3 Sneaky Causes of High A1C That Could Be Driving Your Blood Sugar Readings Up

If recent bloodwork results revealed high A1C levels, you may feel worried about your health—and confused. After all, your fasting blood sugar has been normal, you’ve been prioritizing whole foods, getting regular movement and monitoring your weight, but your A1C isn’t reflective of all the work you’ve been putting in. If this sounds familiar, there could be a sneaky reason your A1C is high. We spoke with two experts to find out why your fasting blood sugar levels could be normal even while your hemoglobin A1c reading is elevated, the surprising causes you may not have considered and what you can do to help reach your A1C targets. 

What is A1C? 

While fasting blood sugar and HbA1c (a.k.a A1C) tests both measure blood sugar, they provide different information about your body’s glucose levels.

“Fasting blood sugar is a snapshot measurement of the glucose in your blood at a single point in time, typically taken after not eating for at least eight hours,” explains Kardie Tobb, DO, MS, FASPC, FACC, a board‑certified preventive cardiologist and the medical director for the Cone Health HeartCare Women’s Heart Health and Cardio-Obstetrics Clinic. “A1C, on the other hand, reflects an average over the past two to three months. It is entirely possible to have a normal fasting blood sugar but a high A1C if your blood sugar spikes significantly at other times, such as after meals, and then returns to normal by the time you are tested in a fasted state.”

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Both Dr. Tobb and Cory Rice, DO, chief clinical advisor at Biote, explain that A1C test results generally fall into one of the following categories:

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

“For people already living with diabetes, many organizations recommend aiming for an A1C goal below seven percent, though your provider may set a different target depending on your age, overall health and other individual factors,” adds Dr. Rice. 

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3 sneaky causes of high A1C

Dr. Tobb says excess body weight, a diet rich in added sugars or refined carbs, lack of exercise, poor sleep habits, a family history of diabetes, stress and medications such as steroids can all lead to a higher A1C readings. Most of these risk factors are ones you’ve probably heard your doctor talk about before. But what about the sneaky causes that could be driving up your A1C, especially if none of these common risk factors apply to you? Here are three that may surprise you:

Anemia 

Anemia is a medical condition where the body lacks enough healthy red blood cells to carry oxygen throughout the body, explains Dr. Rice. Iron-deficiency anemia is one of the most common types, he adds.  

“Anemia can falsely raise A1C because the test relies on the normal lifespan of red blood cells, which is typically around three months,” says Dr. Tobb. “When red blood cells live longer than usual, such as in iron deficiency anemia, they have more time to accumulate sugar, which can make the A1C look higher than your true average blood sugar.”

What to do: Dr. Tobb recommends eating more iron-rich foods to help raise your iron levels naturally, such as beans, lean red meat and leafy greens, paired with a vitamin C-rich option like bell peppers or citrus fruit to help your body absorb iron. “That said, anemia should always be properly diagnosed and treated with your doctor, since the underlying cause matters and self-treating without knowing why you are anemic can delay finding the real problem,” she continues.

Vitamin B12 or folate deficiency 

Our bodies need vitamin B12 and folate to make healthy red blood cells, and abnormally low levels can cause a form of anemia where the red blood cells become too large and do not function normally, explains Dr. Rice. “Just like iron-deficiency anemia, this can cause red blood cells to live longer than usual, and the longer they are circulating, the more time glucose has to latch onto them,” he adds. “This can make an A1C look higher than it really is.”

What to do: Try adding more vitamin B12-rich foods—such as dairy, eggs and fortified cereals—to your diet for a natural boost, recommends Dr. Tobb.

“If you’re vegetarian, vegan or take a medication like metformin which is known to lower B12 over time, don’t wait for symptoms to show up,” adds Dr. Rice. “Ask your provider for a quick blood test.”

Recent blood loss

Whether you receive a blood transfusion, lose blood due to a heavy menstrual cycle or have a gastrointestinal issue that causes blood loss, these can change the number of red blood cells in your body and temporarily skew your HbA1c test results, explains Dr. Tobb.

What to do: Make sure to tell your doctor about any significant blood loss, blood transfusions or recent surgeries before having your A1C evaluated. That way, your doctor can interpret your results with the right context or recommend repeating the test at a more reliable time if needed.

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When to talk to your doctor about high A1C levels

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If you didn’t already talk further with your doctor about your prediabetes diagnosis and you’re wondering if you should bring it up again, Dr. Tobb shares several factors that may make it worth having another conversation. She says these include a personal or family history of kidney disease or blood disorders, symptoms of anemia such as fatigue, pale skin, shortness of breath or dizziness, a recent surgery, significant blood loss, a blood transfusion or pregnancy.

The bottom line on high A1C 

When it comes to our health, things are rarely black and white, including our blood work. So if you recently had your A1C tested and received a high result without any of the common symptoms or risk factors, it may be worth talking with your doctor about what could be driving it. Getting to the root cause can help you take the right next steps to support your long-term health and heart.

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