You may be familiar with the “ABCs” of diabetes: A1C, blood pressure and cholesterol. This acronym is part of a larger diabetes campaign called “Know Your Numbers,” and hopefully you’re aware of all of your numbers — what they are, what they should be, and how often to get them checked. Obviously, knowing your A1C and knowing what you can do if it’s not at goal is a big part of diabetes management.
The focus last week and this week has been on all things A1C: what it is, what the general goal is, why it matters, and ways to get it to where it needs to be.
What else does it take to lower your A1C?
Figuring out how to lower your A1C to whatever your personal goal is can sometimes seem like solving a puzzle. You try something and it may or may not help, or it helps but not enough. Then you try something else. Yes, it can be frustrating, but eventually you’ll hit on a strategy that works for you. Last week, we looked at how a healthy eating plan (including keeping carbs consistent and sticking to an eating schedule) and a physical activity program can help. Research shows that an eating plan can lower A1C levels by 1–2%; physical activity can lower A1C by 0.6–1%, according to various studies. But what if these two strategies aren’t enough? Then what?
Time for medication?
Diabetes medicines generally lower A1C levels anywhere from 0.5% to as much as 3.5%. The A1C-lowering effect of medicines can vary from person to person, however, and the effect is often dependent upon how high the A1C is to begin with.
We know that people who have type 1 diabetes must take insulin. Insulin can be delivered using a syringe or an insulin pen; it can also be administered using an insulin pump. How you decide to take your insulin is a decision best made with your healthcare team. But, suffice it to say that taking insulin is an extremely effective way to lower your A1C. If you have type 2 diabetes, you may or may not need insulin. For example, if your A1C is 9% or higher at diagnosis, your doctor may decide to put you on insulin. For most people with type 2, however, insulin may not come into play until you’ve exhausted other medication options.
Most diabetes treatment guidelines recommend starting someone who is new to type 2 diabetes on metformin. Why metformin? It’s safe, effective, and relatively inexpensive, too. Metformin works to help your body’s own insulin work better to lower glucose levels. It rarely causes low blood sugar. If metformin isn’t an option, though, other types of diabetes pills may be used, including sulfonylureas, DPP-4 inhibitors, and SGLT2 inhibitors. Because type 2 diabetes can change over time (making it harder to keep your blood sugar and A1C levels at target), you may need a second or even a third type of diabetes medication. This may be another type of diabetes pill, or it may include a non-insulin injectable, or even insulin (usually basal insulin, to start).
Non-insulin injectables are the GLP-1 (glucagon-like peptide-1) receptor agonists. These medicines help to lower glucose levels by stimulating insulin release from the pancreas, slowing stomach emptying and reducing the release of glucagon, a hormone that raises blood sugar. GLP-1s can be used along with diabetes pills or with insulin. They may also help with weight loss. The downside? They have to be injected. However, there are some GLP-1s that only need to be injected once a week rather than daily.
Understandably, many people with type 2 diabetes are reluctant to take medication to help manage blood sugar and A1C. This reluctance may stem from a belief that they should be able to manage with diet, weight control and/or exercise alone. Or it may result from a fear of taking medication and possible side effects. Another concern may be cost. These are all valid issues, and ideally should be addressed with a member of your healthcare team. Keep in mind that you may get the most A1C-lowering effect with a combination of lifestyle changes and medication.
Other steps you can take to lower your A1C
Checking your blood sugar with a meter in and of itself won’t lower your A1C. But it will give you the information that you and your healthcare team need to adjust your treatment plan, if necessary. When and how often you check depends on your treatment plan. For example, if you take both basal (long-acting) and bolus (fast-acting) insulin, you may need to check at least four times a day. If you’re managing your diabetes with metformin and lifestyle measures, you might check once or twice a day. How often you check can be determined by your health plan, too, and how many test strips they’ll cover. You might also decide to use continuous glucose monitoring, or CGM, which checks interstitial glucose levels every 5–7 minutes over the course of 24 hours. CGM can be used by those who have either type 1 or type 2 diabetes, although insurance coverage is more likely for those with type 1.
Keeping a log or record of your blood sugars, your food intake and your physical activity is another helpful way to see if you’re on track with your diabetes goals. Yes, it can be tedious to do, but you won’t need to do this forever. And there are plenty of smartphone apps that can make it much easier and faster to track.
Keeping up with appointments
Having diabetes usually means frequent provider visits. They can interfere with work, school and other activities, but it’s important to keep your appointments with your team so that they can stay on top of how you’re doing and catch and treat any issues early on.
Managing diabetes can seem like a full-time job, and no doubt, it can be stressful. Because chronic stress can be harmful to your health and can affect your blood sugars, it’s important to try and manage it as best you can. Staying active, being with friends and family, using relaxation techniques, practicing yoga or meditation and even seeking counseling all can help.
What’s helped you to lower your A1C? Leave a comment below!