Tips to Get and Keep Your A1C on Target
An A1C test reflects an average of all the ups and downs of your blood glucose (or blood sugar) levels over the past two to three months. Think of it as a 24/7 video. When you check your blood sugar with a meter after fasting and before or after meals, you’re just getting a snapshot—it doesn’t capture all the fluctuations you don’t see. The A1C, also known as a glycosylated hemoglobin test or HbA1c, offers an overview to compare with your blood sugar meter checks so you and your provider can evaluate all the information to determine if your glucose is under control or if you have some changes to make.
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The American Diabetes Association (ADA) currently recommends that you have an A1C test at least twice a year if your blood sugar is stable and within target. Your health care provider might want to perform an A1C test quarterly if there have been changes in your diabetes treatment and/or if you aren’t meeting your A1C goals.
The 2014 ADA Standards of Medical Care advise the following A1C levels for people with type 2:
• 6.5 percent or lower for people with diabetes who are not prone to hypoglycemia (low blood sugar) or have experienced problems from treatment, such as weight gain from the use of insulin. This more stringent goal might be best for people who are younger, have not had diabetes for more than 10 years, or do not have significant heart and blood vessel disease.
• 7 percent or lower for people newly diagnosed with type 2 diabetes. At this level, studies have shown that people with type 2 diabetes have fewer long-term complications, such as eye and nerve damage, if that target can be achieved and sustained over the years.
• 8 percent or lower for people with a history of severe hypoglycemia, with limited life expectancy (such as a debilitating illness), or who have had type 2 diabetes for many years.
Follow the Three Essentials
1. Take your blood glucose-lowering medications on time and in the proper dose. Over the years, ask your health care provider about evaluating the right blood glucose-lowering medications for you and in the right amounts to get and keep your A1C in a healthy target range.
2. Eat healthfully by including fruits, vegetables, whole grains, and low-fat dairy foods to get sufficient fiber, vitamins, and minerals. Limit animal fats and protein to lower total fat, saturated fat, and cholesterol consumed. Eat a similar amount of carbs each day. Ask a dietitian to help you develop a healthy eating plan and control your weight.
3. Engage in at least 30 minutes of physical activity a day five days a week, and do resistance training at least two days a week. These steps can help you lower your blood sugar levels and control your weight, cholesterol, and blood pressure.
Adjust Medications as Needed
Type 2 diabetes is a progressive disease. Over time, the amount of insulin made by insulin-producing cells in the pancreas decreases. At the same time, insulin resistance continues to make blood sugar control a challenge. The ADA and other organizations now recommend most people with type 2 diabetes should take a blood glucose-lowering medication when they are diagnosed. The most commonly used medication is metformin, which treats insulin resistance. Metformin, which is available as a generic drug, generally doesn’t cause hypoglycemia and might aid with weight loss.
To keep your A1C in the ideal target zone, you and your health care provider will likely need to gradually increase and/or add other blood glucose-lowering medications throughout the years. The good news is there are more types of medications available on the market today.
Keep Your Medications Organized
To make sure you're on track with your prescribed blood glucose-lowering medicines (and other medications), mentally connect taking them with a regular activity you do, such as your first sips of coffee, brushing your teeth, or eating breakfast (if you need to take medications with food). Get a weekly pillbox, and set aside one time a week—perhaps during your favorite Sunday night television show—to organize your medications for the next week.
Seek Education and Support
Research shows that when you are referred to a diabetes educator and receive diabetes self-management education and support after a diabetes diagnosis, you can drop your A1C level by 1–2 percent. Diabetes educators, who might be a nurse, dietitian, pharmacist, or other health care professional, can combine your personal needs with your diabetes-management needs. The day-to-day effort will be up to you, but look to these health care providers for support and resources. What is critical to your long-term health in preventing or delaying diabetes complications is to get and keep your blood sugar, cholesterol, and blood pressure levels under control.
Pay Attention to Nutrition Facts Labels
When it comes to eating healthfully, start by choosing healthy foods at the grocery store. When the foods you choose have a Nutrition Facts label, use the information to make better decisions about what you buy and eat. You’ll want to keep your eye on several things: the amounts of carbs, fat, saturated fat, and sodium, especially in packaged foods. When it comes to carb-containing foods, such as fruits, vegetables, whole grains, and dairy foods, try to make the amount of carbs you eat about equal for each meal. You can discuss the amount of carbs you need per day with a diabetes educator.
Look beyond the advertising hype on food labels—foods advertised as low in fat may actually contain fat replacers, which are made with carbohydrate and can slightly increase the carb content. The fat-gram count might also be higher in some surprising items. High-fiber bran muffins, for example, might seem healthy, but they could contain extra fat to make the fiber taste good. And just because bread is a darker brown doesn't mean it contains whole grains. Some breads are made with white flour and molasses, which gives them a dark, rich color that’s hiding lots of sugar. Don't be fooled by promises of 100 percent wheat; look for terms like "whole grain" or "whole wheat."
Track Your Food Intake
Many studies that look at success factors for losing weight and adopting healthier eating habits conclude that tracking your food intake over time is essential. Trackers do succeed! It can be arduous to track what and how much you eat day after day, but it can also be revealing and make you accountable for your actions.
To determine the nutrient content of the foods you eat, there are more resources than ever at your fingertips:
• Take advantage of Nutrition Facts labels on various foods.
• Research and download nutrition apps that have larger food databases. Consider SuperTracker, an app developed by the U.S. Department of Agriculture. Other popular commercial apps are Lose It! and MyFitnessPal. Be aware of possible inaccuracies on commercial apps.
• There are books with loads of nutrient content. Do a search on Amazon.com or in your local bookstore. A helpful book published by the ADA is Diabetes Carbohydrate & Fat Gram Guide (4th Edition, 2010) by Lea Ann Holzmeister, RD, CDE.
To take accountability to the next level, consider weighing and measuring your foods from time to time. Use a food scale and measuring cups and spoons to help you control portions. Check in on a weekly basis, such as Mondays, to test your portion accuracy.
Take Small Steps
Think you're too busy to exercise? Laura Hieronymus, RN, CDE, coauthor of 8 Weeks to Maximizing Diabetes Control (American Diabetes Association, 2008), offers ways to fit physical activity into your life with these practical suggestions:
• Exercise while you talk on the phone at home or at work.
• Park your car a little farther from the grocery store.
• Keep moving while you're watching your kids play sports or at the playground. If you have a little one with you, this will teach him or her to be physically active, too.