Yes, stress can cause your A1c level to be higher than normal. The A1c test, also called the hemoglobin A1c or glycohemoglobin test, measures your average blood sugar levels over the past 2-3 months. It provides an overview of how well your diabetes treatment plan is working to keep your blood sugar in your target range. Higher A1c levels indicate poorer blood sugar control.
Stress causes your body to release hormones like cortisol and epinephrine, which raise blood sugar levels. When you’re stressed, your liver releases more glucose into the bloodstream. Stress can also affect diabetes self-care behaviors like checking blood sugar, taking medications properly, exercising, and eating a healthy diet. Failures in self-care due to stress can all contribute to higher A1c test results.
How does the A1c test work?
The A1c test measures the amount of hemoglobin in your blood that has glucose attached to it. Hemoglobin is the protein in red blood cells that carries oxygen. When glucose in your blood sticks to hemoglobin, it becomes ‘glycated’ hemoglobin or hemoglobin A1c.
The more glucose that’s in your blood, the more hemoglobin becomes glycated. By measuring the percentage of A1c hemoglobin, the A1c test shows your average blood sugar level over the past 2-3 months.
Normal A1c levels are below 5.7%. Levels between 5.7-6.4% indicate prediabetes. Levels of 6.5% or above mean you have diabetes. The higher your A1c level, the poorer your blood sugar control has been.
Target A1c levels
The target A1c level for most people with diabetes is under 7%. Some individuals may have a target below 6.5% or as high as 8%, based on factors like age and hypoglycemia risk. Work with your healthcare provider to determine your optimal A1c goal.
Lowering your A1c level as close to normal as possible helps prevent diabetes complications like nerve damage, kidney disease, vision loss, heart attack, and stroke. Reaching your target A1c requires keeping your blood sugars in a healthy range through proper medication use, diet, exercise, and stress management.
How stress affects blood sugar
Both short-term, acute stress and long-term, chronic stress can raise your blood sugar levels and A1c results. Here’s how stress leads to high blood glucose:
Stress hormones
When you feel stressed or anxious, your body releases hormones such as cortisol and epinephrine. These are known as ‘counter-regulatory’ hormones because they counteract the blood sugar lowering effects of insulin.
Cortisol tells your liver to release stored glucose into the bloodstream. Epinephrine (adrenaline) makes your body less sensitive to insulin and limits insulin’s ability to move glucose out of the blood and into cells.
Together, cortisol and epinephrine raise blood sugar levels and can lead to hyperglycemia. Frequent stress-induced spikes in blood glucose cause your A1c results to increase over time.
Inflammation
Chronic stress promotes inflammation, which is linked with insulin resistance. When your cells become resistant to insulin, glucose builds up in your blood instead of being absorbed by cells for energy. The ensuing high blood sugar leads to higher A1c test results.
Unhealthy behaviors
Stress often leads to coping behaviors that raise blood sugar, such as:
- Excess eating of carbohydrate or sugary foods
- Drinking alcohol
- Smoking
- Not exercising
Being stressed out can also interfere with healthy diabetes self-care:
- Forgetting to check blood sugar
- Forgetting to take medications or insulin
- Making poor food choices
- Skipping physical activity
Failing to properly manage your diabetes due to stress contributes to elevated glucose levels that are reflected in your A1c.
Sleep loss
Stress often disrupts sleep quality and quantity. Not getting enough good sleep decreases insulin sensitivity, leading to increased insulin resistance and higher blood glucose levels. Poor sleep also spikes cortisol secretion and inflammation. The end result can be an elevated A1c.
Gut health
Stress alters the microflora balance in your gut, increasing bad bacteria and decreasing good bacteria. This can create a leaky gut, allowing toxins into your bloodstream that promote inflammation and insulin resistance. Gut imbalance can thereby raise blood sugar and A1c.
How much can stress raise A1c?
Research shows that stress can significantly increase A1c levels:
– In a 2017 study of over 7,000 adults with diabetes, each major stressful life event was associated with a 0.14% increase in A1c levels over 3 years. Events like a new illness or job loss had the greatest impact on raising A1c.
– A 2015 study found over a 4 year period, high financial stress was linked with an over 0.5% increase in A1c. Work stress led to a 0.164% increase in A1c.
– A 2012 study reported patients with high stress and depression had 0.7% higher A1c levels than those with low stress and depression.
– Analysis from a 10-year study revealed a prolonged trauma like physical abuse in childhood was associated with a 1.32% higher A1c level in adulthood.
Stress effect on A1c by diabetes type
Research shows stress can raise A1c levels in both type 1 and type 2 diabetes:
– For adults with type 1 diabetes, high generalized stress is associated with 0.5-1% higher A1c values.
– In teens with type 1 diabetes, those reporting high stress have A1c levels up to 1.7% greater than teens with low stress.
– In type 2 diabetes, major life stress events are linked with a 0.33% increase in A1c over 2 years. High perceived stress is tied to 0.43% higher A1c.
Tips to prevent stress from raising your A1c
Here are some tips to minimize the effects of stress on your blood sugar levels and A1c results:
Practice stress management techniques
Try healthy coping strategies like mindfulness, meditation, yoga, deep breathing, and progressive muscle relaxation. Keeping stress levels low can help prevent stress-induced blood sugar spikes.
Prioritize sleep
Aim for 7-9 hours of quality sleep per night. Maintaining healthy sleep will help normalize cortisol levels, insulin sensitivity, inflammation, and gut health to optimize blood glucose control.
Exercise regularly
Aim for 30-60 minutes of activity per day. Exercise lowers blood sugar by increasing insulin sensitivity and glucose uptake by cells. Physical activity also reduces inflammation and cortisol secretion.
Focus on nutrition
Eat plenty of high fiber foods like vegetables, fruits, whole grains, nuts and beans. Choose healthy fats and lean protein sources. Limit sweets, refined grains and sugary beverages. Good nutrition supports healthy blood sugar levels.
Take diabetes medications as prescribed
Properly adhering to your medication regimen helps stabilize blood glucose levels. Don’t let stress or forgetfulness lead to missing or mistiming doses.
Check blood sugar often
Check your glucose levels frequently, especially when feeling stressed. Detecting highs early allows quicker treatment to lower blood sugar before it remains elevated.
Seek support
Enlist loved ones, friends, or a support group to help manage stress and motivation for self-care. Social support aids healthy coping.
Consider therapy
Consult a therapist or counselor to learn constructive ways to handle stress if it’s significantly interfering with diabetes management. Cognitive behavioral therapy and relaxation therapy are options.
Communicate with your provider
Discuss any concerns about stress affecting your blood sugar with your healthcare team. They can help adjust your treatment plan as needed to better control your A1c.
How to tell if stress is raising your blood sugar
Signs that stress may be causing elevated blood glucose include:
– Blood sugar over your target range when checking multiple times per day
– An unexplained rise in glucose levels on your continuous glucose monitor
– An increase in your A1c level at your next test
– More frequent or severe episodes of hyperglycemia
– New onset of diabetes complications like blurred vision or yeast infections
– Increased thirst, urination, fatigue and hunger
– Lack of improvement in your A1c with treatment changes
Pay attention to when you feel stressed and check your blood sugar levels at those times. Look for hyperglycemia episodes that correlate with stressful events or moods. This can confirm whether stress is directly affecting your blood glucose.
Tracking stress and glucose
Keeping written logs or using diabetes management apps to record stress levels, mood, sleep, diet, medication use, activity and blood sugar results each day can help you identify relationships between stress and hyperglycemia. Share your logs with your healthcare provider to help guide treatment adjustments.
Professional help for diabetes and stress
If you feel stress is significantly impacting your blood sugar levels and diabetes control, discuss the following interventions with your care team:
Medication changes
Your provider may alter your diabetes medication regimen to better cover stress-induced glucose spikes. This could include increasing insulin doses or adding additional oral anti-hyperglycemic medications.
Mental health therapy
A psychologist or therapist can help you develop healthier coping mechanisms to minimize how stress worsens diabetes. Cognitive behavioral therapy, relaxation techniques, mindfulness and biofeedback are options.
Diabetes education
Meeting with a diabetes educator or nutritionist to refresh your knowledge on diabetes self-care, diet and lifestyle tips can help you better manage stress and blood sugar fluctuations.
Support groups
Joining a diabetes support group connects you with others facing similar challenges of managing stress with diabetes. This provides encouragement, accountability and resources.
Stress management programs
Structured programs teaching stress management skills like meditation, yoga and deep breathing can reduce stress and enhance diabetes control. Some hospitals and health centers offer group classes.
Medication for anxiety/depression
If you have an anxiety disorder or clinical depression contributing to difficulties managing stress and diabetes, prescription anti-anxiety or antidepressant medication may be helpful.
Conclusion
Stress can definitely cause your A1c level to become elevated. Stress hormones like cortisol directly raise blood glucose levels. Stress also promotes unhealthy behaviors and interferes with optimal diabetes self-care. This results in poorer blood sugar control and increased A1c test results.
Learning to manage stress effectively through lifestyle changes, social support, therapy and medication interventions can help prevent stress from worsening your diabetes and blood sugar control. Work closely with your healthcare provider to find the stress and diabetes management strategies that are most effective for you personally. Consistent application of healthy coping techniques and self-care behaviors will help you minimize stress-related blood sugar spikes and keep your A1c level within your target range.