Recently we had some questions from diabetes sister Kaushiki B, a software professional, the mother of a five year old, and a woman with type 2 diabetes. She writes that she finds it difficult to keep checking her BG throughout the day, though she knows she should not let it go. She was diagnosed in 2004 and takes oral medication for BG control. The questions she asks are of interest and benefit to all of us. Kaushiki asks the following questions:
1. What should be my HbA1C goal? Can the HbA1C test be done during anytime of the day?
Like before meal...after meal, as it’s the average of last 3 months? Does the doctor treating your diabetes perform an A1c test with regularity? It is recommended that it be tested at least twice yearly if your diabetes is in good control, and more often, like every three months when your doctor may be adjusting your medications or if you are undergoing stress or another illness that affects your diabetes control. An ideal A1c value is recommended to be between 6.5 and 7%, which translates to an overall estimated Average Glucose (eAG) of 126 to 154 ml/dl. This is what is considered Excellent Control. If your eAG falls between 7.1 to 7.9%, you may be considered in GOOD to FAIR control. An 8 to 9% may be considered FAIR control. Anything over 9 to 10% is considered ELEVATED and higher than 10% is indicative of POORLY controlled diabetes. It does not matter what time of the day the A1c test performed, nor does It need to be a fasting BG value. The test reads the average of the glucose content of hemoglobin molecules in your blood over a 3-month period. Always know the number value of your A1c or eAG. This gives you a good guideline to know where you are the scale of diabetes control. If your eAG is falling in the 160 to 190 range (A1c higher than 8%), ask your diabetes health team what you can do to lower your numbers into target range of 7% or below (154 or lower).
2. How often should I check my BG? I have glucose monitor at home so it will be helpful if you can let me know about this. Most people on oral medications to control type 2 diabetes test their blood glucose (BG) levels at least twice a day. With type 2 diabetes, it is a good idea to test daily at different times before and after eating. For example, on day 1, test before and 2 hours after eating breakfast. On day 2, test before and two hours after eating lunch. On day 3, test before and two hours after dinner. In addition, it is wise to test your BG level before going to sleep at night and the following morning at least a few times a week to see if you go high or low during the night. It is useful to keep a log book to record your BG numbers and patterns to present and discuss with your health care provider. This helps you and your health care team to determine your BG patterns to be able to adjust you medications accordingly in order to keep your BG numbers in control. Keeping track of your numbers is a valuable tool to help you and your doctor to see how your diabetes control is doing. It is also useful to keep track of the kinds and amounts of foods you are eating so you can see how different foods affect your BG rise values. In the beginning, it can kind of be a period of trial and error. Everyone's diabetes is different, so you have to get to know your own very intimately. By monitoring you learn how to respond to your diabetes, and make adjustments based on the information. For example, if you take insulin, especially insulin with meals, you will need to test more frequently such as before eating and two hours after to make sure your insulin is targeting your BG and you are not too high or too low. In addition, people taking insulin will need to test more frequently to monitor for and treat hypoglycemia (BG levels <70 or lower).
3. Does pranayam help in controlling blood glucose level? For our readers, prana is a Sanskrit word for the vital life force, and pranayam is the act of conscious, or attentive, breathing. I have studied and practiced yoga and pranayama breathing in my own self-management journey with diabetes. It can be very beneficial, as you are inhaling the Vital Life Force energy and exhaling impurities into Vital Life Force energy. Pranayam expands and purifies your mind as well as the how energy circulates throughout your mind-body complex. Keep track of how it affects you. Monitor your BG before and after you practice pranayam. For example, test before you start. Make sure your BG is not too low. Pranayama is gentle, but it can have a very powerful effect as well. Try an experiment and test right before and after you have done pranayam breathing/meditation; then one hour after, then two hours afterward. You do not have to do this testing all the time, just enough to see how it affects your BG levels. If you find that practicing pranayam significantly lowers (or raises) your BG, then have a conversation with your doctor so you can discuss how to practice safely and to adjust your medications for diabetes accordingly.
4. Is green tea beneficial for diabetics? Green tea is a healthful beverage choice because it contains antioxidant properties that can improve cellular functions and protect certain body systems from free radical cellular damage. Free radical damage can cause certain types of cancer. The antioxidants contained in green tea are called polyphenols. They occur in black tea and oolong tea as well, but green tea leaves contain more of them. The benefits of regular drinking of green tea may include a lower risk of heart disease, lower blood glucose levels, better dental health, and stronger bones. Some studies suggest that drinking green tea or taking supplements that contain green tea extract may burn more calories, but it is unclear if green tea products lead to more weight loss.
A reference book that I have found very useful when seeking answers to the some of the very questions that you pose here, is Diabetes Self-Management's Hidden Secrets of Natural Healing (2007), written by Diana W. Guthrie, PhD, ARNP, FAAN, CDE, BC-ADM, AHN-BC, CHTP, and published by Diabetes Self-Management Books. Dr Guthrie is a renowned nurse educator who specializes in holistic nursing and diabetes care. You can find her book here:. http://www.diabetesselfmanagement.com/bookstore/
In conclusion, please check out the resource links listed through DiabetesSisters and Diabetes Self-Management. Ask your treating physician to refer you to a diabetes educator if there is one in your area. Learn as much and everything you can about diabetes and how it affects YOU, for ultimately you are the one who must observe it and respond to be in control of it. I wish you the best of luck and good health!
Connie Hanham-Cain RN, BSN, CDE