Tag Archives: blood glucose monitoring

How managing your A1c can help you reach healthy blood sugars

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When it comes to healthy blood sugar control, the A1C is a vital measuring tool. A1c is the short name for glycosylated hemoglobin. Now, this may sound like a mouthful. It is abbreviated to the A1C to make it easier to understand.

The A1c calculated as a percentage point. Blood glucose attaches to the proteins in the red blood cells. The A1C measures the amount of sugars attached to the red blood cells. This is a normal process that occurs in both people with diabetes as well as non-diabetics.

The average red blood cell last about 120 days, the A1c can measure the blood sugar levels over the prior 6- 8 weeks.

When it comes to managing Type 2 diabetes, the A1c can is used in two ways:

To diagnose Type 2 diabetes or pre-diabetes:

  • An A1c over 6.5% on at least two separate occasions confirms a diagnosis of Type 2 diabetes mellitus
  • An A1c between 5.7- 6.4% on at least two different times is indicative of pre-diabetes
  • An A1c of less than 5.7% is normal

The A1c can also be used to measure blood sugar control:

The A1c is commonly used to monitor overall blood sugar control. It is important to know what your A1c is. I cannot tell you how many times I have been taken aback by patients who have no idea what their A1c is.

 If you are on a mission to THRIVE despite being diagnosed with Type 2 diabetes, you need to not only knowing what your A1c but also getting it under control.

What should be the target A1c in someone living with Type 2 diabetes?

About 20 years ago, there was a landmark study on people with Type 1 diabetes.  The research found that when diabetes was detected early and blood sugars well controlled, this helped to reduce the complications associated with type 2 diabetes.

To learn more about the complications associated with type 2 diabetes, and other information, you can download this free e-book, which is the first three chapters of my award-winning book.  

According to recommendations by the American Diabetes Association, the target goal for A1c should be less than 7.0%. An A1C of less than 7% correlates with sugars on average less than 140 mg/dl.

For every percentage above 7%, the blood sugars go up about 30 mg/dL. The higher the A1c, the higher the blood sugars. The higher the blood sugars, the greater the risk of complications.

So the goal for most people is to keep the A1c less than 7%

Now there may be some caveats to these recommendations-

For instance, if you over 80 years of age, then tighter blood sugar control may not be a reasonable goal. So have a discussion with your healthcare provider about what a reasonable goal should be at that point. Perhaps an A1c between 7-8% may be a more reasonable goal.

What are some factors that may affect getting the A1c to goal?

 For some suggestions on how to achieve healthy blood sugars, I recently put together a mini-course series which is a collation of prior blog articles on just that topic. To learn more click here.  

In summary, the A1c is a percentage measure of the amount of blood glucose that is attached to the red blood cells. The less the blood glucose attached to the red blood cells, the better the A1c. So we need to focus on what we need to do to achieve healthy blood sugars.

How fiber can help reach healthy blood sugar levels in type 2 diabetes

type 2 diabetesA friend of mine was recently sharing me how frustrated her husband was with his blood sugar levels. They seemed to fluctuate widely from high blood sugar levels to low blood sugar levels. He did not know how to react to this and had decided that he was not going to take his medications any longer. Naturally she was at her wits end when she reached out to me. How could she convince her husband that stopping his medications was not the way to deal with fluctuating blood sugars?

Fluctuating blood sugars are not unusual in type 2 diabetes. Whether you are a woman living with diabetes or you know someone living with diabetes, this can be very frustrating .

Let me start by normalizing this for you. You are not alone. There are many reasons why the blood sugars fluctuate. I will cover this topic in more detail in an upcoming article.  In addition to scheduling an appointment to see your healthcare provider, you may also need to make sensible lifestyle changes- to your diet and exercise regimen.

One of the ways things to tweak in diet to increase the amount of fiber. Fiber is a form of carbohydrate. Contrary to popular belief, not all carbohydrates are bad for you!

There are two kinds of fiber-soluble fiber and insoluble fiber. Insoluble fiber does not get absorbed from the intestinal tract. This kind of fiber helps to reduce constipation. Soluble fiber has many proven benefits. Soluble fiber gets absorbed into the bloodstream and so can help regulate blood sugars. It also helps to control cholesterol levels.

Soluble fiber can help to reduce the risk of stroke and heart disease by up to 50%. This is especially important for someone living with type 2 diabetes, where the risk of stroke and heart attacks is increased.

Another benefit of soluble fiber is that it help reduce hunger by maintaining a sense of fullness. This can be useful in weight management. When you feel full you tend to eat less. 

Research has proven that simply losing 10% of your body weight helps to prevent borderline diabetes from becoming full blown type 2 diabetes. Some examples of soluble fiber include psyllium, pectin and wheat dextrin and oat products.

So exactly how much fiber is enough?

 Women should eat about 25 g of fiber and men up to 38 g of fiber a day. With the ‘standard American diet’ we consume an average of 17 g fiber per day.   A study in the New England Journal of Medicine found that by increasing daily fiber up to 50 g, a person living with diabetes was able to achieve healthier blood sugar and cholesterol control.

Some ways that you can start to increase your fiber intake? 

 I usually recommend gradually increasing fiber in your diet. Remember this is a long-term change you are making to your lifestyle.  If you rapidly increase fiber, it may cause gas and abdominal bloating. Too much fiber could also cause constipation if you do not drink enough water.

 So here are some suggestions on ways to increase your fiber intake: 

  1. Create a list of fiber rich foods.  You can do research this online. Click on this link to research a variety of food sources that have high fiber content.
  2. Try experimenting with some new sources of fiber every day.
  3. Gradually increase your fiber intake by 5 g per day until you reach the goal.
  4. As you increase fiber intake also make sure to increase your water intake to reduce bloating and constipation.

Remember to be kind and patient with yourself. There is no quick fix to diabetes. Your goal is to achieve healthy blood sugars so that you reduce the complications associated with diabetes. Increasing the amount of fiber in your diet can be one of your most powerful tools in achieving healthy blood sugars. So start today to take simple small steps each and every day and don’t give up.

To your health and wellbeing,

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Seven Tips On How to Maintain Healthy Blood Sugars During The Holiday Season

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I recall a number of years ago, when a patient left my office based practice and sent me a very nasty note three months later. She expressed how disappointed she was that I was not a person of my word. I had assured her that due to the fact that her blood sugars were well controlled and her A1C was less than 7% that I would attempt to wean her off some, if not all her medications.

The catch was that at the time that this discussion was going on, the holiday season was also upon us. I had made a mental note to address this in the New Year, as I hate to see anyone fail due to no fault of his or her own.
I should have educated my patient on what it was that I intended to accomplish and my reasoning.

For people living with type 2 diabetes, this is one of the more challenging times of the year. Blood sugar levels may gradually begin to rise with each holiday party. And with that, the A1C rises.

By following these seven simple steps, you can survive the holiday season and come out a winner ready to embrace 2017 as you live powerfully!

Tip number 1- Plan your meals

In order to keep blood sugars within a normal range, planning your meals is very important at this time of the year.

Here’s a simple tip-If you know that you are going to be out at a holiday party later on in the day, consider having a light snack just before leaving home. That way you are less hungry and less likely to go for the sweets that will cause your sugars to rise.

Also consider cutting down on the portion sizes of your earlier meals. Be careful if you are on insulin or an oral hypoglycemic agent not to cut down too low so that you do not experience hypoglycemia.

Tip number 2- Increase your amount of fiber intake

Fiber is a complex carbohydrate. The average American diet contains a low level of fiber. Most nutritionists recommend a daily fiber intake of up to 35G.

Studies have shown that by increasing the amount of fiber in the diet can help control blood glucose levels. This is especially if it is soluble fiber. An example of soluble fiber is oatmeal.

Fruits and vegetables are all good sources of fiber. By making a conscious choice to increase the amount of fiber rich foods in your diet will get you to your goal of maintaining a normal blood sugar range throughout the holiday season and beyond.

Tip number three- Plan to incorporate physical activity

The Winter & Holiday season is traditionally the time when the average American gains between 7-10 lbs. Studies have shown that people living with type 2 diabetes can achieve normal blood sugar range by increasing physical activity. During the winter months make an effort to maintain some form of physical activity. Choose an exercise regimen that is easy to follow.  As always be sure to see your physician before starting out on an exercise program. So if you have not already scheduled your annual physical, now is a great time to go ahead and do so.

Tip number four- Drink enough water

There are a myriad of benefits to drinking water. The important thing in a type 2 diabetic is to maintain good kidney function. Drinking water may also keeps you feeling full and so help with weight loss. The traditional recommendation has always been 8 glasses of water a day. However something else to consider is drinking half of your body weight in ounces. So if you weigh 170 lbs. that equals 85 ounces of water a day.

Tip number five- be consistent with monitoring your blood sugars

This is not the time of the year to slack off testing your blood sugar levels.  It is not the time to stick your head in the sand and rationalize that your blood sugar levels are going to be high and there’s nothing you can  do about it anyway. Your mindset is very important. If you have not been checking your blood sugar levels regularly, this is the time to start. By regularly checking your blood sugar levels,  you get instant feedback. Living powerfully with diabetes, requires that you have an awareness attached to action. High blood sugar levels just do not happen to you. You can make the necessary adjustments in your lifestyle in order to control your blood sugars.

Tip number six- Keep all scheduled appointments with your healthcare providers

This is the time to make your healthcare provider aware of any challenges that you may be encountering during the holiday season. That way you both can explore ways to better control your blood sugar levels.

Depending on your A1C, your healthcare provider may decide to adjust your medications. This is a much better option than starting out the New Year with high A1c levels and blood sugar levels out of control. Sometimes it can take more than 6 months to normalize the blood sugars.

Tip number seven- Enlist the support of family and friends

I have written in a previous article about the importance of a support network. Now more than ever is the time of the year to enlist the support of family and friends. Want to get started in an exercise program? Call up a workout buddy. Not sure how to handle ‘Aunt Martha’s’ three layer chocolate cake? Have a family member share a portion with you. It takes teamwork to make the dream work. Do not be afraid to ask for support. Sometimes just knowing there is someone else looking out for you is what makes the world of difference.

I’d love to read your comments and any other strategies that you may have in place to ensure that you keep your diabetes type 2 sugar levels normal this holiday season and beyond.

Until next week,

Here’s to your Health & Wellbeing,

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Pregnancy and Diabetes

Gestational DiabetesDiabetes in pregnancy is called gestational diabetes. Women who develop gestational diabetes usually did not have either borderline or type 2 diabetes before they got pregnant.

According to the centers for disease control, gestational diabetes occurs in about 9.2% of pregnancies. Just like type 2 diabetes, the incidence of gestational diabetes is rising.

Women with gestational diabetes usually do not have any symptoms. This is why it is important to screen for it in all pregnant women.

 

How gestational diabetes is diagnosed

Gestational diabetes is usually diagnosed after 24 weeks of pregnancy. If diabetes is diagnosed before 24 weeks, more than likely this is type 2 diabetes. Your healthcare provider will order a test called the oral glucose tolerance test. For more information about the oral glucose tolerance test, click here.

 

The cause of gestational diabetes

Gestational diabetes is felt to be caused by insulin resistance just as in type 2 diabetes. The high levels of insulin cross the placenta into the baby. The excess insulin converts glucose into fat. Babies born to women with gestational diabetes usually have a high birth weight of over 9 lbs. This is because they are large. This can lead to the baby getting injured as it is being delivered through the birth canal. If the baby is too large to be delivered naturally it may have to be delivered by cesarean section. Cesarean section is major surgery and just like any surgical procedure there are inherent risks to both the mother and the child. A woman who has a cesarean section may have to have another cesarean section in future pregnancies.

 

Treatment for gestational diabetes

 Women with gestational diabetes will need to be monitored very closely by an obstetrician who specializes in high-risk pregnancies. This is to prevent complications to the mother as well as the unborn child. Sometimes these appointments may be on a weekly basis as the pregnancy advances. It is important to know when these appointments are and to keep them.

Diet and moderate exercise are usually the first steps to treating gestational diabetes. If a woman has not been physically active before getting pregnant this is not the time to start a vigorous exercise program. Starting a walking program is a good idea, however it is important she speak with her healthcare professional prior to starting any physical activity.

If diet and exercise do not get control the blood sugars, then it may be necessary to start on medications. A lot of women are started on insulin because it allows for better control of insulin. It is also important that to check blood sugars frequently when pregnant with diabetes. Just as in type 1 or type 2 diabetes this can be taught and will need to be done at home several times a day. It is important to inform your healthcare provider if the blood sugars are not in the target range.

 

Gestational diabetes and future risk of developing type 2 diabetes

Gestational diabetes usually resolves after pregnancy. However women who have had gestational diabetes have an increased risk of developing type 2 diabetes. There is also a chance for recurrence in future pregnancies.

Risks for developing gestational diabetes

 

  • Certain ethnic groups such as African Americans, Latina, or Native Americans
  • Having borderline diabetes
  • Being overweight or obese
  • Family history of type 2 diabetes
  • Being over the age of 25 years

 

Steps to reduce gestational diabetes

 Just as in type 2 diabetes prevention is the key. Taking preventive steps does not reduce the risk of developing gestational diabetes to zero, but it is still a step to having a pregnancy with few complications and delivering a healthy baby.

Here are a few steps every woman planning a pregnancy can take to reduce her risk of developing gestational diabetes

 

  • Try to get as close as possible to your ideal body weight prior to getting pregnant.
  • Start an exercise program. I am a proponent of walking as a simple form of exercise. If you are planning to get pregnant now may not be the time to start training for a marathon, but it is easy to start walking. Purchase a fitness tracker and commit to walking 10,000 steps a day.
  • Eat more fresh fruit and vegetables. These contain nutrients rich in antioxidants, is a good source of fiber. Fiber helps with weight control. Fruits and vegetables are also a good source of folic acid that is necessary to prevent birth defects and support a healthy pregnancy. Juicing is an excellent way to get a variety of fruits and vegetables into your diet.
  • Get an annual physical. Inform your healthcare provider that you are planning a pregnancy and they may order some blood tests such as a fasting glucose, lipid profile and blood chemistry. For instance if you find out through blood tests that you have borderline diabetes, you can take some pro-active measures prior to getting pregnant.

 

Diabetes in pregnancy affects both a woman’s health as well as the health of her unborn baby. To avoid complications, it is important to seek medical care during pregnancy and to follow the advise of your healthcare professional.

To your health and wellbeing,

 

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Blood Glucose Monitoring-Some Strategies to Check Blood Sugar Levels Once a Day

blood glucose monitoringWelcome back! Over the last few weeks I shared some of the lows and highs of living with type 2 diabetes. Namely hypoglycemia and hyperglycemia.

According to American Diabetes Association guidelines, normal fasting blood sugar levels range between 80-130 mg/dL. Blood sugars should also be checked after eating. This is called postprandial blood sugars. The best time to check postprandial blood sugars is  two hours after a meal. Normal postprandial blood sugar levels should be below 180 mg/dL. In order to reduce diabetes complications, it is important to try and keep blood sugars within this range.

Sometimes it may be necessary to check blood sugars several times a day in order to make the necessary adjustments to get blood sugars in the healthy range. This is usually where I would encounter a lot of resistance from my patients. They complain that testing their blood sugars several times a day is painful. Test strips cost a lot of money. Or it may be that because of their work schedule they just don’t have the time.

I found that the more I argued with my patients about monitoring their blood sugars more than once a day, the more resistant some patients became. In fact some even stopped coming in as scheduled. They would stretch out their appointments. For instance, instead of coming in every three months, they made it twice a year.

Now that can be harmful as it is a surefire way to develop complications related to diabetes!

So I had to get creative with that segment of my patients that just were not going to check their blood sugars consistently.

Well here are some strategies that I came up with. For the most part they ended up being about compromise, which I think is something that is very important if you are committed to living powerfully.

Strategy number 1-alternate checking fasting blood sugar levels with post prandial blood sugar levels

This is by far my favorite strategy. This is how it works:

On a calendar, divide the month into odd numbered and even numbered days.

On odd numbered days of the month, check your fasting blood sugar levels.

On even numbered days, check your postprandial sugar levels.  Try to vary the times that you check your postprandial levels. For instance on one day check the levels after breakfast, the next time after lunch. At another time after dinner.

This is a great way to get a general view of how your sugars run during different times of the day and not test more than once a day.

Remember to make a note of the times that you check your sugars so that your doctor can understand the trend. Some blood glucose monitors allow labeling the blood sugars also. Check your glucose monitor to see whether you can do this.

Strategy number 2- check postprandial sugars over the weekend

Here is when I would recommend this strategy:

If a patient cannot check their postprandial levels during the week due to their work schedule, then I encourage them to check the fasting levels during the week and then over the weekend, just to focus on checking their postprandial levels.

They can do this by alternating postprandial levels between breakfast, lunch and dinner over the weekend

Strategy number 3- check your blood sugars for two weeks before you see your healthcare provider

I only bring out this strategy when I am pushed to the wall. Literally I am begging a patient to work with me so that I can help them reach their blood sugar goals.

There is nothing more frustrating than not having an idea about how the blood sugars of a patient are running in between scheduled office visits. It is like shooting in the dark. You get a blood test result that is high, but you have no idea how to go about correcting it.

As I tell my type 2 diabetes patients, on average they get to see their healthcare provider between three to four times per year for routine diabetes care. What happens the remaining 361 days is left in their hands.

With blood sugars taken consistently for even two weeks before an office visit, when combined with the hemoglobin A1C most times it is much easier to spot the problem.

Why is it important to check both the fasting and postprandial blood sugar levels?

In an earlier article I shared some important numbers that a person living with diabetes needs to know. One of those numbers is the A1C also known as the glycosylated hemoglobin. The target range for the A1c is less than 6.5- 7%.  In order to achieve that goal, the fasting blood sugars are within the target range of 70-130 mg/dL. The postprandial levels also have to be consistently less than 140 mg/dL two hours after a meal.

If your A1C is high, then by keeping a log of the blood sugars, you will be able to pinpoint the problem.

For instance if the fasting blood sugar levels are within normal range, but the post prandial levels are high, then perhaps you need to adjust portion sizes.

If the fasting levels are running high, it may be that the evening medications need to be adjusted or that a late night snack needs to be cut out. Sometimes this may even mean that the nighttime medications may need to be cut down. But your physician needs to see your glucose log so that they can target the problem and create a customized plan for you.

Start today to check your blood sugars

Perhaps you are a newly diagnosed diabetic or even if you have had diabetes for some time but just never thought it important to check your blood sugars. Let’s start out fresh.

Review the instructions of your glucometer. If you do not understand how to use it then check to see whether your local pharmacist can help you. If not call your doctor’s office and schedule a visit with the nurse. Most times they can help you. Most times the machines work the same way. A few have extra ‘bells and whistles’ attached to them.

Just as I share in my upcoming book, “Dr Eno’s A-Z Guide to Living Powerfully with Type 2 diabetes”,  two of the hallmarks of living a powerful life with diabetes is being committed and persistent. If you do that you will go a long way to living free of diabetes complications.

I welcome your comments or questions so please leave them here. I’d also love to hear some of the issues that you have as a type 2 diabetic. Come over to my Facebook page and share some of your thoughts with me. It just may be a topic for an upcoming article.

Until next week Here’s to your Health and Wellbeing,

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