Today’s technology makes it easy for people with type 2 diabetes to check their blood sugar (also called blood glucose) at home. But checking your A1c levels often means going to the doctor’s office. Many people on DiabetesTeam feel nervous before these visits because they worry about what their A1c results will show, especially if they’ve been working hard to lower their numbers through exercise and healthy eating.

“I’m due soon for another A1c test — stressful!” one DiabetesTeam member wrote. Another said, “I was so hopeful that my A1c yesterday would drop to maybe 6.9. But no, it was 7.2. In May, it was 7.3. I was sure I had eaten fewer carbs since then. Do I need to give up more carbs?”

If you’re working on lifestyle changes to reduce your A1c levels, it helps to know how long it may take for your A1c levels to improve. Let’s start by learning more about A1c.

What Is A1c?

A hemoglobin A1c test, often shortened to A1c or HbA1c, shows your average blood sugar level over the past two to three months. Your doctor will give you the result as a percentage after doing a blood test. In general, a lower percentage means your blood sugar levels are under better control.

Monitoring A1c allows your healthcare provider to diagnose prediabetes and diabetes. Once you get a diagnosis, they’ll keep tracking your A1c levels to make sure your diabetes is under control.

After a diagnosis of type 2 diabetes, the general A1c goal is to keep it below 7 percent. The target percentage is personalized to your health status.

Episodes of low blood sugar can affect your A1c level, potentially making it appear that your diabetes is well controlled — even if it’s not — especially if your doctor is unaware of these episodes. In older adults, low blood sugar can also increase the risk of falling.

If your A1c levels are significantly above your target range, you may have an increased risk of health issues such as:

• Eye issues
• Kidney disease
• Stroke
• Heart disease
• Neuropathy (nerve damage) or other nerve problems

Some people may be able to lower their A1c through diet and exercise alone, without taking medication, but this approach isn’t suitable for everyone.

By tracking your A1c levels, your doctor can stay on top of how your diabetes is progressing and try to prevent these complications.

Physical Activity, Diet, and A1c

Managing your A1c levels may take trial and error. Your diabetes care team will work with you on a diabetes treatment plan that may include:

• Taking medication, such as pills or insulin
• Participating in a regular exercise routine
• Starting a new, diabetes-friendly eating plan

Some people may be able to lower their A1c through diet and exercise alone, without taking medication, but this approach isn’t suitable for everyone. Always check with your doctor before making any changes to your treatment plan.

“My doctor told me I needed long-acting insulin, quick-acting insulin, and metformin,” one DiabetesTeam member said. “I negotiated a three-month reprieve from medications. She said if I got my A1c down to 6.1, I could gain another three months. Three and a half months later, my A1c was 4.9 and has been in the fives since — no diabetes medications!”

Whether someone with type 2 diabetes can stop taking medicine depends on their health and situation. Talk to your doctor about your goals and interests to develop a treatment plan tailored to your situation.

Diet and A1c

Your doctor or registered dietitian will help you create a diabetes eating plan that fits your lifestyle, goals, and preferences. No single diet has been shown to work well for everyone with type 2 diabetes — the best plan for anyone is one that they can stick with. Some studies have shown that both low-carbohydrate (low-carb) and low-fat diets are useful in improving A1c levels.

Some studies have shown that both low-carb and low-fat diets are useful in improving A1c levels.

The American Diabetes Association lists the following eating patterns as potentially helpful for lowering A1c levels:

• Mediterranean-style eating plan — Emphasizes plant-based foods, whole grains, olive oil, nuts, and fish, while limiting red meat, highly processed foods, and added sugar
• Vegetarian or vegan meal plans — Focus on plant-based foods, with vegetarian plans avoiding meat, seafood, and poultry, and vegan plans avoiding all animal products
• Low-carb eating plan — Limits carbohydrates to about 26 percent to 45 percent of total calories, with an emphasis on nonstarchy vegetables, protein foods, and healthy fats
• Very-low-carb eating plan — Restricts carbohydrates to less than 26 percent of total calories
• Low-fat eating plan — Keeps total fat intake below 30 percent of daily calories, with saturated fat limited to less than 10 percent
• DASH (Dietary Approaches to Stop Hypertension) meal pattern — Emphasizes whole foods such as fruits, vegetables, whole grains, lean protein, and low-fat dairy

Exercise and A1c

Your doctor can help you figure out what types of exercise are safest and most effective for you, especially if you’re trying to lower your A1c levels. In general, adults with type 2 diabetes are advised to:

• Get at least 150 minutes of moderate to vigorous physical activity each week, spread over at least three days.
• Break up long periods of sitting by getting up and moving at least once every hour.
• Do resistance or strength training two or three days a week.
• Aim to stay active regularly, and avoid going more than two days in a row without exercise.
• Choose activities and intensity levels that match your fitness level, overall health, and personal needs.
• Include balance and flexibility exercises, such as stretching or yoga, which can be especially beneficial as you age.

The degree and speed of A1c improvement will vary based on your baseline A1c and type of diabetes, as well as how well you stick to lifestyle changes and whether you’re taking medications.

How Long Do A1c Changes Take?

The degree and speed of A1c improvement will vary based on your baseline A1c and type of diabetes, as well as how well you stick to lifestyle changes and whether you’re taking medications. One study showed that consistent changes in diet and regular physical activity helped people with type 2 diabetes lower their A1c levels within three months.

Another study looked at people with untreated A1c levels between 6 percent and 6.9 percent who followed a low-carb eating plan. Participants consumed fewer than 40 grams of carbs per day for the first three months and fewer than 60 grams a day for the next three months. Researchers compared A1c outcomes in this group with those of participants who continued their usual diets. The results showed that people following the low-carb plan had greater A1c reductions at both three and six months than those with unchanged diets.

Several DiabetesTeam members have shared their results with lowering their A1c levels:

• “My A1c was 6.9 percent in August of 2016. Diet and weight loss got it down to 5.7 percent three months later, and between now and then, it has hung around in the 5.4-to-5.8 range. I have my annual A1c check next month, and my Libre 2 is calculating that I will be sub-6 percent, which is my current target.”
• “My A1c was 14 percent at diagnosis. With diet, exercise, and antidiabetes meds, I’m at 6.7 percent A1c now.”
• “I was initially diagnosed at 6.4 percent last October. Three months later, I was at 6.1 — another three months, I hit 5.9. Then, after nine months, I was at 5.7. I was able to lower it by diet and exercise.”

Continuous glucose monitors (CGMs) provide a glucose management indicator (GMI). GMI isn’t the same as a lab-measured A1c test — it’s a calculated estimate based on your CGM glucose readings that gives an A1c-like number to help show how your glucose levels have been trending over time. Because GMI is an estimate, it may not always match your actual A1c result from a blood test.

Talk With Your Doctor

Not everyone with type 2 diabetes will have the same experiences. That’s why it’s important to talk with your healthcare provider to get a personalized plan to lower your A1c. They can help you create a treatment program that may include diet, exercise, and medications. They’ll be able to advise you about how long it may take to see your A1c numbers decrease.

Join the Conversation

On DiabetesTeam, people share their experiences with diabetes, get advice, and find support from others who understand.

Have you tried lowering your A1c levels through diet and exercise? Let others know in the comments below.