes affect the accuracy of the A1C test. Conditions impacting red blood cell life-cycle, like some types of anemia or hemoglobinopathies, may inaccurately impact the A1C readings. For instance, if someone has a condition that makes their red blood cells live shorter than the normal three months, then their A1C test results might not accurately reflect their average blood sugar over the standard three-month duration. This means the result will be higher due to higher concentrations of glycated hemoglobin in a shorter duration.

Condition	Effect on Red Blood Cells	Impact on A1C
Hemoglobinopathies	Altered Hemoglobin Structure	A1C results may be unreliable
Certain Types of Anemia	May decrease the red blood cells lifespan	May result in a higher A1C

Example: Consider Emily, who carries a gene for a hemoglobinopathy that leads to slightly shorter lifespans for her red blood cells. Although her average blood sugar is well-controlled, her A1C might be slightly elevated simply due to how her red blood cells behave.

Actionable Steps for Less Common Physiological conditions

1. Detailed Testing: Be transparent about underlying condition, so healthcare professionals can investigate if conditions affecting red blood cell turnover are influencing your A1C results.
2. Alternative Testing: Alternate blood glucose markers may need to be used in conjunction to get a better assessment of your glucose status.
3. Personalized Management: Discuss individual specificities with a health care professional in order to get more targeted management advice.

Conclusion: High A1C, Not Diabetic – What Now?

If your A1C level is higher than normal, yet you are not considered diabetic, it’s important not to dismiss the result. Understanding the multiple possible reasons can provide guidance in managing your health proactively. From pre-diabetes and certain medications to underlying conditions, it’s crucial to work with a healthcare professional to evaluate the possible cause of your elevated A1C result. Regular monitoring, alongside lifestyle interventions such as a balanced diet and regular exercise, may help you take proactive control of your blood glucose levels, regardless of your current diagnostic category. Being informed, and taking actionable steps can help you maintain and achieve better metabolic health. If your results cause you concern, remember to consult your physician to make an individualized plan based on your personal and unique circumstance.

I’ve lived with type 1 diabetes since 1997 and what I eat has a huge impact on my blood sugars and my overall well-being. Since a lot of you have asked, here’s a video of what I eat in a day as well as my detailed carb count. Remember, this is not me recommending a way of eating. This is just what I ate last Sunday. If you’re into low carb meals, you can find a lot of low carb recipes on the Diabetes Strong website HERE ► 0:00 Introduction 0:26 Diabetes diets I have followed in the past 2:15 What my breakfast looks like (including detailed carb count) 3:42 What my water intake looks like 4:08 Snack 1 4:50 blood sugar 224 after eating What my lunch looks like (including detailed carb count) 6:31 Snack 2 6:53 What my dinner looks like (including detailed carb count) 8:38 Snack 3 Note: I’m still eating omelets but didn’t like the Thomson English muffins too much so I have switched to Dave’s Killer bread English muffins. They have the same carb count but higher calories (and better texture) SUBSCRIBE to the Diabetes Strong YouTube Channel HERE ► Check out dr stephanie blood sugar 24 hour more Diabetes Tips & Tricks HERE ► FOLLOW DIABETES STRONG ON: Website: Facebook: Pinterest: Instagram: DISCLAIMER: I’m not a medical professional, never stop your current treatment without a1c for 120 blood sugar consulting with your doctorWhat I Eat In A Day – Type 1 Diabetes Edition [fee918]