Tag Archives: diabetes

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 to tell the difference between type 1 and type 2 diabetes in adults

A lot of times, I come across patients who have to use insulin and aren’t quite sure whether they have Type 1 or type 2 diabetes.

I hope to be able to clarify the difference between the two, especially in an adult.

Type 1 diabetes

Type 1 diabetes is commonly called ‘juvenile onset diabetes.’ Type 1 diabetes is usually diagnosed in young children, often under the age of 5 years. Type 1 diabetes is an auto-immune disease. An auto-immune disease is when the body forms antibodies against itself.

In the case of type 1 diabetes, the body develops antibodies against the cells in the pancreas responsible for producing insulin. These are called the beta cells. When the beta cells are attacked and destroyed, the result is a rise in blood sugars. Someone with type 1 diabetes requires insulin.

During community talks as well and media appearances, I take the time to emphasize the difference between type 1 and type 2 diabetes.

It is fairly common for people to flippantly state that “Diabetes is a disease of lifestyle” without differentiating between the two.

Type 1 diabetes is not a disease of lifestyle.

Type 2 diabetes

Type 2 diabetes is different. It is not caused by a lack of insulin; instead, it is caused by a condition called insulin resistance. With insulin resistance, the cells of the body do not respond to insulin efficiently. In my book, I compare insulin resistance to the landlord changing the locks on the door to your apartment so that the key no longer works. The beta cells have to put out more insulin to overcome the resistant cells.

When someone with type 2 diabetes starts using insulin, does that mean they now have type 1 diabetes?

No. It is possible that with the ‘natural progression’ of type 2 diabetes, some people may need to start using insulin. They may also have a condition called late auto-immune diabetes of adulthood (LADA).

Individuals with LADA have a slower progression toward needing insulin than someone with type 1 diabetes.

There are also other scenarios where someone newly diagnosed with type 2 diabetes needs to be started on insulin right away. This still does not make them a type 1 diabetic.

What can happen with type 2 diabetes is that with time, the beta cells (the cells that produce insulin in the pancreas) may begin to degenerate and so cannot keep up with the production of insulin. It may be necessary to start insulin to keep blood glucose levels within the normal range and reduce the complications of diabetes.

How can you tell the difference between LADA, and Type 2 diabetes?

There are several blood tests that your healthcare provider can perform to help tell the difference between LADA and type 2 diabetes. This is particularly important as the treatments are different.

So it’s important to be pro-active when it comes to your overall health and wellbeing. Do not be afraid to ask questions.

I’ll be sharing more details in my upcoming online course, “What your doctor does not tell you about type 2 diabetes’. For more information about Type 2 diabetes, you can download a free copy of the first three chapters of my award-winning book, “Dr. Eno’s A-to-Z Guide to Thriving with Type 2 Diabetes”, by clicking here.

To your health and wellbeing,

Health Awareness Topic- Is your metabolic health up to par?

According to a recent published study by the National Health and Nutrition Examination survey between 2009-2016, only 12% of Americans have good metabolic health. This means that 7 out of every 8 Americans do not have good metabolic health. These are pretty dismal numbers by all accounts.

What was concerning with this study was that even people with so called normal body weight may not have good metabolic health!  The paper goes on to warn that these implications pose a high concern for public health.

In today’s article we’ll go over what metabolic health is. Why we need to be concerned about metabolic health. How this is different from other health parameters. How we can quickly assess our metabolic health. Why we need to be concerned about it and finally what are some of the measures we can start taking to improve our metabolic health.  

What is Metabolic health?

Metabolic health is a term that is used to identify a cluster of measurements that could increase the risk of developing cardiometabolic diseases such as type 2 diabetes, heart disease, and strokes.   

Metabolic health looks at five measurements. The parenthesis show the normal range.

  • Triglycerides (normal less than 150 mg/dL)
  • Waist circumference (women less than 35 inches; men less than 40 inches)
  • Fasting blood sugars (less than 100 mg/dL; or A1c less than 5.7%)
  • Blood pressure (less than 120/80 mm hg)
  • Body weight (BMI less than 25.0)

Why metabolic health is important?

Your metabolic health is simply looking at these five measurements and comparing it to the normal range. It is letting us know your current health status as it relates to these five categories.

Why are these five measurements important? These measurements happen to be the same measurements used to determine your risk for a cluster of abnormalities called the metabolic syndrome.

If any 3 out of the 5 measurements above are abnormal, then this is called metabolic syndrome. Metabolic syndrome there is a higher risk for cardiometabolic disease is higher. To learn more about metabolic syndrome click here.

How to measure your metabolic health

Step 1 -check your weight and take your height.

I usually recommend checking your weight first thing in the morning, after you have used the bathroom and preferably with no clothes on. This gives a more accurate measure of your fasting body weight with no fluid fluctuations that could occur during the day.

Again I prefer this measurement first thing in the morning after a stretch. Stand against a door post and have a friend or family member mark the top most part of your head with a marker.

Next, plug these two numbers into a BMI  calculator.

To calculate your body mass index click here

Step 2-measure your waist circumference

Your waist is the mid-point between the tip of your hip bones and your lower midcage. If you bend to the side the crease you see is your natural waist line. Measure your waist circumference with a measuring tape at this point standing up tall and after you have completely exhaled. In women the waist circumference should be less than 35 inches and in men less than 40 inches.

Step 3 -check your blood pressure

Blood pressure can be measured with a machine called a sphygmomanometer. Most local pharmacies and even department stores have digital blood pressure machines. You can also schedule a nurse visit at your healthcare provider’s office and have your blood pressure checked there. It’s important to take a few deep breaths, sit up straight with your two feet on the ground and using the left arm. It’s a good idea to take three readings at least five minutes apart and then take use the best of the three readings.

Step 4 – have your fasting blood sugar and your fasting lipid panel checked.

You may need to schedule an appointment with your healthcare provider to have this done.

Once you have all the measurements, you’ll be better able to know your metabolic health.

Remember that knowledge is the first step to personal empowerment. Perhaps your metabolic health is not at par. That’s not really where I want to focus on right now. We already know that only 12% of Americans meet the criteria for being metabolically healthy. So, let’s not focus on the doom and gloom.

What I find reassuring when I look at this information, is that these measurements can be modified. They are called modifiable risk factors.

Modifiable means that you can do something about them.

As I point out in my award-winning book, “Dr. Eno’s A-to-Z Guide to Thriving with Type 2 Diabetes” the first three steps to dealing with any challenge are critical mindset strategies- acceptance, belief, and commitment to change.

Instinctively we know what we need to do, eat ‘healthier’ and exercise more. But if it were as simple as that why do we have an obesity epidemic?

My mission is to provide you with tools which will allow you to create a permanent shift in your way of being so that you can become more empowered in the choices you make when it comes to your overall wellbeing.

In my next article I’ll be reviewing how fasting can help improve your metabolic health.

Until next time,

To your health and wellbeing,

To download a free copy of the first three chapters of my book click here

How Type 2 Diabetes Can Affect The Skin

diabetesType 2 diabetes affects many organs in the body. The skin is one of the largest organs in the body. There are several skin conditions that can happen just because of diabetes. For the most part very few of these skin conditions are life threatening. More importantly, a lot of these conditions may show up when the blood sugars are not well controlled.

These skin conditions can be very frustrating, especially for women living with diabetes. By knowing about these conditions will allow you to become a more vigilant. It also helps to hasten healing if you should get any one of these.

Acanthosis Nigricans

This skin condition gives the skin the appearance of soft velvety wart like growth. It is usually seen at the back of the neck, the armpits, beneath the breasts, the flexure surface of the elbow.

It is typically seen in those who are  overweight or obese.

There are other conditions that can cause this skin condition, but usually acanthosis nigricans is a warning sign of  insulin resistance. Insulin resistance can eventually lead to diabetes.

I take the time to point this out to my patients. Especially patients who do not have diabetes. This is a great time to start making lifestyle changes.

Scleroderma diabeticorum

This is a skin condition that causes the skin of the back and the upper neck to become very thick.

The treatment for this is to get the blood sugars well controlled.

Lotions can be applied that will help to soften the skin.

Vitiligo

In vitiligo, the skin loses it’s pigment and causes white patches. Vitiligo is an autoimmune disease. Vitiligo is more common in type 1 diabetes. It is very important to use a sunscreen, to reduce the risk of developing skin cancer.

Vitiligo is treated with skin lightening creams to try to even out the appearance. Some people even attempt to tattoo back in pigment into the white areas.

Eruptive Xanthomatosis

These are lumpy yellow deposits of fat beneath the skin. It is usually an indication that cholesterol and triglyceride levels are high.

Once blood sugars and the cholesterol are better controlled then these may disappear.

Digital Sclerosis

Tight waxy skin on the back of hands, the toes and also the forehead. This condition happens more commonly in people with type 1 diabetes and can cause the hands to become stiff.

Just as in most of the other skin conditions we have discussed thus far, the treatment is to normalize the blood sugars.

Disseminated Granuloma Annulare

Raised oval patches that are either skin colored or red or brown. They usually occur on parts of the body away from the trunk such as the legs or the ears.

In addition to controlling the blood sugars, there are several ways to treat this condition. So please be sure to see your healthcare provider.

Diabetic Blisters (Bullosis Diabeticorum)

These blisters may be large but are usually large and look like burns. They are not painful. They can occur on the fingers, feet, and hands and even sometimes on the forearms.

The treatment is to get the blood sugars within control. They heal by themselves within a few weeks. It’s important to keep them clean.

Necrobiosis lipoidica diabeticorum

This is caused by fat and collagen accumulating beneath the skin. Most times these lesions happen on the legs. The overlying skin then gets thin and can break down easily especially when exposed to injury. It can also get itchy.

It is important to see your primary care physician especially if the lesions break open as it may take a longer time to heal.

Allergic reactions

Allergic reactions that can cause rashes and bumps can also occur in type 2 diabetes. It is even possible to develop an allergic reaction to a particular type of insulin. So be very observant and if this happens inform your physician.

Bacterial infections

These can happen especially when blood sugars are not well controlled. The common culprit is staphylococcus aureus. This can cause boils, folliculitis or impetigo. There is a particular strain of Staphylococcus called MRSA (Methicillin Resistant Staphylococcus Aureus).

It is very important to treat MRSA early and promptly. So be sure to bring any boils to the attention of your physician.

Fungal Infections

These are usually caused by candida (yeast) organisms. Women with borderline or full-blown diabetes may also be at risk of vaginal candidiasis. Fungi can affect various body parts. For instance between the toes it can cause athlete’s foot. It is very important to make sure that the webs between the toes are kept dry to prevent athlete’s foot, as this could become an entry point for bacterial infections. Fungi can also infect the toenails causing the nails to become dark and discolored. This is called onychomycosis. In the groin it can cause a jock itch.

There is a potentially fatal fungal infection that is very common in diabetes called Mucormycosis. This fungus invades the nasal passage and then can spread to the eye and brain.

If you have a ‘sinus infection’ that does not seem to be getting better, especially associated with eye pain, and fever should be evaluated immediately by a physician.

It is important to get evaluated and treated for these skin conditions. Your healthcare provider may refer you to a dermatologist. This is a doctor who specializes in skin diseases.

As you can see from this article, in addition to treating these skin diseases, it is also important to get the sugars under good control.

As with any other complication associated with diabetes, I like to emphasize the importance of prevention rather than treatment.

You may be experiencing difficulty getting your blood sugars under control. Do not despair. It starts with your mindset. You have control over how you choose to live with a chronic illness.

To learn more about this click here to download a free copy of the first three chapters of my upcoming book.

Be persistent. Stay the course.

To your Health and Wellbeing,