Now let us see "10 well-proven steps to lower A1C" Why should you lower your A1C? What should be your A1C number? How long it takes to reduce your A1C levels? And finally, don’t try achieving your target A1C with too much hypoglycemia.
Firstly, don’t get discouraged over your numbers. Trends are more concerned than a single test.
How to lower A1C?
To lower A1C, maintain your blood sugar levels within the target range without being low (hypo) or high (hyper). Now, you may ask, how can you control blood sugar levels within a healthy range?
A low-carbohydrate diet, in combination with regular exercise, can help lower your HbA1c.
On the other hand, a high-carb diet causes blood glucose spikes and requires more insulin, making it challenging to maintain blood sugar. If you can reduce your insulin requirement (i.e., with a low-carb diet), it is easier to prevent hypo or hyper and thus maintain a better blood sugar level.
Why you should lower your A1C?
High A1C increases the chances of developing diabetes complications of heart, kidney, eyes, and nerves.
The clinical trials; the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) have found a correlation between lowering A1C and a drop in diabetes complications. Also, lowering every 1% of the A1C can reduce complications as high as:
- Eye disease by 76%
- Nerve damage by 60%
- Heart attack or stroke by 57%
- Kidney disease by 50%
What should be your A1C number?
The clinical studies and Dr. Richard K. Bernstein's experience confirmed that an optimal A1C target is 4 to 4.6%. This A1C target helps to avoid diabetes complications and provides the longest life expectancy.
However, the right A1C for you is based on five crucial things:
- Your age,
- Ability to identify hypoglycemia,
- The frequency of hypoglycemia,
- Other health conditions you have, and
- Expected life expectancy.
Optimal A1C is better if you can achieve it without any hypoglycemia risk. If you cannot identify your early signs of hypo, then you should aim for a slightly higher A1C. Discuss with your healthcare professionals to help set a perfect A1C goal for you.
Everyone agrees elevated blood sugar leads to diabetic complications. The blood sugar goals advised by the American Diabetes Association (ADA), the Canadian Diabetes Association (CDA), and the Australian Diabetes Association (ADS) are on the higher side.
To prevent complications from diabetes, it is better to keep blood glucose levels within the range of healthy non-diabetic people. Healthy non-diabetic fasting blood sugar stays within 70 to 100 mg/dL or 3.8 to 5.5 mmol/l. After meals (post-meal), it can rise to 120 mg/dL or 6.7 mmol/l and drops below 100 mg/dL or 5.5 mmol/l within two hours.
Know your limits, but never stop trying to exceed them. However, don’t fix any target that is hard to achieve.
Aim for an easy a1c target, once you realize it, you will gain knowledge and confidence to proceed to the next level.
10 Sure Tips to Lower Your A1C
Many people with diabetes may ask, why my numbers are high! How can I lower my A1C? To solve a problem, you should dig to the root of the problem instead of just hacking at the leaves. So, start from scratch and analyze the problematic areas to correct them to achieve your target A1c.
Achieving your target requires patience, readiness to learn, the ability to analyze, and the willpower to accept failures and stick with the plan.
Below are the ten well-proven steps to lower A1C:
1. Carefully choose food
Food has a direct impact on blood glucose and, subsequently, A1C.
Avoid sugar, refined carbs, and factory-made foods. However, you can enjoy it on some rare occasions during festivals; occasionally, high BS does not cause significant damage. Still, you should practice limit; otherwise, your blood sugar level may get disturbed, and becomes difficult to get back on track.
Which diet is better, low-fat or low-carb? - Type 2 diabetes has a problem with carbohydrate metabolism. For type 1 diabetes high carb diet makes it difficult to manage BS. So, whether you are type 1 or 2, a low-carb or reduced-carb diet is the best. However, don’t lose the nutritional benefits of vegetables, fruits, nuts, seeds, and greens. You can lower your carb in steps until you reach your A1C goal.
Make intelligent carbohydrate choices by avoiding simple carbs like processed and refined carbohydrates. Simple carbohydrates that raise blood sugar levels include white bread, white rice, chips, soda, cookies, and sweets. Additionally, it increases the risk of obesity, inflammation, diabetes, and heart disease.
Choose unrefined carbohydrates rich in fiber, vitamins, minerals, and other natural compounds that promote health. Select foods with a low glycemic index, such as whole grains, beans, seeds, and fruits and vegetables.
Consistent with your carb intake: Plan to eat the same amount of carbs at each meal on all days; Ideally, eat the fewest carbohydrates possible for dinner. It can assist you in achieving your desired A1c because it is simple for your body to process.
Restrict calorie intake: A study shows restricted calorie intake leads to a healthier life and the best life expectancy. Calorie restriction helps to lower your blood sugar & A1C.
Eat at the same time every day. Eating on time can help you avoid BS fluctuations. Preferably, you can skip dinner by just having a glass of warm milk with a pinch of turmeric.
Try achieving your target by changing your diet, their combination, timing, and or its frequency.
2. Food that might help lower A1C
Functional foods and herbs can help lower your a1c.
A1C-lowering Foods: Functional foods are avocados, berries, cold-water fish, fiber-rich grains, legumes, nuts, green tea, spinach, cocoa, red wine, and vinegar. Useful herbs are cinnamon, fenugreek, and garlic. Try incorporating these into your regular diet.
Dark Chocolate: Patients with type 1 diabetes who consume 25 grams of dark chocolate daily, two to five times a week, have a significant effect on their A1C.
Drink enough water: A study showed that 1 cup of plain water daily was associated with a -0.04% lower A1C in men. So, drinking sufficient water can help lower your A1C.
3. Increase physical activities
Exercise reduces insulin resistance and helps to move the glucose better into the muscles with lesser insulin requirements.
Exercise helps lower your A1C: Exercise burns more sugar, thus helping reduce your blood sugar and A1C. Exercise for diabetes makes you physically and mentally feel better and stress-free. This peaceful state helps lower blood glucose spikes. If you build muscles, then it increases your calorie consumption, which in turn contributes to maintaining good BS.
Aerobic exercise, resistance training, and their combination were associated with declines in A1C levels in type 1 & type 2 diabetics. Exercise has shown more benefits in shorter bouts of 10 min with higher intensity.
Exercise has shown more benefits in shorter bouts of 10min with higher intensity.
4. Lose weight if you are overweight
Losing weight helps achieve A1C: Losing weight reduces insulin resistance in type 2 diabetes, thus better BS and A1C. In obese type 1 diabetes, losing weight reduces the total insulin requirement and efficient blood sugar control.
Studies show 5 to 10% weight loss makes a massive health benefit; they need less medicine, better BS & A1C, reduced complications, and lowers cholesterol & blood pressure.
5. Avoid, minimize, and manage stress smartly
Stress leads to disturbance in the blood sugar, which in-turn disturb A1C
Psychological problems fluctuate A1C: Stress, depression, anger, anxiety, and panic can fluctuate your BS and A1C. The stress puts you in the fight or flight response mode, which makes your number crazy and would not stabilize.
Many studies confirm a negative mindset affects your number even if you are perfect in other things. The positive thoughts make a massive benefit in attaining optimal A1C and improved wellness. Stress increases hormone secretion, which makes it harder for insulin to perform its regular duty.
Keep yourself cool using music, dancing, aerobics, yoga, and meditation.
6. Get Restful Sleep
During sleep, the body performs detoxification and repair. So, sleep duration & quality is essential for better A1C and overall health.
Research indicates that people with type 1 diabetes who slept for more than six hours had lower A1c levels. Similarly, those who get restful sleep (quality and quantity) had a lower number. According to a different study, patients with type 2 diabetes who slept for longer than nine hours and less than five hours had higher A1cs.
7. Exposing to Sunlight
Studies found vitamin D plays a vital role in insulin production and has a positive association with insulin resistance.
Vitamin D supplementation decreases A1c levels in children and adolescents with type 1 diabetes. Enhanced vitamin D supplementation also improves A1c in type 2 diabetes.
Spending time in the sun is the most natural way to get the required amount of vitamin D. To meet the recommended amount of vitamin D, schedule 10 to 30 minutes of sunlight exposure most days of the week.
8. Understand influencing factors
Many things may affect your blood sugar. such as food type, calorie intake, eating time, routines, stress, infection, sleep quality, illness, weather, pollution, and electromagnetic radiation. Try to figure out which affects you the most and learn how to reduce its influence.
Food type: Avoid foods that are allergic to you. Also, certain foods might cause more BS spikes; find and avoid them.
Eating time: Maintain a consistent eating schedule each day. Avoid late-night eating, which is detrimental to your mental and physical health. Dinner should not be eaten after 10 p.m.; preferably complete before 9 p.m.
Thyroid problems: Have you had your thyroid checked lately? A slightly low level may result in some weight gain and BS spikes.
Infection of any form raises BS levels: Additionally, high blood sugar increases infection risk. You can even suspect infection if your glucose level is spiked without reason. Beware of oral diseases; brush twice daily, floss after meals, and scrap tartar and plaque regularly.
Maintain room temperature: Cold weather may increase A1C levels. For every 1°C decrease in temperature, there was an increase in the risk of A1C of more than 7%
Avoid air pollution: Air pollution was associated with higher A1c. Keep your living space cleaner. If possible, get an air purifier.
Reduce exposure to electromagnetic radiation: High electromagnetic radiation exposure is associated with elevated levels of A1c. You can reduce electromagnetic radiation by limiting the sources, reducing exposure time, increasing the distance from the source, and using radiation shields.
9. Achieving your target BS
Try to maintain your BS as close to the healthy non-diabetic range. If you are experiencing frequent hypoglycemia, then you should be lenient until you can able to avoid lows.
What to do if experiencing frequent High & Low BS? - If you find it difficult to control your BS due to successive highs & lows; then, you need to start from scratch. If you have type 1 diabetes, then begin again ultimately by determining your basal and bolus rates.
Setting the right basal rate is more important to avoid both highs & lows and is the foundation on which the bolus dosing works.
10. Proper treatment to lower A1C
Follow your treatment plan: Diabetes treatment is highly individualized. You and your healthcare provider can determine the steps you need to take to manage diabetes successfully. Always consult your medical team before making any adjustments.
Medication is not everything: Many patients think medicine or insulin can fix diabetes. It is only a small part of diabetes management. You need to support it with a proper diet and physical activity for it to work and produce the expected result. Many type 2 diabetes can control BS without medicine through a synergic combination of healthy eating and exercise. In the case of type 1 diabetes, this synergic combination helps lower the insulin dose.
A slight modification in the treatment makes a significant difference: Sometimes changing the insulin treatment, dosage, or timing can make a huge difference. Just shifting your insulin shot to 15 minutes before your meal can help stop BS spikes after eating. Try achieving your target A1C by modifying your diabetes medication or insulin - dose, type, timing, and or frequency.
Avoid mistakes: Periodically confirm that your glucose meter is accurate. Be sure you are pricking your finger correctly. Choose the proper lab for error-free A1C results. Be careful about the expiry date of the medicines & test strips.
Don't expect too much too soon: Do not rush to see results. Instead, be slow and consistent to achieve a permanent, stable result. Set attainable goals, take baby steps, and make a lasting change. You may give up if you try more than you can manage. Set achievable goals based on your potential rather than impractical ones.
Every individual is different, “Your Mileage May Varies YMMV.” So, an easy A1C target for your friend might not be easy for you and vice versa.
Don’t Rush: 5 Steps to Achieve Your Goal
What is the lesson of the tortoise and the hair story? Slow and steady wins the race.
However, if you are new to diabetes and its control, then, at first it may be challenging to achieve it. Even, Dr. Richard K. Bernstein faced difficulties reaching today’s number (4.1 or 4.2%). He put his best efforts into testing, analyzing, modifying, and again testing, and after years of struggle, he made it. You can also make it if you put in consistent effort until your target has been met.
Strikeout “im” in impossible to make it POSSIBLE
Achieving your A1C target is not impossible if you firmly decide to do it.
- Step 1: The American Diabetes Association (ADA) advised people with diabetes to aim for an A1C of 7% (BS equivalent is 172 mg/dl or 9.6 mmol/l). Thus, you can start by setting an A1C goal of 7.0 to 6.5%; at this target, the diabetes complication risk is high. If you are experiencing frequent hypoglycemia, stay in this range for a few months. During this time, put your maximum effort to understand hypoglycemia triggers and learn to stop them.
- Step 2: Once you become an expert in avoiding hypoglycemia, you can try achieving a pre-diabetic range of 6.4 to 5.7%. Its BS equivalent is 151 mg/dl or 8.4 mmol/l to 126 mg/dl or 7 mmol/l. Medication alone cannot do the magic; support it with a nutritious diet low in carbs and increased physical activity.
- Step 3: By adapting to a healthy lifestyle, you experience occasional or no hypoglycemia. Next, you can aim for an A1C of 5.6 to 5.2 % (BS equivalent is 122 mg/dl or 6.8 mmol/l to 108 mg/dl or 6 mmol/l). Infection raises your blood sugar level; thus, you should prevent it. Learn to handle it if it affects you. Insufficient sleep affects your BS and dieting habits; never compromise on restful sleep. Go to bed on time and wake early.
- Step 4: You have attained mastery in glucose management. Now, you can try for suboptimal A1C of 5.1 to 4.7% (BS equivalent is 104 mg/dl or 5.8 mmol/l to 90 mg/dl or 5 mmol/l). To reach this target, you need a further reduction in carbohydrates and increased physical activity. At this A1C range, your diabetes complications risk is almost zero; keep it up!
- Step 5: Now you can try the best optimal A1C of 4.6 to 4.2%. BS equivalent is 86 mg/dl or 4.8 mmol/l to 72 mg/dl or 4 mmol/l. It is a healthy non-diabetic range. Stress makes you BS crazy and difficult to predict. To achieve optimal A1C, learn to avoid and manage stress. THUMPS UP! You have now gained a MASTER in DIABETES MANAGEMENT. Please share your expertise in the diabetes forum and HELP others.
If you have trouble at any target range, stay at that range for a few months until your body gets practiced to the BS. Once your BS stabilizes, you feel comfortable and confident. Then only, you can try reaching the next target.
ACCORD study shows intensive glycemia treatment is dangerous, is it true?
No, then why? The ACCORD study targeted an A1C of less than 6.0% with excess medication and drug combination. Also, this study advised participants to take a low-fat (means high-carb) diet for BS control. High-carb diet advice needs increased insulin by Insulin Secretagogues or insulin shots. This increased insulin is a risk of hypertension, Coronary Artery Disease, and cardiovascular disease.
Following an intensive treatment with a low-carb diet and increased physical activity with minimal use of medication or insulin shots surely improves your health.
How long it takes to lower your A1C levels?
Is it possible to lower A1C levels overnight? It is impossible to reduce your A1C overnight. Unlike your blood sugars which can go up or down within minutes, your A1C will take weeks to change. The A1C value is a measurement of your three-month average blood sugar. Therefore, you can lower your A1C in one to two months if it is 10% or higher. However, it might take longer to reduce if your A1C is 7%.
Health conditions that stop achieving your target A1C
Health problems such as gastroparesis, IBS, anemia, kidney disease, liver problems, and sickle cell disease can make it tougher to attain the A1C target. In such a case, you must fix a slightly lenient a1c goal.
Don’t try achieving your target A1C with excess of hypoglycemia.
Even though your A1C maybe 5.6%, it is not good for your health if you have a lot of low blood sugar to attain this range. Time in that range, which refers to the percentage of time your blood sugar is within your target range, is crucial.
For example, see the graph with three blood sugar fluctuations. You should achieve line 3, which is the best, and not line 1, which is the worst. Because all the time the blood sugar in line 3 is within the target range. Line 2 has fewer out of target range and line 3 has the highest fluctuation with many highs and lows.
Achieving a target A1C with many blood sugar highs and lows is not beneficial to your health; instead, try achieving a1c with blood sugar always or mostly within the target range.
I wish you all the best of luck in reaching your desired A1C in the healthiest possible manner.