BY AMY CAMPBELL, MS, RD, LDN, CDCES | MARCH 3, 2021
Call it what you will: hemoglobin A1C, glycosylated hemoglobin, HbA1c or just “A1C,” these numbers, known as A1C levels, play a huge role in how your diabetes is managed. It’s also used to diagnose diabetes, as well as prediabetes. Your A1C is a blood test that provides information about your average blood sugar levels over the past three months. Your provider and diabetes care team use this number to gauge how things are going and if and how to tweak your diabetes treatment plan. For most people who have diabetes, the American Diabetes Association (ADA) recommends an A1C of less than 7%. The American Association of Clinical Endocrinologists (AACE) advises a tighter goal of 6.5% or lower. Your goal may be completely different, and that’s OK (just make sure you know what it is!).
Why lower your A1C?
A1C goals aren’t decided upon out of thin air. The targets that the ADA, AACE or your provider advise for you are based on clinical research, as well as other factors, such as your age, your overall health and your risk of hypoglycemia. Landmark clinical trials, such as the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC), for example, have correlated lowering A1C with a decrease in diabetes-related complications. So, for every one point that you lower your A1C, you’ll lower your complication risk as follows:
• Eye disease by 76%
• Nerve damage by 60%
• Heart attack or stroke by 57%
• Kidney disease by 50%
It’s important to realize that your A1C levels reflects an average of your blood sugar numbers. Your A1C levels might be 6.7%, but that may be because you’re having a lot of low blood sugars, for example. For this reason, your A1C levels should be viewed as part of the picture, and not in isolation. Your blood sugar readings, frequency of highs and lows, and quality of life need to be considered as part of your overall diabetes management plan.
How long does it take to lower your A1C levels?
Is it possible to lower A1C levels overnight? Well, the short answer is no. Unlike your blood sugars, which can go up or down in a matter of minutes, your A1C will take some time to change. Remember what your A1C measures: your average blood sugars over the past three months. The good news is that if your A1C is on the high side, say, 10% or higher, it will likely start to drop within two to three months (in other words, the higher it is, the faster it comes down). On the other hand, if your A1C is 7.5%, it may take a little longer to lower A1C levels.
Seven ways to lower your A1C levels
There are a number of ways to get your A1C down. Taking medication is one way (and the reality is that many people with diabetes need to take medication), but lifestyle measures are effective, too. Here’s a rundown of what can work.
Diet
What and how much you eat factors in to your blood sugar control and, in turn, affects your A1C. There’s so much controversy about the best “diet” for diabetes and there’s no shortage of arguments on this topic. However, realize that there is no one “diet” that will work for everyone. And despite popular belief, the American Diabetes Association does not prescribe any one type of eating plan. In actuality, they state that many different types of eating patterns, including lower carb, vegetarian, DASH and Mediterranean can be beneficial. One of the best ways to figure this all out is to meet with a registered dietitian, preferably one who has experience in working with people who have diabetes. Your doctor can provide you with a referral to meet with a dietitian. In the meantime, consider the following for lowering A1C levels:
1. Come up with a plan
Getting into the habit of eating three meals a day, and possibly some snacks, is a great way to get started on controlling A1C levels. In addition, aiming to eat your meals at about the same times each day will make it easier to stabilize your blood sugars. Try not to skip meals or delay eating your meals as much as possible.
2. Be carb choosey
Carb naysayers will proclaim that carb foods are evil and should be avoided as much as possible. But reality and research shows otherwise. It’s difficult for most people to cut out carbs and it’s not the smartest thing to do from a nutrition standpoint, as carb foods can and do provide important nutrients that you won’t get from eating just protein and fat. However, you do need to consider the types of carbs you eat. Refined carbs, such as white bread, white rice, chips, soda, cookies and other sweets have been stripped of their fiber and most of their vitamins and minerals; contain “empty” calories; and can cause “spikes” in blood sugars. Eating refined and processed carbs has been linked to an increase risk of diabetes, heart disease, inflammation and obesity. The carbs to focus on are unrefined, meaning, they retain their fiber, vitamins, minerals and other plant compounds that promote health. These carbs include whole grains, whole fruits and vegetables and legumes (beans and peas).
3. Be carb consistent
Along with eating healthy carb foods comes the concept of carb control for controlling A1C levels. Eating too much carb from any food source can mean higher blood sugars and a higher A1C. Aim to eat the same amount of carb at your meals and snacks each day. Many people count grams of carb and aim for a range at their meals — for example, 30–45 grams per meal. Doing so helps you keep your blood sugars steady, whether you take diabetes medicine or not. Because people do need different amounts of carb, it’s best to check with a dietitian as to what your carb goals should be.
4. Watch portions
Eating too much carb is one thing; eating too much protein or fat is another. Keep an eye on your portions of all of the foods that you eat, especially if you are trying to lose weight (losing weight, if you need to, can help lower your blood sugars and A1C). Using the plate method or sample menus are a couple of ways to help you get on track with an eating plan.
Being active
We’re all bombarded with messages to exercise or be physically active, and after a while, it’s easy to tune them out. But if your goal is to lower your A1C, it’s time to pay attention. Yes, carb counting and losing weight helps, but don’t overlook the power of physical activity, too. Exercise provides numerous health benefits, including a lower risk of heart disease, weight loss, increased energy and a lower risk of depression and stress. Add lower blood sugars to the list.
5. Come up with a plan
If you haven’t been active for a while, you might be wondering how to get started. The first step is to think about what you might like to do. One of the best ways to get moving is to start walking. All you need is a good pair of sneakers. However, bicycling, swimming, using an exercise video or taking a Zumba class, for example, are all great ways to be active.
6. Commit to 150 minutes each week
One reason why people don’t exercise is because they think they need to spend hours at the gym, huffing and puffing away. Not true. The goal is to aim for doing at least 150 minutes of physical activity each week, or 30 minutes, five days a week. And the good news is that you can break those 30 minutes into 10-minute segments, three times a day. If you haven’t been exercising, start slowly and build up, five minutes at a time. By the way, don’t forget to check with your doctor before starting any new exercise program.
7. Combine cardio and resistance
Exercises that strengthen your heart and lungs and that use large muscle groups are often called aerobic or cardio exercises. These include walking, swimming and bicycling. Ideally, your exercise routine should also include resistance, or strengthening, exercises, such as using hand weights, resistance bands, calisthenics or weight machines. Both types of exercise work in different ways to promote health, but they both lower blood sugars and A1C.
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