For monitoring purposes, the way that the A1c is reported is in the process of changing. Traditionally, in the United States, the A1c has been reported as a percentage, and the American Diabetes Association (ADA) has recommended that people with diabetes strive to keep their A1c below 7%. While this is still generally true, more than a decade of national and international efforts to improve and standardize the A1c test and its reporting led to the release of a consensus statement in 2007 (and an update in 2010) by the ADA, the European Association for the Study of Diabetes (EASD), the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), the International Society for Pediatric and Adolescent Diabetes, and the International Diabetes Federation. These joint statements and the completion of a study called ADAG (A1c-Derived Average Glucose) that further examined the relationship between blood glucose concentrations and A1c led to a recommendation that A1c be reported worldwide in two ways:
A landmark paper showed convincingly that intensive control of diabetes (ie, maintaining near-normal concentrations of glucose throughout the day, reflected in lower A1c levels) "delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy."  Fingerstick glucose measurements by patients remain the mainstay of diabetes management for adjusting daily insulin doses, but this study established the importance of ongoing, periodic A1c measurements to monitor compliance and efficacy of therapy.
I have a friend that is 35 and has diabetes. For the past eight years, his weight has always been in check and if anything he may have been a little overweight. Just recently, he has lost a lot of weight and he told me that he weighs less than he did in high school. I think he looks too thin and I am concerned about his health with him being a diabetic. Should there be a concern and what kind of advice can you give me to pass on to him.
Evaluate Your Food Choices: A registered dietitian (RD) or certified diabetes educator (CDE) can help you create a meal plan respects your preferred foods and also reflects good-for-your-blood-glucose-level foods. The goal of the healthy food plan is to assure that you are controlling your blood glucose level by keeping it in a healthy, normal range. Your meal plan should be adjusted to be comfortable and satisfying to you, taking into account your overall health, physical activity, and what you like to eat. There are no diets out there that will work nearly as well as one that has been worked out with your likes and dislikes, cultural preferences,
For those who have had prediabetes or diabetes for a long time, higher A1C results may be a sign that you need to start on medication or change what you’re already taking. Prediabetes can progress to diabetes at a rate of 5–10 percent per year. You may also need to make other lifestyle changes and monitor your daily blood glucose more closely. Talk to your doctor about the best treatment plan for you.
Like fiber, protein tempers insulin secretion, leading to a more gradual rise in blood sugar after a meal. It also fills you up better than any other nutrient. Eating a protein-rich breakfast may be particularly important, as it helps set the tone for the rest of the day. The amount of protein you need in your diet depends on a number of factors, but general protein recommendations for healthy adults are 0.8 to 1.0 gram per kilogram of body weight (55 to 68 grams per day for someone who’s 150 pounds). Good animal sources include wild-caught fish, grass-fed beef, and pasture-raised chicken and eggs. If you’re vegetarian or vegan, load up on these eight plant-based protein sources.
However, in an effort to smooth the transition to the new units, as well as to help both physicians and patients appreciate the clinical context of various hemoglobin A1c levels, many laboratories are now reporting eAG (estimated average glucose) along with every hemoglobin A1c level.  Although the correlation is far from perfect and the use of this parameter has been somewhat controversial,  it has received support from many major organizations, including the American Diabetes Association, the American Association for Clinical Chemistry, and the College of American Pathologists. The equation to calculate eAG (in mg/dL) from hemoglobin A1c (in %) is as follows:
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According to Dr. Shaikh, whether you’re a diabetic patient or not, your meal should be centered around proteins and not carbs. He has a solution to help you make smart decisions when it comes to your meals. The doctor explains, “If you’re having dal rice, don’t add dal to your rice, add rice to your dal. Double the quantity of dal and half the quantity of rice. If you’re a non-vegetarian, increase your quantity of intake for lean proteins like chicken and reduce carb quantity in your meals.”
There is clearly a link between Type 2 diabetes and obesity, and researchers around the world are working to solve the puzzle of how the two are connected. Some scientists think there is a connection between body fat and hormones that regulate appetite and insulin levels. When you lose weight, and reduce your body fat, you may have better control over your diabetes.
The A1C, which is also called a glycohemoglobin or hemoglobin A1C test, reflects your average blood glucose control for the two- to three-month period before the test. This test can be done on a sample of blood obtained from a fingerstick or from a small vial of blood drawn from your arm and then tested in a laboratory..At Joslin we recommend that this test be done every three to six months.
Skipping insulin. Teens, in particular, sometimes skip insulin injections to lose weight. Talk to your child about why this is a dangerous tactic — it can lead to very high blood sugar levels and even diabetic ketoacidosis. Teens who do this may need counseling from a mental health professional to address an eating disorder or other body image or emotional problem.
Prediabetes means a person’s blood glucose (sugar) level is higher than normal, but not high enough yet for a diagnosis of type 2 diabetes. If left untreated, prediabetes can progress into type 2 diabetes. And if 1 in 3 American adults has prediabetes, that means it could be you, your favorite sibling, or your other sibling. Or you, your barber, your barber’s barber. Or you—well, you get the picture. It’s time to take the risk test to know where you stand.
Garlic: Potent, but effective. Garlic is known as one of the oldest medicines in the world…and with good reason. An animal study that administered high doses of raw garlic to rats for 4 weeks found that it had a profound effect of reducing blood glucose levels, as well as cholesterol and triglycerides compared to rats who did not receive raw garlic (2). They also tested rats with boiled garlic, and saw no changes in blood glucose, so the benefit comes from raw garlic.
When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.
Hemoglobin is the oxygen-carrying protein molecule in the blood, specifically in the red blood cells. High hemoglobin count may be caused by dehydration, smoking, emphysema, tumors, or abuse of Epogen. Low levels of hemoglobin may be caused by anemia, blood loss, nutritional deficiency, bone marrow problems, chemotherapy, kidney failure, or sickle cell disease.
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Weightlifting or working out hard for a long time may affect your blood sugar level many hours later. This can be a problem, especially if you're driving a car after your workout. It's one of the many reasons you should check your blood sugar before you get behind the wheel. It's also a good idea to carry snacks like fruit, crackers, juice, and soda.
Beyond the difference in units used to report them, the A1c represents an average over time while your blood glucose reflects what is happening in your body now. Your blood glucose will capture the changes in your blood sugar that occur on a daily basis, the highs and the lows. Each blood glucose is a snapshot and each is different. The A1c is an indication that "in general" your glucose has been elevated over the last few months or "in general" it has been normal. It is inherently not as sensitive as a blood glucose. However, if your day-to-day glucose control is stable (good or bad), then both the A1c and blood glucose should reflect this. It is important to remember the time lag associated with the A1c. Good glucose control for the past 2-3 weeks will not significantly affect the A1c result for several more weeks.
Since prediabetes is the precursor for diabetes mellitus, the pathophysiology is relatable. Hyperglycemia will cause production and release of insulin by the pancreatic beta cells. Excess insulin exposure for long periods of time diminishes the reponse of the insulin receptors the function of which is to open glucose channels leading to entry of glucose into the cells. Decreased function of the insulin receptors leads to further hyperglycemia further perpetuating the metabolic disturbance and leading to the development of not only diabetes type 2 but also metabolic syndrome. In prediabetes, this process is not to the extent of diabetes mellitus but is a first step in a metabolic cascade which has potentially dangerous consequences if not adequately addressed. Hence its imperative to start treatment at the earliest.  If treatment is not started or if the treatment is not adequate, adverse effects on large and small blood vessels (e.g. arteries of the cardiovascular system or retina, kidney, and nerves) may occure.
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
Hordern, M. D., Dunstan, D. W., Prins, J. B., Baker, M. K., Fiatarone Singh, M. A., & Coombes, J. S. (2011, May 30). Exercise prescription for patients with type 2 diabetes and pre-diabetes: A position statement from Exercise and Sport Science Australia [Abstract]. Journal of Science and Medicine in Sport, 15(1), 25–31. Retrieved from http://www.jsams.org/article/S1440-2440(11)00080-6/abstract?showall=true=
Eat mini-meals. A diabetes diet structured with three or more small meals daily is better than a diet plan that includes only one or two big meals. Large meals can cause blood sugar levels to surge, while eating smaller meals more frequently will help keep glucose levels lower after eating. Plus, a diabetes diet consisting of mini-meals spread through the day will help control hunger and calorie intake, possibly leading to faster weight loss.
We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didn’t meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still weren’t at goal, then it was time to start insulin injections.
Oral glucose tolerance test (OGTT): This is another test used to diagnose prediabetes. The doctor will give you instructions on how to prepare for the test, but you won’t be able to eat anything for eight hours before the test; you’ll be fasting. In that way, the oral glucose tolerance test, abbreviated OGTT, is similar to the fasting plasma glucose test.
Unfortunately, there really are no symptoms or signs of prediabetes. It almost always is diagnosed by chance during a medical screening or routine bloodwork. This is why it is important to get screened, especially if you are overweight or have family members with diabetes or pre-diabetes. However, the most common sign associated with prediabetes is being overweight.
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Metformin: The DPP study found that metformin, the safest first-line therapy for type 2 diabetes, may help delay the onset of type 2 diabetes in people with prediabetes. Participants who took the low-cost generic drug had a 31% reduced risk of developing type 2 diabetes compared to the control group (those not on metformin or intensive lifestyle intervention). Again, 15-year follow up data showed that 17% of those on metformin continued to have a significant reduction in type 2 progression. At this time, metformin (or any other medication, for that matter) is not currently FDA approved for prediabetes, and it is sometimes prescribed “off-label” by a healthcare provider. Your healthcare provider can give you more information and determine whether metformin is a good option for you.
Daniel’s first move was taking the stairs at work to get more fit, and he was surprised how quickly his blood pressure came down. But after seeing a photo of himself on Facebook, he decided he needed to lose the weight, too. He downloaded an app on his phone and started tracking food and calories, and he quickly discovered he was eating more calories at a single meal than he should in an entire day.
When it comes to food, too many people have no idea what’s good, what’s bad, and what’s too much, Marrero says. He tells the story of a woman at a diabetes seminar who complained she had nothing for breakfast but coffee and a muffin. Those two items came to 1,600 calories. “She wiped out seven-eighths of her dietary intake needs just with a simple cup of joe and a muffin,” he says.
In addition to these tests, there are a number of symptoms that may be used to help diagnose diabetes, and people with pre-diabetes may already have one or more of these symptoms. However, many people with untreated pre-diabetes or diabetes have not yet had any of these symptoms. The tests mentioned above are the only way to know for sure. Symptoms can include:
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In the United States alone, more than 8 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don't need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health. If you're experiencing any of the following diabetes signs and symptoms, see your doctor.
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The easiest way to make sure that your carb intake is appropriate is to count carbohydrates. It is a simplified way to evaluate foods based on their nutritional value. The best place to start when counting is to aim for 45 to 60 grams of carbohydrates per meal and roughly 15 to 30 grams for each snack in between meals. You may have to adjust this based on your individual needs and your blood sugar readings. It is a lot easier to calculate the carbohydrates when you have a food with a label, but many foods do not. Check the serving size on the label to be sure that you are counting correctly. The US Department of Agriculture has a website that allows you to type in any food and it will give you the nutritional values. Check it out at https://ndb.nal.usda.gov/ndb/. A few examples of 15 grams of carbs include:
Feast on fiber. Generous amounts of fiber help lower blood sugar levels and speed weight loss. Research shows that a higher intake of fiber may prevent weight gain. According to the 2015-2020 Dietary Guidelines for Americans, women between ages 31 and 50 should aim to eat at least 25 grams of fiber daily, while men in that same age range should eat about 31 grams. As we grow older, our fiber requirement drops. Women, 51 and older, require about 22 grams daily, while men need at least 28 grams of fiber. The fiber requirements in the guidelines for both age groups are still higher than most of us typically consume. One trick you can do to help increase your fiber intake is to toss fiber-rich legumes, like chickpeas and black beans, into salads, chili, and soups.
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Can this be accomplished? Thus far, nothing seems to have slowed the increase in both obesity and diabetes. But there is general agreement in the medical field and within the government that we still need to try. As educators, we can encourage healthful eating and increased physical activity for everyone. Only in the future will we know if these efforts will positively affect the trend of increased obesity and diabetes.
Large changes in your blood glucose levels over the past month will show up in your A1C test result, but the A1C test doesn’t show sudden, temporary increases or decreases in blood glucose levels. Even though A1C results represent a long-term average, blood glucose levels within the past 30 days have a greater effect on the A1C reading than those in previous months.
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* Disclaimer: Weight loss varies by individual and cannot be guaranteed. Participants in the Medi-Weightloss® DM Program DO NOT receive medical treatment for diabetes through Medi-Weightloss®. The Program consists of nutrition and lifestyle education in addition to behavior modification to help participants lose weight and manage type 2 diabetes. Program participants must see their primary care physician or a specialist for medical treatment of type 2 diabetes.
Set small goals. “Don’t try to transform your body all at once,” advises McLaughlin. “That can be a recipe for failure.” Instead, set small, realistic targets, such as walking around the block four times a week and having dessert only on the weekend rather than every day. After these goals become habits, move on to your next objective. You’ll gain a feeling of accomplishment, while inching towards your ultimate weight-loss goal.
While exercise is a great way to bring down your blood glucose immediately, remember that physical activity should be a part of your lifestyle, not just a tool for producing one good test result. Getting your recommended periodic A1C tests will help you and your doctor determine if your blood glucose control is on target. And when you use your meter to test at home and at work, be sure to look for patterns in the results. This can help you and your diabetes care team tell whether you need to adjust your diet, medications, or both. The most important thing you can do to manage diabetes well is to control your blood glucose, and exercise is a key step toward reaching that goal.
Apart from administering insulin, the fastest way to lower your blood glucose is to engage in physical activity. Exercise results in an increased sensitivity to insulin. It causes your muscle cells to take up more glucose, leaving less of it to circulate in your bloodstream during and after the physical activity (which means a lower blood glucose when you test). Frequent, regular exercise is very important to good blood glucose control no matter what type of diabetes you have. Research has shown that it is vital in warding off long-term complications like neuropathy, retinopathy, and heart and kidney diseases. Don't forget to check with a doctor, though, before making any major changes to your exercise routine. And, if you have type 1 diabetes and your glucose is 250 mg/dl or higher, check for urine ketones. You should not exercise if ketones are present.
There are a few supplements which may worsen blood sugar control or insulin sensitivity in certain people: excessive amounts of niacin may elevate blood sugar levels, and prescription digestive enzymes may cause an increase or decrease in blood sugar levels in people with exocrine pancreatic insufficiency. CLA (conjugated linoleic acid), a popular supplement for slimming, may worsen blood sugar control in diabetics and in obese people without diabetes.
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Oregano and Sage: One group of researchers tested a variety of herbs and spices for a specific antioxidant activity that help to prevent an increase in hemoglobin A1C, a protein maker in the blood that is affected by blood sugar levels. They found that two of the herbs with the highest antioxidant levels were oregano and sage (1)…can you say Italian food?
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The only reason to continue to give this bad advice is the lingering fear of natural fat. If you’re going to avoid fat you need to eat more carbohydrates in order to get satiated. But in recent years the old theory about fat being dangerous has been proven incorrect and is today on its way out. Low-fat products are simply unnecessary. So this reason doesn’t hold up either.