A High Protein-High Fat Breakfast Can Help Reduce A1C

As is the case for most people, for those with type 2 diabetes, breakfast arguably is the most important meal of the day. Research suggests starting the day with a substantial meal that’s relatively high in fat and protein and low in carbohydrates can help to improve blood sugar control throughout the day and aid in weight loss.

Donald Iain Smith / Getty Images 

In one randomized study, participants ate either a small, high-carb breakfast or a larger, high protein/high fat breakfast for three months that provided about 33% of total daily calories. The people who ate the high protein/high fat breakfast had greater reductions in hemoglobin A1C (a measure of blood glucose levels over three months) as well as in systolic blood pressure than those who ate high carb breakfasts

What’s more, nearly all of the people with type 2 diabetes who were overweight who were in the big-breakfast group were able to reduce their reliance on medications. Both groups lost about the same amount of weight (<1kg).

What Can We Make of This?

While the group who ate the larger, lower carbohydrate, higher protein/higher fat breakfast achieved lower blood pressure and reduced their reliance on medications, it wasn’t because they lost more weight.

One possible reason their blood sugars improved is that blood sugars tend to be higher in the morning and, if you eat a large carbohydrate meal when your blood sugar is already elevated, blood sugars can remain high throughout the day. The liver produces sugar in the evening when you’re in a fasting state. Some people wake up with a higher morning blood sugar—this is called the dawn phenomenon. Also, people tend to be more insulin resistant in the morning; insulin is less effective at bringing sugar to the cells to use for energy.

Eating a lower carbohydrate meal means less sugar entering the bloodstream and less insulin needed. The end result is better blood sugars.  Last, eating a high carbohydrate breakfast such as a bagel, or large bowl of cereal may actually cause more carbohydrate cravings throughout the day, resulting in higher blood sugars. These types of foods cause blood sugars to spike at a quick rate. The aftermath is a drop in blood sugars which can cause cravings.

Applying These Findings

It is hard to generalize when it comes to diabetes, but a lower carbohydrate, higher protein meal for breakfast is likely to be beneficial. It can help with morning insulin resistance and reduce cravings throughout the day. However, a lower carbohydrate meal does not mean no carbohydrates. You don’t want to avoid carbohydrates altogether, rather aim to eat about 30 grams of healthy-source carbohydrates for breakfast. As opposed to eating a high-fat breakfast, aim to eat modified fat especially if you are trying to lose weight. Fat is an important nutrient but has more than double the calories per gram than carbohydrate and protein.  

What Kind of Carbohydrates Should I Eat?

Complex carbohydrates that are rich in fiber and minimally processed are your best choices – particularly for breakfast. Fiber helps to slow the rate at which glucose enters the bloodstream, which can help to achieve good blood sugar control. Fibrous foods keep you full and can aid in reducing bad cholesterol. Carbohydrates rich in fiber include fruits, vegetables, legumes (beans), and whole grains. The American Heart Association says that a diet rich in whole grains can help to reduce the risk of heart disease.

Examples of High Protein, High Fiber, 30-gram Carbohydrate Breakfast:

Below are some examples of ideal breakfast options for people with diabetes, but be sure to consult with your Registered Dietitian or Physician before starting any new meal plan as individual needs do vary:

• 3 scrambled egg whites + 1 whole egg, with ½ cup cooked spinach, ¼ cup shredded low-fat cheese and 2 slices of whole grain bread (100% whole wheat, rye or oat bread)
• 1 non-fat Greek yogurt mixed with ½ cup low-fat cottage cheese, ¾ cup blueberries, and 2 Tbsp chopped almonds
• 1 whole grain English muffin with 2 Tbsp peanut butter and a few sliced strawberries, 2 slices low-sodium turkey
• ½ cup cooked oatmeal, with ½ cup sliced peaches, with 1 Tbsp ground flaxseed meal and 2 hard boiled egg whites 

5 Ways to Lower Your Hemoglobin A1C: Southwest Family Physicians: Family Practice

What is your A1C?

Your Hemoglobin A1C level shows the average of your blood sugar over the past 3 months. Hemoglobin is a protein found in your red blood cells. Sugar gets stuck and crystallizes on the red blood cell, which then becomes known as ‘glycosylated hemoglobin’, HbA1C, or A1C.

If you have Prediabetes or Diabetes, your provider will probably have mentioned your ‘Hemoglobin A1C’ or ‘A1C’ levels.

A high A1C level reveals Prediabetes, or Diabetes – or whether your Diabetes is under control. A non-diabetic A1C level is anything less than 5.7%, 5.7%-6.4% indicates a prediabetic level, and above 6.5% is diabetic.

If your A1C indicates prediabetic or diabetic levels of sugar, you will also be at increased risk for heart disease, kidney disease, eye disorders, nerve issues, hearing impairment, and weight gain. Lowering your A1C will reduce your risk for all of these.

5 Ways To Lower Your A1C

1. Diet

The most impactful changes you can make for your blood sugar levels are dietary, specifically cutting back on or eliminating your sugar and starch consumption. If you are looking to make drastic and quick changes in your A1C levels, quitting sugar and empty carbohydrates (foods made with white flour, rice, corn, or potatoes) is your best course of action.

It can be very difficult to get rid of sweets, pasta, and bread. Place focus on replacing these foods with high-protein alternatives:

• Meats
• Eggs
• Cheese
• Nuts
• Whole Foods

In as little as 2 weeks, you will find that your sugar and starch cravings are less powerful or have evaporated completely. Your energy level should rise as well!

2. Exercise

Exercise naturally fires up your body’s insulin activity. Insulin is the hormone that helps sugar leave your bloodstream and get into your cells to energize them. If there is too much sugar in your blood, your cells will have a hard time absorbing the sugar. This is called insulin resistance and is one cause of higher A1C levels.

Good choices for exercise are:

• Walking
• Climbing stairs
• Cycling
• Swimming
• Weight-lifting

3.

Weight Loss

Studies have shown that a weight loss of 5-10% can reverse Prediabetes and even Type 2 Diabetes. Weight loss when you have extra pounds is an indication that your diet and exercise routine are coming into balance. These things will help lower your A1C as described above. A weight loss goal of even 5% will help make a difference in your A1C level.

4. Medication

Your provider can prescribe medications that help control blood sugar level. This is not usually a first line of defense but if your blood sugar requires medical support to stay in control, medications can help.

5. Manage stress and mental health 

When our bodies are stressed or anxious, our stress hormone – cortisol – takes over. Cortisol prepares us for fight or flight by giving us an energy boost, which in fact is a blood sugar level spike. 

While it is difficult to eliminate stress from your life, we recommend setting time aside everyday for a relaxing activity like:

• Walking
• Reading
• Meditating
• Singing
• Crafting
• Writing

Spending time doing these activities will give your cortisol levels time to drop and reset. If you make a habit of relaxing everyday, you will eventually prime your hormones for lower levels of stress and anxiety. It is not advisable to use TV to relax because most programming purposefully uses tension and fast-paced action to keep your attention, but a side effect of this is that your body stays in a high-alert, high-cortisone state while you are viewing. 

Which of these 5 solutions are you willing to take on?

One Simple Step To Naturally Lower Your A1C

Would you like one simple step to naturally lower your A1C? Everybody likes natural these days, and that’s a good thing. So here’s a completely natural way to lower your A1C, and the case could be made that it’s virtually free.

Hi I’m Toby Smithson with Diabetes Every Day. Thanks for joining me today, please remember to hit the subscribe button and sign up for my monthly newsletter at diabeteseveryday.com.

What Foods Will Lower A1C Levels?

Today we are going to talk about one simple step you can take to reduce your A1C, yes, you heard me correctly. Not only will this one change help your A1C score (I’ll tell you by how much a little later), but it will also help you with digestion, constipation, and reducing your risk of heart disease. This small change can also help with curbing your appetite which can help with weight management. Have you guessed it yet?

Yes, it’s adding more fiber to your daily eating plan. On average, we are only eating about 16 grams of fiber per day. The dietary reference intake for fiber is 14 grams per 1000 calories consumed….that’s 28 grams for the standard reference diet of 2000 calories. So, we are not getting the amount of fiber we need and missing out on all the good NATURAL health benefits.

Let’s check out some of the delicious diabetes friendly food options that will help us bump up our fiber intake and provide both soluble and insoluble fiber

Nuts and Seeds

Chia seeds: 1 ounce provides 11 grams of fiber and 12 grams of carbohydrate. Remember to check out my chia pudding recipe. It’s a win win for getting more fiber and a chocolaty treat! Chia seeds can also be added to your oatmeal, yogurt, fruit or mixed with water for an egg substitute.

Nuts, almonds… At 3 grams of fiber and 6 grams of carb per ¼ cup serving.  In a one-ounce serving, there are 3 g fiber and 5 g carb. ¼ cup pecans 3 g fiber and 4 g carb

Sunflower seeds: 3 grams of fiber and 6 grams of carb in ¾ cup serving

Flaxseed: 2 tablespoons contains 6 grams of fiber and 6 grams of carbohydrate. You can add flaxseeds to your oatmeal, yogurt, salads or vegetables.

Beans and Lentils

Beans: black beans offer 5 grams fiber per ½ cup and 20 g carb and there is some great research showing that beans can often continue to give you steady blood sugar readings hours after eating the beans.

½ cup lima beans contain 5 grams of fiber and 22 grams of carb. Limas can be served as a side dish or in soups and stews

Lentils: in a ¼ cup serving uncooked there are 10 grams of fiber and 30 grams of carb. You can eat lentils as a side dish or main dish and serve them hot or in a salad.

Fruit & Vegetables

Raspberries: 1 cup of raspberries contain 9 grams of fiber and 17 grams of carb which you can have at breakfast, lunch, dinner or as a snack.

Orange: 1 medium orange contains 3 grams of fiber and 15 grams of carb. Again, you can have a serving of fruit with any of your meals or top a salad with orange segments.

Broccoli: 3-ounce serving has 3 grams of fiber and 4 grams of carb. Fruits and vegetables are very versatile. You can fit broccoli in your breakfast omelet, eaten raw in your lunchtime salad or roasted broccoli as a side dish to your dinner meal.

Grains

Oatmeal: 1/2 cup of uncooked oatmeal has 5 grams of fiber and 30 grams of carb. I love sprinkling cinnamon and a low-calorie sweetener on my oatmeal and to post the fiber further, I’ll add almonds.

Pearled Barley- ¼  cup uncooked  has 7 grams fiber and 37 grams carbohydrate

Both oatmeal and barley are “famous” for their soluble fiber.

And even this whole wheat burger bun has 3 grams of fiber at 22 grams carbohydrate

Including foods that are high in fiber has always been a message I’ve given in my role as a registered dietitian. And research continues to show benefits. Studies have consistently shown reductions of A1C by more than one-half of one percent, and a recent analysis of many studies finds significant benefits by increasing average fiber consumption by 15 grams per day to A1C, fasting blood glucose, insulin resistance, total cholesterol, “bad” LDL cholesterol, triglycerides, body weight and measures of general inflammation.

 Little changes- BIG results

You may also enjoy: 1% Reduction in A1C- A “Big Deal”

How To Lower A1c Through A Better Lifestyle: 4 Effective Tips

Are you tired of seeing high A1c levels?

Don’t worry, you’re not alone. Many people with diabetes struggle to control their A1c levels.

The good news is, there are some great methods you can utilize to lower your levels, as long as you consistently abide by them.

To help you return your A1c levels to where you want them, here are 4 effective tips for doing just that.

Eating a Balanced Diet With Good Portion Sizes

Being mindful of the food you’re consuming is very important for lowering A1c levels. For the best advice on what to eat, speak with your doctor or dietitian about a food plan that is right for you.

It’s okay to eat plenty of nonstarchy vegetables, but it’s important to always pay close attention to serving sizes for foods like fruit, bread, potatoes, and other starches, as well as complex carbohydrates and lean proteins. Using smaller plates can help ensure that you’re not going overboard on serving sizes for those foods.

Processed foods should be avoided if possible, as well as sodas and fruit juice that have a lot of sugar.

Use Rebel + Mina For Healthy Diabetes Management

Rebel + Mina is one of the most innovative diabetes management solutions on the market today.

Rebel combines traditional test kits with the need for portability, as it easily attaches to your phone. Mina, your own personal digital assistant, will remind you to check your glucose levels, get exercise, and more.

And the results speak for themselves, both in terms of overall diabetes management and lowering A1c levels:

“Last December my A1c was 6.7, but now that I am testing 3 times a day with Rebel and watching my carbs and making sure I take my medication, I am at 6.5. Thank you for this wonderful product. I absolutely love it on my phone.” – Diane W – Saint Paul, MN

To help control your A1c levels, contact your employer to see if they offer Pops Diabetes’ Rebel + Mina digital diabetes care solution. If they don’t, you can have them reach out to us directly, or hand them this card to get the ball rolling!

Get the Recommended Amount of Exercise

Regular exercise and movement are essential for everyone. But, it is especially important for people who are looking to control their diabetes.

You’ve likely heard that 30 minutes of exercise five days a week is the minimum, but getting a little more than that is a good idea if you want to decrease your A1c level. The good news is, your 30 minutes each day can take the form of really anything that involves movement. A walk in the park, a bike ride, yoga, playing frisbee or catch with a friend, and running are all great ways to get your minutes in.

Downloading a health and fitness app is a great way to make sure you’re hitting your weekly goal (and there are a lot of great free apps out there too!).

Stick to a Meal Schedule That Works For You

In addition to discussing the types of foods you should be eating, speaking with a nutritionist, doctor, or diabetes dietician about when to eat is also wise. Because every person is different, what works for someone else might not work for you. Therefore, it’s important to speak with a professional as opposed to looking for the perfect schedule online.

How to Lower A1c FAQs

How can I get my A1c down quickly?

There is no surefire way to get your A1c down fast. That being said, aerobic exercise and resistance weight training can help drop your blood sugar levels more quickly after you eat. This is because exercise promotes your muscles to take up sugar from your bloodstream. As you make exercise a regular habit, you’ll see a downward trend in your A1c numbers.

What foods can I eat to lower my A1C?

As we mentioned before, always consult with your doctor or dietician about your diet and what you should be putting into your body to lower your A1c.

Here are some of the foods you can expect them to recommend working into your diet, all of which have shown the ability to help people with diabetes control their blood sugar levels:

• Broccoli and broccoli sprouts
• Seafood
• Pumpkin and pumpkin seeds
• Nuts and nut butter
• Okra
• Flax seeds
• Beans and lentils
• Kimchi and sauerkraut
• Chia seeds
• Kale
• Berries
• Avocados
• Oats and oat bran
• Citrus fruits
• Kefir and yogurt
• Eggs
• Apples

How long does it take for your A1c to go down?

Because your A1c is a reading of your blood sugar levels over 3-4 months, it will take time to bring your A1c levels down. To get a better idea of how fast you can lower your A1c—given that you are following your doctor’s instructions—check out this video from Dr. Sten Ekberg. He breaks down in detail the different variables that go into lowering your A1c and how different people can expect different results.

What is the best medicine to lower A1C?

There are many medications out there that can help you lower your blood sugar and A1c over time. The American Diabetes Association recommends the following oral medications for lowering blood sugar:

• Alpha-glucosidase inhibitors
• Biguanides
• Bile Acid Sequestrants
• Dopamine-2 Agonists
• DPP-4 inhibitors
• Meglitinides
• SGLT2 Inhibitors
• Sulfonylureas
• TZDs 

Read more about these medications, how they work, and some potential side effects here.

In General, What is a Normal Blood Sugar Level?

A person without diabetes will have an A1C test below 5.7%, a fasting blood glucose test less than 100 mg/dl, and a glucose tolerance test of 140 mg/dl or below (according to Diabetes Action)

What is a Normal Blood Sugar Reading 1 Hour After Eating?

Typically, the highest blood sugar level reading you’ll have is 1 hour after a meal (particularly if carbohydrates are consumed). Two hours after a meal, protein begins to break down into blood sugar which could again increase blood sugar. Even after a large meal, your blood should not go over 140. (according to Diabetes Action). Your goals for blood sugar readings will vary depending on your body and type of diabetes. For this reason, these numbers should only be considered as general guidelines. To figure out what your optimal blood sugar reading should be, at various times of the day, speak with your doctor.

Good luck with lowering your A1c levels! And remember, consistency in all of these tips is the key to success!

Blood Sugar and Exercise | ADA

There are a few ways that exercise lowers blood sugar:

• Insulin sensitivity is increased, so your muscle cells are better able to use any available insulin to take up glucose during and after activity.
• When your muscles contract during activity, your cells are able to take up glucose and use it for energy whether insulin is available or not.

This is how exercise can help lower blood sugar in the short term. And when you are active on a regular basis, it can also lower your A1C.

Understanding Your Blood Sugar and Exercise

The effect physical activity has on your blood sugar will vary depending on how long you are active and many other factors.  Physical activity can lower your blood sugar up to 24 hours or more after your workout by making your body more sensitive to insulin.

Become familiar with how your blood sugar responds to exercise. Checking your blood sugar level more often before and after exercise can help you see the benefits of activity. You also can use the results of your blood sugar checks to see how your body reacts to different activities. Understanding these patterns can help you prevent your blood sugar from going too high or too low.

Hypoglycemia and Physical Activity

People taking insulin or insulin secretagogues (oral diabetes pills that cause your pancreas to make more insulin) are at risk for hypoglycemia if insulin dose or carbohydrate intake is not adjusted with exercise. Checking your blood sugar before doing any physical activity is important to prevent hypoglycemia (low blood sugar).  Talk to your diabetes care team (doctor, nurse, dietitian or pharmacist) to find out if you are at risk for hypoglycemia.

If you experience hypoglycemia during or after exercise, treat it immediately:

Follow the 15-15 rule:

1. Check your blood sugar.

2. If your reading is 100 mg/dL or lower, have 15-20 grams of carbohydrate to raise your blood sugar. This may be:

•     4 glucose tablets (4 grams per tablet), or
•     1 glucose gel tube (15 grams per gel tube), or
•     4 ounces (1/2 cup) of juice or regular soda (not diet), or
•     1 tablespoon of sugar or honey

3. Check your blood sugar again after 15 minutes. If it is still below 100 mg/dL, have another serving of 15 grams of carbohydrate.

4. Repeat these steps every 15 minutes until your blood sugar is at least 100 mg/dL.

If you want to continue your workout, you will usually need to take a break to treat your low blood sugar. Check to make sure your blood sugar has come back up above 100 mg/dl before starting to exercise again.

Keep in mind that low blood sugar can occur during or long after physical activity. It is more likely to occur if you:

• Take insulin or an insulin secretagogue
• Skip meals 
• Exercise for a long time
• Exercise strenuously

If hypoglycemia interferes with your exercise routine, talk to your healthcare provider about the best treatment plan for you. Your provider may suggest eating a small snack before you exercise or they may make an adjustment to your medication(s). For people engaging in long duration exercise, a combination of these two regimen changes may be necessary to prevent hypoglycemia during and after exercise.

One Drop | How to Treat Diabetes Without Medication

Working to reduce your HbA1c (A1C) is not simple, but it’s extremely worth your while! A lower A1C means a healthier you. And, what it really comes down to, is improving your sensitivity to insulin, and reducing your body’s overall insulin resistance.

The more sensitive you become to the insulin your body naturally produces, the more easily your body will maintain safe, healthy blood sugar levels without taking additional medications.

*Do keep in mind when trying to lower your HbA1C as a person with type 2 diabetes that some people simply will need the help of oral or injectable medications. Keep reading for red flags that indicate it’s time to consider taking diabetes medications.

1. Keep a simple food diary for 5 days. 📒

The first step to improving your nutrition in an effort to improve your blood sugars is to be honest about what your current eating habits look like.

How many of the items in your grocery cart are simple, real, whole foods vs. processed snacks and meal items? (Hint: even that “whole grain” commercial bread counts as a processed starchy carb.)

When you write down the exact foods you eat every day for 5 days, take a look and assess:

❓ How many times a day am I eating fresh vegetables and fruits?

❓ How many times a day am I eating items containing sugar? (Remember, even “healthy” products can have tons of added sugar. Like yogurt!)

2. Eat more plants! 🌱 And fewer processed carbs.

This certainly isn’t the first time you’ve read that eating more vegetables is good for the human body. But when it comes to managing type 2 diabetes, it’s crucial.

Now that you’ve had a chance to look at what you’ve been eating in your food diary, it’s time to choose one meal and one snack of the day to improve.

Maybe you’re swapping your Starbucks’ sugar-laden coffee beverage and sugar-laden muffin for two eggs and an apple.

Ditch the sugar-loaded Nutrigrain bar for a homemade flaxseed muffin in a mug! Swap the processed, flavored oatmeal package for a serving of whole oats with a sprinkle of cinnamon and a handful of blueberries.

Like Dr. Jody says, that Starbucks zucchini bread is just a cupcake without the frosting. That latte, it’s loaded with sugar!

And whoa, if you’re still eating cereal for breakfast (even the “healthy” ones, like Kashi or Raisin Bran), then you’re definitely consuming loads of processed carbs and sugar. Ditch the cereal! Instead, find yourself a spoonful of peanut butter with your choice of fruit. 🍓

3. Get moving, but start small. 🚶‍♂️

If you haven’t been exercising at all, remember to start small. (Puttering around the yard doesn’t count.)

Even just one 15-minute walk after lunch or dinner 5 days a week will do your blood sugars and your body wonders. 🌈 Especially after meals. Because, while your body is digesting what you just ate, you’re counteracting any glucose spikes with walking! Really, that’s all it takes. Just 15 minutes.

When you find yourself thinking, “But I’m too tired for a walk! I just wanna sit and watch Jeopardy!” That’s OK, too! Just stand up, and walk in place while watching your favorite show. It’s just 15 minutes.

And everyone has to start somewhere! I guarantee you’ll feel so good afterward that it’ll make you look forward to the next one.

4. Remember to include treats. Yes, include!

Yes, you read that correctly: include some of the foods you love. A plan based on disciplined perfection, seven days a week, every waking hour is simply doomed for failure.

After you’ve had time to look at just how often you’re consuming sugar-laden foods, then decide what your most valued treat might be. For some, it’s fresh bread and butter. 🥖 For others, it’s a bowl of ice cream.

You might need to start with a once-daily bowl of ice cream while aiming to keep the rest of the day full of healthier choices. Or you might be ready to have your treat every other day, instead.

Think about what’s realistic for you, at this point in time, so you can stick to the bigger picture. Improving your A1C does not require perfection. It just calls for improvements in your overall approach to nutrition.

5. If At First You Don’t Succeed…

Remember, nobody changes everything about how they eat and exercise overnight!

Evolving your relationship with food and exercise, and your entire body, takes a time.

If you give yourself the time and freedom to explore, be curious, and have fun with learning about new ways of eating and cooking and exercising, you might even find yourself having fun! In fact, you might love it. View it as a long-term evolving experiment rather than an upcoming deadline. 🕐

You’ve tried all of the above (like, really tried), and you’re still not seeing the results you want. At that point, it may be time to add some medications into the mix.

Here are the need-to-know-signs: “The first sign of needing to start a medication to help lower your blood sugars,” explains Jody Stanislaw, ND, CDE, “is an elevated A1c level — over 6.5 percent — that is not responding well to your efforts to eat a healthier diet, eat fewer carbs, exercise more, and lose weight. If those four things aren’t lowering your blood sugars over the course of three to six months, it’s time to talk about an oral medication like metformin.”

Dr. Stanislaw, a diabetes coach and creator of diabetes training courses has lived with type 1 diabetes since childhood. “Starting insulin early in your diagnosis of type 2 diabetes can help some patients actually improve their own insulin production by increasing your body’s natural beta cell function,” adds Dr. Stanislaw.

This isn’t guaranteed to be effective in everyone, but it’s a worthwhile reason to let go of your fears of starting insulin early.

“The goal is to get into as healthy of blood sugar control as possible, as soon as possible,” says Dr. Stanislaw.

“High blood sugars create damage throughout the body, especially to the precious beta cells — the cells that make insulin. People should be more fearful of high blood sugars than insulin injections.”

Having to begin insulin injections is often seen as a permanent path, but Dr. Stanislaw explains that it’s simply a powerful tool to help get blood sugars immediately into a healthier range, while continuing to make improvements in your lifestyle like nutrition, exercise, and weight-loss.

Eventually, a patient who has adopted those healthier lifestyle habits will reduce their need for insulin. Not only will they improve their insulin sensitivity, but they’ll also ideally be able to stop taking insulin altogether.

The real goal is to prevent the development of those long-term complications. “If complications are developing,” explains Dr. Stanislaw, “especially if you’ve already started taking a drug like metformin, that’s a big sign that it’s time to consider starting insulin. Especially if your non-insulin medications aren’t keeping your fasting blood sugar below 90 mg/dL, and your A1c is over 6.5 percent.”

What an A1C test can tell your doctor and tips for eating better

The combination of a healthy diet, exercise and medication can bring your blood sugar levels down.

More than 34 million Americans live with diabetes. That’s more than 10% of the population. Many more are unaware that they are at high risk for developing diabetes.

You are more likely to develop Type 2 diabetes (the most common type) if you are age 45 or older, have a family history of diabetes or are overweight. Physical inactivity, race and certain health problems such as high blood pressure also affect your chance of developing the disease. Over time, diabetes can cause problems with your heart, kidneys, eyes, teeth and feet.

The symptoms of diabetes can include:

• Overactive bladder and/or urinary tract infections
• Extreme hunger or thirst
• Feeling tired for no reason
• Losing weight for no reason
• Having cuts or bruises that are slow to heal
• Having trouble seeing (blurry vision)
• Losing feeling or having tingling in your hands or feet

The A1C test is a common blood test used to diagnose Type 1 and Type 2 diabetes and to monitor how well you’re managing your diabetes. It reflects your average blood sugar level for the past two or three months.

Specifically, it measures what percentage of your hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar. The higher your A1C level, the poorer your blood sugar control and the higher your risk of diabetes complications.

The results can help your doctor:

• Identify prediabetes, which may lead to a higher risk of developing diabetes and cardiovascular disease;
• Diagnose Type 1 and Type 2 diabetes; and
• Monitor your diabetes treatment plan and adjust your diabetes medicine if necessary.

If you have diabetes, A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar levels change throughout the day. If you’re reaching your A1C goal but having symptoms of high or low blood sugar, check your blood sugar often and at different times of the day.

A combination of diet, exercise and medication can bring your levels down. Here are some healthy eating habits worth developing:

• Eat a variety of foods from each food group every day.
• Make half your plate fruits and vegetables. Include more non-starchy vegetables such as leafy greens, asparagus, carrots and broccoli, and more whole fruit than juice.
• Choose whole-grain carbohydrates such as brown rice, buckwheat, oatmeal and whole-wheat bread.
• Limit foods that are high in added sugar.
• Eat less fat. Choose lean meats, poultry and fish. Bake, broil, roast, grill, boil, or steam foods instead of frying. Also choose low-fat or fat-free dairy products.
• Cut the salt. Use more pepper and herbs for seasoning.
• Avoid skipping meals.
• Watch portion sizes and read food labels.

Sources:
“Diabetes symptoms.” cdc.gov, Centers for Disease Control and Prevention, 27 April, 2021.
“All about your A1C.” www.cdc.gov, Centers for Disease Control and Prevention, 21 August 2018.
“Eating right with diabetes.” www.eatright.org, Academy of Nutrition and Dietetics, February 2019.
“National diabetes statistics report” www.cdc.gov, Centers for Disease Control and Prevention, 11 February 2020.

90,000 5 Ways to Reduce A1C Level 2021

Getting at least 30 minutes of exercise each day can help improve your daily blood sugar and lower your A1C images Getty

For some, blood sugar can be an important and useful tool for managing blood sugar on a daily basis … However, it only provides an instant snapshot of what is happening in the moment, not long-term information, says Gregory Dodell, M.D., assistant clinical professor of medicine, endocrinology, diabetes and bone disease at Mount Sinai Healthcare in New York. …

For this reason, your doctor may sometimes order a blood test that measures your average blood sugar level over the past two to three months. The A1C test, or the A1C hemoglobin test, is called, this gives a more accurate indication of how well your type 2 diabetes management plan is working.

Taking the A1C test

If your diabetes is well controlled and your blood sugar levels remain stable, the American Diabetes Association recommends that you take the A1C test twice a year.This simple blood test can be done at your doctor’s office.

Some doctors may use the A1C point of view test, where a finger can be made for fingers in the office and the results are available in about 10 minutes. A1C test results give you an idea of ​​how your treatment plan is working and how it can be modified to better control your condition. Your doctor may not be tested more often than every three months if your A1C is not within your target range.

What does A1C

results mean

The A1C test measures the glucose (blood sugar) in the blood by assessing the amount of what is called glycated hemoglobin.“Hemoglobin is a protein in red blood cells. When glucose enters the bloodstream, it binds to hemoglobin or glitates. The more glucose enters the bloodstream, the higher the amount of glycated hemoglobin, ”says Dr. Dodell.

A1C levels below 5.7% are considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes. Type 2 diabetes is diagnosed when the A1C exceeds 6.5 percent. For many people with type 2 diabetes, the goal is to lower their A1C levels to a healthier percentage.

Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced your diabetes is, and any other health conditions. The overall A1C goal for people with diabetes is less than 7 percent, Dodell says. If you can keep your A1C number below your goal, you can help reduce your risk of diabetes complications such as nerve damage and eye problems.

Tips for lower level A1C

Your A1C score is an important part of your diabetes control picture, Dodell says, but it’s not the only indicator of your health.Someone with large swings in blood sugar (which is more common in patients taking insulin) may have an A1C target because the average is good. But daily fluctuations can reduce quality of life and increase the risk of complications, he says.

Diabetes can be challenging to manage, Dodell says. He tells his patients to view diabetes management as a job. It takes work, but the time and effort you put into it can lead to good control and an improved quality of life.“The key to achieving the A1C goal is to follow a healthy lifestyle,” he says.

Making these healthy changes can help you improve your daily blood sugar management and lower your A1C levels:

1. Move more. Try to get at least 30 minutes of exercise five days a week. Dodell says this shouldn’t be a formal exercise. Find something you like to get your body moving – take your dog for a walk, play sports with a friend, or ride a stationary bike indoors or on a regular bike outdoors.

2. Eat a balanced diet with the correct portion sizes. You can load vegetables without glaucoma, but remember that serving sizes should be considered when eating fruits, lean proteins, fats and complex carbohydrates such as bread, potatoes and other starches. Using a salad plate instead of a full-sized dinner plate can help prevent overeating. Avoid processed foods as much as possible, and don’t say no to sugary sodas and fruit juices.A diabetes educator or nutritionist can help if you are unsure about a good diabetes diet.

3. Stick to a schedule. Skipping meals, allowing too much time to pass between meals, or too much or too often, can lead to a drop in blood sugar and an increase in too much. Your doctor can help you determine the best meal schedule for your lifestyle.

4. Follow your treatment plan. Diabetes care is highly individualized.Your doctor can help you determine the steps you need to take to successfully manage your diabetes. Always talk to your doctor before making any changes.

5. Check your blood sugar as directed. Work with your doctor to determine if and how often you should have your blood sugar checked.

Understanding your A1C level is an important part of your overall diabetes. If you have any questions about your A1C levels or what they mean, do not hesitate to ask your doctor.

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Diabetic ketoacidosis (DKA): an overview and more – Health

Diabetic ketoacidosis (DKA) is a dangerous acute condition characterized by hyperglycemia, increased ketone bodies and metabolic acidosis.DKA occurs when your body is devoid of glitch

Contents

Diabetic ketoacidosis (DKA) is a dangerous acute condition characterized by hyperglycemia, an increased content of ketone bodies and metabolic acidosis. DKA occurs when your body is deprived of glucose for energy and is forced to rely on ketones instead. This happens when the body doesn’t have enough insulin to transport sugar to cells for energy.

Elevated levels of ketones can be toxic to the body because they make the blood acidic. In children and adolescents, DKA is the most serious acute complication of type 1 diabetes, usually leading to hospitalization and associated with a mortality rate of 0.15–0.3%.

DKA can occur in anyone with diabetes, although it is less common in people with type 2 diabetes. Knowing the signs and symptoms of DKA can save lives without treatment, DKA can lead to cerebral edema, brain damage, coma, and even death.

Symptoms of Diabetic Ketoacidosis

Anyone with diabetes should study the symptoms of DKA, especially people who are newly diagnosed with type 1 diabetes. The development of DKA is a warning sign that your blood sugar is too high or that you are ill.

It usually starts slowly, but when vomiting occurs, it can progress quickly and become a life-threatening condition. Symptoms can range from mild to severe.

Early symptoms include general symptoms of hyperglycemia:

• High glucose, blood sugar above 240 milligrams per deciliter (mg / dL)
• Thirsty or very dry mouth
• Frequent urination
• Ketones in urine, which may be mild, moderate, or severe

Later symptoms include:

• Weight loss is often accompanied by severe hunger.
• Feeling very tired
• Feeling confused or distracted
• Dry or reddened skin
• Nausea, vomiting or abdominal pain (especially in children)
  (Vomiting can be caused not only by ketoacidosis, but also by other diseases. If vomiting is accompanied by other symptoms or lasts a long time, see your doctor as soon as possible).
• Kussmaul Breathing: Rapid, shallow breathing or sighing that occurs when the body tries to rid itself of ketones.
• Fruity breath from exhaled acetone

Causes

Diabetic ketoacidosis occurs when there is little or no insulin in the body. Without insulin, the body cannot use glucose for energy or fuel and must rely on fat (ketones).

It can happen to people with type 1 diabetes when insulin doses do not meet metabolic needs during times of stress such as pneumonia, trauma, or pancreatitis. It can also be due to insufficient insulin dosing, improper use of insulin pumps, or, in some cases, pump malfunction.

Audrey Koltun, Registered Dietitian / Nutritionist at Cohen’s Children’s Medical Center, Department of Pediatric Endocrinology, says, “Many of our type 1 diabetes patients suffer from DKA due to inadequate dosage of insulin.

“This can happen when they are not taking insulin, when they are eating carbs, or when they do not check their blood sugar and refuse to give insulin when the blood sugar does not reach the target value (this is called correction), or both, and other.

“If people already have elevated hemoglobin A1c levels and they develop colds, flu, gastroenteritis, infection or injury, etc., they may switch to DKA due to stress.”

Koltun also says, “If someone with type 1 diabetes eats an excessive amount of carbohydrates but takes insulin for them, DKA usually does not occur.Although their blood sugar may not be on target because they are taking insulin, they do not have DKA. “

Many people with type 1 diabetes use an insulin pump to control their blood sugar. Insulin pumps are devices that continuously deliver a small amount of insulin throughout the day, as well as more insulin to cover carbs.

A small cannula is inserted under the skin and the person with diabetes can set target blood sugar and insulin levels. Some people with diabetes prefer pumps because it frees them from multiple daily injections and allows them to better control their blood sugar.

One of the concerns about initiating pump therapy is that pumps could fail and increase the risk of DKA. Koltun says, “DKA due to pump failure does occur, but not as often as DKA due to lack of insulin. For example, some people stop taking insulin when they are sick because many people eat little or cannot eat.This is something you should never do. “

There are other reasons why people with diabetes who use an insulin pump may have DKA. For example, Koltun notes that if someone uses an insulin pump and is alerted to

Other pump malfunctions may include: “Low battery, accidental disconnection from infusion set or container, leaking infusion set or container, or forgetting to reconnect to pump after shutdown, ”warns Koltun.

To prevent these types of complications, the standard procedure for starting an insulin pump involves intensive training, and people using an insulin pump should have access to their healthcare team or instructors whenever they have questions or concerns.

People using an insulin pump should also have spare insulin. On the rare occasion that they are unable to use the pump, they must be able to inject insulin through a vial or syringe.

When a child first develops symptoms of type 1 diabetes, they may eat and drink more than usual, which causes a spike in blood sugar because they do not have insulin to compensate.

Parents may not understand why their child drinks and eats more but is losing weight, or why they wet the bed when they haven’t done so before. If these symptoms persist for a long time, they can lead to DKA. In fact, many people who are first diagnosed with diabetes are diagnosed while in DKA.

Koltun says: “It seems that after a few weeks, almost all of our newly diagnosed diabetes patients are diagnosed and hospitalized at the DKA. In 2020, almost 80% of newly diagnosed cases are DKA, which is much more than usual. ”

The good news is that understanding the warning signs of type 1 diabetes can help prevent a child from developing DKA at diagnosis.

DKA can occur in type 2 diabetes

Although DKA is less common in people with type 2 diabetes, it can occur.Hyperglycemia in type 2 diabetes was thought to only lead to a hyperosmolar hyperglycemic state (HGS) without ketosis.

However, people with type 2 diabetes can develop DKA, especially if they take insulin to control their blood sugar. Thus, people with type 2 diabetes should be aware of the signs and symptoms of DKA and how to manage ketones.

Diagnostics

Since DKA is characterized by hyperglycemia (blood sugar levels above 250 mg / dL), a plasma glucose test is required.The result usually shows that the blood sugar level is much higher than 250 mg / dL.

In fact, when your blood glucose is measured with a meter, it will often read HIGH instead of displaying a number. However, in most cases, these values ​​are measured using a blood test.

If a child is admitted to the hospital with suspected DKA, the diagnosis is confirmed by the detection of hyperketonemia (ketones in the blood) and ketones in the urine (ketonuria).

Other measures will confirm the diagnosis, eg bicarbonate levels less than 18 meq / L and pH less than 7.30.Serum electrolytes, blood urea nitrogen (BUN), creatinine and osmolarity should be measured.

Treatment

Treatment for DKA takes place in a hospital and requires correction of high blood sugar and acidosis, volume replacement and prevention of hypokalemia (low potassium).

Replenishment

The water deficit will be corrected to restore fluid that has been lost in the urine. The saline infusion will be given intravenously.Intravenous fluids will also help raise blood pressure. Depending on the degree of dehydration, fluid will flow slowly until blood pressure and urine output are stable.

Correction of hyperglycemia and acidosis

Hyperglycemia is corrected by administering a regular bolus of 0.1 unit of insulin. / Kg at the beginning followed by continuous infusion of 0.1 units. / Kg / h in 0.9% saline solution. Doctors will monitor ketone clearance as well as serum pH and bicarbonate levels.

When blood glucose falls, a small amount of dextrose is added to prevent low blood sugar. The adjustment of the insulin level continues as the person begins to eat and the blood sugar begins to stabilize.

Prevention of hypokalemia

When sugar is carried away in the urine, water, salt and potassium enter the urine. Electrolytes such as potassium play a critical role in cell function.

To prevent hypokalemia (low potassium levels), potassium replacement therapy, given intravenously, may be required.These levels will continue to be checked hourly or one hour later during the initial stages of treatment.

Other measures

Hypophosphatemia often develops during DKA treatment, but phosphorus replenishment has no clear benefit in most cases. If indicated, potassium phosphate can be administered for 6-12 hours.

If potassium phosphate is injected, serum calcium levels usually decrease and should be monitored. The acid-base balance will be corrected. Treating a co-infection, if any, is also part of the treatment regimen.

Prognosis

With timely treatment, more than 95% of patients recover from diabetic ketoacidosis. The overall mortality rate from diabetic ketoacidosis is less than 1%; however, mortality is higher in the elderly and in patients with other life-threatening illnesses. Shock or coma on admission indicates a worse prognosis.

For those people who experience recurrent episodes of DKA each year, there is an increase in mortality.Researchers have identified certain factors associated with recurrent DKA. These include lack of adherence to therapy, low socioeconomic status, substance abuse and low levels of education, and the presence of people receiving care in multiple health systems, which creates additional challenges for the continuity and coordination of care over the long term.

This study was conducted in a select population, which may not apply to all populations, but it is important to note that further research into potential interventions is needed for these types of patients.

Prevention

If you have diabetes or are caring for a child with type 1 diabetes, it is important to work with your healthcare team to plan a sick day.

Illness can cause a spike in blood sugar due to hormones released during illness, such as cortisol and adrenaline. Understanding your insulin needs during illness can help prevent high blood sugar levels that can cause ketoacidosis.

It is also important to know how to test ketones and what to do with this information, as quick action can prevent a serious situation.Safety stores such as extra insulin are another important step in preventing ketoacidosis.

All people with diabetes should have a medical alert – be it a bracelet or a necklace. In an emergency, you want people to be able to tell you that you have diabetes. Finally, always make sure you have the ability to contact the medical team at any time of the day or night.

Continuous Glucose Monitor

Blood Glucose Monitor (CGM) can help alert people with diabetes that their blood sugar levels are high or low.

Koltun says: “Most children are prescribed LMWH shortly after diagnosis. Many of the newer LMWHs can be used to replace manual finger-guided blood sugar checks, which could reduce the burden of diabetes in our pediatric population. For this reason, LMWH are the technology of diabetes that has changed the way diabetes is treated. ”

Parents of children with type 1 diabetes should use CGM with caution. Koltun warns: “It’s important to try not to get hung up on numbers.Sensor-based diabetes micromanagement can be problematic. For example, administering a corrective dose of insulin based on sensor readings before insulin can take effect can lead to hypoglycemia. ”

But CGMs can help parents worry less about blood sugar in young children, especially at night or when they are sick. Parents can set alerts so they know when their blood sugar is high or low and take action accordingly.

Test for ketones

Test for ketones is a simple, life-saving process. You can check for ketones with a urine test. You can also use a small blood sample to test for ketones.

Koltun says: “Ketone blood meters are much more accurate in detecting ketones than strips of ketones in urine. A blood ketone meter can detect ketones before they are found in urine. However, some insurance companies do not cover strips, which can be costly.Urine ketone strips are readily available over the counter and are not overly expensive. ”

When you are sick, it is recommended that you test your ketones every four to six hours, and also when your blood sugar is over 240 mg / dL. It’s also a good idea to test ketones if you have any symptoms of ketoacidosis.

Your sick day plan should provide guidance on how to handle low, medium, and high ketones. However, it is always a good idea to contact your healthcare team if you are unsure how to respond.

The American Diabetes Association recommends testing ketones when your blood glucose is over 240 once or when someone is sick. Koltun says: “For those patients who are given multiple daily injections, if their blood glucose levels exceed 250 mg / dL two or more times in a row, check for ketones. If ketones are moderate or large, drink enough sugar-free fluids and call your doctor. medical team as soon as possible. “

She notes that the protocol for insulin pump users in her office is different.For insulin pump users: “We teach our families to test ketones if their blood glucose or sensory glucose levels are above 250 mg / dL (even once) for no apparent reason. If ketones are low or small, give the correction dose through your insulin pump and recheck after an hour.

“If your blood glucose or sensor glucose does not drop, change the location of your pump. Retest your blood ketones after one to two hours. If they don’t have a ketone meter, check the ketones in their urine the next time they urinate.We recommend drinking plenty of water or unsweetened drinks like Diet Snapple or Crystal Light. ”

Koltun advises: “If blood ketones are moderate or large, drink plenty of sugar-free fluids and call our office right away for instructions on administering a ‘ketone dose’ using a syringe or insulin pen. The place of the pump will need to be changed. ”

Also, check ketones if your blood glucose is over 250 and you plan to exercise. It’s important to never exercise if you have ketones or when your blood sugar is over 240 mg / dL.Exercise when you have ketones can raise your blood sugar and ketone levels and is therefore not recommended.

Continue insulin in case of illness

Do not stop taking insulin even if you are ill and do not eat. Symptoms of a stomach virus or other disease can mimic those of DKA. Never stop taking insulin if you are sick, even if you are not eating.

During illness, the need for insulin is often increased by hormones such as cortisol.If you are unsure of how to treat diabetes while you are sick, be sure to call your healthcare team.

Teach Your Children Self-Governance

If your child is beginning to manage their diabetes on their own and are having trouble dosing insulin or controlling blood sugar, you can always make an appointment with your healthcare team for re-evaluation and training.

Make sure they understand when and how to test ketones. If they are not with you and are not feeling well, you want to feel safe knowing that

Cope

After diagnosis, most families will visit a social worker at the hospital to discuss the emotional and mental aspects of going through a DKA episode.These professionals can provide ongoing resources and support to manage not only DKA but also a type 1 diabetes diagnosis.

Since diabetes is a disease that is being tackled on a daily basis, healthcare providers are aware of the burden it can pose to diagnosed families. In addition to a social worker, children with type 1 diabetes are likely to be seen by a registered dietitian, board certified diabetes care and education specialist, and endocrinologist. This team of professionals can help guide and educate the family about diabetes.

Organizations such as the Juvenile Diabetes Research Foundation offer ways to participate in the diabetes community, such as one-to-one support, a community forum, and many additional resources and support.

DKA is not keto

Diabetic ketoacidosis is not the same as “keto” used for weight loss and the treatment of some type 2 diabetics. Unlike ketoacidosis, ketosis means that your body uses fat as fuel and can lead to the production of ketones, which peak at around 7/8 mmol / L with no pH change.

It is assumed that during ketosis these levels do not exceed these levels because the brain can use ketones as fuel instead of glucose. During ketoacidosis, the pH of the blood decreases and the amount of ketones in the blood can exceed 20 mmol / L. Ketoacidosis can become life-threatening if left untreated.

If done correctly and under supervision, some people with type 2 diabetes (unless they have kidney problems or established heart disease) can safely follow a ketogenic diet.Keep in mind that this takes a lot of work, dedication, meal planning, and supervision.

People with type 1 diabetes should not follow a ketogenic diet. Always discuss with your healthcare professional before starting any new diet.

A word from Verywell

Diabetic ketoacidosis (DKA) is a serious disease that can be life threatening if not treated in time. All people with diabetes should be aware of the warning signs of DKA so that they can strive to prevent serious side effects and prevent hospitalization.Make sure you understand your emergency plan and understand how to contact the medical team if needed.

It is also important to know when and how to check for ketones. If you or your child develops DKA due to a new diabetes diagnosis, know that you are not alone and that you will be supported and provided with the tools you need to live a healthy life with diabetes.

Remember that just because you or your child has diabetes does not mean that a cold, illness, or injury will lead them to DKA.DKA most often occurs when no insulin is given or needs are not being met.

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LR analyzer

LR parser is a parser for source codes of programs written in a programming language that reads the input stream from left to right and produces the right-most output of a context-free grammar.The term LR-parser is also used, where k expresses the number of unread preview characters in the input stream, on the basis of which decisions are made during the analysis. Usually k is equal to 1 and is often omitted. The syntax of many programming languages ​​can be defined by a grammar that is LR1 or similar, and for this reason LR parsers are often used by compilers to parse source codes. Usually, the analyzer is referred to in connection with the name of the language whose source code it parses, for example, “C ++ analyzer” parses the source codes of the C ++ language.An LR parser can be created from a context-free grammar by a program called a parser generator, or it can be written by hand by a programmer. A context free grammar is classified as LRk if there is an LRk parser for it, as determined by the parser generator. The LR parser is said to parse from the bottom up because it tries to infer the top-level production of the grammar by building it from leaves. A deterministic context-free language is a language for which some LRk grammar exists.Each LRk grammar can be automatically converted to an LR1 grammar for the same language, while an LR0 grammar for some languages ​​may not exist. LR0 languages ​​are their own subset of deterministic languages. The LR parser is based on an algorithm driven by a parse table, a data structure that contains the syntax of the parsed language. Thus, the term LR parser actually refers to a class of parsers that can parse almost any programming language for which an analysis table is provided.The parsing table is generated by the parser generator. LR analysis can be generalized as arbitrary analysis of a context-free language without sacrificing performance, even for LRk grammars. This is because most programming languages ​​can be expressed in an LRk grammar, where k is a small constant, usually 1. Note that parsing non-LRk grammars is an order of magnitude slower than cubic instead of quadratic in terms of input size. LR parsing can be applied to more languages ​​than LL parsing and is also better in the error reporting part, that is, it detects syntax errors where the input does not match the grammar as early as possible.In contrast, LLk) parsers can delay error detection until another branch of the grammar due to rollback, often making it difficult to locate the error in the places of common long prefixes. LR parsers are difficult to create by hand and are usually created by a parser generator or compiler compiler. Depending on how the parsing table was created, these parsers can be called simple LR SLR parsers, LALR preview LR parsers, or Canonical LR parsers.LALR analyzers have a significantly higher recognition power than SLR analyzers. At the same time, tables for SLR analysis have the same volume as for LALR analysis, therefore SLR analysis is no longer used.