What to Know about Managing A1C Levels
Diabetes is an endocrine disorder that occurs when there is too much glucose in the bloodstream. Glucose, which comes from the food we eat, is the body’s primary energy source.
The pancreas makes a hormone called insulin, which moves the glucose from the food into the cells. In people with diabetes, the body’s cells may not make enough or any insulin, which leads to too much glucose in the blood and not enough in the cells.
Over time, this can cause serious health problems. Unfortunately, symptoms can be subtle and easy to overlook in the early stages, which is why doctors sometimes recommend A1C blood tests.
What Are AIC Levels?
Unlike a single fasting blood glucose test, which shows only where your blood sugar is at that moment, an A1C test offers a comprehensive view of the last several months of blood sugar levels. It measures glycated hemoglobin, or the amount of sugar that is attached to the hemoglobin protein in your blood.
Any blood glucose that is not used for energy or stored attaches to hemoglobin, the protein that carries oxygen in the blood cells. Red blood cells live for about three months. Higher blood glucose levels over this three-month time period will reflect in a higher A1C level.
An A1C test can show not just how well diabetes is being managed, but can also be used to diagnose prediabetes and diabetes. Normal A1C levels should be below 5.7 percent.
Maintaining an A1C of 6.5 to 8.0 percent is associated with a longer life expectancy and no significant cardiovascular risks. An A1C above eight percent is associated with a lowered life expectancy, vascular complications and a variety of comorbidities. Keeping your A1C below 7.0 is associated with a lower risk of vascular complications.
You and your doctor will develop an A1C goal based on your age, the duration of your diabetes, your hypoglycemia status, and any comorbidities you have.
Symptoms and Causes of Diabetes
Type 1 diabetes occurs when the immune system attacks and destroys the pancreas’ beta cells, which produce insulin. Type 1 diabetes is linked to both genetic and environmental factors and is rare. Type 2 diabetes, which is the most common type of diabetes, is associated with genetic and lifestyle factors, including excess weight, inactivity, and insulin resistance.
Symptoms of diabetes can develop over time or suddenly, and can include:
- Blurred vision
- Increased hunger
- Unexplained weight loss
- Increased thirst and urination
- Tingling or numbness of the extremities
- Sores that do not heal
- Bad breath
Because these symptoms can be easy to overlook or miss, periodic blood tests such as the A1C can be critical for identifying early changes associated with diabetes or prediabetes.
Common Treatment Options
Keeping your blood glucose levels at a constant, normal level is essential to managing your A1C levels and your diabetes. Dramatic blood glucose fluctuations can lead to immediate problems, such as hyperglycemia, hypoglycemia, and ketoacidosis, as well as long-term problems, including damage to the blood vessels that supply the kidneys, eyes, heart, and nerves.
With proper treatment, you can keep your blood sugar under control. Treatment can include weight loss, diet, exercise, and medication. One or more medications can be used to bring blood glucose and A1C into your target levels.
Common drugs used to treat type 2 diabetes include:
- Metformin: Improves insulin sensitivity and reduces glucose production in the liver.
- Sulfonylureas: Stimulates the pancreas to produce more insulin.
- Meglitinides: Works similarly to sulfonylureas, only faster.
- Thiazolidinediones: Improves insulin sensitivity.
- DPP-4 inhibitors: Can help reduce blood sugar levels.
- GLP-1 receptor agonists: Lowers blood sugar levels and slows digestion.
- SGLT-2 inhibitors: Prevents the kidneys from reabsorbing glucose, instead cause it to be excreted in urine.
- Insulin therapy: Used to manage blood glucose levels — also used for type 1 diabetes.
Medications are typically used in conjunction with lifestyle changes for a comprehensive approach. For those with a body mass index over 35, your doctor may recommend weight-loss surgery. Weight loss surgery can significantly reduce blood glucose levels in up to 95 percent of those with diabetes depending on the type of surgery.
Many diabetics use complementary or alternative medicine in conjunction with conventional medicine. In fact, according to the National Health Interview Survey, more than a fifth of people with diabetes use herbs to help manage their symptoms. While alternative medicines and herbs can play a role in a healthy lifestyle, it is important to remember that they do have limits and should be used with caution.
Some of the more promising alternative medicines include:
- Alpha-lipoic acid: An antioxidant that may help lower blood sugar and reduce the risk of diabetes-related nerve damage.
- Chromium: A mineral that can boost glucose metabolism.
- Polyphenols: Antioxidants found in green tea that may help lower blood sugar and cholesterol.
- Ginseng: A plant root that may help lower blood sugar.
Herbal supplements have limitations, and there is not yet enough scientific evidence to recommend any of these for medical purposes. If you do decide to try an alternative therapy, don’t stop taking your normal diabetes medications, and discuss your choices with your doctor to reduce the risk of adverse reactions.
Managing A1C with Diet
While there is no single diabetes diet, eating a balanced diet can be a great way to lower your A1C and manage your diabetes. Look for low-glycemic foods or foods that help keep your blood sugar stable, such as:
- Non-starchy vegetables
- Nuts and peanuts
- Unsweetened Greek yogurt
- Chia seeds or flaxseeds
- Dark chocolate
A registered dietician can help you design a diet that can accommodate your personal preferences, dietary needs, allergies, sensitivities, lifestyle, and other needs.
Exercise goes hand-in-hand with a healthy diet. Once you’ve gotten your doctor’s okay to exercise, look for activities that you enjoy, such as biking or swimming, and make them a part of your daily routine. Most people need to exercise about 30 minutes a day most days of the week. If you are currently sedentary, start slowly and work your way to that level.
Upcoming Medical Innovations
Several innovative treatments are on the horizon that may just help you get your A1C levels even lower. One is a weight-loss drug called Lorcaserin, which regulates hunger in the brain. It also modifies the neurons that regulate blood glucose levels and boost insulin sensitivity.
Another drug currently being researched inhibits an enzyme called LMPTP. This drug causes cells to become more receptive to insulin, especially in the liver. When tested in mice, the drug not only reversed insulin sensitivity; it cured their diabetes.
According to the American Diabetes Association, people with diabetes should have an A1C test at least twice a year. Along with your daily blood glucose monitoring, the A1C test can give you detailed insights into the management of your disease and help you better control your blood glucose levels for a healthier life.