What should A1C level be? Explore the factors that can lead to high A1C levels even if you don’t have diabetes, from anemia to kidney disease to medication side effects.

Factors That Can Cause High A1C Levels Without Diabetes

While high blood sugar may be a risk factor for diabetes mellitus, high A1C is not exclusively seen in those with the health condition. In fact, people can have a high A1C even if they don’t have a history of diabetes. Let’s explore what the A1C test measures, what lifestyle factors can lead to elevated levels, and what you can do if your A1C is high.

What is the A1C Test Measuring?

Any sugar that enters your bloodstream attaches itself to the hemoglobin on your red blood cells. Hemoglobin is the oxygen-rich protein found in red blood cells. Glucose attaches to the hemoglobin protein in the blood, and the amount of this glycated hemoglobin can be measured by a hemoglobin A1C test. This provides a good proxy of how much glucose on average was present in your bloodstream over a two to three-month period. Over time, high A1C levels may lead to impaired fasting glucose, high blood pressure, obesity, and an increased risk of type 2 diabetes and cardiovascular diseases.

Can You Have High A1C Without Diabetes?

The short answer is yes: it is possible to have high A1C levels without diabetes. Because there are a number of lifestyle factors that can affect your hemoglobin, you’ll want to work closely with your healthcare provider to determine what is causing your high A1C level. From there, you may be able to implement certain dietary and lifestyle changes that can help you improve your level. For some people, setting an A1C goal with your doctor may help you track and lower your levels over time.

7 Reasons Your A1C Might Be High

From vitamin deficiency to certain medical conditions, there are many factors that might lead to a high A1C result. Here are seven of the most common reasons:

1. You Have Anemia

Any interference with your red blood cells or changes in hemoglobin can falsely skew the results of an A1C test. Anemia, which is a condition usually caused by a lack of iron or deficiencies in vitamins B12 or folate, is a good example. According to one study, iron-deficient individuals without diabetes had higher A1C more frequently. When classified by gender, the study found that iron-deficient women were more likely to have higher levels of A1C.

2. You Have Kidney Disease or Liver Disease

Those who suffer from kidney disease may find it more challenging to rely on the efficiency of A1C tests. Kidney disease can cause complications like anemia, malnutrition, and even kidney failure. These factors may affect the results of an A1C test. In the case of liver disease, the A1C test may also not be an accurate predictor of glycemic control due to factors such as anemia, which can affect your red blood cells.

3. Some Medications Can Cause High A1C Levels

Several different medications may interfere with A1C test results. Some can even cause errors in readings or bring up inaccurate results. For example, some anti-retroviral drugs and even over-the-counter drugs like aspirin can cause your A1C levels to appear inflated or inaccurate. Research suggests that chronic or overuse of certain medications is what may skew the results of an A1C test to be high.

4. You Have Disorders Related to the Spleen

Spleen disorders, like splenectomy (removal of the spleen) or hypersplenism (enlarged spleen), can also lead to falsely elevated A1C levels. This is because the spleen plays a role in red blood cell turnover, and changes in red blood cell dynamics can affect the A1C test.

5. You Have a Hemoglobin Variant

Certain hemoglobin variants, like hemoglobin C and hemoglobin S, can interfere with the A1C test and cause inaccurately high results. These variants are more common in people of African, Mediterranean, or Middle Eastern descent.

6. You Have Severe Dehydration

Severe dehydration can cause your red blood cells to become concentrated, leading to a falsely elevated A1C reading. This is because the A1C test measures the percentage of glycated hemoglobin, and dehydration can skew that percentage higher.

7. You Have Severe Stress or Acute Illness

Acute stress or illness can cause a temporary spike in blood sugar levels, which can then translate to a higher A1C result. This is because the A1C test provides an average of your blood sugar over the past 2-3 months, so a recent spike will influence the overall reading.

What to Do If Your A1C is High

If your A1C is elevated but you don’t have diabetes, it’s important to work with your healthcare provider to identify the underlying cause. This may involve additional testing, medication adjustments, or lifestyle changes. With the right approach, you can often bring your A1C back down to a healthy range. Remember, high A1C levels can increase your risk of long-term health issues, so it’s important to take steps to manage them, even if you don’t have diabetes.