Question: I have had diabetes for a few years now. For the last year, my A1C has been over 8% and I cannot figure out how to get it down. I know having a high A1C can lead to complications. Can you help me lower my A1c level?
There is not a simple answer to this question. However, I will do my best to sum it up concisely. First, let’s define an “A1c” also known as a glycosolated hemoglobin. The hemoglobin A1c is the amount of glucose that has been attached to the red blood cells for a period of 3months giving your average blood glucose over 120 days. The American Diabetes Association recommends that those of us with diabetes keep the A1c less than 7%. The American Clinical Endocrinologists recommend an A1c of less than 6.5%.These numbers correspond to an average blood glucose of 130-150 mg/dl all the time. So, how do we do that? Management of diabetes is the intricate balance of medication, activity, and food intake to achieve normal blood glucose. The first thing we need to do is check our blood sugars regularly. Research shows that those that check blood glucose daily (more than one time) have a lower A1c. In addition, the more the you check, the lower your A1c tends to be. I realize that for a lot of people, this is the worst thing about diabetes. However, I will often ask my patients to check at least 4 times per day, record food intake, activity and medication for just a week and see if they notice any patterns. This helps isolate the answer to the question, “Why is my blood sugar high at this certain point in the day?” If you know why your blood sugar is high (such as food intake or stress), that information can be used to determine medication adjustments. In Type 2 diabetes, food intake and exercise can play such a huge role in blood glucose (BG) control, but also oral medications may need to be adjusted and/or insulin added if BG values are too high. In type 1 diabetes, it is all about matching the insulin to your body’s needs whether it is basal insulin or insulin for food. We recommend that people check their BG level 1-2 hours after a meal to assess the effectiveness of the mealtime dose. Ideally 1-2 hours after a meal, BG values should be somewhere between 140-160 mg/dl. Usually, if BG values are elevated first thing in the morning or pre-meal, it may mean that the basal dose is not adequate. Fasting and pre-meal numbers should be less than 110 mg/dl. If you are not seeing this fasting levels or pre-meal numbers in this range, then the first step is to rule out excess food intake for insulin taken or some other explanation for a rise in BG. If human error can be ruled out, medication or insulin doses may need to be addressed. No one is going to have perfect blood sugars all the time! It is the nature of the beast and life! There are many variables that can affect this most intricate balance, but I do believe that we can achieve some consistency and reliability in our numbers if we are using all of our resources (medication, information, support) to the best of our ability. There will always be outliers…a low here and a high there. I hope this information was helpful. Since every single woman with diabetes is different and has different needs, it is somewhat difficult to give the precise answer to this question without knowing you personally.It may be helpful for you to find a local diabetes educator to help you review your records and assess the need for change in your regimen. Good Luck!