What Is A1C Related To Diabetes? - 2023, Virtual Office

What Is A1C Related To Diabetes
All About Your A1C What has your blood sugar been up to lately? Get an A1C test to find out your average levels—important to know if you’re at risk for prediabetes or type 2 diabetes, or if you’re managing diabetes. The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months.

It’s one of the commonly used tests to diagnose and and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes. When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells.

Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin. Testing for diabetes or prediabetes: Get a baseline A1C test if you’re an adult over age 45—or if you’re under 45, are overweight, and have one or more for prediabetes or type 2 diabetes:

If your result is normal but you’re over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years. If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years. If you don’t have but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result. If your test shows you have diabetes, ask your doctor to refer you to services so you can have the best start in managing your diabetes.

Managing diabetes : If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you. The test is done in a doctor’s office or a lab using a sample of blood from a finger stick or from your arm.

Diagnosing Prediabetes or Diabetes

Normal	Below 5.7%
Prediabetes	5.7% to 6.4%
Diabetes	6.5% or above

A normal A1C level is below 5.7%, a level of 5.7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes. Managing Diabetes Your A1C result can also be reported as estimated average glucose (eAG), the same numbers (mg/dL) you’re used to seeing on your blood sugar meter:

eAG

A1C %	eAG mg/dL
7	154
8	183
9	212
10	240

img class=’aligncenter wp-image-189362 size-full’ src=’http://virtualofficeku.com/wp-content/uploads/2023/01/jexyxelequzha.jpg’ alt=’What Is A1C Related To Diabetes’ /> Get your A1C tested in addition to—not instead of—regular blood sugar self-testing if you have diabetes. Several factors can falsely increase or decrease your A1C result, including:

Kidney failure, liver disease, or severe anemia. A less common type of hemoglobin that people of African, Mediterranean, or Southeast Asian descent and people with certain blood disorders (such as sickle cell anemia or thalassemia) may have. Certain medicines, including opioids and some HIV medications. Blood loss or blood transfusions. Early or late pregnancy.

Let your doctor know if any of these factors apply to you, and ask if you need additional tests to find out. The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal. Younger people have more years with diabetes ahead, so their goal may be lower to reduce the risk of complications, unless they often have hypoglycemia (low blood sugar, or a “low”). People who are older, have severe lows, or have other serious health problems may have a higher goal. A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings. If you’re reaching your A1C goal but having symptoms of highs or lows, check your blood sugar more often and at different times of day. Keep track and share the results with your doctor so you can make changes to your treatment plan if needed. : All About Your A1C

What happens when A1C is too high?

Summary – The A1C test measures the average blood glucose level over a three-month span. It is used to diagnose diabetes and monitor diabetic treatment. A high A1C level increases your risk of diabetic complications. Over time, high blood sugars cause cardiac disease, diabetic retinopathy, kidney failure, neuropathy, and gum disease.

Can you have high A1C and not be diabetic?

Yes, you can have a high A1C level and not have diabetes. This is because an A1C test measures the amount of glucose that’s attached to hemoglobin. So anything that affects hemoglobin can alter the results. Certain medications, such as steroids, can also raise blood glucose levels in people who don’t have diabetes.

What is the difference between high blood sugar and A1C?

Consistently high blood sugar levels will raise your hemoglobin A1c, and consistently lower blood sugar levels will lower it. However, the two measures aren’t expressed in the same units, which can be confusing. While blood sugar is measured in milligrams per deciliter (mg/dL), hemoglobin A1c is given as a percentage.

What is an alarming A1C?

All About Your A1C What Is A1C Related To Diabetes What has your blood sugar been up to lately? Get an A1C test to find out your average levels—important to know if you’re at risk for prediabetes or type 2 diabetes, or if you’re managing diabetes. The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months.

It’s one of the commonly used tests to diagnose and and is also the main test to help you and your health care team manage your diabetes.
Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes.
When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells.

Diagnosing Prediabetes or Diabetes

Normal	Below 5.7%
Prediabetes	5.7% to 6.4%
Diabetes	6.5% or above

eAG

A1C %	eAG mg/dL
7	154
8	183
9	212
10	240

Can stress cause high A1C?

Acute Diabetes Stressors – Individuals living with diabetes regularly experience acute stressors related to the pathophysiology or treatment of the condition. Stressful situations can include discrete blood glucose-related events (e.g., episode of severe hypoglycemia, diabetic ketoacidosis), treatment changes (e.g., starting on insulin), and the introduction of a new diabetes management device/technology (e.g., insulin pump, continuous glucose monitoring ).

Acute stress can increase endogenous glucose production and impair glucose utilization; however, data from brief stressful events lasting only a few minutes and occurring a few hours before sampling suggest that this short-term process likely does not affect A1c,
Brief stressors may not be of significant duration or intensity to impact A1c, which reflects average glucose over several weeks.

Furthermore, stressful situation-related high or low blood glucose excursions by definition skew the average glucose level and contribute to higher or lower A1c, respectively, making it difficult to disentangle the unique role of stress in the glycemic outcome.

Does exercise lower A1C?

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.

Does A1C go up with age?

CONCLUSIONS – We examined whether A1C increases with age in several ways: by examining two large and racially different nondiabetic populations, by studying a subset of subjects with no evident abnormalities of glucose metabolism, and finally by examining a cohort of nondiabetic subjects over time.

The studies that have failed to demonstrate an association between age and A1C used diagnostic criteria to exclude diabetes that are now outdated ( 14 – 17 ) or were small and possibly underpowered ( 15 – 17 ). In our study we used the most recent criteria for diabetes diagnosis and large population-based cohorts.

We found a consistent increase in A1C with age in the cross-sectional analyses of both FOS and NHANES 2001–2004 nondiabetic populations. Our longitudinal analysis of FOS nondiabetic subjects confirmed an increase in A1C with aging. The 0.03-point increase per year in subjects with no abnormality in glucose homeostasis was greater in magnitude than expected from FOS examination 5 cross-sectional analysis, perhaps related to the relative increase in obesity among individuals of the FOS by the time of examination 7.

An increase in BMI was noted in all age-groups, except for the ≥70 years age-group during that period (data not shown). It is also possible that subjects who returned for visit 7 may have been different from subjects who did not return. Results of our longitudinal analysis are comparable with those for a previous analysis of the original Framingham Heart Study, comprising parents of the FOS population, in which a 0.28% point increase in A1C over a 4- to 6-year period was observed, with a greater increase observed with increasing age ( 30 ).

Even though we found a small increase in FPG and a more significant increase in 2-h postload glucose values across age categories, we could not translate these into mean blood glucose values to estimate the corresponding rise in A1C across age categories.

However, we accounted for variation with age of FPG and 2-h postload glucose levels by performing multivariate analyses. None of these adjustments materially affected the association of age category with change in A1C. In the current study, the upper limit (97.5th percentile) of A1C could be as high as 6.83% in older nondiabetic subjects and 6.60% in older subjects with no detectable abnormality of glucose homeostasis on standard testing.

Despite using similar methodology to determine the 97.5th percentile A1C in the FOS and NHANES nondiabetic populations, the 97.5th percentile A1C was slightly higher in the FOS population than in the NHANES population, even though statistically significant increases with age were noted in both populations.

Differences in assays and in the study populations, including their different racial compositions, and differences in the proportion of subjects with dysglycemic states (supplemental Table A1) may have contributed to the difference observed.
The similar relative increase with age in both cohorts strengthens the conclusion that A1C levels increase with age.

Moreover, the data from both the NHANES and the FOS enhance the generalizability of our results. The age-related increase in A1C observed in our study is similar in magnitude to that in two previous studies: one in Japan ( 8 ) and one in a very small ( n = 109) convenience cohort in the U.S.

10 ). Of the studies that have demonstrated an association between A1C and older age, many have been performed in selected samples ( 6 – 9, 12 ).
Some have inadvertently included subjects with diabetes by not screening the populations for diabetes with fasting or postchallenge glucose levels ( 6, 8, 10 ).

Inclusion of subjects with IGT and/or IFG in previous studies may have contributed to the rise in A1C observed. In the current study, even after excluding subjects with the categorical dysglycemic states of IGT and IFG and controlling for the rise in FPG and 2-h postload glucose with age, we still observed an increase in A1C with age.

A possible explanation for the observed association of higher A1C with increasing age in individuals with NGT is that factors unrelated to glucose metabolism are affecting A1C levels.
One such explanation may be changes in the rate of glycation associated with aging ( 12, 13 ).
There is no evidence for decreased red cell turnover owing to decreased clearance with aging as a possible explanation.

A 2-h OGTT may not adequately capture postprandial glycemic excursions in elderly individuals. It is possible that other factors such as worsening kidney function with aging or anemia could be playing a role; however, these are less likely to play a significant role in healthy aging adults.

As in other studies ( 9 ), sex differences were noted in the relationship between A1C and age.
It is possible that this finding is related to lower hemoglobin levels in menstruating women with more rapid erythrocyte turnover, as suggested previously ( 9 ).
Women in peri- and postmenopausal age-groups had a steeper slope than men.

Even though the association of A1C with complications is well established in individuals with diabetes ( 31 ) and in nondiabetic subjects ( 32, 33 ), the clinical significance of increased A1C in the subset of older individuals who have no evidence of glucose intolerance is unknown.

Current treatment targets for patients with diabetes are similar regardless of age.
A study designed to address the question of age-specific treatment targets would be necessary to determine whether treatment targets should be different.
There are several limitations of this study.
First, the differences in sampling strategies for the two studies precluded combining the data from both.

Second, although both studies used an A1C assay that was standardized by the National Glycohemoglobin Standardization Program ( 27 ), different laboratories performed the FOS and NHANES assays and a comparison of the absolute A1C values may be problematic.

Furthermore, the age distribution and prevalence of dysglycemic states in the two studies differed, and this may also have affected the absolute A1C levels in the two studies. Our sample size was smaller at the extremes of age, and we therefore combined all subjects who were ≥70 years old to have an analyzable sample size in all age categories.

Finally, we did not account for the prevalence of other conditions that could affect A1C in either study population, including anemia and its treatment and kidney dysfunction; however, their effect is likely to be small overall. Despite these limitations, the similar impact of increasing age on A1C in both populations provides confirmation of the relationship between age and A1C in the nondiabetic population.

In summary, in the current study, the uniform results between FOS and NHANES establish clearly that A1C increases with age even after multivariate adjustments for sex, fasting, and 2-h postload glucose. The finding of higher upper limits of normal A1C in older individuals suggests that nonglycemic factors may contribute to the relationship of A1C with age.

If we bear in mind the fact that elderly individuals have an increased risk for hypoglycemia and other medication side effects ( 22, 23 ), the adoption of A1C targets that are lower than age-appropriate nondiabetic values may be associated with more medication-associated complications; however, a clinical study directly addressing the question of whether A1C should be age adjusted is needed.

What is a normal A1C for a 60 year old woman?

– Traditionally, A1C levels are reported as a percentage. Alternately, they may be reported as estimated average glucose (eAG), in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Blood glucose meters and continuous glucose monitors also give eAG readings, some from at least 12 days of data.

The A1C test gives a more accurate long-term average. It takes into account fluctuations throughout the day, such as overnight and after meals. A normal A1C level is below 5.7%. Normal eAG is below 117 mg/dL or 6.5 mmol/L. If someone’s A1C levels are higher than normal, they may have diabetes or prediabetes.

Their doctor might order a repeat test to confirm this.

What is normal A1C for a 70 year old?

TABLE 3. – A Framework for Treatment Goals for Diabetes in Older Adults From the ADA


Patient Category and Associated Characteristics	Suggested A1C Goal (%)	Suggested Average Fasting Glucose Target Range (mg/dL)	Suggested Average Bedtime Glucose Target Range (mg/dL)	Rationale
Healthy	<7.5	90–130	90–150	• Significant life expectancy
• Few comorbidities	• Goal is to prevent future macrovascular and microvascular complications
• Functionally and cognitively intact
Complex/intermediate	<8	90–150	100–180	• Intermediate life expectancy
• Multiple chronic comorbidities or	• High treatment burden
• Two or more IADL impairments or	• At risk for hypoglycemia and falls
• Mild to moderate cognitive impairment
Very complex/poor health	<8.5	100–180	110–200	• Limited life expectancy
• Residency in a long-term care facility or	• Benefit uncertain
• End-stage chronic illnesses or	• High risk of hypoglycemia and falls
• Two or more IADL impairments or
• Moderate to severe cognitive impairment

In 2013, the International Diabetes Federation (IDF) published its global guideline, “Managing Older People with Type II Diabetes” ( 8 ), and recommended individualized glycemic goals according to older adults’ functional status, comorbidities, risk of hypoglycemia, and presence of microvascular complications.

This guideline also divided older adults into three major categories with different glycemic targets. For functionally independent older adults, the IDF recommends an A1C goal of 7–7.5%, whereas for functionally dependent, frail patients or patients with dementia, an A1C goal of 7–8% is recommended. For end-of-life care, IDF recommends avoiding a specific A1C goal and focusing instead on avoiding symptomatic hyperglycemia.

In 2018, the American College of Physicians published a guidance statement on selecting targets for the pharmacologic treatment of type 2 diabetes ( 9 ). Guidance Statement 4 in this document relates to older adults and states that “Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA 1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.”

Can I check my A1C at home?

An A1C test can help to diagnose prediabetes or diabetes. It also measures ‘time in range’ for people living with diabetes. In addition to having your A1C tested in a lab or a healthcare provider’s office, you can also use an FDA-approved, at-home test kit. These are all accurate ways to measure your A1C.

Will cutting out sugar lower A1C?

Avoiding carbs altogether would make your blood sugar levels lower and eventually lower your A1C levels.

Can I get my A1C down without medication?

Updated 9/22/22 Read time: 10 minutes

Lowering A1C can reduce your risk for developing nerve damage, vision problems, heart disease, and kidney disease. Exercising regularly and making the right food choices can support lowering A1C naturally. Being flexible with your approach to nutrition is a key to making long term changes to your A1C.

Did you know that it’s possible to lower A1C without medication? While it’s not simple, it’s extremely beneficial. Lowering your A1C can reduce your risk for developing diabetes-related complications such as nerve damage, vision problems, heart disease, and kidney damage.

Can lack of sleep increase blood sugar?

Learn about the connection between sleep problems and type 2 diabetes. Sleep disturbances are an under-recognized factor in type 2 diabetes. Eve Van Cauter, PhD, a co-author of the “Impact of Sleep and Circadian Disturbances on Glucose Metabolism and Type 2 Diabetes” chapter in the NIDDK publication Diabetes in America, 3rd Edition, explains the relationship between poor sleep and diabetes and how health care professionals can advise their patients.

Q: What are sleep disturbances, and which ones are associated with insulin resistance and diabetes? A: Sleep disturbances, which include sleep problems and diagnosed sleep disorders, are common in modern society. Probably the most common sleep disturbance is insufficient sleep—people are not in bed long enough.

They want to take advantage of leisure opportunities, social networking, and our 24-hour society. High school-age children are probably among the most sleep-deprived segment of the population, and the sleep routines that they develop at that age set them on a trajectory of not prioritizing sleep as a pillar of health.

Irregular sleep is also common.
About 16% of American workers do not have a regular daytime schedule, and their day-to-day sleep pattern is also irregular.
They may be up until 2 a.m.
One day, then recover the next day, and then have to leave very early in the morning another day.
A related behavior is social jet lag, which refers to being sleep-deprived during the week, then trying to catch up during the weekend—a behavior common among adolescents and young adults.

Studies show that many sleep problems are associated with insulin resistance, prediabetes, and diabetes and have a significant impact on glucose tolerance. For example, there is experimental evidence that if you take healthy volunteers and force them into a schedule where sleep does not occur consistently during the night, the result is a decrease in glucose tolerance and insulin sensitivity.

The point here is that a modern lifestyle has brought about sleep irregularity, which adds to the risk factors for developing diabetes.
That’s in addition to the established connection between type 2 diabetes and sleep disorders like insomnia and obstructive sleep apnea (OSA).
OSA affects about two-thirds of people with type 2 diabetes.

Its severity affects glycemic control in people who have diabetes—the more severe the OSA, the lower the insulin sensitivity. Q: Can sleep problems or a sleep disorder increase the risk for developing type 2 diabetes? A: Yes. Multiple studies have shown that repeated awakenings during the night, insufficient sleep, excessive sleep, and irregular sleep all promote glucose intolerance.

Furthermore, if a person has prediabetes or diabetes, poor sleep will worsen the condition. Sleep problems are also an issue for people with no other diabetes risk factors. Studies on mostly young, healthy adults without obesity or any diabetes risk factors have examined the effects of reduced sleep under controlled conditions in a laboratory.

There was a consistent association with decreased insulin sensitivity in the range of 25% to 30% after as little as 4 to 5 days of insufficient sleep. So, there is reliable evidence that insufficient sleep has an adverse effect on glucose tolerance and can bring people who are otherwise healthy to developing prediabetes.

Subsequent cohort studies showed that after controlling for factors such as age, body mass index, being sedentary, and family history, and excluding people who have diabetes, participants who slept for short durations were about 40% more likely than those with 7 to 8 hours of sleep to develop diabetes.

As for people with sleep disorders, we know that moderate to severe OSA is a risk factor for developing type 2 diabetes. The increased prevalence of sleep disorders such as OSA parallels the rise in rates of obesity, and these two epidemics contribute to the dramatic increase in the prevalence of diabetes.

It’s worth noting that sleep disturbances, such as insufficient sleep or difficulty falling asleep or staying asleep, have an impact on diabetes risk similar to that of having a family history of type 2 diabetes. Q: In people with type 2 diabetes, can treating sleep disturbances and disorders improve glycemic control? A: We are still at the beginning of studying the impact of correcting sleep disturbances on glycemic control.

We don’t have many intervention studies yet. There have been a few studies of short sleepers who were asked to extend sleep for brief periods; extending their sleep duration improved their insulin sensitivity. There have also been some studies showing that extending bedtime in short sleepers may reduce hunger and appetite and promote weight loss.

We need more studies in larger groups.
The one sleep disturbance that has been well studied is OSA.
A number of studies have looked at continuous positive airway pressure (CPAP) to see whether this treatment can reduce glucose levels and improve glycemic control.
The results have been mixed.
Some clinical trials of CPAP compared with placebo treatment showed an effect on glucose metabolism or insulin sensitivity, but others did not.

The major issue is that if you do a study under real-life conditions, compliance with CPAP is generally poor. People wear their device for a few hours on most but not all nights, and that is considered excellent compliance. In laboratory studies, compliance can be optimized.

In a proof-of-concept study, we treated patients with type 2 diabetes for 1 week. They had to sleep in the laboratory every night with the CPAP device, which was fitted as well as possible. Every little problem with the CPAP device was solved by the sleep technicians. After 1 week, we observed a decrease in morning glucose levels by about 12 milligrams per deciliter, which is clinically significant.

It’s the equivalent of what you can achieve with one drug. Overall, the mixed results affect what happens in the clinic. CPAP devices have improved enormously, and there are devices now that are much more comfortable, smaller, lighter, quieter, and easier to tolerate.

There are also dental appliances that can reduce the severity of OSA. Despite these advances, most health care professionals do not say, “You have to treat your sleep apnea because it’s making your diabetes worse.” Unfortunately, health care professionals have been somewhat discouraged from considering the treatment of OSA in diabetes as an important part of the therapeutic strategy.

Q: Should health care professionals screen patients for sleep problems? How should they advise patients who have poor sleep or a sleep disorder? A: Health care professionals routinely ask about weight, family history of diabetes, and physical activity.

But even an experienced diabetes specialist often will not ask patients any questions about sleep.
Many health care professionals don’t ask whether their patient has a day job or is coming to the morning clinic straight from work.
Any kind of biochemical test result is affected if the night was spent awake.

There are questions that should be part of any patient history. What is your work schedule? Are you a good sleeper? What time do you go to bed? What time do you get up? And how about weekends? Do you have regular sleep times? There are short, simple questionnaires about sleep that the health care professional can ask people to fill out during an in-person or remote health visit.

One, for example, is a sleep quality questionnaire that assesses habitual sleep duration and sleep quality. Another is a scale of daytime sleepiness that is sometimes revealing regarding the impact of OSA on daytime function. There is also a scale about sleep apnea itself. These questionnaires give health care professionals a good perspective on aspects of sleep that may need treatment or behavioral improvement.

So, it’s just a matter of making sleep part of the evaluation of the patient’s history. The American Diabetes Association’s annual recommendations mention insufficient sleep. OSA is mentioned among the factors that can impair glucose tolerance. That’s a great first step.

The International Diabetes Federation has also included some language regarding sleep in their guidelines (PDF, 383 KB), My hope is that more providers will become informed about these guidelines and will begin to apply these recommendations. Q: Is there anything else health care professionals should know about sleep disturbances and patients with diabetes? A: We are really looking at a triangle of metabolism, sleep, and nutrition.

Food is available all the time—for some people, instead of having three meals a day, they consume excess calories in addition to their normal meals. They snack as the day progresses and into the night. This reduces the duration of the overnight fast and affects glucose regulation. Eve Van Cauter, PhD, is the Frederick H. Rawson professor in the section of endocrinology, diabetes, and metabolism of the Department of Medicine of the University of Chicago. Her research focuses on the impact of sleep and circadian rhythm disturbances on the risk of obesity and diabetes, and their underlying mechanisms.

What foods cause high A1C?

– French fries are a food you may want to steer clear of, especially if you have diabetes. Potatoes themselves are relatively high in carbs. One medium potato contains 34.8 grams of carbs, 2.4 of which come from fiber ( 53 ). However, once they’ve been peeled and fried in vegetable oil, potatoes may do more than spike your blood sugar.

Deep-frying foods has been shown to produce high amounts of toxic compounds, such as advanced glycation end products (AGEs) and aldehydes.
These compounds may promote inflammation and increase the risk of disease ( 54, 55 ).
Indeed, several studies have linked frequently consuming french fries and other fried foods to heart disease and cancer ( 56, 57, 58, 59 ).

If you don’t want to avoid potatoes altogether, eating a small serving of sweet potatoes is your best option. Summary In addition to being high in carbs that raise blood sugar levels, french fries are fried in unhealthy oils that may promote inflammation and increase the risk of heart disease and cancer.

What if my A1C is 14?

– The highest A1C turns out to be a tricky piece of data to ferret out. If you try Google, you find a gazillion people talking about their own personal highest A1Cs and comparing notes with others. Most A1C point-of-care machines cap out at a certain number, including those at-home testing A1C kits you can buy online. At the federal clinic where I’d worked for over a decade, our A1C results capped out at 14 percent. If the A1C is higher than that — particularly at T2D diagnosis time — the machine just reads “>14%.” How much higher is anyone guess. It could be 14.1 percent, or it could 20 percent. If you do the math, clocking a 14 percent means you’re possibly experiencing a 24-7-90 (24 hours a day, 7 days per week, for 90 days) blood sugar average of 355 mg/dL. Of course, labs can calculate higher A1Cs. Personally, the highest I’ve ever seen is an A1C result in the low 20s. If your A1C was, say 21 percent, it would take a 3-month average blood sugar of 556 mg/dL. How is that possible? If your blood sugar were in the 500s, wouldn’t you go into a coma long before the 3 months were up? Those with T1D would, but those with T2D do not generally go into comas because they have insulin in their bodies all the time, even if they can’t process it well enough to keep their BG at safe levels. Now, coma-free does not mean problem-free. Blood sugar levels this high are toxic. People diagnosed with sky-high A1Cs are generally also diagnosed with complications right out of the gate — most commonly retinopathy and sometimes kidney and nerve damage, as well. But that doesn’t answer the question of the unfortunate individual who holds the record for highest A1C ever. Someone I know mentioned they’d once seen a 27 percent A1C, but that’s hard to believe without any documentation to back it up. In asking my own healthcare colleagues, I posed this question online to a group of endocrinologists: What’s the highest A1C you’ve ever seen, or what’s the highest you’ve ever heard a colleague talk about? I had my money on 35 percent. That would be a 3-month blood sugar average of 1,000 mg/dL. But the answers I got were surprising, as none of my esteemed colleagues had ever seen or heard of A1Cs as high as I had commonly seen in my clinic in New Mexico.

What would cause a spike in A1C?

What Is A1C Related To Diabetes A1C levels can fluctuate because of vitamin deficiencies, supplements, stress, lack of sleep, and more. If you’ve lived with type 2 diabetes for a while, you might be a pro at managing your blood sugar levels, You may know that it’s a good idea to limit carbs, exercise regularly, check other medications for possible interactions, and avoid drinking alcohol on an empty stomach.

By now, you may be well attuned to how your day-to-day activities impact your blood sugar.
So, if you see a big shift in your hemoglobin A1c (HbA1c) levels that you can’t explain, you might be surprised or frustrated.
Sometimes, things you may not even think about can affect your blood sugar, which can lead to serious complications, such as heart attacks, kidney disease, blindness, or amputation,

Learning to recognize behaviors and circumstances that you don’t usually associate with blood glucose fluctuations may help you prevent more serious health concerns now and in the future.

How is high A1C treated?

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%.

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.

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.

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.

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.

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.

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.

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.