COVID Pandemic Leads to a Sharp Drop in A1c Testing


Skipping routine A1c tests because of the ongoing COVID-19 pandemic and telehealth appointments have left many people with diabetes with rising blood sugars and too little support.

The sharp drop in A1c testing over the last year during the ongoing pandemic and a rocky transition to virtual healthcare has left many people with diabetes with rising blood sugars and too little support.

Obstacles to getting your routine A1c test

Depending on the resources where you live, getting an A1c test prior to a telehealth appointment with your doctor came with many potential obstacles such as:

  • The labs in your area were closed.
  • Open labs are not within reasonable distance from your home.
  • Your healthcare team had no system in place to order labs under these circumstances.
  • Doctors working from home had no way to send referrals from home computers.
  • Doctors working from home were unable to access their usual appointment process.
  • You were afraid to go get blood work done due to the pandemic.
  • You didn’t want to sit in your car and wait to be called into the lab.
  • You were reluctant to go somewhere new for lab work.
  • You were given a referral to get blood work done but decided not to go.

“75 percent of our patients are still choosing telehealth appointments,” says Jennifer Okemah, MS, RD, BCADM, CDCES, CSSD, from Salute Nutrition near Seattle, WA. Okemah and her team work with people with diabetes from all over Washington state.

Fortunately, Okemah and her team were well-prepared for virtual healthcare, because it had been part of their clinic prior to the pandemic with clients spread across the state and only four physical offices.

However, the patient referrals Okemah normally receives from other primary care and endocrinology offices revealed just how significant the lack of A1c testing was for patients in other clinics, and the inability to send referrals at all during stay-at-home orders.

A1cs at 10 percent and higher because of interrupted care

“Earlier this spring, we started getting a lot of referrals with really high A1cs in the double-digits,” recalls Okemah.

These were patients who were already diagnosed with diabetes, but the interruption in their usual healthcare meant their diabetes support was slipping through the cracks in a system unprepared for telehealth.

Okemah says gradual or rapid rise in A1c levels could be related a number of factors during the pandemic with the rocky transition to telehealth and lack of A1c testing, including:

  • You stopped taking your usual medications, for a variety of reasons.
  • You started a medication, but didn’t like the side-effects, so you stopped taking it.
  • You likely needed to try a different medication, but weren’t aware of other options.
  • You started a medication, but the dose was never adjusted.
  • Your usual health schedule, habits, and routine were disrupted.
  • You don’t have access to the internet, and thus no access to telehealth.
  • You don’t have access to continuous glucose monitor (CGM) technology to monitor “time-in-range

The consequences of rapidly rising blood sugar and A1c levels means an increased risk of developing diabetes related complications, including vision loss and infections in small cuts that could threaten the safety of your toes, feet, hands and fingers.

Helping people bring high A1c levels down safely

Dropping your A1c too quickly can feel very uncomfortable because your body has gotten used to blood sugar levels in the high 200s and 300s. If you lower your blood sugar levels too quickly, you’ll feel like you’re low even when you’re in a safe range.

“It’s really important to bring blood sugar levels down slowly when your A1c is in the double-digits, 10, 11, 12, etc.,” explains Okemah. “When your A1c is that high, making changes in your diet or taking the maximum dose of metformin is not going to work, because you’re in a state of glucose toxicity.”

Signs of glucose toxicity in type 2 diabetes include:

  • Feeling tired all the time
  • Needing to pee all the time
  • Not sleeping well
  • Increased craving carbohydrates

Using any combination of diabetes medications—including insulin, for some—to gradually lower your blood sugars over the course of several weeks can help you get back into a healthier range safely.

“I like to check in with people every two or three weeks during this process,” says Okemah. “If you aren’t feeling well or you think something isn’t working, don’t wait for your next appointment, reach out to your doctor.”

Whether you’re seeing your healthcare team in-person or through telehealth appointments, Okemah hopes you can build a trusting relationship so you always feel comfortable reaching out to your healthcare team for help.

“Trust is the number one most important ingredient,” adds Okemah. “‘It is our job to work with you in a way that earns that trust. Without trust, we can’t talk about what’s going on, and we can’t help you improve your diabetes health.”



This content was made possible with support from Lilly Diabetes. Beyond Type 1 maintains full editorial control of all content published on our platforms.

WRITTEN BY Ginger Vieira, POSTED 05/27/21, UPDATED 12/13/22

Ginger Vieira is an author and writer living with type 1 diabetes, celiac disease, fibromyalgia and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1 as digital content manager, Ginger wrote for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.