What are the symptoms of prediabetes. How is prediabetes diagnosed. Can prediabetes be reversed. What factors increase the risk of developing prediabetes. How does blood sugar of 130 after eating relate to prediabetes. What are the treatment options for prediabetes.

Prediabetes: A Silent Precursor to Type 2 Diabetes

Prediabetes is a condition that often goes unnoticed, yet it affects millions of people worldwide. It’s characterized by blood sugar levels that are higher than normal but not high enough to be classified as type 2 diabetes. A blood sugar reading of 130 mg/dL after eating could be an indicator of prediabetes, depending on when the measurement was taken.

The Centers for Disease Control and Prevention (CDC) estimates that approximately 84 million Americans have prediabetes, with only about 10% being aware of their condition. This lack of awareness is primarily due to the subtle nature of prediabetes symptoms, which can easily be overlooked or attributed to other factors.

Recognizing the Symptoms of Prediabetes

Prediabetes symptoms are often mild and develop gradually, making them easy to miss. Some common signs include:

• Increased thirst
• Frequent urination
• Unexplained weight changes
• Fatigue, especially after meals
• Blurred vision
• Slow-healing wounds
• Darkened skin in certain areas (acanthosis nigricans)

Is fatigue after meals always a sign of prediabetes? While post-meal fatigue can be a symptom of prediabetes, it’s not exclusive to this condition. However, if you consistently experience tiredness after eating, especially when combined with other symptoms, it’s worth discussing with your healthcare provider.

Diagnosing Prediabetes: Beyond Blood Sugar 130 After Eating

Diagnosing prediabetes involves more than just a single blood sugar reading. Healthcare professionals use several tests to assess a person’s blood glucose levels and overall diabetes risk:

Fasting Plasma Glucose (FPG) Test

This test measures your blood sugar after an 8-hour fast. For prediabetes, the range is typically between 100-125 mg/dL.

Oral Glucose Tolerance Test (OGTT)

This test involves drinking a glucose solution and measuring blood sugar levels after two hours. A result between 140-199 mg/dL indicates prediabetes.

Hemoglobin A1C Test

This test provides an average of your blood sugar levels over the past 2-3 months. A result between 5.7-6.4% suggests prediabetes.

Does a blood sugar of 130 after eating always indicate prediabetes? Not necessarily. Blood sugar levels can fluctuate based on various factors, including the timing of the measurement and the composition of the meal. A reading of 130 mg/dL two hours after eating could be within normal range for some individuals, while for others, it might suggest impaired glucose tolerance.

Risk Factors for Developing Prediabetes

Several factors can increase your likelihood of developing prediabetes:

1. Being overweight or obese
2. Physical inactivity
3. Family history of type 2 diabetes
4. Age (45 years or older)
5. Ethnicity (higher risk in certain populations)
6. History of gestational diabetes
7. Polycystic ovary syndrome (PCOS)
8. Sleep disorders, including sleep apnea

Can genetics alone cause prediabetes? While genetics play a significant role in diabetes risk, lifestyle factors are equally important. Even individuals with a strong family history of diabetes can often prevent or delay the onset of prediabetes through healthy lifestyle choices.

The Pathophysiology of Prediabetes: Beyond Blood Sugar 130 After Eating

Understanding the underlying mechanisms of prediabetes is crucial for effective management and prevention. Two primary pathways lead to prediabetes and, eventually, type 2 diabetes:

Insulin Resistance

In this scenario, cells become less responsive to insulin, the hormone responsible for facilitating glucose uptake. As a result, the pancreas produces more insulin to maintain normal blood sugar levels. Over time, this increased demand can lead to pancreatic fatigue and declining insulin production.

Beta-cell Dysfunction

Some individuals have a genetic predisposition to gradual dysfunction and destruction of pancreatic beta-cells, which are responsible for insulin production. This decline in insulin-producing capacity can lead to rising blood sugar levels over time.

Is insulin resistance reversible? In many cases, insulin resistance can be improved through lifestyle modifications such as weight loss, regular exercise, and dietary changes. However, the extent of improvement varies among individuals.

Treatment Options for Prediabetes

Managing prediabetes involves a multifaceted approach aimed at improving insulin sensitivity and preserving beta-cell function. Key treatment strategies include:

Lifestyle Modifications

• Weight loss (if overweight or obese)
• Regular physical activity (at least 150 minutes per week)
• Balanced diet rich in whole foods, lean proteins, and healthy fats
• Stress management techniques
• Adequate sleep

Medications

In some cases, healthcare providers may prescribe medications to help manage blood sugar levels. Common options include:

• Metformin
• GLP-1 receptor agonists
• Thiazolidinediones

Can lifestyle changes alone reverse prediabetes? For many individuals, adopting a healthier lifestyle can significantly improve blood sugar control and potentially reverse prediabetes. However, the effectiveness of lifestyle interventions varies based on individual factors such as age, overall health, and the duration of prediabetes.

Monitoring and Long-term Management of Prediabetes

Regular monitoring is crucial for effective prediabetes management. This typically involves:

• Routine blood sugar checks
• Regular A1C tests (every 3-6 months)
• Annual comprehensive health screenings
• Ongoing lifestyle adjustments based on blood sugar trends

How often should blood sugar be checked in prediabetes? The frequency of blood sugar monitoring in prediabetes varies based on individual circumstances. Some people may benefit from daily checks, while others might only need periodic testing. It’s best to consult with a healthcare provider to determine the most appropriate monitoring schedule.

Preventing Progression to Type 2 Diabetes

While a diagnosis of prediabetes can be concerning, it also presents an opportunity for intervention. Taking proactive steps to manage blood sugar levels can significantly reduce the risk of developing type 2 diabetes. Key prevention strategies include:

Dietary Modifications

Adopting a balanced diet that emphasizes whole grains, lean proteins, fruits, vegetables, and healthy fats can help stabilize blood sugar levels. Specific dietary approaches that may be beneficial include:

• Mediterranean diet
• DASH (Dietary Approaches to Stop Hypertension) diet
• Low-glycemic index diet

Regular Exercise

Physical activity plays a crucial role in improving insulin sensitivity and managing blood sugar levels. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week, along with strength training exercises at least twice a week.

Weight Management

For individuals who are overweight or obese, losing even a modest amount of weight (5-10% of body weight) can significantly improve insulin sensitivity and reduce the risk of progression to type 2 diabetes.

Stress Reduction

Chronic stress can contribute to elevated blood sugar levels. Incorporating stress-management techniques such as meditation, yoga, or deep breathing exercises can help maintain better glycemic control.

Can prediabetes be completely prevented? While it’s not always possible to prevent prediabetes, especially in individuals with strong genetic predisposition, adopting a healthy lifestyle can significantly reduce the risk of developing the condition or slow its progression.

The Role of Technology in Prediabetes Management

Advancements in technology have opened up new avenues for managing prediabetes more effectively. Some innovative tools and approaches include:

Continuous Glucose Monitors (CGMs)

These devices provide real-time blood sugar readings, allowing individuals to see how different foods, activities, and other factors affect their glucose levels throughout the day.

Mobile Apps

Numerous smartphone applications are available to help track blood sugar levels, food intake, physical activity, and medication adherence. Some apps also provide educational resources and personalized recommendations.

Telemedicine

Virtual consultations with healthcare providers can make it easier for individuals with prediabetes to receive regular check-ups and adjust their management plans as needed.

Wearable Fitness Trackers

These devices can help monitor physical activity levels, sleep patterns, and heart rate, providing valuable data for overall health management.

How effective are CGMs in managing prediabetes? Continuous glucose monitors can be highly effective tools for individuals with prediabetes, providing insights into blood sugar patterns and helping to identify triggers for glucose spikes. However, their use should be discussed with a healthcare provider to determine if they’re appropriate for an individual’s specific situation.

The Psychological Impact of a Prediabetes Diagnosis

Receiving a prediabetes diagnosis can be emotionally challenging for many individuals. Common reactions may include:

• Anxiety about future health implications
• Guilt or self-blame
• Overwhelm regarding lifestyle changes
• Depression or mood changes

It’s important to address these psychological aspects of prediabetes management. Strategies to cope with the emotional impact may include:

Seeking Support

Joining support groups or connecting with others who have prediabetes can provide valuable emotional support and practical advice.

Education

Learning more about prediabetes and its management can help alleviate anxiety and empower individuals to take control of their health.

Professional Counseling

In some cases, working with a mental health professional can be beneficial in addressing emotional challenges associated with a prediabetes diagnosis.

Can addressing the psychological aspects of prediabetes improve outcomes? Absolutely. Managing the emotional impact of prediabetes can lead to better adherence to treatment plans, improved lifestyle choices, and ultimately, better blood sugar control.

Future Directions in Prediabetes Research and Treatment

The field of prediabetes research is continually evolving, with scientists and healthcare professionals working to improve understanding, diagnosis, and treatment of the condition. Some promising areas of research include:

Personalized Medicine

Researchers are exploring ways to tailor prediabetes management strategies based on individual genetic profiles, lifestyle factors, and other personal characteristics.

Novel Medications

New drugs are being developed that target specific aspects of glucose metabolism and insulin resistance, potentially offering more effective treatment options for prediabetes.

Gut Microbiome Research

Studies are investigating the role of gut bacteria in glucose regulation and how manipulating the microbiome might help prevent or manage prediabetes.

Artificial Intelligence and Machine Learning

These technologies are being applied to improve risk prediction, personalize treatment plans, and enhance monitoring of prediabetes.

What potential breakthroughs in prediabetes management can we expect in the coming years? While it’s difficult to predict specific breakthroughs, ongoing research suggests that we may see more targeted and personalized approaches to prediabetes management, potentially including tailored dietary recommendations based on individual glucose responses, new classes of medications, and more sophisticated monitoring technologies.

In conclusion, understanding prediabetes – from its subtle symptoms to its complex pathophysiology – is crucial for effective management and prevention of type 2 diabetes. While a blood sugar of 130 after eating may be a cause for concern, it’s important to consider this reading in the context of overall health and other diagnostic criteria. By recognizing the signs of prediabetes early, implementing lifestyle changes, and leveraging available treatments and technologies, individuals can take proactive steps to manage their blood sugar levels and reduce their risk of developing type 2 diabetes. As research continues to advance our understanding of prediabetes, we can look forward to even more effective strategies for prevention and management in the future.

Prediabetes: Symptoms, Diagnosis & Treatment

The day you’re diagnosed with prediabetes can feel like a remarkably scary day. It can also be a day that motivates you to take action. While type 2 diabetes is a progressive disease (more on that later), there are still many things you can do to improve your blood sugars right away.

In fact, prediabetes is type 2 diabetes in its earliest stages — which is why it shouldn’t be dismissed or taken lightly. You’ve earned the “pre” in front of “diabetes” because while your blood sugar levels are higher than normal, they simply aren’t high enough to qualify for full-fledged type 2 diabetes.

For some, prediabetes and type 2 diabetes is “reversible.” For others, it may not be.

In this article, we’ll look at the symptoms of prediabetes, how it’s diagnosed, how it’s treated, and whether or not it can be “reversed.”

Table of Contents

Symptoms of prediabetes

The trickiest part of prediabetes is that the symptoms can be very subtle and easy to ignore for years — until blood sugar levels are high enough to catch your attention.

The surest way to catch prediabetes in its tracks is by scheduling annual check-ups with your primary care doctor and requesting that your HbA1c level be tested. More on A1c’s later….

Like type 2 diabetes, the symptoms of prediabetes are the result of gradually increasing blood sugar levels, insulin resistance, and inadequate levels of insulin.

The most common prediabetes symptoms are:

• increased thirst
• increased hunger
• frequent urination
• dry mouth
• headaches
• feeling tired after meals
• inexplicable weight-gain or weight-loss
• blurry vision

The Centers for Disease Prevention and Control (CDC) report that as few as 10 percent of people with prediabetes are actually aware of their increasing symptoms.

The CDC also estimates that 84 million American — 1 out of every 3 people — has prediabetes, most of whom don’t know it.

Diagnosing prediabetes
The American Diabetes Association qualifies a diagnosis of prediabetes based on your HbA1c and your “fasting” blood sugar level (when you first wake up in the morning) and 2 hours after eating a meal:
HbA1c: 5. 7 to 6.4 percent
Fasting blood sugar: 100 to 125 mg/dL
2 hours after a meal: 140 mg/dL to 199 mg/dL
You can compare those numbers to the blood sugar levels in a non-diabetic:
Fasting blood sugar (in the morning, before eating): 70 to 90 mg/dL
1 hour after a meal: 90 to 130 mg/dL
2 hours after a meal: 90 to 110 mg/dL
5 or more hours after eating: 70 to 90 mg/dL
Diagnosing prediabetes or type 2 diabetes is actually fairly straight-forward, but the problem is that both you and your doctor may not see an A1c or blood sugar level in the “prediabetes” zone as the red-flag that it truly is.
This is diabetes. It’s just the earlier stages of the disease. You should take action. You should treat it with as much concern as you would if it was diagnosed as “type 2 diabetes.”
To be tested for prediabetes or type 2 diabetes, you’ll need to schedule a check-up with your primary care doctor and ask for these two blood tests: your fasting blood sugar and your HbA1c.
 
What is your fasting blood sugar?
Simply put, your fasting blood sugar is your blood sugar first thing in the morning before you eat breakfast. Since it’s been typically has been more than 8 hours since your last meal, the fasting blood sugar indicates how your body has managed its blood sugar levels when variables like food are not present.
What is the HbA1c test?
Your HbA1c — also known as A1c — is a blood test that measures the amount of “leftover” glucose (also known as “advance glycogenated end-products or “AGEs”) that have accumulated in your bloodstream during the prior 3 months. The higher your A1c is, the more damage is occurring to your body’s nerve endings and blood vessels in areas like your eyes, your fingers, and toes, and your kidneys.
The more AGEs are present in your blood, the more damage is occurring that can develop into diabetes complications like retinopathy, neuropathy, hair-loss, gastroparesis, dermopathy, and nephropathy.
The higher your blood sugars are each day, the higher your next A1c result will be!
 
Factors that increase your risk of prediabetes
While mainstream media often depicts type 2 diabetes as the result of being overweight, not exercising, and eating unhealthy food, it is significantly more complex.
There are actually two pathways that lead to prediabetes and type 2 diabetes.
The first is basic insulin resistance, which means your body needs more and more insulin in order to maintain healthy blood sugar levels. At a certain point, the pancreas can’t keep up with the demand, and blood sugars begin to rise.
The second is a genetic disposition that results in the gradual dysfunction and destruction of your pancreas’ beta-cells. Beta-cells play the leading role in insulin production, and many people with type 2 diabetes struggle to actually produce normal amounts of insulin.
Determining which group you are in isn’t easy, or even possible for the average patient.
For patients in this second group, “reversing” diabetes isn’t likely possible, but that doesn’t mean you can’t take steps towards improving your health isn’t worthwhile.
The most important factors that increase your risk of prediabetes are:
If you are overweight
If you are age 45 years or older
If you have a parent or sibling with type 2 diabetes
If you exercise less than 3 times a week
If you had gestational diabetes during pregnancy
If you gave birth to a baby that weighed over 9 pounds
If you are African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian Americans. These ethnicities have all shown a higher risk of developing type 2 diabetes.
 
How to reduce your risk of prediabetes & type 2 diabetes
Whether your diabetes is the result of insulin resistance or genetic beta-cell dysfunction, there are still many things you can do to improve your body’s sensitivity to insulin and prevent or delay the further progression of the condition.
Get moving
The more you exercise, the more calories and glucose your body burns over the course of 24 hours, and the more it burns even afterward when you’re at rest.
Even going for a 15-minute walk every day at lunch is a worthwhile start. Walking is often dismissed as not being intense enough to provide many benefits, but walking is actually a great way to burn fat and calories without increasing your appetite. It’s also very easy on the joints, can be done on a treadmill or outside, and you can set your own comfortable pace.
The next time you come home from work and think, “I’m too tired to exercise,” stop that pattern of thinking and commit to just 15 minutes of movement.
Make a few changes to your diet
Eating a healthier diet doesn’t mean you have to cut out all the things you love. Even making changes to one or two meals a day can have benefits.
For example, maybe you start eating a very green salad loaded with fresh veggies for lunch instead of that footlong sub-sandwich. Or perhaps you start limiting your soda consumption to one can per day instead of 4 cans per day.
Pick a couple of places to make changes so it isn’t quite so overwhelming. Over time, you may find that you want to keep making improvements to other food choices, too. And remember, the goal doesn’t have to be 100 percent perfection. The “80/20 Rule” is great: choosing healthy, real food 80 percent of the time, with 20 percent left for less-than-perfect treats.
 
Get more sleep
Getting too little sleep has been linked directly to a variety of issues that impact your blood sugars, hunger levels, weight-gain, mood, and cravings.
A lack of sleep — especially a consistent lack of sleep — can take a tremendous toll on your insulin sensitivity, too, which means you’ll need more insulin to regulate your blood sugars than normal. This can easily lead to weight gain, reduced energy, and higher blood sugars over time.
There’s no way around it — your body needs more sleep. Start improving your own sleep habits by setting an alarm or reminder in the evening to ding when you need to begin getting ready for bed.
Lose weight
Easier said than done, certainly, but all of the aforementioned steps towards reducing your risk of diabetes should also help you lose weight.
Extra body fat, quite simply, increases your body’s resistance to insulin. The more extra body fat you have, the more insulin it will take to help your body achieve healthy blood sugar levels. Losing weight also decreases inflammation levels, which decreases insulin resistance, too.
*Do keep in mind: for some, losing weight may be challenging if your diabetes has progressed to type 2 diabetes already, and blood sugars are already significantly elevated. Talk to your doctor about medications that will help bring your blood sugars down while you continue to work on your weight-loss goals.
Quit smoking. Nicotine has proven in research to actually make insulin less effective. Which means, as a smoker, you’re creating higher levels of insulin resistance even if you’re doing other healthy things like exercising and eating a healthy diet.
Smoking actually increases your risk of diabetes by 30 to 40 percent. Quit smoking and instantly increase your sensitivity to insulin, thus improving your blood sugars without making any other changes.
 
Can prediabetes be reversed?
For some, prediabetes is reversible if it is the “simple” result of weight gain and unhealthy habits. For many, however, prediabetes is the result of the body’s gradual destruction of beta-cells.
Beta-cells play a critical role in insulin production. More and more research today regarding type 2 diabetes demonstrates that approximately 60 percent of people with type 2 diabetes are experiencing a lack of insulin production through “beta cell dysfunction and destruction.”
“It is now well recognized that 2 factors are involved: impaired [beta-cell] function and insulin resistance,” explains John E. Gerich, MD, in a study published by the Mayo Clinic Proceedings. “Prospective studies of high-risk populations have shown insulin-resistance and/or insulin-secretory defects before the onset of impaired glucose tolerance.”
This means that while you should absolutely still pursue healthier habits around nutrition, exercise, weight-loss, sleep, quitting smoking, the gradual progression of your disease means your diagnosis is here to stay.
That being said, making any changes you can in your habits can play a tremendous role in whether or not you need to start taking diabetes medications or if you need to start insulin injections to help bring your blood sugars down to a healthy level.
Read more on “reversing” diabetes: Is Type 2 Diabetes Reversible?
 
Living well as a person facing a diagnosis of prediabetes or type 2 diabetes is very possible. The first step is to take action and do whatever is in your power to improve your body’s sensitivity to insulin, improve your diet, get more exercise, get more sleep, and say goodbye to detrimental habits like smoking.
Prediabetes is diabetes. The sooner you take action, the sooner you improve your health.
How to Lower Your A1c: The Complete Guide
We are always told that having a low A1c is an important goal in our diabetes management, but do you know why? Do you know what a good A1c target is, how to lower your A1c, and how quickly you can lower your A1c safely?
These are the questions I will answer in this comprehensive guide on what A1c is, how to lower your A1c, and why achieving a low A1c isn’t the only (or necessarily the best) goal when it comes to diabetes management.
Table of Contents
What is A1c?
A1c, hemoglobin A1c, HbA1c or glycohemoglobin test (all different names for the same thing) is a blood test that measures your average blood sugar over the last 2-3 months. It’s not an “even average,” but an average where your blood sugars over the last few weeks count a little more than your blood sugars 2-3 months ago.
According to the National Institute of Diabetes & Digestive & Kidney Diseases:
“The A1c test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about three months. Thus, the A1c test reflects the average of a person’s blood glucose levels over the past three months. The A1c test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1c level is below 5.7 percent.”
It’s important to note here that the term “normal A1c level” in this context refers to people without diabetes. I will get back to what a “normal A1c level” is for people living with diabetes below.
 
How to test your A1c
Your doctor or endocrinologist should test your A1c regularly (typically every 3-6 months). The doctor simply pricks your finger (or ear if you prefer) and takes a tiny blood sample. If the doctor’s office has an A1c kit, you should get your result before your consultation is over.
You can also buy home A1c kits (no prescription required) and do the test yourself. Home A1c kits can be useful if you go for more than three months between doctor visits and want to keep an eye on how your A1c is developing yourself.
The home kits are generally accurate within plus/minus 0.5 percentage points, which is more than good enough to give you a trustworthy result. The downside of the home kits is that they require a larger amount of blood (four large drops) than a regular blood sugar test, and if you don’t apply enough blood, you’ll get an error message and will have lost a test strip.
You can find home test kits on Amazon and in some pharmacies.
Why you should care about your A1c
Multiple studies have shown that high average blood sugars increase the risk of diabetes-related complications. Lowering your A1c to the recommended range will reduce the risk of diabetes-related complications significantly:
Eye disease risk is reduced by 76%
Kidney disease risk is reduced by 50%
Nerve disease risk is reduced by 60%
Any cardiovascular disease event risk is reduced by 42%
Nonfatal heart attack, stroke, or risk of death from cardiovascular causes is reduced by 57%
Achieving an A1c in the recommended range is, therefore, one of the most important things you can do to improve your long-term health when you live with diabetes.
However, the closer you get to the recommended A1c target, the less benefit you will get from lowering your A1c further. Taking your A1c from 12% to 11% makes a big difference while lowering your A1c from 7% to 6% provides a much smaller benefit. In fact, lowering your A1c too much may not be a good idea if it means that you increase how often you experience hypoglycemia (low blood sugar).
I will explain why “time-in-range” is just as important as a low A1c later in this guide.
 
What is a “normal” A1c?
Now that you have your A1c number, let’s look at what that number actually tells you. The American Diabetes Association has established the following guidelines:
This does NOT mean that you need an A1c of less than 5.7% if you’re living with diabetes. It means that if you do NOT live with diabetes, your A1c is expected to be below 5.7%. There are different recommendations for what an appropriate A1c is for people living with diabetes.
I had a chance to asked Dr. Anne Peters, MD, Director, USC Clinical Diabetes Program and Professor of Clinical Medicine Keck School of Medicine of USC as well as Gary Scheiner, MS, CDE, owner and Clinical Director of Integrated Diabetes Services and author of Think Like a Pancreas, what their perspectives are on a good A1c target:
Dr. Peters:
“The A1c target should be whatever is best given the person’s clinical situation. For athletes, too many lows can limit performance, for someone who is pregnant it should be <6%, for an older person the target should be higher. I generally think an A1c target of 6.0 – 7.0% is ideal and data shows that going below 7% has fairly little impact on complications. Basically, I’d rather see someone with an A1c of 6.9% and low blood sugar variability than an A1c of 6.2% with lots of variability”
Gary Scheiner, MS, CDE:
“A1c goals should be individualized based on the individual capabilities, risks, and prior experiences.  For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly. Someone with significant hypoglycemia unawareness and a history of severe lows should target a higher A1c than someone who can detect and manage their lows more effectively. And certainly, someone who has been running A1c’s in double digits for quite some time should not be targeting an A1c of 6%… better to set modest, realistic, achievable goals.”
In their Standards of Medical Care in Diabetes, the American Diabetes Association recommends an A1c target of below 7% for adults living with diabetes. An A1c of 7% roughly translates to an average blood sugar of 154 mg/dl (8.6 mmol/L) as you can see from this conversion chart.
To learn more about blood sugar levels, please read “What are Normal Blood Sugar Levels“.
 
A1c vs. Time-in-Range
A1c has long been considered the best measure of diabetes management because it was the most accurate tool to observe long-term blood sugar trends. This has changed with the introduction of Continuous Glucose Monitoring (CGM). By using a CGM, you can now get a very accurate picture of not only your average blood sugar, but your blood sugar fluctuations as well.
This makes it possible to track another key component of diabetes management: Time-in-Range.
Time-in-range refers to the percentage of time in which your blood sugar is within a specific range. To see why time-in-range is important, take a look at the three lines in the graph below. All three lines show an average blood sugar of about 154 mg/dl (which equals an A1c of about 7%) but with very different fluctuations. I think we would all prefer our blood sugar to follow line 3 rather than line 1.
Graph used with permission from Diatribe
Some guidelines state that your blood sugar range should be set to 70-180 mg/dl (3.9-10 mmol/l), but you may find that to be too large or small of a range for you. According to this interview with several diabetes experts, most recommend that you spend less than 3% of the time below 70 mg/dl (3. 9 mmol/l) and less than 1% of the time below 53 mg/dl (3 mmol/l). However, they also agree that the actual time spent in range needs to be individualized.
On average, the experts didn’t expect the general diabetes population to be in range more than 50% of the time at most, so talking about incremental improvement probably makes more sense than setting a fixed number.
 
How to measure Time-in-Range
If you wear a Continuous Glucose Monitor (CGM), your time-in-range should be listed when you download your data (as in the example from a Dexcom CGM below). If you don’t use a CGM, all you can do is look at your manual blood sugar tests and pay attention to your amount of high and low blood sugars. What’s an acceptable high and low is something you have to discuss with your medical team.
What is more important: a low A1c or a high Time-in-Range?
Optimally, you’d have an A1c below 7% accompanied by a low blood sugar variance (high time-in-range). A good general guideline is:
The higher your A1c, the more important it is to focus on getting it down.
The lower your A1c, the more important time-in-range becomes.
If your A1c is below 6-7%, focusing on increasing your time-in-range will probably have a larger positive health impact than lowering your A1c further.
So is A1c a bad way to gauge whether your diabetes management is on track? Not necessarily, but to quote Gary Scheiner, MS, CDE:
“I’ve never been a huge fan of using A1c to gauge the “quality” of a person’s glucose control, simply because it represents an average… and an average can reflect lots of highs and lows rather than time spent within one’s target range. However, it’s not something we can ignore either since there is a correlation between A1c and the risk of long-term complications.”
 
Can your A1c be too low?
As described above, the answer to this question depends almost entirely on how often you experience hypoglycemia (low blood sugar). If you (almost) never experience hypoglycemia, your A1c technically cannot be too low. Some people achieve A1c levels below 5% by following a very strict diabetes management and diet regimen and have almost no blood sugar fluctuations.
HOWEVER, if you often experience hypoglycemia, that will result in an “artificial” low A1c reading because your hypoglycemia events are lowering your blood sugar average. In that case, focusing on increasing time-in-range is much more important than further lowering your A1c. In fact, you may even benefit from a slightly higher A1c with fewer blood sugar fluctuations.
It’s also important to note that lowering your A1c below the recommended range of 6-7% hasn’t been proven to provide any health benefits. Therefore, a very low A1c shouldn’t be a goal in itself.
How to lower your A1c
Now that you have a thorough understanding of A1c and time-in-range, as well as why looking at your A1c in isolation isn’t optimal, the obvious question is:
How do you lower your A1c while improving or sustaining your time-in-range?
I will cover the four most important things you can do below but it’s always recommended that you start by having a conversation with your medical team before making changes to your diabetes management.
 
Identify the main “pain points”
Whether you are self-managing your diabetes or work closely with your medical team, the first step should always be to try to identify the main “pain points” or reasons why your A1c is higher than you’d like. The only real way of doing this is by tracking your blood sugars very closely.
If you wear a Continuous Glucose Monitor, you can look at your 7-day, 30-day, and 90-day data to see if you can spot any trends. For example, you might find that you are running high from 1-5 AM every night, every morning (hello Dawn Phenomenon) or every day after meals. Or perhaps you always go low after exercise. We all have different blood sugar patterns.
It’s also very possible that you simply are running your blood sugar a little too high all the time and could benefit from adjusting your diabetes medication. Identifying patterns like that makes it possible to pinpoint areas of potential improvement so you can start making a plan for how to limit your high and low blood sugars.
If you rely on manual blood sugar testing, it’s a little trickier since most people don’t test every five minutes. What I would recommend is increasing how often you test for a while, and maybe even test during the night if you wake up anyway. Most meters allow you to download data to your computer, or you can upload the data to app-based platforms like One Drop or mySugr. This can help you see the data in a more cohesive way so you can start looking for trends.
 
Create a plan for your diabetes management
Now that you have a better idea of what your “pain points” are, you can start making changes to your diabetes management.
Your doctor may suggest a different medication regime. For example, some people (regardless of their type of diabetes) are prescribed Metformin to help with Dawn Phenomenon (morning blood sugar spikes not related to eating). Others may need adjustments to insulin dosing, etc.
If you’re insulin-dependent and consistently have high blood sugars in the morning, getting your blood sugar fluctuations and A1c down might be as simple as adjusting your nighttime basal insulin. Or, if you run high every day after meals, your carb-to-insulin ratio might be off, and adjusting that could be what sets you on a path of a lower A1c. Until you collect the data and do the analysis, you have no way of knowing this.
I want to make an important point here: increasing your diabetes medication is not a sign of failure! It’s often the best (and sometimes only) way to control your blood sugar and bring down your A1c.
I adjust my insulin up and down all the time when I change my diet or exercise routine. Adjusting your medication is an important tool in your diabetes toolbox and something you should always discuss with your medical team.
 
Understand nutrition and adjust your diet
What you choose to eat and drink can have a major impact on not only your waistline, mood, and well-being, but also on your blood sugar levels.
All macronutrients (carbohydrates, proteins, and fats) can affect your blood sugar to some degree so developing a good understanding of how they affect your blood sugar will enable you to be proactive and prevent blood sugar swings.
Carbohydrates (carbs)
Carbohydrates have the greatest impact on your blood sugar, which is why many people with diabetes can benefit from following a low- to medium-carb diet (or even a ketogenic diet). The fewer carbs you eat, the less insulin you need to take, which makes diabetes management easier.
However, you don’t have to follow a low-carb diet if it doesn’t work for you – physically or mentally. As I wrote in my post about which diet is best for people with diabetes, it is very possible to have great blood sugar control on a medium (or even high) carb diet, as long as you experiment, take notes, and learn to take the right amounts of insulin for the carbs you are eating.
It is very important to realize that we all react differently to carbs so you have to find the diet and foods that are right for you.
As an example, people react very differently to carbs like oats or sweet potato. Some people can eat oats with only a small increase in blood sugar while others see a quick spike. By simply knowing this, people struggling with a certain type of carb can choose to reduce their consumption or cut it out of their diet altogether.
Protein & fats
While carbs affect blood sugar most significantly, protein and fat also have an impact. Some, like Dr. Sheri Colberg, even think that simply looking at carbs when estimating blood sugar impact (and dosing insulin) is an outdated and inefficient way to perceive diabetes management and that you should focus more on total calories (read more here).
The key thing to be aware of is that when protein and especially fat is consumed with carbohydrates, the energy from the meal will be released more slowly, which means that your blood sugars will be impacted more slowly as well.
While I don’t believe your diabetes management should completely dictate how you live your life and which diet you choose to follow, it can be worth evaluating what food choices make life easier for you. By making a conscious choice of which type of nutrition plan to follow (the majority of the time), you can more easily establish healthy habits that will benefit not only your overall health but also your daily blood sugar levels, and thereby your A1c.
 
Increase activity (exercise)
While exercise is essential for building and maintaining good health and improving insulin sensitivity, it can be a double-edged sword if it constantly throws your blood sugars for a loop. Not only is that very frustrating, scary, and annoying, but it can also affect your A1c and time-in-range negatively.
The key is to understand how different types of exercise affect blood sugars and, if you use insulin, learn your formula for insulin and food around workouts.
Cardio
Cardio, such as brisk walking, jogging, swimming, biking, or dancing, are all excellent types of exercise, and as little as 20-30 minutes a day can make a significant difference when it comes to improving insulin resistance and managing blood sugar levels.
Not only does exercise reduce blood glucose during exercise, but it also improves your insulin sensitivity for hours after your workout, meaning that you need less insulin.
If you treat your diabetes with insulin, you will have to manage your insulin levels so you don’t experience exercise-induced hypoglycemia. This comes down to reducing your insulin significantly or consuming carbs before your workout.
In general, it should not be needed to “carb up” to do up to 60 minutes of steady-state cardio, but there can be situations where reducing insulin before exercise can’t be done, so additional carbohydrates must be consumed.
 
Resistance training
Adding resistance training to your daily routine, even if it’s just bodyweight exercise, can be instrumental in increasing your insulin sensitivity and lowering your A1c.
Whereas cardio will lower blood sugar during exercise and potentially up to 36 hours after exercise, resistance training can increase insulin sensitivity for much longer since muscles work as little “glucose tanks” and you’ll store more glucose in your muscles rather than sending it directly to your bloodstream. The more muscles you have, the better your insulin sensitivity.
Just be aware that most people will see an increase in blood sugars during resistance training (research was mainly done on people living with type 1 diabetes) rather than a decrease. The reason for the increase in blood sugar is that the improved insulin sensitivity from exercising is surpassed by your body’s increased glucose production. Your body is producing glucose faster than you can use it!
For a detailed guide to resistance training and diabetes, please see my article “How Resistance Training Affects Your Blood Sugar.”
Because resistance training is so effective at increasing your insulin sensitivity, it’s a great way to lower your blood sugar consistently. If you exercise regularly, the effect of exercising overlaps from one workout to the next and you essentially achieve a permanent increase in insulin sensitivity.
 
How quickly can you lower your A1c?
Because A1c is simply a measure of your average blood sugar over 2-3 months, it can (in theory) decrease by any amount over that time period. If you, from one day to the next, decreased your daily average blood sugar from 300 mg/dl (16.7 mmol/l) to 120 mg/dl (6. 7 mmol/l), your A1c would decrease from 12% to 6% in around two months.
However, it may not be a good idea to lower your A1c so quickly, as I will explain below.
Why you shouldn’t lower your A1c too quickly
It can be a good idea to approach lowering your A1c with a bit of caution. Just as crash dieting isn’t healthy, there can be some serious health risks associated with lowering your A1c too quickly. I turned to Dr. Peters for an explanation:
“If you lower your A1c too quickly, many bad things can happen. First, weight gain and total body swelling. Next, it can cause bleeding in the retina (back of the eyes) which can lead to blindness, and third, it can cause painful neuropathy that never goes away. It’s slightly different for newly diagnosed patients, but, in general, no one should try to go from an A1c of 10% to 6% quickly. Take slow steps. Wanting to get to a “low” number very fast only causes harm. Diabetes is a long-term disease, so slow steps to establish new habits that can last a lifetime is the way to go. Anything too sudden and the body reacts badly.”
 
My perspective on A1c as a person living with diabetes
I have a very ambivalent relationship with my A1c myself. I’ve been living with type 1 diabetes for over 20 years, and my A1c is not something I think about in my daily life. However, every three months when I see my endo, I get a little anxious because receiving your A1c can feel a lot like getting your diabetes report card.
And, quite honestly, that’s really silly. My A1c number doesn’t reflect what’s been going on in my life for the last three months. It doesn’t tell me how much effort I’ve put into managing my diabetes and it does not define me as a person. It’s a good source of information, nothing more.
Still, we tend to look at it and judge, good or bad, how we’ve done with our diabetes management. But we really shouldn’t!
That doesn’t mean that I think we shouldn’t get our A1c checked. I absolutely think we should, but we also need to understand what it means as well as why we should look beyond the A1c number. I hope this guide has given you the knowledge and tools to do so!
 How to live with diabetes? – Kirov Clinical Diagnostic Center (former Kirov Clinical Hospital No. 8) 
 Tuesday,
 18
 November
 2014
 Diabetes mellitus is a chronic disease characterized by high levels of glucose in the blood (hyperglycemia).
 Diabetes results from impaired insulin secretion, insulin action, or both. Chronic hyperglycemia in diabetes mellitus is accompanied by damage, dysfunction of various organs, especially the eyes, kidneys, nerves, heart, blood vessels.
 However, it is possible to learn how to manage your illness and live a fulfilling life.
 How to live with diabetes?
 It is important to monitor your blood glucose regularly and keep it as close to your target as possible.
 To do this, you need to take a few simple steps towards a healthy lifestyle:
 ** reduce excess body weight
 ** healthy diet
 ** regular exercise
 ** stop smoking
 ** moderation in alcohol consumption
 ** good oral hygiene (patients with diabetes are at high risk of dental and gum disease).
 And also:
 ** maintaining normal levels of blood glucose, blood pressure, cholesterol, glycated hemoglobin (HbA1c) – compliance with the recommendations of the attending physicians.
 ** regular intake of antidiabetic drugs (tablets and insulin).
 In addition:
 ** regularly (at least once every 1-2 months) undergo an examination by an endocrinologist (therapist).
 ** regularly (at least once a year) undergo an examination by an ophthalmologist, a neurologist (if indicated), a cardiologist (if indicated), an angiosurgeon (if indicated).
 ** Perform regular self-monitoring of blood sugar (using a glucometer), glycated hemoglobin (HbA1c), blood pressure and cholesterol.
 reduction in excess body weight
 If there is excess body weight, the body cannot use insulin effectively. This means that diabetes control cannot be carried out properly.
 Significant dietary changes are required to lose weight. An increase in physical activity will also be helpful. Don’t be discouraged if weight loss slows down over time. This is a rather lengthy process.
 Weight loss benefits:
 ** Helps lower blood pressure, cholesterol and blood glucose levels.
 ** improved control of diabetes mellitus.
 ** You may enjoy exercise.
 ** You will be more confident.
 regular physical activity
 Physical activity is very important for maintaining proper blood sugar levels and reducing the risk of diabetes complications.
 Before starting regular exercise, you should consult with a specialist.
 Benefits of physical activity
 1) Prevents or slows the progression of type 2 diabetes.
 2) Helps to compensate for diabetes.
 3) Prevents the development of cardiovascular diseases.
 4) Helps reduce the level of “bad” cholesterol.
 5) Helps control blood pressure.
 6) Helps to reduce and control weight.
 7) Improves well-being.
 Physical activity must necessarily include: warm-up, main part, unloading. It is advisable to practice at least 5 times a week for 30 minutes.
 In addition, it is quite simple to increase physical activity without going to the gym, for example: walking up the stairs instead of using the elevator, walking instead of using transport, getting out of transport before you stop, cycling, swimming.
 Helpful Hints:
 Ø Every time you exercise, check your blood sugar. It is necessary to have a snack before exercise if:
 – blood sugar level is 3.5–8.0 mmol/l;
 – you have injected insulin.
 Ø In the event that the blood sugar level is above 15 mmol / l, it is not recommended to exercise.
 Ø Carry medical identification at all times (eg diabetic card, special medallion or bracelet).
 Ø Always start with slow exercises. Do not try to do too many exercises at a fast pace, even if you feel that you are capable of it. The load should be increased slowly, as far as physical fitness allows.
 Ø Record progress: record your progress in a diabetes diary.
 Ø Start exercising an hour or two after eating to balance food intake and exercise.
 Ø If possible, exercise at the same time every day. For those days when the regular schedule is broken, it is necessary to draw up a special meal and medication plan.
 Ø Always carry foods containing easily digestible carbohydrates (sugar, juice, sweets).
 Ø Wear comfortable socks made from natural fibers and comfortable, well-fitting shoes that allow the skin to breathe and support the foot well.
 ** After exercise: Check your blood sugar. The blood sugar level will show the need to increase or decrease the amount of food the next time you exercise.
 Be aware that sugar levels may drop within hours of exercise.
 healthy eating
 The recommendations for a healthy diet are the same for people with and without diabetes:
 varieties , potatoes, rice, cereals).
 Ø Eat more foods rich in omega-3 polyunsaturated fatty acids (salmon, cod, haddock and other northern sea fish, vegetable oils, nuts and seeds).
 Ø Reduce your intake of foods rich in saturated fats (high-fat meats and dairy products):
 – Choose lean cuts of meat and trim visible fat
 – Grill, steam, microwave, boil or bake instead of pan frying.
 Ø Choose dairy products with a low fat content (milk with a fat content of no more than 2.5% or skimmed milk, diet yogurt, cottage cheese with a fat content of 0-4%).
 Ø Eat vegetables and fruits daily (at least 500g per day).
 Ø Read food labels for protein, fat, and carbohydrate amounts (low-fat foods can be high in carbohydrates).
 Ø Eliminate sugar-containing foods – cakes, chocolate, sweet pastries, etc. from the diet.
 Ø Reduce your salt intake (to 2-3g per day is a teaspoon without top), try experimenting with different herbs and spices as seasonings.
 Ø Drink 1. 5-2 liters of water per day.
 smoking cessation
 Smoking increases the risk of cardiovascular disease and diabetes complications.
 Quitting smoking can help you save money and improve your fitness and appearance.
 Quitting smoking is not easy, but there are methods to help you – talk to your doctor about quitting smoking.
 moderation in alcohol consumption
 Drinking alcohol is not prohibited for people with diabetes, but it is important to follow these guidelines:
 Ø For a diabetic patient, alcohol consumption should not exceed 1 standard unit (corresponding to 350 ml of beer, 150 ml of wine or 45 ml of spirits) per day for women and 2 standard units for men.
 Ø Take into account the carbohydrate content of different drinks. Some low-alcohol beers are high in carbohydrates.
 Ø Alcohol increases the risk of hypoglycemia (a dangerous drop in blood glucose levels), so it is important to eat snacks containing carbohydrates before and during drinking.
 Ø The state of hypoglycemia can be mistaken for the behavior of an intoxicated person and vice versa, therefore, if alcohol is consumed outside the home, it is imperative to have documents confirming the presence of diabetes (special card) with you.
 Ø Mix alcohol with juice to reduce the risk of hypoglycemia.
 Ø Check blood glucose levels regularly, as well as snack before bed and check blood glucose levels at night, since the risk of developing hypoglycemia persists for 24 hours after drinking alcohol.
 Ø If bedtime glucose testing is not possible, eat a piece of bread or fruit to reduce the risk of hypoglycaemia at night and in the morning.
 maintenance of normal blood glucose, blood pressure (BP), cholesterol and glycated hemoglobin (HbA1c).
 The diagnosis of arterial hypertension is established after repeated detection of an increase in blood pressure in a person (140/90 mm Hg and more with successive measurements in different settings). With the simultaneous combination of high blood pressure and diabetes in a person, the risk of developing cardiovascular diseases or complications increases 4 times compared to those who have only one of these diseases. With regular monitoring of blood pressure, the risk of developing complications of diabetes can be reduced by one third.
 In some cases, high blood pressure can only be reduced through lifestyle changes. If necessary, the doctor will prescribe medications to lower blood pressure. The drugs should be taken daily. Normalization of blood pressure is not a reason for discontinuation of drugs. It is unacceptable to stop taking or change the dosage of the drugs recommended for you without consulting a doctor – this can lead to an exacerbation of the disease. Do not take additional medications on your own without consulting your doctor. Some drugs, when they are discontinued, can cause a “withdrawal syndrome” – a significant increase in blood pressure and a deterioration in well-being, while others, when they interact, can sharply reduce it.
 Target blood pressure level in diabetes mellitus is not more than 130/80 mm Hg.
 Many people with diabetes have high levels of cholesterol and other fats in their blood. Since this can lead to serious health problems, it is important to check your blood cholesterol levels regularly. Diabetes mellitus and high cholesterol levels increase the risk of developing atherosclerosis, a disease in which fatty substances in the blood are deposited inside the walls of blood vessels and gradually make them less elastic, the lumen of the vessels narrows, blood flow is blocked, and this can lead to a deterioration in the blood supply to various organs (brain, heart , kidneys).
 Check your cholesterol levels at least once a year.
 The target level of total cholesterol in diabetes mellitus is not more than 4.5 mmol/l.
 Blood glucose monitoring is an essential part of managing your diabetes on a daily basis. Your healthcare provider will advise you on blood glucose targets that are optimal for your age, duration of illness, and complications. It is necessary to record blood sugar levels in a self-monitoring diary.
 When to measure glucose
 § Before each main meal and at bedtime
 § Before and after exercise
 § If symptoms of hypoglycemia occur
 § More often during illness (7-8 times)
 § More often if pregnancy has occurred (7-8 times and according to indications).
 § Sometimes at 3-4 am to make sure there is no hypoglycemia at night.
 § In order to obtain a clear daily blood glucose profile, it is necessary to measure daily several times over several days (5-6) – always at the same time of the day.
 § With some antidiabetic drugs, it may be necessary to check the glucose level 2 hours after a meal.
 § Before driving.
 Normal blood glucose levels vary from patient to patient.
 Glycated hemoglobin (HbA1c) test – this laboratory test shows the average blood glucose level over the past 3 months.
 In people without diabetes, its values ​​are 4-6%.
 Glycated hemoglobin target is individual for each patient.
 Important!
 Follow your doctor’s instructions for taking antidiabetic drugs (hyperglycemic drugs or insulin) and do not stop or change the dosage on your own. What foods can and cannot be eaten for hemoglobin increase
 Article content: 
 Basic principles of nutrition
 What foods can be eaten with anemia
 Unwanted products
 Doctor’s advice
 How to make a diet
 Sample menu for the day
 According to the data obtained after medical examination in the Russian Federation, 70% of the inhabitants of our country had a low level of hemoglobin in the blood. At the same time, most people did not know that they had this blood disease, attributing the unpleasant symptoms of anemia to fatigue due to overwork and domestic problems.
 Anemia is a decrease in the content of hemoglobin and erythrocytes in the blood, leading to the development of oxygen starvation of tissues. Such a diagnosis is made if hemoglobin values ​​fall below 115 g/l in women and 130 g/l in men.
 This pathological condition may be the result of blood loss or pathologies of internal organs. The less hemoglobin in the blood, the more severe the disease. The determining role in the treatment of this pathological condition is played by the normalization of the regimen and diet. Source: 
 Features of therapeutic nutrition of patients with anemia in penitentiary institutions. Napris Zh.S., Egorushkina Yu.S., Chugunova G.N. Nutrition issues. 2019. No. 6. pp.73-78. This allows you to compensate for the lack of iron in a natural way and speeds up the recovery of the patient.
 Basic principles of nutrition 
 The main goals of the diet for anemia are:
 reduction in the proportion of carbohydrates and fats;
 introduction to the diet more foods containing iron;
 food calorie control;
 normalization of the diet;
 maintaining the balance of vitamins and trace elements in the body.
 Protein-rich foods must be present in the diet, as they improve the absorption of iron. At the same time, the amount of fats and carbohydrates should not be higher than the recommended norms, since they do not affect the absorption of this microelement in any way. Source: 
 On the issue of rational nutrition, correction of micronutrient status, prevention and treatment of iron deficiency in pregnant women. Tayupova I.M. Nutrition issues. 2015. №2. pp.25-32.
 There are no strict restrictions, a reasonable approach is needed. For example, sugar can be replaced with honey, and muffins with desserts from fruits and berries.
 It is important that liquid meals are included in the diet. Various sauces, soups, broths stimulate the synthesis of gastric juice, which improves digestion. It is necessary to observe the drinking regimen. It is recommended to drink at least 1.5-2 liters of fluid per day. Purified ferrous mineral water without gas is best. But strong, tea, coffee, sweet soda is better to exclude from the diet.
 What foods can be eaten with anemia 
 The list of allowed foods for this pathological condition of the body is as follows:
 eggs;
 lean meats and poultry;
 marine lean fish;
 oatmeal, buckwheat barley, millet porridge;
 sturgeon caviar;
 fresh fruits and berries;
 stale bread;
 vegetables, herbs.
 In addition, products that improve the quality of blood in patients include legumes, cottage cheese, yeast, durum wheat pasta, fig. Dark honey, which is half fructose, is extremely useful for this disease. Source: 
 The effectiveness of iron deficiency anemia treatment programs. Mandelbaum A.Ya. Abstract dissertations of Cand. Sciences. 2009.. This list of iron-containing products for anemia can be supplemented if necessary.
 It is extremely important that a sufficient amount of vitamins enter the body with food:
 vitamin C – improves the quality of iron, accelerates its absorption, found in large quantities in citrus crops, black currants, bell peppers;
 vitamin B12 – the most important trace element, the lack of which can lead to the development of anemia, is found in honey, brewer’s yeast;
 folic acid – found in lettuce, citrus fruits, yeast, liver, nuts, fish, meat;
 vitamin B6 – helps to increase the level of hemoglobin in the body, found in nuts, fish, meat, legumes.
 A minimum of 20 milligrams of iron should be ingested daily by the patient through food. For better absorption of this trace element, it is necessary to combine the above products with vitamin C intake. For example, meat with freshly squeezed orange juice, porridge with pomegranate, and so on.
 Unwanted products 
 The prohibited list includes products that interfere with the absorption of iron:
 strong black tea, coffee;
 milk;
 fresh rich bread;
 cakes;
 chocolate;
 fast food, smoked, fatty, salty, spicy, spicy food.
 It is recommended to temporarily exclude pork from the diet. You don’t have to give up dairy products completely. The main thing is not to combine them with foods that have a lot of iron, since milk greatly impairs the absorption of this trace element into the blood.
 Many pregnant women experience low blood pressure. To raise it, some of them drink strong coffee in the morning. It is important to understand that this does not benefit the body. Moreover, all drinks that contain caffeine block the absorption of iron in the small intestine. Therefore, it is better to refuse coffee during the treatment of anemia. It can be replaced with fruit drinks and compotes from fresh berries, which are not only very tasty, but also healthy, as they contain many vitamins and microelements.
 Recommendations of doctors 
 There are recommendations for different age groups and patients with serious illnesses:
 1. Nutrition for children. For babies, the best option would be to breastfeed as long as possible. Mother’s milk contains relatively little iron, but it is very well absorbed by the child’s body due to the presence of a special protein called lactoferrin.
 Many parents at the time of the start of complementary foods or when fully artificial feeding use regular dairy and sour-milk products from the store that are not adapted for the baby. This leads to the development of internal microbleeding and, as a result, the development of anemia.
 If a child is fully artificially fed (especially preterm, born with low birth weight), then he has an increased risk of developing this pathology. It is recommended that such children be given only special mixtures enriched with iron.
 Older children should receive the following amount of iron from food daily:
 1-3 years – 1 mg/kg;
 4-10 years – 10 mg;
 over 11 years – 18 mg.
 It is especially important that girls have enough iron during puberty. This is due to the appearance of menstruation, as well as the unreasonable desire to lose weight, which often occurs in adolescents. The task of parents is to control the nutrition of the child and include all the necessary products in the list. In addition, you can take iron supplements in prophylactic doses (as directed by your doctor).
 2. Nutrition of pregnant women. During pregnancy, the development of the disease is usually associated with a deficiency of vitamins and iron. The woman’s body gives a lot of useful substances to the fetus, so it needs to get more iron and vitamins from food. It is recommended to include fresh fruits, berries, low-fat varieties of fish and meat, eggs, liver, buckwheat in the diet.
 3. Nutrition for the elderly. In this age group, the diet is adjusted taking into account the characteristic symptoms, age, general health, and lifestyle of the patient. If there are problems with the integrity of the dentition, then products containing iron can be consumed in a pureed form. As a rule, the level of hemoglobin in adults becomes good and approaches normal after 3 months. However, there is no need to relax after that. It is recommended to use iron preparations for a few more months to fully restore the reserves of this trace element in the body.
 4. Nutrition for patients with diabetes. This pathological condition disrupts the functioning of the kidneys, which, among other functions, synthesize the hormone erythropoietin. It is needed for the synthesis of red blood cells. If the hormone is produced little, then the patient develops anemia and renal failure. The issue can be resolved by taking medications that contain erythropoietin. However, the mode and quality of nutrition are also important. The patient must be on a strict diet enriched with folic acid and iron. The menu should include persimmons, pomegranates, vegetables, legumes, juices, buckwheat porridge.
 How to make a correct diet 
 Experts recommend to eat fractionally (5 times a day, little by little). Here are the main tips:
 you should never skip breakfast – you can eat chicken liver, buckwheat porridge, fresh vegetable salads and wash it all down with berry compote, cranberry juice;
 as a first snack, you can use nuts, apples, boiled eggs, dried fruits;
 at lunch you should definitely eat soup, a meat dish, a fruit salad is perfect as a dessert;
 for an afternoon snack you can eat honey with low-fat cottage cheese;
 dinner should be healthy and low in calories.
 When compiling a daily menu, the ratio of carbohydrates, fats and proteins must be taken into account. Dishes must be combined so that the body must receive folic acid, iron, vitamins B, C. In addition, the diet should have enough fiber. Source: 
 Treatment and recommendations for therapeutic nutrition for patients with iron deficiency anemia. Gubasheva S. West Kazakhstan Medical Journal. 2012. №3. p.102. This will help the digestive system, cleanse the body of toxins, and accelerate the absorption of iron.
 Sample menu for the day 
 In the diet for iron deficiency anemia, it is necessary to include foods that contain a lot of iron, and also help this trace element to be absorbed by the body.
 Below is a sample menu for the day:
  Breakfast  
 High iron cereal, freshly squeezed orange juice. The use of coffee and strong black tea should be limited, at least until the end of the course of treatment.
  Lunch  
 Beef chops with mashed potatoes, vegetable stew or bean porridge. You can drink everything with dried fruit compote.
  Dinner  
 Seafood or meat, leafy vegetables.
 Peculiarities of therapeutic nutrition of patients with anemia in penitentiary institutions. Napris Zh.S., Egorushkina Yu.S., Chugunova G.N. Nutrition issues. 2019. No. 6. p.73-78
 On the issue of rational nutrition, correction of micronutrient status, prevention and treatment of iron deficiency in pregnant women. Tayupova I.M. Nutrition issues. 2015. №2. p.25-32
 Effectiveness of iron deficiency anemia treatment programs. Mandelbaum A.Ya. Abstract dissertations of Cand. Sciences. 2009.
 Treatment and recommendations for therapeutic nutrition for patients with iron deficiency anemia. Gubasheva S. West Kazakhstan Medical Journal. 2012. №3. p.102
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 Appendicitis is an acute inflammation of the appendix of the caecum.