9 Tips To Lower Your A1c Level

When you have diabetes, you probably know you should check your blood sugar regularly. Your doctor will also recommend that you take an A1c blood test a few times a year, with a goal of lowering the results to help protect your health. And there’s a lot you can do to move toward meeting that goal.

Unlike a regular blood sugar test, the A1c test measures the amount of sugar that clings to a protein, called hemoglobin, in your red blood cells. The test shows your average blood sugar levels over the past few months, so you know how well your diabetes is under control.

In general, the goal for your A1c is to be lower than 7%. Exactly how much lower will depend on your individual treatment plan. When you take steps to get your A1c in a healthy range, you lower your risk of complications such as nerve damage, eye problems, and heart disease.

Your doctor will let you know the best target for your A1c. How do you get there? Here are a few tactics to try, in addition to taking any medications your doctor prescribes.

Get some new kitchen gear. You’ll want to get a set of measuring cups and a kitchen scale if you don’t already have them. These will help you with your portion sizes. Your blood sugar will go up if you eat more food than your body needs. Keeping servings in check is a good way to reduce your A1c level.

At first, it’s a good idea to measure your food to give you an idea of what healthy portion sizes look like for different foods. That’s where the measuring cups and scale come in handy. You may be surprised at first to see what one serving looks like, especially of high-carb items like cereal, rice, and pasta. But this will help ensure you don’t eat more than you intend to.

Be carb smart. It’s true that carbohydrates affect your blood sugar more than other nutrients you eat. Chances are that if you overdo starchy carbs on a regular basis, your A1c number will start to creep up. But remember, all carbs aren’t a problem. You want ones that have a lot of fiber and nutrients, more than those that just serve up starch.

Tweak your plate. Experts advise filling about half your plate with vegetables that are low in starch, such as carrots, greens, zucchini, or tomatoes. One-quarter of your plate should be a lean protein like chicken or tofu, and the last quarter should be whole grains like brown rice or quinoa.

Make a plan. The guidelines for what to put on your plate give you a lot of flexibility. But even though it sounds simple, you’ll probably be better off if you plan your meals. Why? If you skip set menus and eat on the fly, it’s easy to end up with calorie-dense, high-carbohydrate food choices — like fast food, bagels, and frozen pizza — that will cause your blood sugar and A1c numbers to soar.

Instead, at the start of each week, pencil in a rough plan for what foods you’ll eat at each meal and what groceries you’ll need. This way, you’ll be prepared with plenty of choices that limit post-meal blood sugar spikes. A Mediterranean diet, which is low in saturated fat and high in vegetables and fruit, reliably lowers A1c numbers.

Maybe downsize your weight loss goal. Not everyone with type 2 diabetes is overweight. But if you are, you may not need to drop as much as you think to make a difference in your A1c level.

If you’re overweight, diabetes doctors will often recommend you try to lose just 5% to 10% of your current weight. Here’s why: As you shed extra pounds, the insulin in your body lowers your blood sugar levels more efficiently, which will cause your A1c levels to drop over time. In one study, people with type 2 diabetes who lost 5% to 10% of their body weight were three times as likely to lower their A1c by 0.5%.

You may have a different goal for your weight or other health considerations on your mind. Ask your doctor to help you make a weight loss plan that matches your overall goals.

Rethink your exercise plan. Other than upgrading your nutrition, exercise is one of the most important habit changes you can make to lower your A1c. But don’t just grind it out on the treadmill, or you’ll miss another effective workout: strength training.

No offense to the elliptical machine or your cycling class. You can choose whatever type of exercise you prefer as long as it’s a challenging workout. Both aerobic exercise and resistance (weight) training lower A1c levels if they’re part of a regular routine.

There’s solid science to support how much working out helps you whittle down your A1c level. Since exercise prompts your muscles to take up sugar from your bloodstream, it helps your blood sugar levels drop more quickly after you eat a meal. As you make exercise a regular habit, you’ll see a downward trend in your A1c numbers.

Never miss your meds. You can reliably lower your A1c through diet and exercise. But if your doctor has prescribed medication, such as metformin, miglitol, or insulin, it’s important to take them exactly as prescribed. If you miss doses regularly, your blood sugar numbers may creep up and cause your A1c to rise. But if you follow the medication plan that your doctor recommends and go to every appointment, your blood sugar should stay under control — and your lower A1c number will reflect that. If your goal is to cut down on, or even stop needing, your meds, tell your doctor that you want to work toward that. But don’t stop them on your own.

Be savvy about supplements. Many dietary supplements say they’ll lower your A1c. But there’s not always much research to back that up. Still, some may have promise. These include berberine, made up of extracts from a variety of plants, and coenzyme Q10 (CoQ10), an antioxidant that reduces inflammation in your body. Cinnamon may also lower A1c levels over time. As with any supplement, it’s best to check with your doctor first.

Put your plan on repeat. Stick with it and give it time. Since your A1c level reflects your average blood sugar over several months, it’s going to take that long for your A1c to drop. You won’t do everything perfectly, and that’s OK. Just keep moving in the direction you want to go in. And rest assured: Your A1c number will come down, and it’ll be worth it.

5 Ways to Lower A1C and Manage Your Blood-Sugar Levels

• To lower A1C levels, you may need to lose weight, get regular exercise, regulate your carbohydrate intake,  take insulin, or use medication like metformin. 
• A1C levels measure your blood sugar over a period of about 12 weeks and are an important indicator for people with type 1 or type 2 diabetes, as well as those at risk.
• This article was reviewed by Jason R. McKnight, MD, MS, a family-medicine physician and clinical assistant professor at Texas A&M College of Medicine.
• This story is part of Insider’s guide to Diabetes. 

An A1C test measures the amount of glucose in your blood over the previous 12 weeks. This is important because it provides a long-term measure of blood-sugar levels, which are used to diagnose and manage diabetes or prediabetes.

Those with type 1 or type 2 diabetes should have their A1C levels measured about every three months. If you’re at an increased risk, you should have A1C measured twice a year, says Dr. Charles Richardson, the CEO of Cleveland

Diabetes

Care.

Through an A1C test, early detection of elevated blood-sugar levels can help reduce the risk of health complications from diabetes, like heart disease or kidney disease. Here’s what you need to know about A1C levels and how to lower them.

What is A1C? 

A1C represents the amount of glycosylated hemoglobin in your blood. This is the amount of glucose that becomes attached to hemoglobin, a protein in red blood cells.

Over the normal 90-day life cycle of a red blood cell, glucose attaches faster in people with higher blood-sugar levels, Richardson explains. A1C measures the percentage of red blood cells that have hemoglobin that is coated with sugar, and it is an important marker of blood sugar.

Otherwise-healthy adults who are overweight — a risk factor for

type 2 diabetes

— should have their A1C measured every three years by having the doctor order blood work to test A1C. People who have no risk factors for diabetes and are not overweight do not need to check their A1C unless they or their doctor have cause for concern. 

People with diabetes should have A1C measured about every three months, and more often if they have trouble controlling their blood sugars or if they are changing diabetes treatments.

Normal A1C levels 

Your A1C levels can indicate the following: 

• Normal: 5.6% or lower 
• Prediabetes: 5.7% to 6.4% 
• Diabetes: 6.5% or higher 

If you receive a diagnosis of diabetes or prediabetes, your doctor will work with you to set an individual target for your A1C levels. Most people with diabetes have a target A1C level of less than 7%. Doctors might set a higher goal for people with other health conditions like

heart disease

.

If you have diabetes or prediabetes, lowering your A1C is important. In fact, each percentage-point decrease in A1C levels can reduce risk of long-term complications from diabetes by 40%, according to the American Diabetes Association.

Richardson says the amount considered a significant reduction varies from individual to individual, so you should work with your doctor to set a personal goal. Dropping your A1C by even half a percentage point can have significant benefits, he says.

How to lower A1C 

Your A1C levels are lowered when you reduce your average blood-glucose levels. This can be done through lifestyle changes and medication.

Related

6 ways to lower your blood sugar naturally

“With a multidisciplinary approach including optimal nutrition, implementing an exercise regimen, and diabetic medication, most patients can lower the hemoglobin A1C,” Richardson says. 

Here are a few of the most effective ways to lower your A1C levels:

1. Lose weight 

Losing weight can help you better control your blood sugars and lower your A1C levels.

A 2012 study published in the journal Diabetes Education found that losing 10% of body weight was linked to a 0.81% decrease in A1C levels for patients with type 2 diabetes.

2. Exercise regularly

“Exercising helps the body absorb glucose from the bloodstream and can help to make the body more efficient at accessing and utilizing glucose,” says Claudia Hleap, a registered dietitian based in Philadelphia who regularly works with patients to lower their A1C levels.

A 2017 study published in BMJ Open Diabetes Research and Care followed 65 patients with type 2 diabetes over eight years. One group completed 90-minute exercise sessions three times a week. Their A1C levels decreased by as much as 1.84%, and researchers concluded that people who exercised reduced their A1C more consistently than those who did not.

3. Count carbohydrates

Working with a dietitian to create an eating plan can help you lower A1C levels. In particular, people with diabetes and prediabetes need to monitor the amount of carbohydrates they eat, since carbs have the greatest effect on blood sugar.

“It is essential to undergo diet education in order to understand how eating certain foods will affect your blood sugars,” Hleap says. “Using this knowledge, it is important to move towards a consistent and controlled carbohydrate diet, in order to create lifelong sustainable dietary changes.”

A 2014 scientific review published in The Lancet Diabetes and Endocrinology found that people with

type 1 diabetes

who counted carbohydrates reduced their A1C levels 0.64% more than people who did not count carbs.

For more information, read about how many carbs you should have a day if you’re diabetic.

4. Take oral diabetes medication 

Oral diabetes medications, like metformin, can reduce your A1C levels. A widely cited 2012 scientific review in Diabetes Care found that metformin reduced A1C by an average of 1.12% for people with type 2 diabetes.  

In addition, a 2019 study published in the Pakistan Journal of Medical Sciences followed 200 patients with type 2 diabetes. All of them saw their A1C levels drop within three months of taking metformin at the dose prescribed by their doctors, with the biggest decreases for people with higher starting A1C levels.

5. Use insulin

If your initial A1C levels are higher than 9% — most commonly for people with previously undiagnosed diabetes — your doctor might recommend starting insulin right away.

A 2010 scientific review published in Diabetes Technology and Therapeutics found that insulin regimens reduced A1C by an average of 1.4% for type 2 diabetics.

Takeaways

Measuring A1C levels is an important way to monitor prediabetes and reduce your risk for diabetes complications. Working with a dietitian and your doctor can help you develop a plan to lower your A1C levels, but having patience is also important, Hleap says.

“Your hemoglobin A1C will not change overnight,” she says. “It is essential to make small and realistic changes one step at a time to ensure that the modifications you’re making to your diet and exercise regimen will be sustainable for the long term. These suggestions take time to implement. Mindset is important in making and sustaining these changes for the long haul.”

Ways to Lower Hemoglobin A1c (HbA1c)

Blood sugar changes measured by HbA1C levels are directly associated with inflammation in the body. Inflammation is the main player in the diseases we all want to avoid- heart disease, dementia, diabetes and many more. In this post, you will learn about lifestyle, diet, and supplement strategies that can improve your levels.

However, remember that the most important thing is to work with your doctor to find out what’s causing your high HbA1c levels and to treat any underlying conditions.

Discuss the strategies listed below with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

Lifestyle to Lower Hemoglobin A1c (HbA1C)

1) Lose Weight

One of the best things you can do to decrease your blood glucose and HbA1c it to lose weight if you are overweight [1, 2].

This will enable your cells and tissues to use and respond to glucose more efficiently [3, 4]!

2) Exercise

There are a plethora of studies showing exercise helps lower HbA1c in both healthy people and those who have diabetes. Studies, in general, suggest that engaging in moderate to vigorous exercise for at least 30 minutes on more than 3 days per week is most beneficial [5, 6, 7].

Aerobic exercise, resistance training, and both combined were each associated with declines in HbA1c levels in several studies with type 2 diabetics [8, 9, 10].

One study of 2.7k people found that physical activity was more beneficial in shorter bouts of ≥10min with higher intensity [11].

A systematic review of 47 trials with over 8.5 diabetics showed that exercising for more than 150 minutes per week reduced HbA1c more than 2 times as efficiently compared to 150 minutes or less of exercise per week [9].

3) Quit Smoking

Studies show that smoking increases HbA1c levels [12, 13].

In a meta-analysis of over 35 men and women without diabetes, HbA1c was 0.1% higher in current smokers and 0.03% higher in ex-smokers, compared with those who never smoked [12].

Smoking is also associated with unsatisfactory blood sugar levels in diabetics. Both type 1 and type 2 diabetes patients who smoked had higher HbA1c values than non-smokers [14].

Among 2.3k women with gestational diabetes, HbA1c was higher than expected in women who smoked at the beginning of the pregnancy [13].

4) Get More Sleep

Sleep duration and the number of sleep segments are associated with HbA1c in type 2 diabetes patients. A one-hour longer sleep duration was associated with a 0.174% (1.4 mmol/mol) decrease in HbA1c in a study of 118 diabetics. Moreover, those who napped had lower HbA1c [15].

In 210 type 2 diabetics, later bedtime on weekends was significantly associated with poorer glycemic control [16].

In another study, in 2.5k type 2 diabetics, sleep compensation during weekends (sleep duration of about 1h more during weekends compared to weekdays) had a beneficial effect on HbA1c [17].

A meta-analysis of 22 studies has found that adults with type 1 diabetes who reported sleeping >6 hours had lower HbA1c levels than those sleeping ≤6 hours. Similarly, those reporting good sleep quality had lower HbA1c than those with poor sleep quality [18].

Another meta-analysis of 15 studies showed that both short (<5h) and long (>9h) sleep durations were associated with an increased HbA1c in type 2 diabetes patients. So was poor sleep quality [19].

In 80 people with type 1 diabetes, social jetlag, a small but recurrent circadian misalignment between biological and social time, was associated with higher HbA1c [20].

5) De-Stress

Stress impacts many aspects of your body, including your blood sugar and HbA1c. Studies suggest we shouldn’t neglect our emotional health and should instead find healthy ways to avoid or cope with stress [21, 22, 23, 24, 25, 26, 27].

Mood difficulties are common among patients with diabetes and have been linked to poor blood glucose control and increased diabetes complications [25, 26]. In one study of 100 diabetics, lower HbA1c levels were significantly associated with less affect intensity and with higher emotional intelligence [24].

Studies indicate there is an association between behavior problems (internalizing, externalizing) and HbA1c levels in youth with type 1 diabetes. Increased problematic behaviors in youth with type 1 diabetes have been associated with elevated HbA1c and mediated by low self-confidence and diabetes mismanagement [27].

A study of 312 type 2 diabetics has shown that lower life satisfaction was associated with higher HbA1c [23].

In a study of 938 non-diabetic people, weight discrimination has been associated with higher HbA1c in obese people, in addition to the effects of obesity on HbA1c itself. The study suggests that psychological and social factors can increase vulnerability to diabetes in nondiabetic obese people [22].

Higher socioeconomic status or high levels of parental education were found to be associated with lower HbA1c in children and adolescents with type 1 diabetes [28].

Caucasian, higher socioeconomic status, two-parent household, more frequent self-monitoring of blood glucose and low insulin requirements were associated with lower HbA1c concentration one year after the onset of type 1 diabetes in children [29]. These factors probably translate into HbA1c levels through increased diet quality, less stress, and more exercise.

Evidence is in favor of mind-body wellness techniques for emotional regulation and mindfulness-based cognitive therapy. Mindful self-compassion training significantly reduced depression, diabetes distress, and HbA1c in a randomized controlled trial [25].

6) Oral Hygiene

Improve your oral hygiene. It may come as a surprise, but studies suggest that proper and regular tooth brushing may help decrease your blood glucose and HbA1c levels. Also, address any existing periodontal (gum) issues such as inflammation, as these can increase HbA1c [30, 31, 32, 33, 34, 35].

7) Avoid Air Pollution

Long (1-year) and intermediate (3 months) term exposure to higher levels of air pollution was associated with increases in HbA1c [36, 37, 38, 39].

Air pollution was associated with higher HbA1c levels in 9.1k newly diagnosed type 2 diabetes patients [40].

Air pollution may result in increased low-level chronic inflammation in the body that, in turn, can have an adverse effect on blood sugar control.

8) Get More Sun

Getting more sun increases Vitamin D levels.

An association was found between higher HbA1c levels and lower Vitamin D in 160 pregnant women [41].

Vitamin D administration decreased HbA1c levels in a study of 65 children and adolescents with type 1 diabetes [42].

Enhanced vitamin D supplementation also improved HbA1c in a study of type 2 diabetes overweight and obese patients [43].

However, other studies in healthy subjects found no correlation between vitamin D and HbA1c [44, 45].

Dietary Changes that May Lower Hemoglobin A1c (HbA1C)

1) Avoid Sugar and Processed Carbs

Avoid sugary foods and processed carbs [46, 47]. They cause spikes in blood sugar levels.

A loose restriction of carbohydrate intake in a study of 133 type 2 diabetes patients improved HbA1c levels significantly during the 2-year follow-up period [48].

A low carbohydrate diet reduced HbA1c and BMI in a study of 66 Japanese patients with poorly controlled type 2 diabetes [49].

When an energy-restricted, protein-rich meal was used to replace certain meals in15 obese type 2 diabetes patients, over a period of 12 weeks, HbA1c decreased from 8.8% to 8.1%. Participants who continued with the practice further reduced their HbA1c [50].

2) Increase Fruits, Vegetables, and Fiber

Increase your fiber intake. Fruits and vegetables are generally rich in fiber, and studies show they can help keep your blood sugar levels under control. Beans, chickpeas, broccoli, berries, pears, avocado, and nuts are all great fiber sources [51, 52, 53, 54].

Higher total fiber intake was associated with lower HbA1c in a study of over 2k people with type 1 diabetes [53].

Similarly, HbA1c levels were lower in both people with and without type 2 diabetes when they consumed more fiber. Increasing fiber intake may be an effective approach to improve blood sugar levels in type 2 diabetic patients [51, 52].

Oats are a great source of fiber and can help decrease HbA1c and fasting glucose. The intake of oats and beta-glucan extracted from oats tends to lower HbA1c. Higher consumption of whole oats and oat bran, but not oat or barley beta-glucan extracts, were associated with lower HbA1c, fasting glucose and fasting insulin, in a meta-analysis of 18 studies [55].

A study showed in over 3k people showed that in nondiabetics, for every extra 80 g vegetable portion consumed, HbA1c reduced by 0.01% [46].

3) Mediterranean Diet

A Mediterranean diet includes many healthy components, such as fruits, vegetables, nuts, legumes, whole grains, and fish. There is lots of research showing that this type of diet has beneficial effects on diabetes and lowers HbA1c [56, 57, 58, 59, 60].

The essential nutrients and health-promoting properties of the diet, including high fibers, high magnesium, high antioxidant flavonoids, and high monounsaturated fatty acids (MUFA) are all powerful ways to decrease inflammation in the body [57].

In a meta-analysis of 9 studies with 1178 diabetics, a Mediterranean diet improved blood sugar control, body weight, and heart disease risk factors.

In a study of 27 diabetics, compared with the usual diet, a traditional Cretan Mediterranean diet lowered HbA1c from 7.1% to 6.8% [58].

In a study with over 200 overweight middle-aged men and women with newly diagnosed type 2 diabetes, a low-carbohydrate Mediterranean diet resulted in a greater reduction of HbA1c levels, a higher rate of diabetes remission, and delayed need for diabetes medication compared with a low-fat diet [59].

A meta-analysis of 8 studies found that the Mediterranean diet reduced HbA1c significantly compared to the usual diet, but so did the Paleo diet [60].

4) Paleo Diet

Several initial studies suggest that a paleo diet, consisting of lean meat, fruits, vegetables, and nuts, can also help improve blood sugar and HbA1c levels [61, 62, 60].

5) Drink More Water

A study showed that 1 cup of plain water per day was associated with a -0.04% lower HbA1c in men. Men had a 22% reduced odds of having HbA1c≥5.5% for each cup per day of plain water. There was no such association in women, however [63].

6) Moderate Alcohol Consumption

Studies suggest that moderate alcohol consumption (1 serving per day) can reduce HbA1c in both non-diabetics and diabetics [64, 65].

In Japanese women, HbA1c levels were lower in occasional, regular light and regular heavy drinkers than in nondrinkers. HbA1c was further significantly lower in regular light and heavy drinkers than in occasional drinkers [66].

Higher alcohol consumption was associated with lower HbA1c in diabetes patients [65].

Higher alcohol intake was associated with lower HbA1c levels in Korean adults [67].

However, it’s very important to remember that alcohol consumption is associated with other health issues and diseases so always talk with your physician about the optimal amount of alcohol you should be taking.

7) Probiotic Yogurt

Multistrain probiotics and probiotic yogurt decrease HbA1c in several studies of people with type 2 diabetes [68, 69, 70, 71].

A probiotic strain, L. fermentum reduced HbA1c in a study of 45 volunteers with borderline-high values [72].

Some studies, however, failed to find improvement associated with probiotics [73, 74].

8) Dark Chocolate

Among type 1 diabetes patients, those who consumed dark chocolate (25 g/day 2 – 5 times/week) showed a significantly lower HbA1c than both patients who consumed the same amount of milk chocolate or neither dark nor milk chocolate [75].

In another study of 7.8k people, those who ate up to 2 – 6 servings (28.5 g) of dark chocolate per week had a 34% lower risk of being diagnosed with diabetes [76].

Supplements that May Lower Hemoglobin A1c (HbA1C)

Talk to your doctor about the following foods and supplements. Initial studies suggest they may help decrease blood sugar levels and HbA1c:

• Aloe [77, 78, 79, 80]
• Alpha-lipoic acid [81, 82]
• Berberine [83, 84, 85, 86]
• Caffeine/Coffee [87, 88, 89, 90, 91, 92]
• Chromium [93, 94]
• Curcumin [95, 96, 97, 98]
• Dark chocolate [76, 99, 100]
• Fiber, such as glucomannan or beta-glucans [101, 102, 103, 104, 105]
• Garlic [106, 107]
• Green tea [108, 109, 110]
• Milk thistle [111, 112]

See also:

HbA1c Part 1: All About HbA1c and 33 Reasons to Maintain Healthy HbA1c Levels

To Skip or Not to Skip: Does Intermittent Fasting Help People with Diabetes?

By Brett Goerl

We’ve reviewed the latest research to weigh the benefits and drawbacks of intermittent fasting and time-restricted feeding for people with diabetes.

Living with diabetes means carefully making sure you are eating foods that will keep your blood sugar and insulin levels in balance. However, a recent trend in the diabetes community focuses on when (and when not) to eat. You may have heard friends, family, and healthcare professionals use words like ‘intermittent fasting’ and ‘time-restricted feeding’ to describe this trend. We are going to take a closer look at what these eating strategies entail, how they might affect people with diabetes, and the risks and benefits to consider if you choose to skip a meal.

Intermittent fasting (also called IF) refers to a style of eating in which you alternate through a pattern of consuming little to no calories for a while (could be a few hours or a full day) and a normal eating schedule. Popular IF schedules include alternate day fasting, where one day you consume very little food (500-700 calories or less) and the next day you eat like you normally would – this regimen is usually repeated every other day, though some people make exceptions to this depending on what works best for their lifestyle. Another method is periodic fasting (also called 5:2 fasting), where you reduce your food consumption on certain days of the week (i.e., Tuesdays and Fridays) but then eat regularly on the other days. These patterns aim to reduce the number of calories you are consuming.

Time-restricted feeding (or TRF) is similar to intermittent fasting, but with a key difference: you fast for a specific portion of each day (but not for an entire day). A common approach to TRF is called 16:8 fasting, which restricts the eating window to eight hours a day (for example, you might only eat from noon to 8 PM) while fasting for the remaining 16 hours. Some people with diabetes, like Justine Szafran, have found TRF to be extremely helpful as part of a daily routine for diabetes management.

According to Dr. Mark Mattson, a neuroscientist at Johns Hopkins University who has studied fasting for more than 25 years, our bodies have evolved to handle extended periods of time without food. In modern times, however, many people have access to high calorie food around the clock and can snack all day long – which he believes has contributed to obesity rates and the prevalence of type 2 diabetes. His research suggests that fasting could reverse this trend.

How Does Fasting Affect My Metabolism?

Sugars and fats serve as our body’s main sources of energy. After a meal, sugars are used for energy first. They are broken down and delivered to the bloodstream, while fats are stored for energy later. When we restrict eating, our bodies run out of carbohydrates to use for energy and instead breakdown stored fats, converting them into ketones.

Ketones are our body’s alternative to using glucose for energy, and fasting or carbohydrate restriction can make this alternative available for energy use. The change from using sugars to using ketones is known as metabolic switching, a process that scientists believe produces many of the health benefits attributed to IF beyond weight loss. Intermittent fasting and time-restricted feeding allow us to control this process and cause metabolic switching in our own bodies.

However, the excess production of ketones can lead to a dangerous condition known as diabetic ketoacidosis or DKA, especially if you have type 1 diabetes. Because of this risk, you should talk to your healthcare team before starting a diet that includes fasting so that your health can be monitored effectively and your medication doses can be adjusted. If you have type 1 diabetes, you will have to regularly test your ketone levels to avoid the risk of DKA. This risk is especially high if insulin doses are reduced excessively to avoid hypoglycemia (low blood sugar) while fasting.

There is an additional curveball that people with diabetes must consider with a diet that involves fasting – how does fasting affect blood sugar and insulin?

Fasting Affects Blood Sugar Management and Insulin Resistance

What does fasting have to do with insulin? Insulin is the primary hormone our bodies use to regulate blood sugar levels. Maintaining stable blood sugar levels (also called ‘glycemic control’) is an important goal for people with diabetes and is often measured by Time in Range, A1C, and fasting glucose levels.

Recently, clinical researchers looked at how IF and TRF affect things like blood sugar management and insulin resistance and found promising results.

• In a 2021 literature review, eight studies showed that individuals who practiced intermittent fasting had significant reductions in fasting glucose levels (an average decrease of 4.16 mg/dL; p = 0.003). Other important findings included a reduction in A1C levels, weight loss, and an increase in adiponectin (a natural hormone shown to increase insulin sensitivity and reduce inflammation).

• A study of men with prediabetes found that early morning TRF decreased insulin levels (in people with prediabetes, consistently high insulin levels can lead to insulin resistance, obesity, heart disease, and more), reduced fluctuations in insulin levels, and decreased insulin resistance. This translates to an improvement in insulin levels and insulin sensitivity.

• A research team from the University of South Australia conducted a pilot study and a larger study to look at the 5:2 IF method in people with type 2 diabetes. Both studies found significant reductions in A1C levels and body weight after 12 weeks.

Interestingly, these results did not all necessarily correlate with weight loss – but some studies showed that even if a person’s weight did not decrease, they could still experience improvements in insulin sensitivity. These results align with the growing theory that the effects of IF and TRF on blood sugar and insulin levels may not only be due to weight loss but also to the metabolic switching caused by fasting. 

Is Intermittent Fasting Safe for People with Prediabetes and Type 2 Diabetes?

While studies on intermittent fasting have demonstrated positive improvements in several key measurements of diabetes (including A1C levels, insulin resistance, blood pressure, and weight loss), it is important to know that fasting might have negative side effects for someone with diabetes. In a clinical study on intermittent fasting among 137 people with type 2 diabetes, dizziness, headaches, hunger, and hypoglycemia were the side effects most often reported. This study was conducted using the 5:2 IF approach.

When it comes to blood sugar, “Both IF and TRF will drop a person’s glucose levels, meaning that medication adjustments are necessary to avoid hypoglycemia during the period of calorie restriction,” said Dr. Robert Ratner, a long-time scientific and medical leader in diabetes. “Changes in eating patterns on a daily basis will also require medication adjustments to keep glucose levels in range.”

There is currently no evidence to suggest that TRF would be less safe than IF, in particular because the fasting windows for TRF (when hypoglycemic events are most likely to occur) are shorter. IF and TRF appear to be most safe for people who do not take glucose-lowering medications that could cause hypoglycemia.

Is Intermittent Fasting Safe for People with Type 1 Diabetes?

Many people with type 1 diabetes have found that IF and TRF can help reduce morning blood sugar fluctuations and improve their energy. An observational study on people with type 1 diabetes who participated in various forms of IF/TRF found that these eating schedules can be safe as long as the individual works with their healthcare professional to reduce their usual insulin dose while fasting, and they must monitor their glucose levels carefully to avoid hypoglycemia. Fasting will also increase your ketone levels, so it is important to test your blood ketone levels if you have type 1 diabetes to avoid the risk of ketoacidosis. Remember that people with type 1 diabetes absolutely require insulin to avoid DKA, so insulin dose adjustment to avoid low glucose levels must be done cautiously.

For anyone with diabetes, before trying any type of fasting you should talk to your healthcare professional. For people who take sulfonylureas or insulin, it is important to closely monitor blood sugar levels, especially when you first start a fasting regimen, as dose reductions may be necessary to avoid hypoglycemia. Never stop taking a medication or change its dosage without consulting your healthcare professional first.

Drawbacks to Consider Before Starting Intermittent Fasting

Although IF/TRF may carry health benefits and is generally safe for people with diabetes, there are some drawbacks:

• It is difficult to start a new eating routine! Transitioning from a ‘round-the-clock’ eating schedule to one with planned feeding and fasting times can be stressful, and it might not align well with your daily life. For example, if you exercise in the morning or are an athlete, it might not be possible to participate on an empty stomach.

• Any style of fasting will affect your blood glucose levels and insulin requirements. Especially when starting a fasting regimen, you will need to closely monitor these indicators to make sure that your glucose levels stay in range. If you have type 1 diabetes or are dependent on insulin, you should also test your ketone levels consistently to avoid the risk of ketoacidosis (DKA).

• IF/TRF can have side-effects, such as shakiness, hypoglycemia, irritability, hunger, increased heart rate, sweating, chills, and dizziness.

• Know that IF/TRF can lead to unhealthy eating habits, including disordered eating. If you are concerned that you or someone else with diabetes may be experiencing disordered eating, contact the Diabulimia Helpline or We Are Diabetes; the National Eating Disorders Alliance is a resource for anyone with or without diabetes.

Tips & Tricks for a Healthy Fasting Experience

Dr. Ratner said, “The health benefits of IF and TRF are due to calorie reduction. If people overcompensate when they are eating, the impact is lost.” If you decide you want to pursue some sort of intermittent fasting plan, here’s what you should keep in mind:

• Consult your healthcare team before making any significant changes to your diet or medication. If your healthcare team agrees that it’s safe for you to try a new eating pattern, they should advise you on how often to monitor glucose and whether you’ll need to adjust your insulin dosing or other medications.

• Ask your friends and family who have tried IF/TRF to share their experience with you. Read Justine Szafran’s “Intermittent Fasting: Stabilizing My Morning Blood Sugars.”

• Consider making a meal plan for the days you will be fasting. This will help you make sure you are getting enough food.

• During fasting periods, you can drink water or any unsweetened, zero calorie beverage (i.e., coffee, tea). In fact, you should try to drink extra water while fasting to avoid dehydration.

• 16:8 Time-Restricted Feeding might be easier to incorporate into your daily schedule than Intermittent Fasting – it gives you the chance to build a regular schedule of eating every day.

• It’s okay to feel hungry! You will likely experience more intense food cravings at the beginning of a fasting period, but often your body will get used to the new eating pattern. Some people even experience a boost in energy after they get past the initial hunger.

• When starting a fast, monitor yourself for side effects (i.e., hunger, dizziness, headache, hypoglycemia). Start a journal where you can record your feelings and experiences for future reference and to discuss with your healthcare team.

• When resuming normal feeding, IF/TRF does not require you to adhere to any specific food plan. However, for people with diabetes it is best to consume natural, nutrient-rich whole foods that are not likely to spike your blood sugar.

• It is okay to miss a day of fasting or time-restricted feeding – that doesn’t mean you’ve failed. Similarly, it’s okay if IF/TRF is not for you!

Intermittent fasting (IF) and time-restricted feeding (TRF) are two ways people reduce calorie consumption over time as an alternative to traditional dieting. While research on these forms of fasting is limited in populations with diabetes, some evidence suggests that IF and TRF may offer people with diabetes or prediabetes a means to lose weight, stabilize blood sugar levels, and increase sensitivity to insulin.

While IF and TRF appear safe for people with diabetes, fasting can increase the risk of hypoglycemic events, especially in individuals taking medicine to lower blood sugar levels. Everyone’s body is different, so before trying IF or TRF, consult your healthcare professional to help determine if this plan would be safe and helpful for your health and wellbeing.

Diabetes Experts Share Ways To Lower Your A1C Levels

Diabetes management at home is an important way of controlling your blood sugar levels without the help of an expert.

In that sense, you are in control of your diabetes on a daily basis. However, the American Diabetes Associations’ recommends that a person with diabetes should get their A1C tested by a doctor at least two times a year. The test will give you a picture of your journey with diabetes as a whole. Now, once you do get the numbers, what do you do with that information?

If you are on the right track, you will continue doing whatever it is that has been working so far. you feel encouraged! However, if the numbers are not what you and your health care provider were expecting, it is imperative that you embark on the path to lowering them so you can avoid any diabetes related complications in the future. The task can be daunting and overwhelming.

We have rounded up 37 experts to share tips and ways that will help you in lowering your A1C levels and keeping them that way. The wisdom they share with us today will help you take those little steps towards a healthier lifestyle.

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1. Sharon Castillo

Rootedonthevine.com

In a recent study published by the University of Toronto, it was shown that cinnamon has properties which can reduce blood pressure, especially for those who have prediabetes or type 2-diabetes.

Hypertension or high blood pressure is common among those who have prediabetes and type-2 diabetics. High blood glucose levels create oxidative radicals which can damage the arteries.

I recommend reading the following articles:

The damage to the arteries can result into the scarring of the blood vessels. The scarring builds up plaque which reduces the size of the blood vessel. The reduction in the size of the diameter increases blood pressure.

While not all of cinnamon’s mechanisms of action are understood, there is research which demonstrates that Cinnamon can reduce A1C levels. Damage to the arteries is reduced because of the reduced blood sugar levels.

2. Jeffrey Dachis

Onedrop.today

Here are some tips:

• Test your blood sugar. We can’t fix what we can’t see. If your A1C is not where you want it to be, try testing more often to get a better picture of what your blood sugar levels are doing throughout the day.
• Use tech as a tool. You can also talk to your doctor about ordering a Continuous Glucose Monitor (CGM) which senses glucose levels once every few minutes without a fingerstick.
• Look for patterns. Is your blood sugar highest in the morning before breakfast? In the evening after dinner? Once you have the glucose readings from your meter and/or CGM, you can begin to look for problem areas and then make a plan to tackle them. Ask your doctor or diabetes educator for help spotting patterns if needed.
• Eat fewer carbs. While we do need some carbs, we do not need as many as have been recommended in the past. This is especially important for people with diabetes, since carbs are the main reason why blood sugar levels go up in the first place. You may see improved blood sugars by reducing your carb intake (fewer highs and fewer lows too!).
• Increase activity. Physical activity makes us more sensitive to insulin, meaning it’s easier to lower blood sugar levels. The effects of activity last many hours afterwards too, so even a little bit of activity can go a long way towards lowering your blood sugar readings and your overall average.
• Watch your weight. Being overweight makes it more difficult for insulin to do its job of lowering blood sugar levels. Eating healthy and staying active can help keep weight in check (and they also help blood sugar levels as well!).
• Take meds as directed. Diabetes medications help blood sugar levels in a variety of ways, and taking them as directed ensures they are as effective as they can be.
• Adjust meds when needed. Overall blood sugar trends can change over time- what worked last year may not work as well this year. Talk to your doctor if you notice higher readings, especially if you’ve already worked on reducing carbs and increasing activity. A different medication, a tweak in timing, or a simple dose change may be all it takes to get you to your goal A1C. Continuing to watch for changes in blood sugar trends can help you know when it’s time.
• Manage stress. For most people with diabetes, stress hormones cause blood sugar to surge. Stress can come in many forms, including mental, emotional, and physical stress (like getting sick or not sleeping well). Taking steps to reduce stress and to manage stress when it does occur can help keep your A1C in check.
• Get support. Connect with other people who “get it,” whether it’s an in person support group or an online community. Finding support can not only reduce stress and help you feel empowered, it can also be a sounding board of practical, everyday tips and tricks to make living with diabetes easier while improving blood sugar levels.
• Use your health care team. Diabetes is never a do-it-yourself condition. Your health care team plays a huge role in how easy or difficult it is to lower blood sugar levels over time. Can you be seen relatively soon if an issue comes up? Does your doctor help make dose adjustments in between visits? Do your providers listen to your concerns and take them into consideration when making treatment decisions? If you feel like your health care team has not made your diabetes control a priority, advocate for yourself and consider finding a team that does.
• Ask for “DSME”. Diabetes Self-Management Education is an in-depth, individualized review of all the things that go into diabetes care. Even if you’ve had diabetes for a while, diabetes education can provide insights to help lower your blood sugar. Start by asking for a referral from your doctor. And if possible, look for a diabetes education program that is accredited by the American Diabetes Association (ADA) or American Association of Diabetes Educators (AADE), like One Drop | Experts.

Just remember: reaching your goal A1C is great, but having frequent episodes of low blood sugars puts you at risk. Talk with your doctor if you’re having low blood sugars often, and discuss different ways of lowering A1C without frequent lows.

3. Max Szadek

Divabetic.org

GLAM MORE, FEAR LESS! I recommend starting a ‘Sugar Lips’ Log book to lower your A1C. Make it a goal to check your blood sugars after you reapply your lipstick throughout the day. Jot down the time of day, your medication, and any changes in food, activity, illness and/or stress related to your blood sugars. When you stop and think that most women apply their lipstick 4 or more times in one day the resulting ‘sugar lips’ data could prove to extremely beneficial to you and your doctor at your next appointment. I bet both of you will be smiling! And guess what? A new tube of lipstick is a healthy way to reward yourself for lowering your A1C.

4. Karen Pennington

Simonwilliamsonclinic.com

It is important to remember that the A1C is a 3 month average, so when you get your A1C result from your provider, you should count backwards 3 months to know the date range that the A1C covers. If your A1C is not at or below the 7% recommended target, ask yourself if there have been any unusual circumstances that could have elevated your A1C. For example, having a steroid injection (or taking prednisone orally) or running out of your diabetes medication. If the answer is “no”, look back and your blood glucose log and see if the numbers you have recorded are in agreement with the A1C level. If not, the reason could be that you are not testing often enough or that you are only testing once per day such as in the morning when you are fasting. After meal testing (about 2 hours after eating) is helpful to more accurately predict your A1C.

If your A1C is elevated, you should ask your provider for a referral to a diabetes educator. If your A1C has been elevated for several visits in a row, you should ask your provider for a referral to an endocrinologist.

Keeping your A1C at or below target will help ensure less blood vessel damage and fewer diabetes complications in the future, so make sure you are proactive in getting your A1C to target.

5. Dr. Barry Sears

Zonediet.com

There are two ways to lower HbA1c:

1. reduce the levels of glucose in the blood, and
2. reduce the formation of free radicals.

The high levels of glucose come from insulin resistance in the muscle cells and the increase in free radicals comes from a lack of polyphenols in the diet.

Practical guidelines for reducing the levels of HbA1c long-term, sustainable basis is to follow a calorie-restricted diet (1,200 to 1,500 calories per day) containing adequate protein (90-110 grams of low-fat protein per day), moderate amounts of carbohydrate (130-150 grams of low-glycemic carbs per day) and a low levels of fat (40-50 grams of primarily monounsaturated fat per day).

These are essentially the dietary guidelines of both the Joslin Diabetes Center at Harvard Medical School and also the Zone Diet. To reduce the formation of free radicals, you want to make the vast majority of carbohydrates coming from non-starchy vegetables and limited amounts of fruits as these are rich in polyphenols without excess levels of carbs (as in whole grains). 10 servings per day (8 of vegetables and 2 of fruits) per day would provide adequate levels of polyphenols.

6. Amanda Goodwin

Amandagoodwin.biz

Consistency is key to lowering your A1C! This is where working with a health coach may be helpful. Each day and with each meal you have the opportunity to change your health for the better!

You can do this by daily improving your diet, and watching your portion size. I would encourage you to have a protein breakfast, rather than a carb loaded breakfast. Do your best to manage your stress level with meditation or yoga. Get a good night’s sleep, as it has been shown a poor night sleep increases the next day’s glucose level. Last but not least exercise daily. A simple 20-30 minute walk is very effective at managing your glucose levels. (And it’s free!)

Purchase a blood glucose monitor and test how you personally react to foods. You need to learn your “carb tolerance”, the amount of carbs your body can handle. Check your blood sugar prior to your meal and record this number. Follow up with a test at 1 hour, 2 hours, and 3 hours after your meal. (Record each number.) You need to recover to your original number (Before eating) by hour 3. You do not want to get higher than 140 after a meal…this is the upper end of the range. Try to achieve 120 or lower. 150+ causes arterial damage. By sticking with lower glycemic foods, you will be controlling your numbers better and causing less inflammation and less damage to your body.

An often overlooked resource would be to have your thyroid and HPA Axis (adrenals) checked, as they may be a culprit in higher sugar numbers. Someone like myself can provide you with a 4 point saliva cortisol test and a full thyroid panel. A full thyroid panel includes TSH, T4, T3, RT3 and the following antibodies TRAb, TPO, TG/TGA, TSI.

Check with your doctor as some medications can raise blood sugar. Some examples could be asthma meds, cold meds, blood pressure meds, and thyroid meds.

After taking a thorough health history, I may also suggest certain herbs and herbal teas to help my clients lower their blood sugar and control their sugar cravings.

7. Francine M. Kerber, MS, RD, CDE

Fromyourrd.com

Lowering A1c%:

Many people have forgotten or were never properly taught about this quarterly (usually every 3-4 months) blood test. I like to remind clients that the A1c measurement is a rolling and weighted average. The most recent blood glucose numbers “count” more than results from months prior. I also find clients very surprised at an unexpectedly high result when they have not noticed significant changes in the BG tests at home or noticed more symptoms.

Here are a few ideas I share with clients once we are clear on the definition and goals:

• Check home BG at various times of day 1 or 2 times per week.
• Avoid only checking fasting BG, shake it up to learn more about how your BG recovers from a late dinner or a skipped meal.
• Don’t skip checking your BG when you know it will be “bad” – this is an opportunity to learn, not a time to feel ashamed.
• Spot Check Your Diet – log your food intake or closely count carbs 1 day each week (make it a different day each time for better results).
• Get Moving – take 5-10 minutes after most meals to move more. The activity helps both medication and your body to work better.
• If medication changes occur, check BG more often until you and your healthcare team know how the change affects your BG.

Remember that learning more about how your BG responds to changes in schedules, stress or new medication is data that will help lead you and your healthcare provider (MD, RD or CDE) to maintaining a more even and healthy blood glucose result.

8. Joanne Laufer Milo

Thesavvydiabetic.com

Tips/ways I use to lower my A1C:

While A1c is just one part of the picture for better diabetes management, it is an important range and goal. When the DCCT trials reported that the lower the A1c, the better. But we now know that having an A1c too low often indicates an unhealthy number of low blood sugar episodes, which is equally dangerous.

I try to keep my A1c in what I call my sweet spot: 6.2-6.7 … and somehow that has been working.

Here’s what I try to do:

I rely on my CGM, particularly after meals, watching for rapid rises (160 and arrow upward or straight up), possibly because of miscalculation of carbs or hidden sugars, etc.

• If I see a steady rise (upward arrow), I will give a correction bolus.
• If my rise is fast and showing no sign of leveling off (1 or 2 arrows straight up), at 200 or above, I will often use Afrezza inhalable insulin, 4u cartridge, as a “rescue” dose. That usually levels and gently lowers my bg back into the 120-150 range.

I wake up with CGM alarms during the night.

• If I am running high, I will give a correction bolus, which is set at about 50% of my daytime correction bolus. I do not want to drop low, just stop and gently low the rise.
• If I am dropping low, I will take sugar and possibly put in a temp basal of 0% for ½ hour.

I try to avoid stacking insulin because then I am yo-yo-ing and feel awful.

As I mentioned, A1c is only part of the plan. My bigger concern in the variability … standard deviation of my blood sugars. That means how much my blood sugars swings low to high to low. I want fewer swings and lower highs and lows.

• Before going on my pump and certainly before CGM, my standard deviation was about 75.
• I am now around 35.
• If I wanted to work really hard, I would eat even less carbs and bring my standard deviation to about 25.

And finally, I know I can lower my A1c by eating a low carb diet. I’m not willing to be that strict. But I do try to hold my meal carbs to under 35 at a time. Seems that carbs are my enemy – can’t easily live with them and can’t easily totally eliminate them.

My last A1c was 6.4. I’m smiling!

9. Dr. Shira B. Eytan, MD

Parkavendo.com

A1C is a good test to measure blood glucose, on average, for the prior 2-3 months. However, diabetics wide fluctuations in blood glucose and frequent episodes of hypoglycemia may have a normal or low A1C, though they are not well controlled. Therefore, the goal is to achieve a good A1C without significant hypoglycemia. This can be done by:

1. Watching your diet, and having balanced meals.
2. Taking your medications as prescribed by your doctor.
3. Checking blood glucose regularly, and as directed by your doctor.
4. For type 2 diabetes, modest weight loss can have a significant impact on A1C (5-10% of body weight).
5. Daily exercise! Avoid sitting for prolonged periods.
6. If available to you, a continuous glucose monitor has been shown to improve A1C control with less fluctuations in blood glucose. These are available to Type 1 diabetics, and occasionally to Type 2 diabetics. Consult with your endocrinologist to see if if this could be the right fit for you.

10. Marianne Hutton

Facebook.com/FinelyFit

Four ways to lower your A1C:

1. Lose weight. A weight loss of 10 percent of your body weight will do wonders to lower your A1C. For many people that’s 10-15 lbs.
2. Decrease your food intake by eating 1/3 of what you normally eat. Make some simple changes in your food habits: Cut out calorie containing drinks such as juice, soda, lattes, beer and wine. Fill up on high fiber vegetables and water. Get busy to distract yourself from eating. Keep a food journal to become aware of your calorie, fat and carbohydrate intake. See a Registered Dietitian, Certified Diabetes Educator for assistance with food habit management and behavior modification.
3. Know what your diabetes medications do; how they work. Know if the medication you are on causes weight gain or weight loss. Ask your health care provider if they can prescribe one that causes weight loss. Work with a CDE to learn all you can about the different classes of diabetes medications and which core diabetes defects they target. There are at least 8 core defects of diabetes.
4. Test your after meal blood sugar and don’t let it rise above 130-140. If it does, know that exercise will lower it. And eating less the next time will help too.

11. Joan Trute, MA, RD, CDE

Linkedin.com/joan-trute-ma-rd-cde

Eat more fruits and veggies, do some sort of physical activity work up to 150 minutes a week limit packaged foods and take all your medicine for diabetes. Try to reduce stress with deep breathing or connecting with nature.

Also, use the plate method: ½ plate non starchy veggies, ¼ plate protein(fish, chicken, lean beef, etc.) and ¼ plate whole grains. Stay away from sweetened beverages. Switch to water, coffee and tea instead.

12. Amy Campbell

Twitter.comamypcampbell

First, talk with your doctor, diabetes educator, and/or dietitian (ideally, all three!). Diabetes self-management requires a team approach; you’re the captain of your team and your team members are there to support you. Lowering your A1C usually requires a multi-pronged approach. Start off with lifestyle measures: a healthy eating plan that’s individualized to your needs and preferences; regular physical activity – choose an activity or two that you enjoy doing and will do consistently; weight control – reaching and staying at a weight that’s healthy for you; stress management – using techniques such as deep breathing, exercise, meditation, yoga, or counseling, if necessary, to help you keep stress under control; and getting adequate sleep (not too much, not too little!).

Second, revisit your diabetes medication plan. This is a discussion to have with your team. Do you need to start taking medication? If you already take medication, does the dose need adjusting, or do you need to add a medication? Sometimes lifestyle measures aren’t enough to get your A1C to your target. Finally, stay on top of your blood sugars, which means checking them. Decide, with input from your team, how often is reasonable for you to check your blood sugars with your meter. Then, share your results with your team to tweak your treatment plan and help you reach your A1C goal.

13. Diana L. Malkin-Washeim, PhD, MPH, R.D., CDE, CD-N

Linkedin.com/diana15

To lower an A1C there needs to be a few components, such as the following:

1. Activity. If people incorporate any type of daily exercise, this will build up lean muscle mass, which will decrease insulin resistance, help with weight loss and/or maintenance, and help with the flexibility of food consumption.
2. Eating a well balanced and small meals and snacks. Keeping all food choices colorful, green and leafy, fruity, high protein, whole wheat or other high fiber grains (quinoa, barley, spelt, triticale, etc.) and less starchy type foods.
3. To limit or eliminate sugary beverages. Not only does drinking sugary beverages add empty calories but they contribute to elevated triglycerides and high blood sugars and ultimately contribute to an elevated A1C in the short and long term.
4. To maintain a social support with family and friends. To move from being serious to light and fun embraces a social support, which helps with refocusing from always thinking about diabetes, and problems to a life of less stress and joy.
5. To check your blood sugars regularly. Checking blood sugars helps not only your health care provider in making the appropriate dose adjustments to your medication but helps you in figuring out how your activity or lack of activity and the types of food that may be affecting your blood sugars.
6. Keep your appointments. By keeping your appointments with your doctor and certified diabetes educator this enables you to be part of your team. The team is there for you to help with your diabetes management.

14. Dr. Carl Knopke, MD

Inlandempireweightloss.com

As far as tips for lowering your HgA1c, I have several suggestions. The most obvious ones are the same ones that are required to lower your fasting blood sugar. These will include things such as decreasing your intake of sugar sweetened beverages and refined carbohydrates. You should also watch foods with a higher glycemic index. These are foods that have sugar that can rapidly be absorbed.

Consider things such as rice, potatoes and sweet fruits. As your fasting blood sugar starts to come under good control, which I usually consider to be a fasting blood sugar of less than 90, you may be frustrated by the persistantly elevated HgA1c. Gettiing your initial number down from a high of say 10, is comparatively easy using, diet, exercise, and medications. However, once your HgA1c is getting into the 6.5-7.0 range, you may notice that decreasing your fasting blood sugar further is not working to lower your HgA1c. That is because in the lower range of your HgA1c, your numbers are more of a reflection of your post-prandial (after meal) blood sugar and not just your fasting blood sugar.

What I usually tell my patients to do is to perform the occasional experiment on themselves. If you really want to know what happens to your blood sugar after a meal, then check it. Here is how: Check your blood sugar right before the meal in question and then 90 minutes after starting the meal. Compare this change to a meal that you know does not contain any carbs, think eggs and ham, which should really not affect your blood sugar at all. If your blood sugar is going up by 30 points or more, this is really too much and you need to think about where those carbs are coming from in the meal.

The other trick that goes with this one is knowing how to save your glucose sticks. I usually tell my patients to only check their fasting blood sugar every 2-3 days if the numbers have been looking good. This will allow you to save a few sticks to do experiments on yourself.

15. Dr. Phyllisa Deroze

Diagnosednotdefeated.com

The best way to lower my A1C has been to remain consistent with eating by the plate method and or carb counting and walking after meals, especially dinner.

I find that if I remain consistent, then one or two high carb meals won’t kill me.

I try to avoid bringing foods into my home that are high in carbs and are dangerously delicious. Sure, you tell yourself “I will eat 1 today and 1 tomorrow,” but if it’s your weakness, then you are only fooling yourself. The entire box or bag will be gone in a day or two. So, I try to shop with the mindset of someone who is trying to lower their A1C.

Walking in is my best friend. I may not walk 10,000 steps a day, but I make sure to walk after every big meal. This helps my body digest the food and glucose which makes my A1C.

16. Valerie Goldstein, MS, RD, CDE, CDN

Eatingtofuelhealth.com

The key to maintaining a consistent normal A1C is to maintain consistent daily blood sugar levels. Three tips that will enable you to lower A1C are:

Use a journal to map out and analyze blood sugar and food/exercise relationships. Frequently monitor blood sugar throughout the day; pre/post meals and activities, until consistent blood sugar numbers are achieved, then rigorous testing is not necessary. Once your numbers are consistent spot checking blood sugar is a viable option. Analyze which foods are detrimental to blood glucose levels. Make lifestyle changes accordingly.

One hundred percent of any type of carbohydrates, good or bad will send daily blood sugars skyrocketing similarly to sugar. Keeping carbs between 25-50 grams total for the day will help prevent glucose excursions and promote steady state blood sugar.

Exercise and nutritional supplements should be used as first line of therapy before medications. Both exercise and nutritional supplementation can act as insulin sensitizers just like popular medications such as metformin without the adverse side effects. Using insulin or oral hypoglycemic agents may make blood sugar control more difficult if timing of meals is not strictly followed. Matching medication and its onset of action with food is a difficult task.

17. Anna Norton

Diabetessisters.org

If using a continuous glucose monitor, lower the “high” alert, so you can get ahead of highs before they get too high. By doing this, you will spend less time in the high zone and lower A1c in a safe way.

Run basal tests to ensure you are injecting the proper amount of insulin. A correct basal will hold blood sugar steady without the aid of food, exercise or bolus insulin. Integrated Diabetes Services offers advice on how to properly basal test.

Take note of what particular foods do to your blood sugar. By observing this, you will be able to better plan insulin dosing, timing of medication, and exercise. Not all carbohydrates and/or fats are created equal!

Eat more whole foods. Processed foods can cause a spike in blood sugar that can linger for hours.

18. Andrew P. Mandell

Defeatdiabetes.org

It’s important for the diabetic patient to understand what diabetes is, how it affects your body, and what steps can be taken to minimize (if not eliminate) the negatives.

In this article I will reduce the many scientific and medical terms to a basic understanding that will serve you well.

1. Diabetes, very simply put, is the result of when the food we eat which, when digested and converted to energy, isn’t properly absorbed and/or distributed throughoutour bodies via the bloodstream (glucose [blood sugar]). This “glucose” will remain in our bloodstreams and won’t feed the 60 trillion cells in our bodies until provided the key to release it– the hormone, “insulin”.

In order for this process to work properly, it’s necessary for the hormone “insulin” to kick in. Insulin is produced by a vital organ in our bodies, the Pancreas, which also produces digestive enzymes, and more. Normally, it occurs naturally in the correct amounts in response to the food we consume. Not the case when you have diabetes.

Diabetics need to take special care to make sure the proper amount of insulin is released into our bodies to properly balance the glucose – not too much and not too little. So, depending on the level of malfunction, astrict diet control, oral medications and/or insulin injections are required to produce this delicate balance.

2. When this delicate balance is NOT reached, then, over a period of time (months to years), damage will absolutely occur to ALL the organs in our bodies and cause serious medical problems.These problems which, if not professionally addressed, will result in irreversible damage, such as: blindness, amputation, kidney disease and a whole lot more. Eventually, it will cause premature death!! It’s important to note that diabetes is a medical issue first, and MUST be so addressed!!!

3. However, the picture doesn’t need to be so bleak. Fortunately, there are measures we can all take to minimize, if not totally eliminate, the medical realities that will surely occur if we don’t follow some basic rules.

• Diabetes is a medical issue and must be addressed by a qualified specialist: an Endocrinologist or an Internal Medicine specialist.
• Diabetes is a metabolic disorder which requires proper nutrition. For this guidance your doctor will arrange for you to sit down with a Registered Dietician or Nutritionist.
• Proper exercise is also necessary. Your doctor will advise you on working with a certified Physiologist to make sure an exercise program is designed to meet your individual needs and abilities.

Once these three steps are in place (a,b,c), you are now responsible to make sure to follow the program. And, to confirm that you’re in compliance, the following measures are very important to follow:

1. See your doctor every 3 months for a complete medical evaluation. I have faithfully done this since 1985 when first diagnosed. If something in the reportindicates any need(s) to be adjusted, it’s easy to fix, at this point.
2. Get a glucometer and check your glucose levels frequently during the day. This test will give you a snapshot of your glucose level(s) for that moment in time and, depending on the results, will alert you to make any adjustments in your behavior.
3. The A1C TEST: This is the all-important blood test that should be performed every 90 days. It’s done in a lab (or your doctor’s office) and provides the critical information you and your doctor need to know about how well you’re following your prescribed regimen. The A1C TEST measures the cumulative effects of your glucose levels for the previous 90 days with a heavier emphasis on the time (4-8 weeks) closest to the time of the test.So, by taking care of your diabetes on a daily basis, the incontrovertible cumulative results will be reflected in the A1C TEST.

And, just so you know, nobody is perfect and we all “fall off the wagon”. When that happens, it’s even more important to see your doctor every 90 days. Your doctor works for you and will always be there to help you.

Also, important to realize: the diabetic lifestyle is the most perfect lifestyle to live:

1. see your doctor regularly;
2. eat properly; and
3. get proper exercise. If everybody followed this regimen, whether they’re diabetic or not, you’d see all kinds of diseases be drastically reduced in numbers of cases and their severity.

Further, for those at risk for developing diabetes, the A1C TEST will tell you if you have diabetes years in advance of the symptoms showing up. Early identification is key to avoiding the dire consequences of the disease.

[NOTE: There are 1440 minutes in each day. The average visit to your Endocrinologist (or Internal Medicine specialist) is 16 minutes per visit (or, 64 minutes per YEAR)!! Therefore, it’s absolutely necessary for each diabetes patient to become pro-active in their own diabetes care. Learn as much as you can about diabetes and how you can improve your own health.]

19. Lori Zanini, RD, CDE

Lorizanini.com

Here are some tips you can do everyday to help lower your A1C level:

Meet with a nutrition expert. Unsure of where to start with your diet? Meet with a RD or CDE to help make an easy to follow meal plan that includes foods you love but eliminates those that may contribute to a higher A1C.

Don’t skip meals. Eating regularly throughout the day helps to stabilize your blood sugar levels. Using carbohydrate counting and insulin-to-carbohydrate ratios to help appropriately dose insulin and keep blood sugar levels stable can help lower A1C levels in those individuals using insulin injection or insulin pump therapy.

Try to get in 30 minutes of physical activity on at least 5 days of the week. Don’t have 30 uninterrupted minutes to get in a good workout? That’s okay! Start with 10 minute bouts of exercise such as a quick workout before your shower in the morning, a brisk 10 minute walk on your lunch break, or a 10 minute walk or bike ride after dinner. Studies show breaking your 30 minutes of exercise up into 10 minute bouts is just as effective as doing all 30 minutes at once.

20. Bonnie R. Giller, MS, RD, CDN, CDE

Brghealth.com

Diabetes management is the key to living a healthy life free of diabetes complications. The best way to keep your diabetes under control and lower your A1C levels is to work with a Registered Dietitian (RD)/Certified Diabetes Educator (CDE). A RD,CDE can help you learn proper meal planning techniques that work best for you. These techniques can include eating consistent carbohydrates throughout the day, not skipping any meals, and being mindful of portion sizes for all foods. This will help you avoid big spikes and drops in your blood glucose, which ultimately affects your A1C levels. It is also important to engage in regular body movement to keep your blood glucose levels stable and even lower them, which will also help you lower your A1C levels. Body movement does not have to be formal exercise, it can be anything you enjoy that gets your body moving, such as taking your dog for a walk, riding a bike outdoors, or going for a hike.

Although diet and exercise have the most influence on your A1C levels, keeping your stress levels down can also aid in lowering your A1C levels. Chronic stress can result in elevated blood glucose levels leading to higher A1C levels. Consider beginning a meditation to help lower your stress levels, and you may see a positive effect on your blood glucose and A1C levels too.

21. Dr. Taz Bhatia, MD

Centrespringmd.com

Lowering your A1C is possible, you just have to think about the gut and the liver to see a change in these numbers. Removing inflammatory, hard to digest foods like dairy, sugar, and even salt can improve your A1C. Adding probiotic rich foods to ease the digestive process including bone broth, heavily fermented bread, or kombucha can improve your A1C numbers as well.

Supplements like alpha lipoic acid and the Ayurvedic supplement gymnemna sylvestre further lower A1C. Finally, regular and consistent exercise can reduce A1C numbers even further.

22. Dr. Sonica Krishan

Drsonicakrishan.com

Natural ways to lower A1C levels

Following the right diet and lifestyle tips and Ayurveda recommendations could go a long way to keep you A1C level in control.

Diet Recommendation:

• Ayurvedic Diet Recommendation for Diabetes in general advises that a diabetic patient needs to inculcate the tastes of bitter, pungent and astringent in their daily diet plan.
• Try and drink water from a glass made of the wood of Vijaysaar. It would be all the more beneficial if you could keep this water overnight and drink the same early morning on an empty stomach.
• Seeds of Karela or Momordicacharantia (Bitter Gourd) are to be pounded and the powder may be taken twice daily with warm water and also the fresh juice extracted by grinding fresh bitter gourd, is recommended.
• Tender leaves of Neem (Azadirachtaindica) and Bilva (Aegle marmelos) are to be taken first thing in the morning on an empty stomach. These hold naturally blood sugar lowering properties.
• A powder prepared by crushing the dried seeds of the fruit of Jamun i.e. Eugenia jambolana (Blueberry) helps considerably. This could be supplemented along with the routine medication. While it helps significantly in cases of debility and excessive urination experienced by the diabetic patient, in many cases it has miraculously cured cases of borderline diabetes.
• Fenugreek leaves may be included in diet. Also, as a home remedy, the seeds of fenugreek can be soaked night long in a glass of water. This water is to be taken on an empty stomach. This purifies blood and also is immensely beneficial for the patients suffering from diabetes.
• Shilajit or Black Bitumen or Mineral pitch that oozes out of the rocks of the Himalayas in the form of a liquid, is another useful drug of choice used in Ayurveda. It is believed to be supportive in lowering A1C levels and it prominently supports the pancreas in keeping diabetes at bay.
• Fresh juice of Aamla (Indian Gooseberry) proves beneficial when taken on an empty stomach.

Lifestyle Recommendations:

• Whereas maintaining a controlled diet pattern which is low in starches and sugars is essential, everyday exercise schedule in form of brisk walk in fresh air for one hour or undergoing yoga poses like Dhanurasana, Shavasana, Paschimottanasana, Yogamudra, Sarvaangasana, Utaanpadasana etc. and pranayama (deep breathing techniques) would be of good help.
• Sedentary lifestyle and sleeping during the day time is to be restricted and an active life is rather imperative.

23. Michelle Buelow

Linkedin.com/michelle-buelow

There are several lifestyle factors that aid in lowering a person’s Hgb A1c level. Weight, diet and physical activity all play an important role in lowering an A1c level.

Following a healthy diet with special considerations placed on consistent and moderate carbohydrate intake can beneficially effect a person’s blood sugar levels, and therefore, lower their Hgb A1c. There are also several medical interventions that can help lower a person’s Hgb A1c level. Your Doctor will work with you to determine if medication is needed, in addition to following a healthy lifestyle pattern. If medication is required to achieve your target Hgb A1c levels, it is still very important to follow a healthy lifestyle.

24. Cyndy Cohoon RN, CDE

Kidswithcourage.org

In my role through years as a diabetes educator, I have found three important factors that contribute to the success of lowering A1C blood glucose levels. Firstly, keeping children with diabetes active is an instrumental component in their health. Secondly, being able to dose prior to eating healthy meals has shown to be effective. Thirdly, having a support system for making healthy choices can make all the difference in the world.

When children see their parents and siblings active, they are more inclined to be active on a regular basis themselves. If the family is not willing to be inclusive in activity, the person with diabetes may feel it a burden to be active and therefore will not exercise alone. This is also true of the family unit when dealing with adults with diabetes. This singular change of getting out and exercising can help lower A1C levels.

When dosing, it is crucial to do so ahead of the meal so that the insulin is working by the time the food is eaten. For those who are picky and feel they must dose after the meal, a portion of the insulin can be given ahead of the meal and the rest given when it is determined that the remaining food can be eaten. The “My Plate” guide, set up by the USDA, is an important tool and a great way to think about what should be on our plates at meal time. If an insulin pump is involved, there are special features such as extended blousing, that can be used to compensate for those that linger over their food.

Lastly, the embarrassment of having a condition that other family members do not, is very difficult to overcome. Support should be given even when daily diet and exercise are not perfect. Children should be coached and taught rather than badgered about sticking to regular diabetes care. Those children who are left with the burden of total diabetes care are less likely to stay on track. It is essential to know that each day is a new day to start over and with a great support system they can make better choices.

In conclusion, there are several things that can help people with diabetes keep their A1C levels in a normal range. Embracing an active lifestyle, making good food choices, effective dosing protocols and a positive support system can help people manage their diabetes. The combination of these things and the knowledge that every day can be a new start, can be extremely comforting and useful.

25. Dr. Matthew Mintz

Drmintz.com

The goal of all physicians and patients when treating diabetes is to lower the A1c. This is because high A1c’s are proven to correlate with complications from diabetes (heart attack, kidney failure) and lowering the A1c has been shown to dramatically reduce these complications. There seems to be a linear relation, i.e. the lower the better; but more recent thinking is that for some patients (older patients in particular) trying to get as close to normal as possible may be dangerous. So, the first question is “how low do you go?” The answer is somewhere between 6-7%. You and your doctor can partner to decide what number is right for you.

There are many ways to lower A1c.

1. Diet and exercise. Most patients know that losing weight is important in lowering A1c. However, many patients don’t realize that losing just 5-10% of body weight can make a huge difference. So an overweight diabetic at 200 pounds might still be overweight at 180, but losing 10-20 pounds can make dramatic improvements.
2. Address medication side effects. Side effects are not fun, and many patients stop taking or don’t take medications regularly to avoid them. One side effect for diabetes medications is low blood sugar or hypoglycemia. This can be uncomfortable, scary and even life-threatening. The most common medicines causing hypoglycemia are sulfonylureas like glyburide and glipizide. Unfortunately, because they are the cheapest, they are the most popular. They also have the side effect of weight gain. I would recommend getting off these medications and using newer medications that don’t cause hypoglycemia.
3. Use multiple medications. Many endocrinologists will tell you that if two pills don’t work, using a third won’t help. I disagree with this. There are now four agents (SGLT2 inhibitors, thiazolidine diaones, DPP4 inhibitors, and metformin) that are combined in several pills, such that taking 4 agents (potentially combined in two pills) isn’t that hard. Because all four agents have different mechanisms, they are complimentary. My philosophy is to keep adding pills/agents until you lower the A1c.
4. Fear insulin not the injection. In my experience, diabetic patients are petrified of starting insulin. It’s not just the fear of injecting themselves, but checking their blood sugars regularly, risk of hypoglycemia, and stories of loved ones who started insulin –likely too late- and bad things started to happen. Insulin is a life-saving medicine, and sometimes must be used in patients with type 2 diabetes. However, many patients can lower there A1c without insulin. In addition to the four agents previously mentioned, the GLP-1 analogues are also excellent agents that don’t cause hypoglycemia and can help with weight loss. They are injectable, but come in convenient pens. They are super easy to use. Because they don’t cause hypoglycemia, checking finger stick glucoses is not necessary. Whenever I suggest these medicines to patients, before making any decisions, I have the patient self-inject in the office. The typical responses are “I can’t believe that was so easy,” “I didn’t even feel it,” or “I can do that!” If you are not able to lower A1c on multiple agents, then injections may be an excellent options. Give it just one try in your doctor’s office and you will see that you have nothing to fear.

26. Lawrence Labenne

When diabetics consistently do the following A1c reductions happen:

1. Eat a balanced diet per dietary guidelines
2. Avoid refined carbohydrates (ie avoid: sugar; flour; fruit juice)
3. Engage in physical activity*
4. Check blood sugar
5. Follow prescribed treatment regimen

*Physical activity does not have to be complicated. The simple act of walking at a moderate pace 45-60 minutes 5-6 days a week will yield results. Bottom line, one should find activities they enjoy and do them consistently.

27. Prof David Segal

Endo.co.za

To lower ones A1c (assuming it is above target) then there are a certain number of behaviour that need to be adopted and maintained.

The first and most important is for the person with diabetes to believe that diabetes is manageable and that they are responsible for managing it.

The person must be on the right insulin or medication, take it at the right time and in the right dosage- if all three of these criteria are met the blood glucose will be normal.

• Take insulin to cover all meals and snacks.
• Make a meal plan and follow it- adjust it as required to use diet to control blood glucose not just medicine.
• Eat smaller portions, less carbohydrates and snack less often and on free foods.
• Migrate injection sites so that they get a chance to heal in between shots. Do not create or inject into lumps.
• Do meaningful blood glucose monitoring, check readings and adjust food, insulin, medications and exercise to keep blood glucose levels within the target range.
• Educate yourself to equip yourself to manage diabetes properly.

28. Elizabeth Ebner, M.S., R.D., CDE

Hackensackmeridianhealth.org

A1C% can be lowered with primarily increasing post meal activity, carbohydrate counting and medication. As a dietitian I focus on the first two and can often get the A1C% down 1-2% points. This is so empowering to the patients because it puts responsibility on their own behavior changes. Exercise can really help in their insulin sensitivity, so post meal exercise can be very impactful. I sometime recommend that they take a pre and post exercise blood glucose to see the effect it has. Meal planning and making / keeping a food log is VERY important as well.

29. Jennifer Smith

Integrateddiabetes.com

I think it’s important to first consider and note what A1C actually indicates for readers. It is of course an average of where the blood glucose levels have trended in the past 3 months (or 120 days which is the lifespan of red blood cells). An average is just one value and it misses all the highs and lows that have allowed the mid-range or average to show up.

Overall, A1C is not, and should not be, the “end all, be all” of evaluation for glucose control. It should only be a starting place for discussion and more specific glucose records should be evaluated for trends up and down that can be adjusted more precisely by time of day.

One big thing A1C misses, if it is the only evaluation tool for glucose in use, is hypoglycemia and hyperglycemia. If someone has an A1C that is 6.2% and that is the only “look” at glucose control that is evaluated then a practitioner will be missing the variance in glucose which typically will include time spent too low (as well as too high). This isn’t optimal for overall management. What should be evaluated is time spent in range. This is of course best evaluated using the CGM as a tool to collect data between fingersticks. this is the most optimal way to find out where adjustment to diabetes medication, food, activity needs to be made. If no CGM is available, then gather data with well timed fingersticks – fasting, before meal and 1.5-2 hours after meals (as well as before/after exercise, etc) and bedtime. These values will show where adjustment to current strategy should be focused.

Overall the first best place to start in the effort to get A1C lower is evaluation of the overnight glucose control. If you consider that every 24 hour day is a set of three 8 hour time periods, then consider if you get the overnight well managed without lows or highs you are carving out a 33% chunk of time that is weighted into the A1C. A third of the weight of A1C that is in range will improve the value. Also, if you start the day with an in target glucose value it tends to be easier to keep things in range for the following hours, which is another chunk of an 8 hour time period that weighs in on that A1C value and can get it further into target.

Overall, getting A1C lower means we need to take a more in depth evaluation of our day to day glucose trends and look at where the largest excursions happen. Zone in on that area (overnight, after meals, etc) and it will star to improve that average blood glucose which translates into a lower A1C.

If you use tools like a CGM to gather trending data, also focus in on whether you have roller coaster from high to low or gentle rolling hills – more optimal to have less variance from high to low and more time spend in range.

30. Johanna Burani

The Hgb A1c test is easy to obtain and full of important information about your diabetes status. Taken from a simple blood test, it tells you your average blood glucose level over the past 2-3 months.

Hemoglobin is a protein found in the red blood cells of the body. Glucose tends to stick onto the hemoglobin molecule as it circulates in the blood. More glucose molecules in the blood means more glucose is attached to the hemoglobin molecules. The life span of a red blood cell is about 3 months.

The Hgb A1c test measures the level of this glucose “coating” on your red blood cells as a percentage:

• Normal 4.0 – 5.6
• Pre-diabetes 5.7 – 6.4
• Diabetes 6.5+

If you have diabetes, your goal is to stay under 7.0 or get closer to it than you currently are.

Some see this test as a “report card” or a “grade.” It is helpful, instead, to consider your Hgb A1c result as a “progress report” or “checking in” tool. If your number looks good, keep doing what you’re doing. If you or your doctor or diabetes educator think your number needs to improve, here are a few ideas to consider:

• Follow a balanced diet – whole grains, fruits, vegetables, lean sources of animal protein, plant protein, low fat dairy – at every or most meals.
• Be mindful of portions – the best way to do this is by weighing and measuring; the eye and the hand are less accurate than the scale!
• Choose slow steady carbs, not ​no ​ carbs – carbohydrates are the body’s fuel of choice; keep it happy with low glycemic carbohydrates (whole unrefined grains, most fruits, vegetables, legumes, low fat dairy) that “trickle” rather than “gush” glucose into the bloodstream.
• Be consistent with exercise – deliberately do something physical everyday; it doesn’t have to be strenuous or for a long time; just move your body in a way that makes your body feel good. Try walking: no membership card or special equipment needed – and you already know how to do it!
• Consider every decision you make about taking your medications, your diet and your exercise commitment as impacting your health – one way or another.

“Progress, not perfection.”

31. Rohit Moghe

Twitter.com/rohitamoghe

Although some intellectuals in diabetes are challenging the utility of A1Cs, it is still widely used marker to define diabetes control. It does not always correlate as consistently as we once thought with patient outcomes based on newer trials of medications used to treat diabetes, prompting many new studies to look at cardiovascular and mortality outcomes despite A1C attainment. However, since this is still the most widely accepted marker of diabetes control, what I can recommend as the best way to reduce A1C is through a multi-pronged approach:

• What you eat – preferably > 90% plant-based. High blood sugars trigger a vicious inflammatory reaction in one’s body, which in turn, can make it very challenging to manage blood sugars. Eliminating or significantly reducing animal-based foods and reduce this inflammation, and possibly help with better blood sugar control.
• Staying active – constant motion and small bouts of higher intensity exercises (as long as heart is healthy enough). Sitting is the new smoking and new heart disease! This means get out and move, regardless of what time of the year it is, safely and within reason. This includes getting enough sunshine to boost mood and get your daily dose of vitamin D. Ask for an exercise prescription.
• Monitoring – making sure you check your blood sugars as determined by you and your diabetes team
• Taking medications – making sure you are adherent and persistent with your medication regimen, but more importantly documenting how the medications are making you feel, including if you are experiencing something good vs something unusual. Unintended (i.e. side) effects of medications do occur, but may be self-limiting or may persist longer. The key is to identify how they impact your quality of life – positive, marginal, or negative. If you don’t like the idea of taking medications, make sure you communicate with your diabetes management team, and ask what it would take for you to get off, which in most, cases, is improving the choices you make. There is not one pill or two pill solution to this diseases – it’s mostly lifestyle!
• Managing stress – making sure you identify how your blood sugars are impacted by stress. There are two types of stress – “good” and “bad”! Very few people experience “good” stress – this is the kind that motivates someone and helps push them beyond their limits. Think about athletes and those who are in high stressful jobs, but never affected negatively by it. Most people are afflicted by “bad” stress, and lack of proper coping skills or inattention to cultivating strong, sustainable coping skills can hamper how we respond to situations. In most cases, it’s how we react in situations, that is the root of our stress. The best to be as bulletproof as possible to handling stress is through mind-body connections such as meditation & mindfulness practices, yoga, deep breathing, and other relaxation techniques. Seeking a counselor to help you cognitive change your brain connections and understanding of your situations will also be very helpful. This process requires YOU to search deep within yourself and actualize an individual IS capable of doing great things instead of being complacent and doubtful.
• Sleep – getting enough sleep at least 7 hours of good restful sleep

For both major forms of diabetes, the lifestyle choices we make will affect our blood sugars, and ultimately our A1C. A chronic condition like diabetes, especially Type 2 is a largely a lifestyle disease – that is, fixing your choices is the most sustainable method to gain control. It is a daily experiment, and documenting and/or journaling will help you reflect and review the types of things that have worked and what is keeping you from making them work, and well as help with goal setting.

32. Susan Schussler, RD, CDE

I primarily work with people who have pre-diabetes or newly diagnosed type 2. My understanding is that postprandial blood glucose excursion influences A1c values the most. So I recommend:

Check blood glucose 2 hours after the start of the meal to be sure it is 180 analyze previous meal carb content—too many, type of carbs: refined vs. high fiber, if >180 exercise for 15-20 minutes to lower it.

33. Therese Franzese MS, RD/N, CD/N, CDE

Linkedin.com/therese-franzese

A1C (hemoglobin A1C) estimates the percent amount of sugar on your red blood cells. Red blood cells have about a 90-120 day life-span, so if we measure the amount of glucose on your RBC’s every few Months, then we can estimated how high your sugar has been over that period of time. Your A1C may be high even if your regular daily finger sticks are within desirable limits. A1C can reveal an overall blood sugar range that may tell a different story about your blood sugar changes throughout the day and is related to how much carbohydrate you eat at each meal or snack.

A target or goal is something that you are trying to reach. Your health care team use numbers that are backed up by scientific evidence and proved to increase better medical course outcomes. People with diabetes have blood sugar targets that they should try to reach at different times of the day. You don’t have to have perfect numbers all of the time, since that would be unrealistic for most. Unachievable goals lead to disappointment and may interfere with your self-care plan.

Finger stick ranges for Type 2 Diabetics should be:

• Right before your meal: 80 to 130
• Two hours after the start of the meal: Below 180
• A1C could be a good screening tool for pre-diabetes 5.7 – 6.4%
• A1C over 6.5% is considered frank diabetes

You don’t have to take your blood sugar 6 – 8 times per day. To get a better understanding of your possible “trouble” glucose spots and triggers throughout the day, stagger your finger sticks over a typical 7 – 14 days and record with food and portion records. When, where, how the food was prepared and any other relevant information should also be added, if possible.

Know your numbers (AKA ABC’s): A1C, Blood Pressure and Cholesterol.

Follow your Diabetes Professional Team’s advice and orders. Don’t cancel follow-up appointments.

What you eat matters. Watch your portions sizes. Just like your finger stick tracking, if you want to help yourself achieve better numbers you should try your best to have a lower fat, lean protein and steady carbohydrate diet with fewer items made with “simple sugars”. Your plate should be ½ vegetables and fruit and one quarter of whole grain starch and the last quarter a low-fat protein. A snack could be a low-fat yogurt and a fruit with a tablespoon of nuts or seeds. Water is always a good alternative to soda or juice to help save calories and too much carbohydrates. Using a pre-set menu, shopping list, preparing and cooking your own food is always better than eating out. Have your Certified Diabetes Educator and Registered Dietitian help you learn a diet plan that works around your life.

Watch your weight and do your best to meet the weight your Diabetes Team has set.

Increase your activity. Start with 10 minutes of walking per day and slowly add time until you reach 30 minutes every other day. Do something like gardening to help use your upper body muscles as to maintain your total body strength. Your body’s insulin works better with bodies with more lean muscle mass than it does in bodies with more fat tissue.

Wear shoes that protect your feet and check your feet everyday for scratches, blisters or cuts. If they don’t heal, call your DM team.

Learn good coping skills. Stress may increase your blood sugar. Your health care team likely has a counselor.

34. Dr. Louise Achey

Askdrlouise.com

2 FAST Ways to lower your A1c:

• Drink water instead of sweetened beverages.

What kind of beverages do you drink? It’s not just soft drinks that pack a lot of sugar: sweet tea, flavored lattes, mochas, frappacinos, even an 8 ounce glass of orange juice can shoot your blood sugar up like a rocket. When one of my patients began cutting out 1 can of non-diet cola per week ( he drank 6 per day), within 2 months he was drinking water instead and had lost 6 pounds. In two more months he had lost 18 pounds and his A1C had dropped by a whole point. Another patient couldn’t go “cold turkey” like him so instead she started watering down her fruit juice and sweet tea until she could make the switch to water, which she still does most of the the time. She lost 5 pounds and her A1c dropped by nearly a point.

• Make friends with good fats.

Don’t eat a low-fat diet. Good fats stabilize your blood sugar between meals and help you get off the roller coaster of blood sugar highs and lows. Eating a high carbohydrate breakfast in the AM like cereal or toast can leave you starving before by 10am and vulnerable to sweet treats like doughnuts. Pairing up good fat with whole fruit or veggies is a winning strategy: carrot slices with almond butter, apple slices with sunflower butter, even peanut butter and banana are much, much better choices than dry cereal with milk, muffins, or sweet breads.

35. Dr. Carolyn Dean

Drcarolyndean.com

Here is what can help in preventing and treating diabetes:

Having meals that include protein, complex carbohydrates. You must avoid simple sugars and white flour. Stevia, which can be found in a plant from South America, can be an alternate for sweetner. Oat bran, flaxseed and apples contain fiber and can have a positive effect on keeping your sugar levels under control. In addition, the elimination of dairy, gluten, corn can be wise as well.

36. Patricia Henry Lewandowski, M.Ed., RDN, LD, CDE

Affinitymedtx.com

One of the first ways to lower A1c is to know what your number is. Many times, individuals do not know the number or what it means. Also, it is important to know if your number is going up or down. This can help point you in the direction that you want to take to improve it.

Next, you need to test your blood glucose levels on a regular basis. If you are on Medicare or have a limit to the number of strips you get, use them wisely. I have people test 2 times per day 3 days per week than every day. You get better information that way. I also ask that when they do test, they test fasting and before one other meal. I have them write down what they ate at the previous meal and then we look for common foods or patterns. Does the number increase or decrease? Did they take their medications as prescribed or forgot to take them? I also have them keep track of any physical activity they do so we can see how and when exercise affects their blood glucose level. If they eat the same meal several times and the numbers are good, I don’t have them test for that meal unless they have changed something – a food, a portion size, a combination.

Last but not least, I remind them it is just a number. I have them pick a number and then plan on what they can do when they see that number. Exercise more, eat less, take more medication (if approved by their physician) are all choices. I also remind them they are the only one who controls their blood glucose numbers. Educators, physicians, family members can help; however, only they control the number. Good or bad, you need to own up to it.

37. Dr. Michael Klaper, MD

Doctorklaper.com

Type 2 diabetes is essentially a disease of fat toxicity. Diets chronically high in fats, especially saturated fats, keep a steady supply of lipids in the blood. Over time, these fats accumulate in the muscle cells (intramyocellular lipids) and eventually oxidize – generating free radicals, ceramides and other toxic fatty compounds. These, in turn, injure muscle mitochondria and inhibit the enzymes needed to transport glucose from the bloodstream into the muscle cell. As a result, glucose builds up in the bloodstream.

In this condition, there is plenty of insulin in the blood, knocking on the enzymatic door to let glucose into the cells, but since the enzymes needed to do that are being blocked by toxic fats, insulin’s knock goes unanswered. If is as if someone put chewing gum in the door lock.The muscle cell is said to have become “insulin resistant.”

As a result, sugars levels in the blood remain high for hours after a meal with starches and simple sugars, so the blame is directed at the “carbs” – when the real culprit is the excessive fats clogging the enzymatic machinery within the muscle cells.

High carbohydrate, low fat diets – based on whole food, plant-based ingredients only, with no added oils – have been shown to consistently reverse Type 2 diabetes (https://nutritionfacts.org/video/what-causes-insulin-resistance/)

After weeks of consistently elevated sugar levels, glucose sticks to (glycosylates) and ultimately damage proteins throughout the body, including hemoglobin. The percent of glycosylated hemoglobin (HgbA1c) reflects the average blood sugar over the previous approximately 12 weeks. Any more than 5% of hemoglobin sticky with sugar is too much and implies prolonged periods of hyperglycemia.

To lower the average blood sugar, and thus lower the HgbA1c, one must let the toxic fat clear out of the muscle cells (and liver and pancreas cells, as well) and nothing does this like a whole food, plant-based diet with no added liquid oils and a daily walk. An effective version of such a diet plan is described in Dr. Neal Barnard’s book, Dr. Barnard’s Plan to Reverse Diabetes as well as The End of Diabetes by Joel Fuhrman, M.D. This strategy predictably results in great improvement in glucose control – and, assuming the pancreas’ insulin secreting beta cells have not been irreversibly injured by the same toxic fats – often a complete resolution of the diabetic state that was induced by a diet overly high in fats.

We understand that living with diabetes can add more stress in your life than what you are used to. You are constantly trying to juggle several things at the same time ensuring the puzzle pieces match and work in harmony. Keeping your A1C levels manageable is not an easy feat because you have to make changes in other parts of your lifestyle in order to meet your goals. With that in mind, we hope that the words of our experts have helped in alleviating some of your stress and burden. Please share with us your thoughts on our piece or any other comments you may have. We are always open to receiving other topic suggestions or expert round ups. If you have a question, we will do our best to get an answer, and not just from anyone but from experts in the field.

This post has been condensed and edited.

Disclaimer: The views and opinions expressed in this article are those of the contributors and do not necessarily reflect the official policy or position of TheDiabetesCouncil.com.

TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 21, 2020

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Lower A1C Levels Naturally & Quickly (Overnight) Without Meds

Do you have diabetes and you are wondering
the best ways in lowering a1c levels naturally? You came to the right place!

People who have diabetes require a
significant level of discipline when it comes to medication and lifestyle. This
way, they will be able to improve their condition and prevent possible
complications.

However, before jumping into the different ways on how to lower a1c levels fast, you need to be familiar first with the A1C test.

What is the A1C Test and How Can I Lower It Overnight?

Do you want to confirm whether you have a
diabetes? Then, you need to undergo an A1C test. It is a blood test that
screens for diabetes.

An A1C test is also known by other names
such as hemoglobin A1C, glycosylated hemoglobin, and glycated hemoglobin. Its
result will reflect the average blood sugar level for the past 2 to 3 months.

What do the scores mean?

In an A1C test, the results are reported in
the form of a percentage.
You need to acquire valuable ideas of what do the scores mean.

• An A1C levels below 5.7 percent is considered normal.
• An A1C between 5.7 and 6.4 percent signals prediabetes.
• An AIC levels above 6.5 percent means positive on diabetes.
• An A1C levels of 7 requires treatment.

Normal Blood Sugar Range After Meals

If you want to improve the natural ways to lower a1c, you need to
monitor your food intake. But, what is the normal sugar level after a meal?

You need to be aware that a healthy blood
sugar level should be less than 100 mg/dL after you have not eaten for at least
8 hours. Thus, the range is less than 140 mg/dL 2 hours after a meal.

What are the signs of diabetes?

Did you know that diabetes can be developed even developed even without
warning signs? However, below is the list of signs of diabetes.

• Dry mouth
• Urine
  infection or frequent urination, increased thirst or hunger
• Fatigue
  including tired feeling and weakness
• Headaches
• Blurred
  vision

Diabetic Men at Higher Risk for Heart Disease

Heart disease is among the common
complications of diabetes and men are known to be at higher risk. Based on a study, men who have
type 2 diabetes who are being treated with insulin can develop a higher risk
for cardiovascular events including heart attack, stroke, and death.

After getting familiar all about the A1C test, the next big thing for you to learn on how you can reduce and lower a1c levels naturally.

How To Lower A1C Levels Overnight Naturally With Type 1 Diabetes

Having a type 1 diabetes can be devastating. Good thing, there are
effective ways of lowering a1c naturally.

Give Up Smoking

Do you still smoke while you are treating your diabetes? It is better for you to quit smoking to ensure that you can lower a1c naturally and even overnight. Also, you have a chance to control your blood sugar, reduce possible cardiovascular complications, lower the risk of kidney complications and improve your blood circulation.

Find An Activity You Enjoy and Become More Active In
It

By being active in the things you enjoy,
you can reduce a1c naturally.
So, think about the activities you love and spend time enjoying it. Thus, you
will be able to relieve stress and obtain relaxation.

Lose Some Weight with Active Lifestyle – Reduce Blood
Glucose During Exercise

If you have a type 1 diabetes, it is recommended for you to
monitor and maintain a healthy weight. You can choose between yoga and gym
which are both effective in helping you lose weight while lowering a1c
naturally. See to it that you are comfortable with the type of exercise you
choose.

Ensure A Good Night’s Sleep

By getting enough sleep overnight, you can naturally lower a1c. This is because when you have poor sleeping habits, your insulin sensitivity and sugar levels are affected. Also, if you have sleep deprivation, there can be increased cortisol levels and decreased the release of growth hormones which are both essential in the blood sugar control.

Have An A1C Level Goal and Stick to A Schedule To Reduce It.

In lowering a1c naturally, you need to have your a1c levels goal to keep your motivation. Also, it is necessary to stick to your schedule. Remember, your blood sugar might rise or fall too much if you do not follow the right meal schedule.

Essential Oil for Diabetes

When it comes to lowering a1c levels naturally, essential oils are quite useful. You can choose from coriander seed, lemon balm, clove bud, black seed, black pepper, cinnamon, lavender, and many more.

PREVENT
AND REVERSE DIABETES USING YOUR FOOD AS MEDICINE

The food you eat have a significant impact
on reducing a1c naturally. Certain foods can help you in preventing and
reversing diabetes.

Diabetes Diet

You can consult your doctor for you to
determine the ideal diabetes diet for you. You have to eat three healthy meals
each day and snacks in between to regulate your blood sugar level. Also, you
need to eat meals with appropriate portion sizes as well as eat more
vegetables.

Cut Back On Carbohydrates

When consider cutting back on
carbohydrates, there is a better chance for you to control your blood sugar
level, lose weight, and lower a1c naturally. So, you need to be very particular
with the food you eat especially to those who have a high level of carb.

High Fiber Foods and Fruits

Another way of lowering a1c naturally is by eating high fiber foods and fruits. These foods can help you in obtaining better blood sugar control. You can take advantage of fruits with skin on it, whole grains, and non-starchy vegetables.

Add Probiotics to Your Diet

Probiotics are known to lower insulin and
glucose levels in people with diabetes. L. casei and Lactobacillus acidophilus
can help you improve your hyperglycemia and glucose tolerance.

Apple Cider Vinegar

By consuming apple cider vinegar, you will be able to control your
blood sugar levels. One study has demonstrated that it can reduce sugar levels.

In ensuring that you
can effectively reduce a1c naturally, you need to determine the critical steps
as well as the foods you need to take. But, see to it that you have the discipline and follow a
fixed schedule. Also, you need to maintain a healthy lifestyle.

The Effects of Weight Loss on the A1C

Blood samples in test tubes on a lab sheet.

Image Credit: dina2001/iStock/Getty Images

An A1C test is commonly used to diagnose diabetes. It measures your blood sugar levels over a three-month period by showing the amount of glucose that is attached to your red blood cells. The glucose sticks to the cells until they die which is typically two to three months, reports Utah.gov. Having too much blood sugar can cause an excess amount of glucose to attach to the cells which will give you a higher A1C and increase your risk of diabetes. Lower your A1C and your risk of diabetes by losing weight.

Losing weight is the first step to lowering your A1C. Your A1C should be below 120 mg/dL, or between 4 to 6 percent. Having two separate tests showing an A1C 120 mg/dL to 140 mg/dL, or 6 to 6.5 percent, may determine that you have pre-diabetes, reports the Mayo Clinic. If your A1C is above 150 mg/dL, or 7 percent, your doctor may diagnose you with diabetes. In some cases, your doctor may also suggest medications to help lower your A1C if weight loss is not enough.

Reduced Risk of Type 2 Diabetes

Your doctor will use the A1C results to diagnose or treat your diabetes. The more fatty tissue you have in your body, the more resilient you become to insulin. Your body uses insulin to regulate the movement of sugar into cells. The higher your A1C, the greater your risk of developing type 2 diabetes and having diabetes complications, according to the Mayo Clinic. There is no cure for type 2 diabetes, but you can reduce your risk and lessen the complications. Eat a healthy diet full of whole grains, vegetables, fruits and lean meats. Also, increase your physical activity to lose weight and help lower your A1C.

Decreased Risk of Other Diseases

Having a high A1C puts a tremendous strain on your body. Losing weight and lowering your A1C can reduce your risk of a heart attack and other cardiovascular illnesses. Having too much sugar in your blood stresses your heart and kidneys. It also increases your risk of blindness, according to Utah.gov. Talk to your doctor before you begin a weight loss regime to help you set weight loss goals to get you on the right path to a lower A1C.

Having a normal-range body mass index, or BMI, may help lower your A1C. According to the Mayo Clinic, if your BMI is over 30.0, you have obesity. Having overweight is 25 to 29.9 and having normal weight is 18.5 to 24.9. You are considered having underweight if your BMI is less than 18.4. Calculate your BMI by dividing your weight in pounds by your height in inches squared. Multiply that number by 703. For example, if you weigh 200 lbs and you are 66 inches tall, your BMI is 32.3 which is in the obesity range. Having a high BMI can increase your risk for type 2 diabetes.

90,000 10 foods for diabetics

Healthy food choices to control blood glucose levels are key for people with type II diabetes. Researchers have identified some key foods that can improve disease and possibly reduce the risk of disease or complications.

Blueberry

Blueberries are rich in nutrients and research suggests that regular consumption of blueberries increases insulin sensitivity.Scientists also believe that blueberries have anti-inflammatory effects, which can help reduce the risk of developing some of the cardiovascular diseases found in type II diabetes.

Oranges

Oranges, Grapefruits, Tangerines – Research shows citrus fruits have positive, long-term effects on blood glucose and cholesterol levels. This may be due to the anti-inflammatory compound hesperidin and a healthy dose of soluble fiber.Research from the Harvard School of Public Health, USA, shows that eating whole fruit, not just juice, is associated with a lower risk of developing type II diabetes.

Chickpea

Chickpeas, as well as beans and lentils, are well-known low glycemic index foods, making them a good choice for diabetic patients. However, new research suggests that eating legumes may actually have therapeutic effects.In a 2012 study published in the Archives of Internal Medicine, individuals with type II diabetes consumed 1 cup of legumes daily as a carbohydrate source for 3 months. Compared to other study participants, these patients showed greater reductions in hemoglobin A1c and blood pressure values.

Dark chocolate

Several studies have found that a small amount of high quality dark chocolate consumed daily reduced fasting insulin and blood pressure.The observed effects are possible thanks to compounds called polyphenols. However, any changes and additions to your diet should be discussed with your doctor.

Plant food

Vegetarians have a significantly lower risk of type II diabetes mellitus than those who consume animal products. Vegetarians also tend to have a lower body mass index (BMI). A 2012 study found that a diet with a high concentration of nutrients has a significant positive impact on people with diabetes.The diet includes eating fruits, vegetables, nuts and legumes, and avoiding meat. In fact, after following this diet for 7 months, study participants experienced significant decreases in hemoglobin A1c, blood pressure and triglycerides, increased levels of “good” lipoproteins, and 62% of participants experienced blood glucose levels in the normal range.

Olive oil

Replacing saturated and trans fats with healthy unsaturated fats is a key recommendation for all people.However, the type of fat consumed may play an even greater role in the health of individuals with type II diabetes. This is because diabetes is associated with an increased risk of heart disease and stroke. Consuming olive oil not only lowers the risk of developing diabetes, but also improves the use of glucose by cells due to its anti-inflammatory properties.

Green vegetables

Higher intakes of leafy greens and non-starchy green vegetables in patients with type II diabetes mellitus 65 years and older have been associated with decreased hemoglobin A1c levels and the risk of cardiovascular events.Whether these effects are related to nutrient concentrations in vegetables – especially vitamins A, C and E, as well as magnesium – or replacing less nutritious foods with vegetables is still being explored. The best results were observed when the patient included at least 200 g of vegetables in the diet each day, of which at least 70 g were green vegetables.

Nuts and peanut butter

Eating 5 servings of nuts per week (1 serving – 30 g of nuts or 1 tablespoon of peanut butter) was associated with a significant reduction in the risk of cardiovascular disease and stroke in women with type II diabetes.The 2011 Nursing Health Study, published in the journal Diabetes Care, found that patients with diabetes improved blood glucose and lipid control when they ate 60 grams of nuts daily instead of carbohydrates.

Probiotics

In recent years, several studies have examined the effects that beneficial bacteria may have on glucose regulation. Some of the research focuses on yogurt consumption and others on probiotics.Initial results from all studies show that eating foods high in probiotics, in particular yogurt, significantly lowers fasting glucose and / or hemoglobin A1c when consumed regularly for 8 weeks.

Cinnamon

Cinnamon increases insulin sensitivity, thereby helping to lower blood glucose levels. The exact mechanism of how this effect is mediated is still being explored, but most research points to the ability of cinnamon to help control blood glucose levels in the long term without potential side effects.

Based on materials from www.health.com

Brave Designers | Hidden Features: What You Need to Know About Conversational UI

We have prepared an adapted translation of Matt Hartman’s article. It details the different types of chat interfaces, their benefits, and new features for users.

1) Basic concepts

Chatbots and chat interfaces are not the same thing, although they overlap.In this article, it is advisable to rely on the following definitions: a bot is a program for exchanging messages between a user and a system of ready-made answers (another person is not involved in communication). And chat interfaces are an extended version of bots: any application, interaction with which is more like a conversation than a click on buttons. So, every bot has a chat interface, but not all chat interfaces are bots.

In the chat interfaces that I used, there were classic bots and bots, partially controlled by humans, as well as their hybrids: interfaces in which some roads lead to live operators, and others to bots.Some of them really increase productivity, others are purely entertainment:

Here are examples of services using classic bots:

• Digit: once a day sends a report on the state of the bank account and balance changes for the last day. You can answer with the word why to get a complete list of transactions for the last day, recent (last) – for the last three days, balance – the system will transfer some funds to the account for savings.In addition, I receive a message every time a payment (usually a salary) arrives on my card.
• PlusPlus: Slack bot tracks user karma changes in any Slack channel. You can increase someone’s karma with a message like @ mathartman ++ (or lower it with @ mathartman—), and the bot will keep track of it. Just for fun.
• Eat Arcade: Sends me a text message every day with two options for lunch, by noon the chosen one is on my desk. One word is enough to answer.
• Movie Night *: The Kik messenger bot picks up films from the current distribution. No unsolicited push notifications, just responses to my requests: movies and session schedules.
• Massively: A game app that lets you compose a story by exchanging messages with characters.
• Assi.st: A cross-platform text messaging interface (I use it on Telegram) that can do anything for you, from buying flowers to calling a taxi. They seem to have just hooked up a set of APIs recently, so there are no live operators there.
• Howdy: A Slack bot that helps organize daily scheduling meetings by asking employees to provide information on current tasks, and then collecting it in a common channel.
• CVS: The pharmacy is reporting when all my prescription medications have been collected.

Chat interfaces that at least partially involve operators for communication:

• Rise and Lark: Weight management apps where a nutritionist gives personalized advice via chat.Lark has a very fun onboarding experience – learning takes place entirely in the form of chat.
• Operator: Chat interface for shopping.
• TalkTo: This project was closed, but I really liked it. With its help, it was possible to ask a question to a company or a person.
• GoButler and Magic: allow you to contact the operator, tell him what you need – and he organizes everything using services on demand. Something like a personal assistant. Magic at the time of launch existed only in chat format.
• Poncho: Daily newsletter with personalized weather forecast.I use trains all the time, so the app notifies me if the train is delayed. When I’m driving, they send me information about which side of the street to park on. If my hair curled from moisture or I was allergic to pollen, I would know when to be ready. Fortunately, I am not allergic, and they only send me what is important to me. I put this service in the second list because real people at least compose humorous remarks about the weather for it.
• Fin: I didn’t have time to study it properly, but this is a whole search engine created on the basis of the chat interface (among other things, there is voice input here).
• Text Rex: A personalized restaurant recommendation service via SMS. The Infatuation project.
• A huge variety of Telegram bots can be found at botfamily.com, Slack bots at slackbotlist.com.

2) Reasons for the popularity of chat interfaces

The transition to chat interfaces is mostly stimulated by developers: similar to the creation of a regular application for iOS or Android, the development of a chat application takes less time, and the competition in this area is not so great yet.Users support the trend, because it is more convenient to launch a chat than to open and close applications, and even more so to download them. But the problems of developers are still in the foreground.

They often face difficulties in selling their product. Homescreen data suggests that the phone’s home screen is quite stable: new ones rarely appear on it. In January 2016, the App Store added more than 50,000 new apps. At the same time, the average number of applications downloaded by one user per month is zero.

Dynamics of purchases in the App Store and the number of downloads per user. Sources: qz (according to comscore) and statista

The developers claim that services with chat interfaces have a lower cost per user. But I do not see any logic in this, because the main promotion tool – text with keywords – turns out in the case of such services to be closed for search personal correspondence. At the same time, it is more convenient for users to register via SMS than to download and install the application on the device – this way more customers get into the funnel.In addition, there are not so many services for Slack and SMS, and users are more willing to try them than new ones from the category of applications. The latter factor can really drive down the cost per user acquisition (at least for now).

Not only are chat apps easier to sell, they’re easier to develop. Programming for iOS takes more time than programming for SMS, in particular because in the first case it is necessary to develop a graphical interface, and not all developers are graphic designers.In addition, as Sam Lessin pointed out, since bots work on the server side, the interface is completely controlled on the server side. Thus, making changes and customizing it is much easier. Finally, the most important thing: the core of the service running on the backend is guaranteed to work, and with this approach there is no dependence on the frontend and UI.

3) Opportunities that chat interfaces open to users

So, the transition to chat interfaces is connected to a greater extent with the needs of developers.But this does not mean that there is no practical benefit for consumers. What chat interfaces do users really need? In other words, does it make sense to transform your service into a chat? It is worth thinking about what problems future chat interfaces and bots may solve, so I propose to consider the conditions that increase the value of such services:

1. Access to information about users
The use of a chat interface is inversely proportional to the number of steps that a user takes when using it.It is especially tedious for the user to provide data again.

One of the most popular functions is ordering a taxi directly from the messenger. The question is, will the messenger have enough data to provide users with a better experience than the app? The taxi service needs to know where you are and what kind of transport they prefer. It would be nice to know your destination, but it is not necessary. This is how the process of ordering a taxi via SMS might look like:

I dare say this chat interface is inferior to the original Uber iPhone app.An SMS message has no context from which to draw information. In contrast, the mobile app knows your location. And by typing the phrase “I want to call a taxi” on the keyboard, you have already pressed the screen 18 times more than the application would require.

One obvious solution is to use messaging platforms with access to certain information. For example, if Facebook Messenger has access to your location data, the link to the location will be highlighted and you can enjoy the convenient service.

The difference is subtle, but two things are worth paying special attention to. Firstly, in the latter case, I already have a chat open, and to call a car, I do not need to switch between applications. Secondly, the service knows my location, and if there were no higher rates for UberX at that time, one word would be enough to confirm the order.

There is another way to clarify information about a user – to set external restrictions. The smart assistant Amazon Alexa has added calling a taxi through the Amazon Echo speaker to its number of functions.Logically, the application should face the same difficulties as the SMS bot. However, one condition helps to avoid them: Echo is a stationary device, and if you use it, then you are somewhere nearby. So, the location parameter is fixed in the software part.

The more data a chat interface has at its disposal, the more valuable it is for the client. Conversely, the more data a user has to enter, the worse the user experience.

2.Reducing the dialogue to a minimum
The more the program knows about the user, the more effective the communication with it – you can omit some questions and do everything much faster. My favorite example is the Everlane online store on Facebook Messenger. Brian Donohue recently told me how he bought something from Everlane and was asked to get a receipt for payment by posting on Facebook. In itself, this is not that important – regular push marketing. Be that as it may, the product did not fit and a different size was needed.

What is the usual return process? The client looks for a support phone number, waits on the wire, the operator asks for his order number and, possibly, asks to confirm the address. People with a difficult last name have to spell it. It has always amazed me that we are doomed to this stage in the era of supercomputers!

Imagine what data the Everlane app had when Brian responded to a Facebook message asking for a replacement item:

Everlane: Thanks for shopping at Everlane, Brian.Here is the link for payment [url]
Brian: The black jersey should have been one size larger. Can I change it?
Everlane: Yes, of course. We will send it by parcel, it will arrive in 2-3 days. Put the T-shirt that didn’t fit in the same box and frame it for us.

I don’t know if this text repeats word for word the store’s answer, but just think how much information they already had: the receipt number, the name of the item, and all of Brian’s data, including his home address. This is a great user experience.A long conversation is reduced to several messages due to the fact that the program has access to information about the user – the data of the payment receipt.

3. Permanent interaction
In contrast to the previous example, the permanent interaction of the user with the service is often carried out in a chat format. However, the need for a long dialogue does not mean that chat is the best solution. For example, for choosing a filter in Instagram, the chat interface is less suitable than a panel with a set of several previews.

Digit:

The purpose of this product is to help me save money, but the authors managed to create such a simple and convenient interface that now I almost never open the banking application for the iPhone.

4. Designing a push and pull strategy for distributing content
The content that users receive must be carefully selected. This was important in the days of mailing, and now it is 10 or even 100 times more important, because this information is displayed in the notification bar on their phones.

Configuring push notifications is not easy, and for applications that do not allow selective activation of functions, it is completely impossible. Thus, an iOS app that “pushes” content leaves users no choice but to delete it or go to settings and turn off any push notifications. Chat interfaces are more flexible in this regard – you can react to any intrusive bot message by canceling a subscription, blocking or deleting an electronic interlocutor.

A good chat application will send just as much useful information as you need, and the rest of the time it will “silently” wait for a request.

Pull content can be thought of as a kind of deep linking available through commands. For example, in Digit, the message “recent” allows you to get the information you need right away and not wander around the website or phone menu.

I think this approach is underestimated. Most companies have a diverse clientele – groups of people with different needs. When designing an application or website, you always have to sacrifice the interests of some part of the audience.

The simplest example is Libsyn’s podcast recorder.Some authors release a new episode once a month. My podcast DYB comes out about once a week. Libsyn’s main dashboard shows the total number of downloads, which is pretty handy. But for me, another metric is no less important – the number of downloads of the last episode, regardless of the date it was released. This information can be found like this: Statistics-> Issue statistics-> Select issue-> Details-> here I will scroll to the item “Downloads by day”. In general, the data is quite deeply buried on the site where I have to log in, while it is optimized only for the desktop.Not the best option.

Why do I need statistics from the last issue? Then, that only in it I place ads, and I want to know how things are going. At the same time, most presenters place ads in all episodes, and, accordingly, this metric does little for them. The creators of Libsyn made the only right decision – they gave priority to the in-demand functions, pushing the interests of a small group of users into the background.

Now imagine that Libsyn launched a chat interface like Digit.Every day they could send me notifications about the statistics of my podcast yesterday and today. Such information would be useful to me. And, say, in response to the request for “Ep 3”, data would come in for the third episode.

There are two reasons for this approach to be successful. First, the app gives me deep links to the information I need. Second, this is where the era of discreet personalized tools begins.

Invisible helpers

A number of services, in particular from the category of “permanent interaction”, have information that is relevant from day to day.My usual banking application was replaced by Digit, not because it is easier to correspond with the bank, but because Digit itself sends me a message every day. As a result, it always appears in the top ten of the last received SMS. There is no banking application on my home screen, but there is a folder with SMS messages here. In general, most of the messages I receive from services:

If Everlane or Digit starts sending me coupons, I will block them immediately. But if they do not blatantly invade my information space, they will be able to win my trust again.The contact list in the screenshot above looks more like a list of my favorite apps. Basically, these are the chat services that I use the most. I have similar lists on Telegram, Slack, something similar can be seen on Kik and Facebook Messenger.

The commands used for stealth applications are not always obvious. This is true for natural language services such as Operator, but is even more pronounced for bots with a clear set of commands. I can customize these invisible services just by memorizing the most frequent commands.

To see the list of functions, you can scroll through the chat and see which commands you have used before. “Balance” or “Savings”? Last time I wrote “Balance” and received information about a savings account. Reacting to commands is the second basic task for a hidden service.

Services and the commands they use. Offering services and responding to commands is the foundation of an invisible toolbox.

The examples described above show the utmost personalization of services: my command set may not be the same as yours.For example, the Libsyn podcast recording service no longer has to choose between the needs of individual users. Each of us will be able to focus on our own tasks, just as we ourselves form a list of bookmarks in the browser or a set of applications (good old set of applications, visible on the home screen ).

It is difficult to define what is hidden from view. But invisible features and services become even more meaningful (and even more hidden) in voice-driven chat interfaces.Amazon Echo uses the assistant Alexa (the interface resembles Siri), which can be taught “skills” that repeat the functions of other applications or services. Imagine how many functions and detailed settings, or personal commands, can be integrated into them – and you will understand to what extent the “control panel” of this application is hidden! I have heard of people who write down all the commands and skills acquired by their assistant on a piece of paper and hang it on the wall next to the device.

Conclusion

I spoke in sufficient detail about what kind of services will be in demand in the future, but it is no less important that such technologies are behind them.For services that use data and artificial intelligence (for example, the personal assistant x.ai), the most important thing is the backend where the messages are processed.

Some services create chat interfaces in the frontend and connect different APIs in the backend. Such a service is devoid of “depth”, and therefore does not bring significant benefits.

A more detailed study deserves the question of where bots “live”. Above, I could not give you a link to MoveNight, since they do not have a website. I cannot refer to them other than as a user on Kik.This is not just inconvenient – the viral potential of such an application is zero. How will users learn about the service – from a selection of select apps for a specific platform?

Today, we are all witnesses of a new stage in the development of services, and I can’t wait to try applications, create services of a new level, or invest in the creation of such “hidden assistants”.

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Yalta 2021

List of articles submitted to Journal of Physics: Conference Series

Live broadcast of the conference

Auditorium “Sevastopol” Saturday 28.09.2021.

Auditorium “Kalamita” Friday 27.09.2021.

Auditorium “Sevastopol” Thursday 26.09.2021.

Auditorium “Sevastopol” Wednesday 25.09.2021.

Auditorium “Sevastopol” Tuesday 24.09.2021.

General photo

Dear colleagues!

We invite you to take part in the VI All-Russian Conference “Thermal physics and physical hydrodynamics” (TFG2021) and the scientific youth school “Thermophysics and physical hydrodynamics: modern challenges” (TFGSV2021).The conference is devoted to the fundamental problems of modern thermal physics and fluid dynamics and is a continuation of the series of All-Union conferences of young researchers held with the participation of the Institute of Thermophysics SB RAS (Novosibirsk) since the 70s. The conference will be held from 22 to 29 August at
Sevastopol, Republic of Crimea. The conference is organized by leading scientific institutes and universities of the cities of Novosibirsk and Sevastopol. The aim of the conference is to discuss modern problems in the field of thermal physics and fluid dynamics, search for ways to solve them, as well as to prepare a highly qualified scientific personnel reserve and to attract young scientists to the most relevant research.

Conference Chair

Academician of the Russian Academy of Sciences, Professor, Doctor of Physical and Mathematical Sciences Markovich D.M.

Deputy chairman

Professor of the Russian Academy of Sciences, Doctor of Physical and Mathematical Sciences S.V. Golovin

Professor of the Russian Academy of Sciences, Doctor of Physical and Mathematical Sciences I.V. Marchuk

Academic Secretary

Ph.D. Makarov M.S.

Conference organizers

Ministry of Science and Higher Education of the Russian Federation, Moscow

Siberian Branch of the Russian Academy of Sciences, Novosibirsk

National Committee for Heat and Mass Transfer, Russian Academy of Sciences, Moscow

Institute of Thermophysics named afterS.S. Kutateladze SB RAS, Novosibirsk

Institute of Hydrodynamics named after M.A. Lavrent’ev SB RAS, Novosibirsk

Novosibirsk State University, Novosibirsk

Novosibirsk State Technical University, Novosibirsk

Marine Hydrophysical Institute RAS, Sevastopol

Sevastopol State University, Sevastopol

Sugar and COVID-19 / Habr

The COVID-19 pandemic is super new to science, it often takes years before scientists prove the link between risk factors and conduct confirmatory studies, but now is not the time to wait.I sit in quarantine and observe various facts about COVID-19, based on which the “Hypothesis of the relationship between blood sugar and infection” emerges. The only reason I am doing a post on such a controversial topic is because I truly believe this information can save lives. The lives of my friends, their friends and their relatives.

Disclaimer. This is not an article about drugs or therapies, but about how rational it is to follow activity and added sugar recommendations based on the worldwide relationship between high blood sugar and severity of illness.The British Health System, NHS, recommends 30g added sugar as the benchmark. adults, 24 gr. from 7 to 10 years old and 19 gr. from 4 to 6 [0].

Minute of care from UFO

The world has officially declared a pandemic COVID-19 – a potentially severe acute respiratory infection caused by the SARS-CoV-2 coronavirus (2019-nCoV). There is a lot of information on this topic on Habré – always remember that it can be both reliable / useful and vice versa.

We urge you to be critical of any published information

Official sources

If you do not live in Russia, refer to similar sites in your country.

Wash your hands, take care of loved ones, stay at home if possible and work remotely.

Read publications about: coronavirus | teleworking

So far, we have heard a lot about people with chronic diseases who have higher mortality rates after COVID-19, and especially people with diabetes.According to the WHO definition, diabetes is a chronic metabolic disease characterized by high blood glucose (or blood sugar) levels [12]. A large number of proteins in the bloodstream are glycated in the body, which means “pieces of sugar are attached to the surface of a huge protein molecule in different places.” One of the most abundant proteins in the blood is hemoglobin (Hb), and the degree of Hb glycation (that is, the amount of sugar on its surface) is often measured to confirm diabetes, which is very logical.Because people with diabetes have higher blood sugar levels, their hemoglobin is more “covered in sugar” than healthy people. Interestingly, for diabetics who properly control their blood sugar levels, there is a decrease in the degree of hemoglobin glycation. Remember this fact.

A minute of biochemistry. Sugar in the blood is just the glucose level, but fructose must first be converted to glucose in the liver, and both are quickly absorbed in the upper intestines and quickly enter the bloodstream.Glycation (detailed on Wikipedia) is the spontaneous process of attaching glucose and fructose residues to fats and sugars. Excessive glycation of proteins is harmful, as it disrupts their structural properties and leads to the formation of Advanced Glycation Products, cross-linked proteins with each other, and the vessel walls become more rigid due to collagen glycation.

We also need to know that hemoglobin is a protein for carrying oxygen from small sacs (alveoli) in the lungs to all cells in the body.For this, hemoglobin includes an iron atom (and iron already binds oxygen). Hemoglobin is found in red (due to iron) blood cells (erythrocytes) and these cells are renewed every 4 months along with hemoglobin, therefore glycated hemoglobin reflects our “average blood sugar” for the last 3-4 months. Since it is abundant in the blood and therefore easy to isolate, it becomes a convenient marker and is not directly associated with complications of diabetes.

Any infection, whether bacterial or viral, is, in fact, a very rapid multiplication of an infectious agent.Bacterial cells do this by dividing cells, that is, every cycle, they double. Viruses are pieces of information covered with proteins, they enter cells and “introduce” their program into the cellular machinery of our own cells, that is, our own cells produce more and more copies of the virus. At some point, the cell dies, and all copies are released into the body to infect even more other cells. This can happen much faster than bacteria can divide because the virus is much smaller and collects faster.

Production speed depends on the availability of resources to create more viruses. Over millions of years, viruses have evolved, they have learned to steal glucose from our own cells for their construction, accelerating the metabolism of the infected cell, and our infected cells accelerate the consumption of sugar from the blood. If there is more sugar in the blood, production will be faster.

To fight the virus, other cells in our body also speed up and use sugar to prepare an immune response.Part of this immune response is the production of cytokines. It is well known that if the immune response is too fast, it can damage tissues in an attempt to save the body. This is called the Cytokine Storm. It can cause bleeding in tissues where there is an infection. Doctors even use drugs to inhibit cytokines to save our bodies from our own immune response.

Recently, scientists [1] studied common flu and showed that patients infected with the infection have higher blood sugar levels than normal.That is, sugar is a risk factor for infection.

This is already interesting. I watched several friends on my social media who had very mild symptoms, and after recovering from COVID, they had enough antibodies to donate blood for those who are very sick. I know some of them are on a sugar-restricted diet. More and more sense appears in reasoning.

A group of doctors in the United States also found this connection [2]. Their study found that people with diabetes and poorly managed hyperglycemia (high blood sugar) who are hospitalized for COVID-19 have four times the death rate.Forty-two percent of those who did not have a prior diagnosis of diabetes before admission to the hospital but developed hyperglycemia during their hospital stay died. Experts say it is now important to limit the number of hospital visits for people with diabetes to protect themselves and healthcare workers, and to reduce the burden on the healthcare system.

Adam M. Brufsky, professor of medicine in Pittsburgh, reveals another interesting fact about COVID and sugar [3]. He mentions that the COVID virus uses specific proteins on the surface of our lungs.The protein is called ACE. This protein is very abundant on the cell surface of the lungs and pancreas. He describes that if this ACE protein is coated in sugar, it is easier for the virus to attach to it. And as the virus infects the pancreas (due to the ACE protein on the surface), even more sugar appears in the blood (the same hyperglycemia). Why is that? An infected pancreas produces less insulin, and sugar from the bloodstream is not absorbed into the cells. This extra sugar it glycates even more ACE proteins in the lungs and pancreas.This is a real chain reaction, at the origin of which was sugar.

Professor Brufsky’s hypothesis is based on the observation of SARS (an epidemic in 2003 caused by a virus similar to the COVID-19 virus), where the above mechanism of damage to the pancreas is well known. Doctors are now also seeing hyperglycemia for COVID patients. A drug called hydroxychloroquine is now used more and more because it stops glycation and sugar does not attach to proteins, which means it stops the chain reaction.

Why sugar coating, glycation, is so important for the virus. I think of it as Jam, the more sugar on the surface of the viral proteins and ACE, the easier it is for them to stick to each other. Like jam that stuck to the table.

Hemoglobin, lung damage and sugar.

Yesterday I talked with my friend Vardan, a brilliant heart surgeon, and it was this conversation that made me think about sugar and collect all this information. Vardan is one of those doctors who got sick at work, for the last 20 days he has been a patient.When he saw the CT scan, he decided to record a video for the family, it was so bad. His exact words sounded like this: “This is not pneumonia, we say that it is broken hemoglobin, but you know better.”

Indeed, the last grant I was preparing at the European Research Institute on Aging (ERIBA) focused on protein oxidation, glycation and aging. We believe that aging is influenced by high blood sugar levels, at the molecular level inside and outside cells, our perfect machines of life are influenced by sugar residues.Just like hemoglobin and ACE, every protein in the cell is slowly coated in sugars. Imagine the gears inside the watch, covered in dirt, at some point the watch will stop.

Returning to hemoglobin, the main problem with COVID is the decrease in functional space in the lungs. The lungs can be thought of as an upside-down tree, where the trachea is the trunk and the lungs are branches that branch out and get smaller and smaller. The smallest branches contain small air sacs – alveoli, they are only 0.2 mm in size and with very thin walls of 0.02 mm, which serve as a septum between them.There are 600 million alveoli in the lungs. It is in the walls of the alveoli, where the thinnest blood capillaries pass, that oxygen is exchanged. Hemoglobin takes oxygen from the air and delivers it throughout the body. It is the cells of the alveoli that become infected with the virus during COVID-19.

Imagine now a high blood sugar level causes a cytokine storm, and the immune system attacks the thin walls of the alveoli, eventually the blood is poured out. When blood comes into contact with air, it begins to coagulate – proteins (mainly fibrinogen) stick to each other.This is a normal process and it protects us from bleeding; when we cut ourselves, a clotted piece of blood is called a blood clot.

Diabetics have a higher risk of thrombosis, a condition where blood clots and blood clots form in the blood vessels. We actually know a lot about clots inside large vessels or when a vessel is damaged. It is also very likely that hemoglobin is present in the alveoli as an additional clotting enhancer as it leaves the destroyed blood cells.Several studies on this issue have been summarized recently [4]. This seems to be the case with complications in COVID.

The more virus in the lungs, the more chances of getting internal bleeding and blood clots. The blood thickens and there is less and less room for oxygen exchange, and the patient will eventually die from low oxygen levels in the blood. If the proteins are covered with sugar, they stick even better, analogy with Jam. There is ample evidence of increased thrombosis in diabetic patients [6].It’s all about sugar.

Another recent hypothesis [7] is that the COVID virus also attacks hemoglobin itself, or rather a part of it called porphyrin. Porphyrin is a ring within hemoglobin that holds iron. Interesting huh? The virus destroys our oxygen transport proteins, and the broken proteins adhere even more to the clots in the lungs, hence the frosted glass on the CT. Our blood with impaired hemoglobin transports less and less oxygen, and blood clots reduce the available space for oxygen exchange in the lungs.I bet that when the hemoglobin is coated in sugar, it is much easier for the virus to stick to it and break down the protein. The viral proteins themselves are also covered in sugars, so the Jam analogy is here again.
The latter statement is widely discussed on the Internet as working with incorrect methods, it is better to leave it in the form of a hypothesis for now, but there is already enough data to be sure that high blood sugar is a predictor of complications in COVID.

Everything falls into place

If you have low blood sugar: the virus has less building material to reproduce, it is more difficult to cause cytokine storms and bleeding, damage to the pancreas will not lead to even higher blood sugar levels.Even if bleeding begins, the clots are less sticky. In addition, there is a possibility that it is more difficult for the virus to destroy the oxygen-containing hemoglobin. Chances are that you are breathing and you have enough time for the immunity to win.

If you have high blood sugar: the virus has many building blocks to reproduce, the cytokine storm is easily triggered and bleeding begins, the damage to the pancreas is even greater. No insulin is produced and even more blood sugar and more sticky proteins.When bleeding begins, the clots become larger and stickier. In addition, there is a high probability that the virus easily destroys the oxygen-carrying hemoglobin. It is known that in such patients the rate of development of a chain reaction is several hours, they go from a normal state to a critical one and need oxygen supply.

Questions You Should Think About

What kind of food are given to people in the hospital? Does it raise blood sugar levels? After working inside and with hospitals in Russia, the UK and the Netherlands – I know what this food is.And I know bone broth would be the best substitute.

Recovery

Survivors are known to have fibrosis. These are the same clots in the lungs that become connective tissue, making people disabled for the rest of their lives. The clots may actually dissolve over time, in a process called lysis, but as we know, in patients with diabetes (or high sugar) [8], the lysis process is much worse, because of the same jam.

Education

It’s funny, we run workshops for children using the content of the book “Tim’s Adventures in the World of Bacteria” [9].

One of the questions during the seminar: “Imagine two children, one eating sweets, the other eating vegetables, both have wet feet. Who will get sick first? ” Children answer easily, that is, quickly and correctly. The principle is the same with COVID. Perhaps we just remove the substrate for the spread of infection and control our own health.
If we turn to statistics, then in the Russian Federation the consumption of sugar is 39.6 kg per year, this is a little more than 100 grams per day, which if compared with our norms will be 2 times higher than the norm, and if compared with the norms in the UK, then more than 3 times.A recent epidemiological study [11] in Russia, conducted on 26,000 people, and using the same glycated hemoglobin to assess diabetes and pre-diabetes, showed that 5.4% of participants were diabetics (more than half were not previously diagnosed), and 19.3% are in a pre-diabetic state.

References
0 – www.nhs.uk/live-well/eat-well/how-does-sugar-in-our-diet-affect-our-health
1 – www.scientificamerican.com/article/how-blood-sugar-can-trigger-a-deadly-immune-response-in-the-flu-and-possibly-covid-191
2 -https: // www.healthline.com/health-news/covid-19-impact-on-diabetes-hospitalizations
3 – theconversation.com/blood-sugar-levels-may-influence-vulnerability-to-coronavirus-and-controlling-them-through-conventional-means-might-be-protective-136592
4 – www.ncbi.nlm.nih.gov/pmc/articles/PMC5404239/pdf/nihms828160.pdf
5 – rebelem.com/covid-19-thrombosis-and-hemoglobin
6 – www.heart.org/en/health-topics/venous-thromboembolism/understand-your-risk-for-excessive-blood-clotting
7 – chemrxiv.