Type 2 Diabetes Is More Than Just About Your A1C


When you’re living with type 2 diabetes, you’re probably used to your doctor ordering lab work every three months to check your A1C. While waiting for your results, you’re probably hoping all of the changes you’ve made and the healthier habits you’ve developed have paid off and resulted in a lower A1C. 

But here are some questions: What if your A1C isn’t as low as you hoped? Or, what if it isn’t low at all?  What if it’s out of range or even higher than you anticipated?

Do you believe that successful diabetes care and management is only reflected in your A1C? Many people with diabetes tend to think of their A1C readings as a final test, but there’s a lot more that goes into living well with type 2 diabetes. While your A1C is undoubtedly important, it’s not the only factor you should consider while reflecting on your progress.

Things other than A1C to keep in mind

Your physical, mental and emotional health all matter when it comes to living well with diabetes. Here are a few things to consider:

Physical health

  • Cardiovascular health (blood pressure, cholesterol and triglycerides)
  • Eye health 
  • Kidney health 
  • Exercise habits
  • Time-in-range 
  • Sleep habits

Mental and emotional health

  • Anxiety and depression 
  • Stress
  • Relationship with food 
  • Outlook on quality of life
  • Relationship with others 
  • Relationship with yourself 

Physical health

Cardiovascular health: Diabetes increases your risk for cardiovascular diseases. To reduce your risk, keep an eye on your blood pressure, cholesterol and triglycerides. High blood pressure, cholesterol and triglycerides increase the chances of a stroke, heart attack and heart disease. Depending on your numbers, your doctor may suggest prescribing you a statin, ACE inhibitor, ARBs, calcium channel blockers and other medications used to treat high blood pressure, cholesterol and triglycerides. If you’ve never gotten this lab work done before, make sure you request these labs from your healthcare provider. Learn more about protecting your heart while managing type 2 diabetes by checking out our heart health resources here. 

Eye health: No matter how well you’re taking care of your diabetes, you still need to get annual eye exams to catch any changes in your vision and prevent eye complications. People with type 1 and type 2 diabetes have an increased risk of developing eye complications. The earlier your doctor catches eye problems, the more they can do to help you prevent them from progressing. Conditions such as macular edema and retinopathy are two of the leading causes of blindness. Read this interview with an ophthalmologist about why every person living with diabetes needs to be screened for eye complications—even if your A1C is under 7 percent. 

Kidney health: The role of your kidneys is to filter water and waste out of your blood, and excrete that waste through your urine. This also helps maintain healthy blood pressure levels. Chronically high blood sugar and blood pressure levels can damage your kidney’s ability to filter waste properly. This leads to waste building up in your body. Kidney disease takes a long time to develop, so you may not notice any symptoms until it has reached deeper phases. Telling signs and symptoms of this condition include frequent urination, ankle and leg swelling and high blood pressure. The best way to know if you’re developing kidney disease is through regular blood work with your doctor—those regular appointments are important. This emphasizes the importance of getting annual checkups with your primary care provider.

Exercise: For the record—exercise could easily go under the mental and emotional well-being categories because of how well it can relieve stress and anxiety. Exercise also helps your muscles be more responsive to insulin—in other words, exercise improves your insulin sensitivity and reduces insulin resistance. If you’ve been out of the exercise game for a while, make it easy for yourself to get back into it. Do something you enjoy and don’t put pressure on yourself to do too much at once. For example, you may only want to commit to walking twice a day, or instead of joining a gym, participate in group classes. Small steps can lead to major progress. Only compare your progress against yourself. Trying to measure up to more advanced exercise levels right off the bat can set you up for failure or burnout. Celebrate the small wins—every step you take is valuable. Check out our other exercise tips to manage type 2 diabetes here. 

Time-in-range: Time-in-range (TIR) is a metric that’s getting a lot of favor over A1C. You can consider A1C and time-in-range as complementary metrics to track your progress. Time-in-range measures the amount of time you spend between the blood glucose numbers (range) set by you and your doctor. This is a feature used in continuous glucose monitors (CGMs). TIR is an effective measurement because it shows you an accurate picture of your blood glucose levels over time. Whereas A1C only captures your average blood glucose over the previous three months. It doesn’t show you how often you’re experiencing high or low blood glucose levels. The standard goal for TIR is to spend 70 percent of the time between 70–180 mg/dL. This corresponds to an A1C of about 7 percent. 

Sleep habits: Do you ever feel like you’re not getting enough rest at night? Your blood glucose levels may have something to do with that. High blood glucose can make it more difficult to sleep and can be a factor in feeling fatigued the next day. Also, sleep can impact the ability to feel full and impact your hunger hormones. Not getting enough sleep can make you more likely to indulge in foods that are higher in sugar, fat and calories. Long-term effects of lack of sleep include restless sleep disorder and sleep apnea. Get enough sleep by staying consistent times to go to bed, taking nighttime medications, exercising regularly and avoiding caffeine at night. 

Mental and emotional health

Anxiety, depression and stress: People with diabetes are more likely to suffer from anxiety and depression, and diabetes can be a burdensome and stressful illness. While diabetes certainly doesn’t mean your life is over, the daily grind of managing diabetes can lead to diabetes burnout. Diabetes burnout is when you feel tired of managing it and develop a sense of hopelessness about your life with it. Fear of complications or other worries related to diabetes are also signs of diabetes distress. If you’re feeling overwhelmed or stuck in your routine with diabetes, try these self-care tips. Also, consider finding a mental health provider who works with people with diabetes. 

Outlook on quality of life: Ask yourself this—how do you view the scope of your life and future? While we all have our ups and downs, can you say your life is mostly filled with positive, uplifting moments? If you feel mostly positive about the current state of your life and where it’s going, try to apply that attitude to your diabetes self-care routine, too. That optimism can make dealing with the challenges of diabetes easier. 

Relationship with food: Food is a major component of living with diabetes, probably the most important part for some. Food is meant to be an enjoyable experience, especially because it is at the heart of a lot of social interactions. But, diabetes can make you second-guess what you “should” and “shouldn’t” be eating, making decisions around it more complex and challenging. Some may even feel guilt for indulging in certain foods. Others may feel frustrated that even after making healthy choices, their blood glucose levels still aren’t where they want them to be. All of these factors can impact your relationship with food. Fortunately, there are ways to enjoy the foods you love, even if you have to make a few tweaks to do it. Start enjoying your relationship with food again when you check out our 11 nutrition tips and our guide on how to enjoy your favorite foods with diabetes

Relationship with others: You don’t need to do diabetes alone; in fact, you shouldn’t do diabetes alone. Surround yourself with people who uplift you and who you can safely confide in about your struggles with diabetes. This may include talking with a friend about being able to stick with a routine designed to improve your health. It could also include speaking with a trusted healthcare provider about your fears surrounding complications, or a family member or significant other about the financial challenges diabetes presents. Whoever you choose to be in your inner circle, ensure that these people are there to encourage you and have your best interests in mind. Steer clear of those who use guilt, shame, or stigmas associated with type 2 diabetes to “show support.”

Relationship with yourself: The most important relationship you will have is the one you have with yourself. No one can manage your diabetes for you, and even if you have the support of many, it won’t matter much unless you prioritize yourself. This means learning to advocate for yourself when necessary, ensuring you are taking care of your mental and emotional health, prioritizing physical activity and finding healthy ways to manage stress. The person who knows you best is you. Only you can give yourself the best support. Your inner circle is there to complement what you give yourself. Put yourself first!

Thinking of your diabetes holistically can help you see improvements over time. We hope this article has helped you see your type 2 diabetes management beyond your A1C.

Educational content related to type 2 diabetes is made possible with support from Lilly Diabetes. Beyond Type 2 maintains full editorial control of all content published on our platforms.

Written By T'ara Smith, MS, Nutrition Education, Posted , Updated 09/01/23

T’ara was diagnosed with type 2 diabetes in July 2017 at the age of 25. Since her diagnosis, she focused her academic studies and career on diabetes awareness and living a full life with it. She’s excited to have joined the Beyond Type 1 team to continue her work. Two years later, T'ara discovered she'd been misdiagnosed with type 2 and actually has latent autoimmune diabetes in adults (LADA). Outside the office, T’ara enjoys going to the movies, visiting parks with her dog, listening to BTS and cooking awesome healthy meals. T’ara holds an MS in Nutrition Education from American University.