Your Blood Sugar Isnt Just Because Of What You Eat
Mainstream media would have you believe that your blood sugar levels are impacted only by what you eat and how much you exercise, but people with type 1 and type 2 diabetes who test their blood sugars frequently could tell you otherwise.
Its especially important to keep this mind when looking at your own blood sugars and your goals because there are certain variables and challenges that impact blood sugar levels that you cant always control.
- Menstrual cycles: raises blood sugar and insulin needs
- Adrenaline rushes from competitive sports, heated arguments, rollercoaster rides: raises blood sugar and insulin needs
- The common cold and other illnesses: usually raises blood sugar and insulin needs
- Hormonal changes due to puberty and healthy growth in young adults: raises blood sugar and insulin needs
- An injury which raises overall inflammation levels: raises blood sugar and insulin needs
- Glucogenesis during anaerobic exercise: raises blood sugar
While you cant necessarily prevent these factors that affect your blood sugar from occurring, you can work with your diabetes healthcare team to adjust your insulin, other diabetes medications, nutrition and activity levels to help compensate for them when they do occur.
For example, when engaging in anaerobic exercise like weightlifting many people with type 1 diabetes find it necessary to take a small bolus of insulin prior to or during their workout because anaerobic exercise can actually raise blood sugar.
Determining The Right A1c Goal For You
Just because a normal blood sugar range of 70 to 130 mg/dL is considered the healthiest doesnt necessarily mean thats the appropriate goal range for you especially if you have type 1 diabetes, or take insulin as a person with type 2 diabetes.
The reason this may not be the right goal for you is that extremely tight blood sugar management in people taking insulin can potentially lead to frequent low blood sugars which can be dangerous.
Achieving extremely tight blood sugar management, like a range of 70 to 130 mg/dL, also often requires a strict nutrition plan, more frequent than usual blood sugar monitoring, precise medication management, and most importantly, years of experience studying your own blood sugar levels.
How To Calculate Your A1c
The Hemoglobin A1c test is a blood test used to measure the average blood glucose concentration in your body in the past 1-3 months. For diabetics, this is the standard way of determining how well the diabetes is controlled. An A1c of less than 7% is considered good.
Getting the test every 3 months is usually enough. But sometimes you may want to just estimate your A1c level based on the data from your regular self-tests. The formula below could help in this case.
Accuracy, of course, could vary depending on how often and when you check your blood sugar. I found it pretty accurate last time I used it. My calculation was off only by 0.1%. This is the same formula GlucoseTracker uses in the app’s dashboard.
Glucose in mg/dL:
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Create A Plan For Your Diabetes Management
Now that you have a better idea of what your pain points are, you can start making changes to your diabetes management.
If youre insulin dependent and consistently have high blood sugars in the morning, getting your blood sugar fluctuations and A1c down might be as simple as adjusting your nighttime basal insulin. Or, if you run high every day after meals, your carb-to-insulin ratio might be off and adjusting that could be what sets you on a path of a lower A1c. Until you collect the data and do the analysis, you have no way of knowing this.
I want to make an important point here: increasing your diabetes medication is not a sign of failure! Its often the best way to control your blood sugar and bring down your A1c.
I adjust my insulin up and down all the time when I change my diet or exercise routine. Adjusting your medication is an important tool in your diabetes toolbox and something you should always discuss with your medical team.
How Quickly Can You Lower Your A1c
Because A1c is simply a measure of your average blood sugar over 2-3 months, it can decrease by any amount over that time period. If you, from one day to the next, decreased your daily average blood sugar from 300 mg/dl to 120 mg/dl , your A1c would decrease from 12% to 6% in around two months.
However, it may not be a good idea to lower your A1c so quickly, as I will explain below.
Can This Test Be Used During Pregnancy
Although the A1c test can be useful in the early pregnancy to diagnose if improvement has diabetes before pregnancy, A1c testing is typically not very correct during the pregnancy due to changes in hemoglobin and expansion and blood volume. Typically your endocrinologist will use glucose tolerance test and follow you with glucose testing with fingersticks or continuous glucose monitoring systems.
The bottom line
Endocrinologists and primary care doctors, commonly use this test to diagnose and treat and monitor diabetes. It reflects average blood sugars within the last 3 months. This is because the test relies on hemoglobin turnover that is typically 3 months. If there are problems in your red blood cells or hemoglobin due to a variety of situations we have discussed above, the test may not be reliable. There are also many caveats that diabetes specialists, as well as diabetic patients, should be mindful of when interpreting test results.
About the author: Dr. Ergin operates a large diabetes practice mostly in West Palm Beach, FL, and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him to track patient progress and be available at all times. Soon to be available in NY and NJ.
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Why Your A1c Matters
In a nutshell: your A1c is one of the clearest indicators of your risk for developing diabetes complications like neuropathy , retinopathy , nephropathy , and severe infection in any part of your body that requires healing.
For instance, a small cut on your toe could become infected due to high blood sugars, struggle to heal, and become severe enough that the infection could lead to an amputation.
The general guidelines from the American Diabetes Association recommend an A1c at or below 7.0 percent for the best prevention of diabetes complications. Your risk of developing a diabetes complication continues to drop as your A1c drops closer to 6 percent.
Some people with diabetes aim for A1c levels in the 5s and lower especially those who follow strict low-carb diets like the ketogenic diet and the Bernstein diet. However, this hasnt been proven in research as especially necessary, nor is it reasonably achievable for the larger population of people with diabetes.
Its also important to remember that your blood sugar levels and your A1c are just information that tells you whether your body needs more or less of factors like insulin, other diabetes medications, changes in your nutrition, and changes in your exercise.
If you dont like the number youre seeing on your glucose meter or your A1c results, use that number as motivation to make changes in how you safely manage your diabetes in order to get different results.
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What Is A1c And Why Is It Called Hemoglobin A1c
Hemoglobin formed in new red blood cells are freely permeable to glucose. As a result, glucose attaches the hemoglobin irreversibly. The more glucose you have, the more glucose binds to the hemoglobin. Since the average lifespan of hemoglobin is 120 days, A1c reflects average glucose levels within the last three months.
Ways To Lower Your A1c
A1C is a blood test that shows how well your diabetes management plan is working. Here’s how to reach a healthy A1C number and avoid diabetes complications.
For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of whats happening in the moment, not a full picture of whats happened in the long term, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City.
For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides another lens on how well your type 2 diabetes management plan is working.
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How To Test Your A1c
Your doctor or endocrinologist should test your A1c regularly . The doctor simply pricks your finger and takes a tiny blood sample. If the doctors office has an A1c kit, you should get your result before your consultation is over.
You can also buy home A1c kits and do the test yourself. Home A1c kits can be useful if you go for more than three months between doctor visits and want to keep an eye on how your A1c is developing yourself.
The home kits are generally accurate within plus/minus 0.5 percentage points, which is more than good enough to give you a trustworthy result. The downside of the home kits is that they require a larger amount of blood than a regular blood sugar test, and if you dont apply enough blood, youll get an error message and will have lost a test strip.
You can find and in some pharmacies.
Understand Nutrition And Adjust Your Diet
What you choose to eat and drink can have a major impact on not only your waistline, mood, and well-being, but also on your blood sugar levels.
All macronutrients can affect the blood sugar to some degree so developing a good understanding of how they affect your blood sugar will enable you to be proactive and prevent blood sugar swings.
Carbohydrates have the greatest impact on your blood sugar, which is why many people with diabetes can benefit from following a low- to medium-carb diet . The fewer carbs you eat, the less insulin you need to take, which makes diabetes management easier.
However, you dont have to follow a low-carb diet if it doesnt work for you physically or mentally. As I wrote in my post about which diet is best for people with diabetes, it is very possible to have great blood sugar control on a medium carb diet, as long as you experiment, take notes, and learn to take the right amounts of insulin for the carbs you are eating.
It is very important to realize that we all react differently to carbs so you have to find the diet and foods that are right for you.
As an example, people react very differently to carbs like oats or sweet potato. Some people can eat oats with only a small increase in blood sugar while others see a quick spike. By simply knowing this, people struggling with a certain type of carb can choose to reduce their consumption or cut it out of their diet altogether.
Protein & fats
How Accurate Are The Results
The calculator looks to provide an estimate of what your HbA1c value may be based upon your average blood glucose results and vice versa. Its important to note that HbA1c and blood glucose tests measure different things.
Blood glucose tests measure the concentration of glucose molecules in the blood at a single point in time.
The HbA1c test measures the proportion of haemoglobin molecules in the blood that have become chemically bonded with glucose over a period of up to 3 months.
However, the calculator serves as a useful guide which can give you a close indication of what your HbA1c result might be based on your blood glucose results?
What Are Some Alternatives To Hba1c Measurement
Just like hemoglobin, many other proteins also can attach to glucose. This glucose interaction and attachment can lead to a similar interpretation and can be used to estimate glucose control. Generally, there is a good correlation between A1c values and fructosamine. However, there are some problems with the use of fructosamine as well. For example, because the turnover of serum albumin is more rapid than hemoglobin, fructosamine values reflect average glucose values in a much shorter time. This time is typically 1 to 2 weeks.
If patients have albumin problems such as protein-losing kidney disease or liver disease, fructosamine values may be incorrect.
1,5-anhydroglucitol is a polyol that comes in the diet. In normal individuals, this is completely reabsorbed by the kidneys after the filtration. As a result, serum concentrations are typically stable in normal individuals. When glucose levels go up, the kidney reabsorption of the substance is inhibited. As a result, 1,5-anhydroglucitol levels will go down as glucose levels go up.
3.Continuous glucose monitoring systems
Continuous glucose monitoring systems such as Dexcom, freestyle libre, or Medtronic guardian systems can also give you continuous blood glucose readings that can have a corresponding A1c. Since it is average blood sugar, if your average blood sugars on CGM as 150, you can safely assume that your A1c is at 7%.
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For Monitoring Diabetes Control
Experts disagree somewhat on what the A1C target should be. The ADA recommends a general A1C target of less than 7% without significant hypoglycemia , while the American Association of Clinical Endocrinologists recommends a general target level of 6.5% or below.
The ADA’s Standards of Medical Care in Diabetes for 2021 note the following A1C targets:
|A1C Targets for Diabetes Management|
|Most non-pregnant adults without significant hypoglycemia||< 7%|
|Adults who take no medication or only oral medication have a long life expectancy or have no significant cardiovascular disease||Target may be set lower than < 7%|
|Adults with limited life expectancy or advanced micro- or macro-vascular disease||< 8%|
The ADA recommends that an A1C target should only be set below 7% if it can be achieved without significant hypoglycemia or other adverse effects.
While helpful, these targets are general guidelines. Both the ADA and the AACE emphasize that A1C goals should be individualized based on factors such as:
- Length of time you’ve had diabetes
- How well you comply with your treatment plan
- Your risk of developing complications from hypoglycemia
However, for most people, a lower A1C is ideal so long as they’re not having frequent bouts of low blood sugar. Some people are able to substantially lessen their risk of complications from diabetes if they can keep their A1C under 7%.
High A1c With Symptoms Of High Blood Sugar
If you do have symptoms of high blood sugar and your initial A1C is high, this will confirm a diabetes diagnosisâespecially if you also had the random plasma glucose test done and that was high.
This means that your healthcare provider will need to see you as soon as possible to discuss starting a treatment plan to manage your diabetes.
This plan will depend on whether you have type 1 or type 2 diabetes, but may involve insulin supplementation, medication, glucose monitoring, exercise, and lifestyle changes.
Your healthcare provider will likely repeat the A1C soon after you’ve started treatment to see how it’s working and how well you’re complying.
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Different Levels And What They Mean
The ranges of safe levels of blood glucose depend on factors such as what time of day it is and when you last ate. Safe levels of blood sugar are high enough to supply your organs with the sugar they need, but low enough to prevent symptoms of hyperglycemia or complications of diabetes which follow the National Institute of Diabetes and Digestive and Kidney Diseases guides. Dangerous levels of blood glucose are outside of this range.
The target levels can also vary if you have diabetes. For example, if you are diabetic and are monitoring your blood sugar, you might get a reading of 65 mg/dl. That is considered to be mild hypoglycemia, and you would be wise to eat 15 grams of fast-acting carbohydrates and retest your blood sugar in 15 minutes.
If you were not diabetic, you probably would not know that your sugar was low because you would not test and because you would not symptoms, and you would not act.
That is fine because your body is capable, under normal circumstances, of raising your blood glucose to healthy levels when needed, even if you have not eaten. It is important to keep them in control to help prevent issues like heart disease or nerve damage.
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Identify The Main Pain Points
Whether you are self-managing your diabetes or work closely with your medical team, the first step should always be to try to identify the main pain points or reasons why your A1c is higher than youd like. The only real way of doing this is by tracking your blood sugars very closely.
If you wear a Continuous Glucose Monitor, you can look at your 7-day, 30-day, and 90-day data to see if you can spot any trends. For example, you might find that you are running high from 1-5 AM every night, every morning or every day after meals. Or perhaps you always go low after exercise. We all have different blood sugar patterns.
Its also very possible that you simply are running your blood sugar a little too high all the time and could benefit from adjusting your diabetes medication. Identifying patterns like that makes it possible to pinpoint areas of potential improvement so you can start making a plan for how to limit your high and low blood sugars.
If you rely on manual blood sugar testing, its a little trickier since most people dont test every five minutes. What I would recommend is increasing how often you test for a while, and maybe even test during the night if you wake up anyway. Most meters allow you to download data to your computer, or you can upload the data to app-based platforms like One Drop or mySugr. This can help you see the data in a more cohesive way so you can start looking for trends.
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