Diabetes Tracking And Treatment
- Follow your diabetes treatment plan: Understand the treatment plan before leaving the healthcare providers office and discuss barriers that could prevent you from following the program. Attend all follow-up visits.
- Consistently take prescribed medications: If a healthcare provider has prescribed medications to reduce blood sugar levels, take them regularly. Some people only take medication when they arent feeling well, but these medications dont work unless taken consistently.
- Monitor and track blood sugar: Regular blood sugar monitoring is the most important step in diabetes management, according to the CDC. Healthcare providers can inform patients of different types of meters and help patients find the best one for them. Providers can also tell patients how often to check their blood sugar and what their target blood sugar range is.Keep a log of your blood sugar levels to look for patterns and triggers for blood sugar spikes and lows. If you wear a continuous glucose monitor, you can use the data. Learning what causes blood sugar to rise or decrease can help you create a plan to keep it consistent.
We Dont Even Need To Follow The A1c For Some Patients
Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level. Who would be included in this group? People with a life expectancy of less than 10 years, or those who have advanced forms of dementia, emphysema, or cancer or end-stage kidney, liver, or heart failure. There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls. There is the added consideration that elderly and sick patients often end up on a long list of medications that can interact, causing even more side effects.
What Causes A Sudden Increase In A1c
A sudden increase of at least three points within one year could mean that something serious has happened such as pregnancy, puberty, illness or diabetes-related complications like nephropathy , neuropathy , injury/surgery, prescription drug side effects, or eating disorder/lack of hunger from depression.
Not paying too much attention to your blood glucose levels could also be the reason for the sudden increase. Unregulated blood sugar levels and bad management increase A1C levels.
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Know Your Numbers: Cholesterol
High cholesterol is another heart disease risk factor that’s important to watch when you have diabetes. Total cholesterol should be below 200, with low-density lipoprotein , or “bad” cholesterol, levels under 100 and high-density lipoprotein , or “good” cholesterol, higher than 40 for men and 50 for women. Triglycerides, a type of fat found in your blood, should be less than 150 for both men and women. Limiting saturated fats found in meat, full-fat dairy products, and fried foods can reduce unhealthy cholesterol levels. Getting more physical activity and taking cholesterol-reducing drugs can also help you meet your target cholesterol levels.
An A1c Goal Of Between 7% And 8% Is Reasonable And Beneficial For Most Patients With Type 2 Diabetes
though if lifestyle changes can get that number lower, then go for it. For patients who want to live a long and healthy life and try to avoid the complications of diabetes, they will need to keep their blood sugars as normal as possible that means an A1c under 6.5%. However, studies show that using medications to achieve that goal significantly increases the risk of harmful side effects like hypoglycemia and weight gain. To live longer and healthier and avoid both the complications of diabetes as well as the risks of medications, theres this amazing thing called lifestyle change. This involves exercise, healthy diet, weight loss, and not smoking. It is very effective. Lifestyle change also can help achieve healthy blood pressure and cholesterol levels, which in turn reduce the risk for heart disease. And heart disease is a serious and common complication of diabetes.
Lifestyle change should be the cornerstone of treatment for type 2 diabetes. The recommendations go on to say that for patients who achieve an A1c below 6.5% with medications, we should decrease or even discontinue those drugs. Doing so requires careful monitoring to ensure that the person stays at the goal set with his or her doctor, which should be no lower than 7%, for the reasons stated above.
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Three Sneaky Reasons Your A1c Levels Fluctuate
When youve lived with type 2 diabetes for a while, you become a pro at managing your glucose levels. You know that its best to limit carbs, exercise regularly, check other medications for possible interactions, and avoid drinking alcohol on an empty stomach.
Sometimes, things you may not even think about can affect your blood glucose, which can in turn lead to serious complications, such as heart attacks, kidney disease, blindness, or amputation. Learning to recognize behaviors and circumstances that you dont normally associate with blood glucose fluctuations may help you prevent more serious problems now and in the future.
Who Should Get An A1c Test And When
Testing for diabetes or prediabetes:Get a baseline A1C test if youre an adult over age 45or if youre under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:
- If your result is normal but youre over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.
- If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
- If you dont have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.
- If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.
Managing diabetes:If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.
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What Does An A1c Test Measure
An A1C test measures the percentage of hemoglobin in your blood that carries glucose. Having a high A1C means that you have too much glucose in your blood and may have prediabetes or diabetes.
The helpful thing about an A1C test is that it represents your average blood glucose levels over 2 to 3 months. In other words, the pizza you had the night before doesnt affect it, and you dont have to avoid eating for the test to be accurate. Thats because glucose stays attached to hemoglobin for the entire life of a red blood cell, or about 2 to 3 months.
There are other factors that can affect A1C testing and cause false results. Those factors may include:
How Do We Achieve Remission
Significant weight loss appears to be the most effective way to achieve type 2 diabetes remission. Professor Roy Taylor, a leading researcher of type 2 diabetes, and colleagues at Newcastle University conducted the first ever dietary and lifestyle intervention trial with remission as the primary endpoint. This was called the DiRECT study. 320 participants, all diagnosed with type 2 diabetes within the last 6 years, were randomised into either the intervention group or the control group.
The intervention was a very low-calorie diet programme. Participants dramatically reduced energy intake to 850 calories a day and then were slowly reintroduced to a regular, healthy diet to maintain weight loss. The control group received the usual current treatment on the NHS for type 2 diabetes.
This study is ongoing, but so far the results have demonstrated that after 1 year, those in the intervention group lost significantly more body weight compared to the control group . In addition, 46% of the intervention group went into remission, compared to only 4% in the control group.
At 2 years, 36% of those who began the trial in the intervention group were in remission as opposed to 3% of those in the control group.
These results suggest that significant weight loss can reverse type 2 diabetes and result in regular insulin activity for some, even if the individual has been diagnosed up to 10 years ago.
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How Often Is A1c Tested
To keep A1C levels in check, patients should have the test repeated regularly. If the A1C is less than 5.7, indicating you dont have diabetes, you should have it checked every three years, according to Robert Williams, MD, a family doctor and geriatrician in Lakewood, Colorado, and a medical advisor for eMediHealth. If it is between 5.7 and 6.4, indicating you are at risk of developing diabetes, you should have it rechecked every one to two years. If you have a confirmed diabetes diagnosis, and your blood sugar is well-controlled, you should have an A1C test every six months. If you already have diabetes and your medications change, or your blood sugar is not well-controlled, you should have an A1C test every three months.
What Are The Limitations To Measuring Hemoglobin A1c
Since HbA1c is not influenced by daily fluctuations in blood glucose concentration, it cannot be used to monitor day-to-day blood glucose concentrations and is inappropriate to be used for adjusting insulin doses nor can it detect the day-to-day presence or absence of hyperglycemia or hypoglycemia. HbA1c may be increased falsely in certain medical conditions. These conditions include
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What Can Affect Your A1c Results
Anyone whos had diabetes for any length of time knows that A1C tests havent been reliable until recently. In the past, many different types of A1C tests gave different results depending on the lab that analyzed them. But the National Glycohemoglobin Standardization Program has helped improve the accuracy of these tests.
Manufacturers of A1C tests now have to prove that their tests are consistent with those used in a major diabetes study. Accurate home test kits are also now available for purchase.
But accuracy is relative when it comes to A1C or even blood glucose tests. The A1C test result can be up to half a percent higher or lower than the actual percentage. That means if your A1C is 6, it might indicate a range from 5.5 to 6.5.
Some people may have a blood glucose test that indicates diabetes but their A1C is normal, or vice versa. Before confirming a diagnosis of diabetes, your doctor should repeat the test that was abnormal on a different day. This isnt necessary in the presence of unequivocal symptoms of diabetes and a random sugar over 200 mg/dl.
Some people may get false results if they have kidney failure, liver disease, or severe anemia. Ethnicity can also influence the test. People of African, Mediterranean, or Southeast Asian descent may have a
Biological Variability Of A1c Is Lower Than That For Fpg
When the same subjects have two assessments of the available glucose-related parameters, the correlation is stronger among the individual A1C measurements than among the FPG or 2-h PG measurements. The coefficients of variation of A1C, FPG, and 2-h PG are 3.6, 5.7, and 16.6%, respectively . This reflects of course both biological and analytical variability. However, although the latter was similar for A1C and FPG , biological variability of A1C was severalfold lower than that of FPG . This finding confirms that the two required assessments of FPG to diagnose diabetes can provide quite unreliable information, whereas A1C, especially if measured twice as recommended, provides more robust clinical information.
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Check Your Blood Sugar Levels As Your Doctor Has Directed
Work with your doctor to determine if, and how often, you should check your blood sugar. You may be tempted to pick up an A1C home testing kit, but Dowdell does not recommend doing that. As he mentions, day-to-day fluctuations in your blood sugar can be masked by an A1C result that is at your goal level. Instead, if you have a personal continuous glucose monitor, such as a Dexcom G6 or a Freestyle Libre , Dowdell recommends checking your time in range to see if you are at the optimal level. For many people that is 70 to 180 milligrams per decilter , according to ADA guidelines. Having your A1C checked by your healthcare provider every three to six months is sufficient, he adds.
Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C levels or what they mean, dont hesitate to ask your doctor.
Additional reporting by Mikel Theobald.
What Causes Type 2 Diabetes
Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. If you have type 2 diabetes, cells dont respond normally to insulin this is called insulin resistance. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas cant keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. High blood sugar is damaging to the body and can cause other serious health problems, such as heart disease, vision loss, and kidney disease.
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Reasons Your A1c Might Be High When Youre Not Diabetic
Are you worried youâre at risk of diabetes because of high blood sugar levels on your A1C test? Does your blood sugar spike even when youâre eating healthy foods like apples and pears?
While high blood sugar is a common sign of diabetes, itâs not exclusive to those with the health condition. In fact, people often encounter high levels even if they donât have a history of diabetes.
Medications With A1c Of 61
Many doctors wont prescribe diabetes medication for someone with an A1c of 6.1. However, when other risk factors are present, such as high blood pressure or high cholesterol, your doctor might prescribe a first line drug to reduce your blood sugar.
The most common first line drug is Metformin, an oral drug that reduces glucose production in the liver, decreases the absorption of glucose in the stomach and improves your bodys insulin sensitivity.
Already on medication to manage your diabetes? If so, an A1c of 6.1 might be considered adequate, though getting below 5.6 is still recommended.
Talk to your doctor about whether an A1c of 6.1 is the optimal level for you and if medication, dosage or injection adjustments are necessary.
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Tracking Blood Sugar Control Over Time
One easy, accurate way for us to measure a persons blood sugar over time is the hemoglobin A1c level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months.
Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people , with a lower goal closer to normal, or under 6.5% for younger people.
We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didnt meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still werent at goal, then it was time to start insulin injections.
While all this sounds very orderly and clinically rational, in practice it hasnt worked very well. I have seen firsthand how enthusiastic attention to the A1c can be helpful as well as harmful for patients.
And so have experts from the Clinical Guidelines Committee of the American College of Physicians, a well-established academic medical organization. They examined findings from four large diabetes studies that included almost 30,000 people, and made four very important new guidelines around blood sugar control. Heres the big picture.
Setting Goals For A1c Levels
The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes. Someone who has had untreated diabetes for a long time might have a level above 8%.
If you have diabetes and your level is above your target, your doctor may change your treatment plan to get your level down.
A combination of diet, exercise, and medication can bring your levels down.
People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year.
People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements such as vitamins C and E and high cholesterol levels. Kidney disease and liver disease may also affect the test.
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