I was once admitting a patient to the hospital. He had been living with type 2 diabetes for over 15 years. Unfortunately he had developed kidney failure and so now had to be on hemodialysis.
He seemed to know how his blood sugars were doing. He even recognized that a recent infection was the reason that his blood sugars were high.
I was impressed and excited. Then I asked him this, ‘So what’s your A1C?’ ‘What’s that?’ he replied with a blank stare. I was taken aback at his response, ‘You know your glyco hemoglobin?’ I ventured again. Another blank stare. ‘Never heard of that’ he responded off offhandedly.
Here was a man who by all intents and purposes seemed actively engaged in managing his diabetes. And yet he had NEVER heard of the A1C!
So this week, I will discuss getting to know your diabetes numbers.
One of the keys to Living powerfully with diabetes is to know your numbers.
I love acronyms. They help to make learning easier. For instance in my soon to be released book, Dr. Eno’s A-Z Guide to Living Powerfully with Diabetes’ I use the letters of the alphabet to cover different topics related to type 2 diabetes.
I am going to use the simple acronym ABCs to show how to remember some diabetes numbers. The uppercase letter will be for what I’ll call actual numbers. The smaller ‘a’ will go with some of the lifestyle adjustments that need to be made as a person living with type 2 diabetes.
So here goes:
- A – A1C
- B – Blood sugar
- C – Cholesterol
A1C is a short name for glycosylated hemoglobin. That may sound like a mouthful, so it’s been abbreviated it to the A1C. The A1c is calculated as a percentage point. The A1C measures the average of the blood sugar levels over the prior 6- 8 weeks. The A1C measures the amount of sugars that attached to the red blood cells.
The higher the blood sugars, the higher the A1C. Typically the red blood cells live for about 120 days before they die off.
The goal is to keep the A1C less than 7%. An A1C less than 7% correlates with sugars on average less than 140 mg/dl.
How to get tested for the A1C:
You do not have to fast overnight before getting tested for the A1C. Most healthcare providers can do this test in their office; otherwise it can be done in the laboratory.
I encourage everyone to try to adapt some form of physical activity. Research has shown that prolonged sitting and a sedentary lifestyle increases your risk of heart disease, cancer and diabetes by up to 40%. Research also shows that increased physical activity helps to control blood sugars.
A lot of people use the excuse of lack of time for not getting enough physical activity. Here are some creative ways to incorporate physical activity into your daily life:
- Purchase a fitness tracker so that you can track your movement. When you track any activity you become more aware of that and this makes you want to do more of what you track.
- Encourage your friends and colleagues to purchase fitness trackers. Have them join you in a fitness tracking challenge. A good idea would be to check with your health insurance company to see if fitness trackers are a covered benefit.
- Instead of looking for a 30-45 minute block of time, how about creating three to four 10-15 minute blocks of time throughout the day?
- Rather than taking the elevators, look for every opportunity to take the stairs.
- Get to work 15 minutes earlier park further away and get a brisk walk.
- Get up several times during your workday and do squats at your desk.
- Do leg raises when you are sitting down
- Spend time during your lunch break walking outdoors.
- Instead of delegating that task of walking the dog to your kids, get a long leash and walk it!
It is important to keep your blood sugars within a healthy range. Depending on the treatment goals that your healthcare provider sets, you may have to check your blood sugars at home. This is known as self-monitoring of blood glucose. I’m often surprised to find patients who do not want to check their blood sugars. Perhaps they feel it is painful or they are scared stick themselves.
A healthcare provider only gets to see their patients on average 4-5 times a year. That’s every 3-4 months! Knowing your blood sugar levels gives you instant feedback as to how well you are managing your diabetes. It alerts you to a problem and you can work with your healthcare provider to make corrections.
Knowing your blood sugars is key to living powerfully with diabetes.
Currently there are more than two third of adult Americans are overweight or obese.
BMI correlates with body fat and is relatively unaffected by height. It is calculated from the weight and square of the height as follows:
BMI = body weight (in kg) ÷ stature (height, in meters) squared
Know your BMI
The definition of overweight and obesity varies by race.
According to the WHO and NHBLI guidelines, overweight for Caucasians, Hispanics and blacks is a BMI between 25 and 29.9 kg/m2.
Obesity is when the BMI of 30 kg/m2 or more.
For Asians, overweight is a BMI between 23 and 29.9 kg/m2. Obesity a BMI >30 kg/m2.
There are several apps that can help to calculate your BMI once you enter in your weight and height. You can also check with your healthcare provider on a routine visit.
Cholesterol is produced in the liver. It gets transported from the liver to the cells of the body where it performs a variety of functions. If the cholesterol levels run high then there is a risk for heart disease.
It is important to know your cholesterol numbers.
You should get a fasting lipid panel as part of your routine diabetes care.
The fasting lipid panel is made up of several parts:
- HDL (High Density Lipoprotein) I call it the ‘happy cholesterol’ This level should be more than 40 mg/dl. More than 60 mg/dl is excellent.
- LDL (Low Density Lipoprotein) I call it the ‘lousy cholesterol’. You want to keep this as LOW as possible. The current guidelines are to get the LDL as low as 70 mg/dl.
- Triglycerides – These are all the fatty substances in your blood. The goal is to keep the triglycerides less than 150 mg/dl.
The amount and quality of calories that you eat plays a crucial role in how well controlled your blood sugars are going. Calories are also tied directly to how much weight you gain or lose. It’s a very simple equation.
Calories in more than calories out = gain in weight (high BMI + High blood sugars + high A1C)
Calories in less than calories out = weight loss (lower BMI + normal blood sugars + normal A1C)
Ways to monitor your calories:
- A simple way to start of is to simply watch your portion sizes.
- Don’t fill your plate or use a smaller plate.
- Eat only till you are about 80% full. This is a principle that the Okinawans in japan use. They live into their 100s.
- Increase your intake of fruits and vegetables.
- Drink at least half your body weight in ounces of water per day. This helps to keep you full.
- Increase the intake of fiber. This also helps control your blood sugars.
So there you have it. Know your ABCs.
As always I welcome your questions and comments.
Here’s to your Health & Wellbeing,