Liz H

Q:

After an A1c reading of 8.5, I have lost 27 lbs, exercise 3-4 times per week, drink a minimum of 64 oz. of water daily and cut out all processed sugar. My A1c went up to 8.8! Explanation?

Amy Campbell

A:

First, congratulations on your weight loss, your exercise regimen and the changes that you’ve made in your eating plan! No doubt you’ve been working very hard to make these changes. I don’t have an exact explanation as to why your A1C has increased, but I can venture a few guesses. You didn’t mention how long you’ve had diabetes, nor did you indicate if you are taking any medication to help manage your diabetes. I’m assuming that you have type 2 diabetes, and it’s important to understand that type 2 diabetes changes over time. When you first develop type 2 diabetes, your pancreas still produces insulin, but it either does not make enough for your glucose to stay under control, and/or your body isn’t able to use it efficiently. In the early stages of type 2 diabetes, weight loss, healthy eating and regular physical activity may be enough to control glucose levels. Some people need to start on medication right at diagnosis, though. And over time, even if one is controlling his or her weight, eating healthfully and staying active, the pancreas just can’t keep up with the body’s demand for insulin. So, A1C levels start to increase. Most people with type 2 diabetes need to take diabetes pills, often starting with one type, and gradually needing two or three types. Injectable medications, such as exenatide or liraglutide may be added. Eventually, almost half of people with type 2 diabetes will need to take insulin. This is not a reflection of anything that the person is or isn’t doing; it’s simply the natural course of diabetes. It may be that your diabetes has changed and that you need to discuss your medication with your healthcare provider. Another possibility is that you’re consuming more carbohydrate than your body can easily handle. Processed sugar is once source of carbohydrate, but remember that carbs are found in a variety of foods, including whole grains, beans, milk and yogurt, and fruit. Even “healthy” carbs need to be counted in your meal plan. You might consider meeting with a dietitian to review your eating plan and make sure that your carb goals are reasonable.