I’m Christel from Diabetes Strong in this video I’ll be going over how to lower your A1c
and that includes specific meaningful steps that you can take to keep your A1c in a
healthy range first I’ll spend a little bit of time explaining what is an A1c what is it
quote unquote normal A1c why we focus so much on that number and how to measure it if you do not
care about any of this if you just want to get to the four things that you can do to improve your
A1c just go down in the video description and click on that time code or you can fast forward
A1c or hemoglobin A1c or hbA1c or hemoglobin test all the name for the same thing and that is
a blood test that shows you your average blood sugars for the last two to three months it's
worth noting that it's not an even average in the sense that your blood sugars the last few weeks
will weigh a little heavier than your blood sugars 2-3 months ago if your A1c is high that means
that your blood sugars on average are elevated and elevated blood sugars increases the risk
of diabetes related complications people who do not live with diabetes usually have an A1c of 5.7%
or lower and it's worth noting that whenever you hear the term normal A1c it often refers to an A1c
for people who do not live with diabetes so when we talk optimal A1c levels for people living with
diabetes the American Diabetes Association's 2022 recommendation is that most adults should aim for
an A1c of 7% or lower that equals an average blood sugar of 154 mg/dL or that's 8.6 mmol/L
and you can see a full conversion table here so while you look at that I do want to add that I
had a chance to interview Dr Anne Peters and she is a professor of medicine at the Keck school of
medicine of USC and director of the USC clinical diabetes programs and I interviewed her for an
article on the diabetes strong website and her perspective is that A1c targets should be adjusted
for the individual for example someone who's pregnant might want to keep the A1c at 6% or below
and an older person's target should be higher generally she finds that having an A1c target
of 6% to 7% is ideal and that going below 7% has fairly little impact on complications
so a very low A1c shouldn't necessarily be an end goal in itself especially if that low A1c is
achieved through a lot of low blood sugars a lot of people now focus on time and range especially
if you wear a Continuous Glucose Monitor the goal then is to stay as much of the time between
70 mg/dL and 180 mg/dL but we do focus a lot on A1c because it is an indicator of your average
blood sugars over time and multiple studies have shown that elevated average blood sugars can lead
to diabetes related complications so lowering your A1c to the recommended levels and keeping it there
can help you reduce the risk of diabetes related complications you might have heard about some
of these potential complications they all sound very scary they include eye kidney nerve disease
as well as cardiovascular disease we should definitely aim for blood sugars at a healthy level
it's also worth noting that the closer you get to the recommended A1c target range the less benefit
you'll get from lowering your A1c even further so for example lowering A1c from 12% down to 11%
makes a big difference whereas lowering it from 7% down to 6% provides smaller benefit A1c is
measured by testing a sample of your blood and you can either have that done at the doctor's
office or you could do it with an at-home A1c test it's actually sampled a few different tests and I
made a video about that I’ll link to that up here so you can check it out if your doctor recommends
that you lower your A1c or if you just decided that you want to or if you're struggling to keep
your A1c steady there are a few different things you can do I personally aim for an A1c of 6.5%
or lower I’d rather be closer to 6% to be honest this was my latest test so I’m
pretty much there and these are the four things that I consistently do to achieve that so as I
just mentioned I’ll be going over the four things that I do consistently to keep my A1c below 6.5%
I do have to add that you should not make any changes to your diabetes management without
consulting your medical team first analyzing my numbers and addressing pain points frequently
what I found to be the most impactful thing to do when it comes to my diabetes management is
to review my historic blood sugar numbers every few days and not just rely on my endos analysis
whenever I see her every three to four months I look at my historic blood sugar data every
few days and assess whether or not I need to make any changes to my diabetes management I must admit
usually I have a pretty good idea even before I look at the data whether or not anything major
has come up because you know I’ll remember if I’ve had repeatedly high blood sugars in the afternoon
or have been going high or low overnight but I also know that memory can be totally unreliable
so I’d rather look at hard data and what I look at is I look at my Dexcom reports that's a continuous
glucose monitor I wear that sends my blood sugar readings automatically to my phone and I also look
at my in-pin report so Inpen is a smart insulin pen that I use and combine those two devices they
collect all my blood sugar data as well as all my insulin injection data but you don't need all that
gear to get good data all you need is glucometer frequent blood sugar measurements and a notebook
but of course it's not enough to just look at the numbers I also look for pain points or set
differently I’m look I look for trends that can indicate that I should make changes to my diabetes
management and that leads me to the second thing that I do consistently to keep my A1c below 6.5%
and that is making changes to my diabetes management when needed and that can be daily
I manage my blood sugars using insulin so often making changes to my doses on a daily basis makes
sense I manage using a long-acting insulin that I take in the morning as well as the evening as well
as a rapid-acting insulin that I take for meal and corrections so my long-acting insulin that I
take in the morning is probably the one I change the dose off the least I’d say but I do change
it once in a while so especially if I find that I run let's say high in the afternoons consistently
if I find I run high in the afternoons and let's say it's outside the four-hour window after I last
took rapid-acting insulin then I have a fairly good idea that it's my long-acting insulin
that's off and I’ll make changes the next day and remember I said consistently so for example one
afternoon high that's just an event that's not a pattern so if I consistently see that I have highs
in the afternoon for example then I’ll make the change I adjust my nighttime long acting insulin
fairly frequently so I’ll adjust it depending on my activity level and my eating pattern so I’ll
vary between anything from one unit to eight units before you know I go to bed in the evening
so that's quite a lot and then when it comes to my rapid-acting insulin again the one for meal
and corrections for that one I have kind of an assumptions that I go by and the assumption is
that I have a carb ratio of 1 to 10. so that means that one unit of insulin covers 10 grams of carbs
I also assume that I have a correction factor or insulin sensitivity factor of 50 meaning that one
unit of insulin will lower my blood sugar's 50 mg/dL so that's the base assumption but let me
give you an example I recently noticed that my blood sugars would start to climb just before
bed which I would correct so they would climb to maybe 160 175 and I would correct with one unit
of insulin assuming a correction factor or insulin sensitivity factor of 50. However what I found was
that that was actually too much I was dropping down in the low glucose territory I was getting
closer to 70 and below which of course I don't want to be there especially not at night so what
that made me realize that after that it happened a few times again I needed to see that consistently
before making a change then I could go and look at my data actually realized that one unit of
insulin at 10 pm in the evening was actually lowering my blood sugars closer to 100 mg/dL
that means that my correction factor that time was probably is probably 100 and not 50.
that's a small tweak it's only half a unit but that small tweak meant that I can correct my blood
sugars so don't go high while maintaining healthy blood sugars not going low either again small
tweak but it's based off of my data if you do not manage your diabetes using insulin you probably
won't have to assess your medical needs as often however I wouldn't go years without having that
discussion with your medical team and even if you do not manage your diabetes using any medications
there's still things you can do and we'll be talking a little bit about food shortly and the
third thing that I do to keep my A1c below 6.5% is to exercise consistently it definitely helps
that I really like to exercise but I also really like how exercise improves my insulin sensitivity
thereby making it much easier for me to manage my blood sugars and thereby my A1c to a level
that I’m comfortable with improved insulin sensitivity basically means that your body
becomes more efficient at utilizing the insulin that you either inject or that your body makes
and for me that just means that it becomes easier for me to keep my blood sugars at a steady level
if you do not use insulin to manage your diabetes exercise might be one of the most effective ways
that you can improve your A1c levels because when you exercise again you improve your
insulin sensitivity thereby making it easier for your body to regulate your blood sugars
and thereby pulling down your A1c into a healthier level so even something as straightforward as a
walk can be extremely effective in lowering blood sugars because when you walk you're utilizing some
of those larger muscles like your quads and your hamstrings and when they work they actually pull
glucose out of your bloodstream without any additional insulin present so that's nifty I
sometimes use something like a walk or bike ride as a way of lowering my blood sugars especially
after meals so since I do inject insulin with my food and walking will never you know
eliminate the need for my insulin but since I do inject insulin I do have to be a little careful
because if I inject too much insulin then go for a walk I’m also at a risk of a low blood sugar
so I do have to dial back my rapid acting insulin a little bit and it is a balancing
act but it's definitely doable and today's fourth and final thing I do to keep my A1c below 6.5% is
understanding how different things impact blood sugars so I could be more proactive than reactive
when it comes to blood sugar management upwards of 22 things can impact blood sugars
so I think when we say that diabetes is a full-time job and it's highly complicated
we're not exaggerating I’m not going to sit here and tell you that I know how all 22 things impact
my blood sugars or that you should either but I think it's really important that we pay attention
and we learn and get to know those things that impacts our blood sugars the most we all know
that carbohydrates impacts blood sugars and I’ll talk more about that in a minute
but do you also pay attention to some of the other things that can impact blood sugars
how about sleep quality your stress level your hydration how about hormone fluctuations
how are you feeling are you sick are you drinking a lot of coffee yep it's like coffee some people
actually see quite a significant impact on blood sugars when they drink coffee my point here is to
pay attention to blood sugar patterns and thereby we can identify what impacts our blood sugars
and not just when it comes to food but when it comes to life so that we can manage our blood
sugars accordingly I for example often see a blood sugar rise in the morning that has nothing to do
with food it's my body releasing glucose into the bloodstream so it's a hormonal response and
because I’ve noticed that because I’ve seen it consistently that means I can proactively go in
give myself a little bit more insulin and I can prevent high blood sugars in the morning another
example I know that if I don't exercise for a week let's say I’m going on vacation
my insulin sensitivity will drop and my insulin needs will therefore go up so what that means is
I can proactively increase my insulin levels so I won't run high for a whole week and then there's
understanding how different types of food impacts blood sugars and I’m not just talking
about carbs here most people myself included will see blood sugar impact if you for example
eat large amount of protein nothing wrong with that it's just something to be aware of so that
we can manage for it but yes carbohydrates are carbs um it is micronutrients that we talk the
most about because it is the one that will hit blood sugars most aggressively but the thing is
we don't all react or see the same blood sugar reaction to certain carbs so for example let's
take something like oatmeal so some people see very sharp increases in blood sugars maybe even
prolonged increases when they eat oatmeal I’m lucky to be one of those who can eat it without
any crazy blood sugar fluctuations but if you do see those sharp increases or prolonged increases
you might want to consider maybe trying a different portion size
maybe change if you manage with insulin change up your dosing strategy a little bit or maybe
it's just not worth it for you and that means cutting it out for a while that's okay
as long as you pay attention to how it impacts you and come up with a strategy while I don't believe
in letting your diabetes management dictate how you live your life I do think that we have to
assess how different things impact us so that we can come up with strategies for how to best
live with those choices or change those choices so that we can live healthy with diabetes and
maintain good blood sugar levels and healthy A1cs and those were the four things that I do
consistently to keep my A1c below 6.5% I hope you enjoyed this video if you did please give
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