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.
Your Treatment May No Longer Be Effective
Because type 2 diabetes is a chronic disease, its likely that your treatment will need to change over time to effectively manage it, Lenhard says. An A1C thats higher than your target may be a sign that your current treatment plan isnt working as well as it should.
If your doctor currently has you managing your A1C with diet and exercise, it may be time to consider a prescription medication designed to lower A1C or improve how your body processes insulin, Lenhard notes. If youre on an oral medication and its not as effective as it once was, you may need to try another or change your dose, Lenhard. Your doctor may also prescribe insulin or non-insulin injectables to help control your blood sugar. Once youre on a new treatment, be sure to follow the doctor-prescribed regimen, Lenhard adds, as thats the only way the medications will work to control your A1C, he says.
High A1C is not healthy for anybody, but its particularly dangerous for the elderly and people with preexisting comorbidities such as heart disease, Lenhard explains. I like to set an aggressively low A1C target for young, healthy people and a more lenient target as people age. I am happy with an A1C between 7 and 8 percent for most people in their 80s, for example, but the target is individualized.
Statins Linked With Type 2 Diabetes Progression Study Suggests
People with diabetes who are on statins may be more likely to experience dangerous spikes in blood sugar and require insulin or new medications to manage their condition, but that doesnt mean the drugs are without benefits.
Statins are a powerful tool for lowering high cholesterol and reducing serious heart events including for people with type 2 diabetes. But a new study suggests that people with type 2 diabetes need to weigh these benefits against the risk that statins may make their blood sugar harder to control.
For the study, published October 4 in JAMA Internal Medicine, researchers examined data on 166,000 people who received care through the Veterans Affairs health system and were diagnosed with type 2 diabetes between 2003 and 2015. Half these individuals started treatment with statins during the study period, and the other half did not.
Diabetes progression, including dangerous spikes in blood sugar or the need for new medications to manage blood sugar, occurred with about 56 percent of participants on statins, compared with 48 percent of people who didnt use these cholesterol-lowering pills.
Overall, statin users were 37 percent more likely to experience diabetes progression. The subset of participants on more intensive statin therapy designed to achieve more aggressive reductions in cholesterol levels had an 83 percent greater likelihood of diabetes progression.
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What Does A Hemoglobin A1c Of 57% Mean
Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher change of getting of diabetes. Levels of 6.5% or higher mean you have diabetes. 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.
Why Is My A1c High
As blood sugar level rises, so do A1C levels. A high A1C indicates that blood sugar control is not optimal. This in itself is not an emergency, but it gives your healthcare provider a picture of how blood glucose has, or has not, been controlled, says Dr. Williams.
Poor diabetes control or a need for medication adjustments might cause higher A1C. Diet changes, daily exercise, or medication adjustments might quickly lower A1C. Because Type 2 diabetes is a progressive disease, adjustments to ones treatment might be a part of the process of controlling diabetes. Poor diabetes control does not always mean a patient is doing something wrong. But there are other reasons why levels might be high.
As previously mentioned, other health conditions can cause skewed results. These include kidney disease, anemia, liver disease, asplenia, blood loss, hypothyroidism, uremia, and sickle cell anemia. Other factors that might lead to a high A1C level include increased age, pregnancy, and gestational diabetes.
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What Is A Reasonable Target Hba1c Value For A Type 2 Diabetic Patient
Navigating the Targets for HbA1c Over the past ten years the American Diabetes Association recommendations for glycemic control have consistently targeted HbA1c values of less than 7%,² pointing to the vascular benefits of maintaining HbA1c in this range while remaining mindful of the risks of hypoglycemia.
Large Trial Compared Usual Tools For Assessing For Diabetes In Adults
The researchers looked at data from 9,000 adults, ages 20 years and older, from the 2005-2014 National Health and Nutrition Examination Survey . The information collected by the research team included body weight and blood test results.
Based on the fasting blood glucose test and the OGTT, 765 patients were diagnosed as having type 2 diabetes . However, only about 27% of these individuals were classified as having diabetes based on their A1c levels, which is how Dr. Villacreses and her team determined that nearly three-quarters of those at risk for diabetes were not aware that they had this chronic disease, and therefore were not receiving treatment.1
“Most worrisome, 73 % of patients would have missed out on early intervention and treatment,” she tells EndocrineWeb. While the A1c test is convenient, ”we recommend that we do not rely solely on this number,” Dr. Villacreses says.
The guidelines for diagnosis and treatment of type 2 diabetes from the American Diabetes Association already advise against relying solely on A1c,3 she says. While the American Diabetes Association guidelines specify that diabetes can be diagnosed based on fasting plasma glucose , the OGTT, or the A1c, our findings confirm that reliance on A1c remains the least reliable method for assessing diabetes risk.
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Oral Glucose Tolerance Test
The oral glucose tolerance test takes a little more time than the other two glucose tests for diabetes. In this test, your blood is taken after an overnight fast, and then again two hours after you drink a sugary drink.
Its normal for blood sugar to rise after the drink. Normal blood sugar falls to below 140 mg/dL within two hours, however.
If your blood sugar is between 140 and 199 mg/dL, your doctor will diagnose prediabetes. Anything 200 mg/dL or above is diagnostic for type 2 diabetes.
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You should have healthy fats each day as well.
Using the information from your food log, you can begin to make small changes. The goal is to choose less processed, whole foods, instead of highly processed foods that contain added sugar, little fiber, and unhealthy fats.
For example, if you arent eating the recommended servings of vegetables, try adding one serving of vegetables a day to your diet.
You can do this by having a salad with lunch or dinner, or snacking on carrot sticks. Just be careful about add-ons such as salad dressing or dips. They can sneak in unhealthy fats or extra calories. Check out these 10 healthy salad dressing recipes.
Youll also want to work on reducing the number of empty-calorie foods and beverages youre consuming, as well as switching out simple carbohydrate foods for complex carbohydrates. Examples of substitutions you can try to include:
Signs And Symptoms Of Type 2 Diabetes
The signs and symptoms of type 2 diabetes can vary from person to person, but there are certain things to look out for.
As type 2 diabetes means the body struggles to properly get glucose from the bloodstream into the cells where it can be used for energy, one of the most common symptoms of type 2 diabetes is often feeling very tired and fatigued.
High blood sugaralso means the kidneys have to work overtime to try and filter the excess sugarout. This can lead to needing to urinate much more frequently than usual,especially at night. This increased need to pee can also cause dehydration, sopeople with type 2 diabetes may feel much thirstier than the average person.
Prolonged highlevels of blood sugar can cause damage to small blood vessels and nerves, whichcan lead to blurred vision that may become permanent vision loss if leftuntreated. This nerve damage can also impact the circulation, causing even thesmallest cuts and grazes to take weeks or even months to heal.
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What To Eat To Lower Blood Sugar Level
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The Study Doesnt Prove A Link Between Statin Use And Diabetes Progression
One limitation of the study is the potential for diabetes progression to be detected more often among statin users simply because these patients have more frequent checkups than people who arent on statins, the study team points out.
Still, the findings offer fresh evidence of a potential risk statins pose for people with type 2 diabetes. The U.S. Food and Drug Administration in 2012 required drugmakers to add a safety warning to the labels of all statins indicating the potential of these drugs to raise blood sugar.
Overall, the risks of high cholesterol including heart attacks, strokes, and deaths from cardiovascular disease are serious enough that patients should still consider statins if their cholesterol isnt in a healthy range, regardless of the person’s heart health history, says Connie Newman, MD, an adjunct professor at the New York University Grossman School of Medicine in New York City who wasnt involved in the new study.
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A1c Tests Can Be Affected By Changes In Red Blood Cells Or Hemoglobin
Conditions that change the life span of red blood cells, such as recent blood loss, sickle cell disease, erythropoietin treatment, hemodialysis, or transfusion, can change A1C levels.
A falsely high A1C result can occur in people who are very low in iron for example, those with iron-deficiency anemia. Other causes of false A1C results include kidney failure or liver disease.
If youre of African, Mediterranean, or Southeast Asian descent or have family members with sickle cell anemia or a thalassemia, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes. People in these groups may have a different type of hemoglobin, known as a hemoglobin variant, which can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care professionals may suspect interferencea falsely high or low resultwhen your A1C and blood glucose test results dont match.
Not all A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test to measure their average blood glucose level. The NGSP provides information for health care professionals about which A1C tests are appropriate to use for specific hemoglobin variants.
What Is An Ideal Target Goal For A1c
Many people with diabetes who are not pregnant will aim for an A1C of 7 or below. However, the ADA recommends that you individualize your A1C goal based on your circumstances, says Dr. Brady. Your age, other health conditions, and health goals should all be factored into finding your target A1C, she adds. Your healthcare provider, such as a primary care physician, certified diabetes educator, or endocrinologist, can help you determine your A1C target.
The overall recommendation is that you try to get the A1C as low as you can without causing adverse side effects, says Brady. Such side effects could include episodes of severe low blood sugar, she notes, which multiple studies have linked to health problems like dementia, poor quality of life, and early death.
People certainly need to work with their healthcare provider to determine what the goal should be for them, says Brady.
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Youre Eating Healthy Foods But Youre Eating Too Much
Portion control is vital to managing your A1C, Gallagher says. Watching the amount you eat helps you maintain a healthy weight, but it also helps you manage your intake of carbohydrates and maintain healthy blood sugar levels, according to the Centers for Disease Control and Prevention . The agency offers a guide for estimating portion sizes. They also recommend taking steps to control your food intake, such as measuring out portions of snacks, rather than eating straight from the bag or box, and having your server wrap half of your meal if youre eating out, so you can enjoy it later. A registered dietitian or certified diabetes care and education specialist can help you develop a meal plan to help keep your blood sugar under control.
Maintain A Healthy Weight
Eating a balanced diet and exercising can help you lose or maintain weight. Ask your doctor what a healthy weight is for you.
Work with them to determine how many calories you should be eating. If you need to lose weight, ask them how much weight you should be losing per week to stay healthy.
Crash diets and extreme workout plans may make for entertaining television, but they arent realistic for long-term maintenance. Theyre often unhealthy as well.
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Can Your A1c Be Too Low
As described above, the answer to this question depends almost entirely on how often you experience hypoglycemia . If you never experience hypoglycemia, your A1c technically cannot be too low. Some people achieve A1c levels below 5% by following a very strict diabetes management and diet regimen and have almost no blood sugar fluctuations.
HOWEVER, if you often experience hypoglycemia, that will result in an artificial low A1c reading because your hypoglycemia events are lowering your blood sugar average. In that case, focusing on increasing time-in-range is much more important than further lowering your A1c. In fact, you may even benefit from a slightly higher A1c with fewer blood sugar fluctuations.
Its also important to note that lowering your A1c below the recommended range of 6-7% hasnt been proven to provide any health benefits. Therefore, a very low A1c shouldnt be a goal in itself.
Sometimes The Test Isnt Accurate And Heres Why:
- If you are bleeding a lot, the protein in your red bold cells may be low, so it could say your A1C is lower than it actually is.
- If youve just had a blood transfusion or have other forms of hemolytic anemia, your A1C test results may be lower than it actually is.
- If you are low in iron in the blood, your A1C test results may be higher than it actually is.
- If you have a special hemoglobin . Most people have Hemoglobin A. With the variant, you can be falsely high or low. A lab test can be done to see which one you are and special lab tests can then give you an accurate A1C.
- A new lab can give different results as well. Keep this in mind if your results were sent away to a new facility. It could account for minor reading variations.
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What Is A Dangerous Level Of A1c
When levels rise to 9.0, the risk of kidney and eye damage and neuropathy increases. Some people who are newly diagnosed could have levels over 9.0. Lifestyle changes and possibly medication can lower levels quickly. For someone who has long-standing diabetes, levels rise above 9.0 could signal the need for a change in their treatment plan.
Some labs estimate average blood glucose , which corresponds to home glucose meter readings , allowing patients to understand the results better.