Updated: Feb 2
HbA1c is your average blood glucose over the last 2-3 months. It's a routine test that a lot of us dread as our clinic date begins to creep up on us.
In an ideal world, a healthy persons HbA1c should be within the range of 4.0 mmol/mol and 7.0 mmol/mol. In reality, this is not always the case for those living with Type 1 or Type 2 diabetes. With Type 1 especially, you're left to spin all the plates on your own without the help of your body, which is too incompetent to carry out its normal function. There are so many factors which influence how our blood glucose behaves; exercise, diet and illness being only a few. Trying to get that perfect balance between insulin, carbohydrate intake and daily activities can seem impossible at times, particularly when you feel like you're doing everything you can to improve your health.
So, when it comes to our clinic appointment, seeing that number on the screen tends to either make or break our day.
I know how frustrating it can be to not achieve your desired HbA1c reading. Fine tuning your diet and insulin for a steady blood glucose takes time and tends to be very trial and error.
My current HbA1c reading is 7.0 mmol/mol, which for me is great! Even when I was at University, my result never really topped 7.8 mmol/mol... I'd say that's pretty good going for a student who lived a HECTIC lifestyle.
From my experience, I have identified 5 important ways to keep my daily blood glucose steady, and more importantly, lower my HbA1c reading.
1. LOW CARB DIET
The single most important factor that plays a HUGE rule in how your blood glucose behaves. A diet of high carbohydrate/sugary foods is destined to wreck havoc on your blood glucose and skyrocket your HbA1c. Trust me on this one.
The best thing I ever did for my general diabetes control was to switch to a lower carbohydrate diet. I'm not talking Keto (under 20 g ), rather under 150 g a day. Keeping your carbohydrate intake on the lower side will increase your sensitivity to insulin, which results in you needing less insulin throughout the day. Not only this, but it means less erratic spikes in your blood glucose after eating your meals. These spikes often lead to your glucose trends looking like a heart rate monitor; making your control more difficult. Another complication of post-meal spikes is over-treating the spike with more insulin. The amount of times I took a second bolus to try and correct a post-meal spike is crazy, and more often than not led to me having a heavy hypo only an hour or two later. This would then lead to me over-treating the hypo, causing a repeat of the whole mess.
A low carb diet will do the following for you:
Lower your insulin intake
Increase control over your glucose
Decrease risk of hypo
Decrease risk of Hyper
Help you lose weight
Here's what my blood glucose looks like on a day where I've eaten high carb...
Regularly exercising has been a holy grail for keeping good glucose control. In fact, it's probably joint first place with a low carb diet.
Regular cardiovascular exercise is a brilliant way to stop unwanted spikes after meals and helps to shift a chronically high blood glucose down. One of the biggest benefits of cardio is that it tends to increase your sensitivity to insulin up to a few days after the initial activity. For me, this has meant that I've had to reduce my basal insulin as well as my bolus (for meals) to avoid hypo's.
My plan is as follows:
Monday - 30 mins intense cardio
Wednesday - 30 mins intense cardio
Saturday - 30 mins intense cardio
This way, I achieve a stable blood glucose all week, whilst also requiring less insulin.
Like a low carb diet, regular exercise anchors my blood glucose below 10 mmol/mol and gives me tighter control throughout the day, meaning when I test my blood glucose I won't expect it to be above 10 mmol/mol.
Here is an example of how my blood glucose behaves overnight after exercising the evening before:
Regular exercise = lower blood glucose = reduced insulin requirement = stable blood glucose
3. DRINK ALTERNATIVES
It's very easy to forget that those small amounts of carbohydrates you drink into your body still have an impact on your blood glucose. What I'm talking about are drinks which have any form of carbohydrate in them. This could be your Starbucks coffee, your home made white coffee, milkshakes, regular fizzy drinks, milk, slush puppies, beer, alcohol etc. I used to find that when I was having 6 or 7 tea's/coffees throughout the course of the day (an addict, I know), I would be putting in a fair amount of milk. At the time I would assume that such small quantities of milk wouldn't make a dent in my glucose, but it most certainly did! Since last year, I no longer drink any hot drink with milk in it. Instead I opt for black coffee and tea, which I now prefer! Don't underestimate milk!
This idea also applies to other liquid carbohydrates. It's a given that we really shouldn't be consuming sugary drinks, and if you do, I suggest you stop and switch to diet. These drinks are unnecessarily high in sugars and will cause chaos with your glucose control. If you do end up getting a take-away coffee from Starbucks or wherever, opt for milk alternatives such as almond milk or soy. These are much better...
4. INTERMEDIATE FASTING
Intermediate fasting (IF) is something I try my best to do as often as possible. This is a lifestyle-based eating habit whereby you consume all of your calories and nutrients in a strict time window within the 24 hour day. For the remaining hours you don’t eat or drink anything other than water, black coffees and teas. In terms of diabetes management, IF is really effective at stabilising blood glucose during the fasted window. If I do choose to fast, I usually won’t eat my first meal until gone 1pm. During the night and morning, I find that my blood glucose is within the normal range, with no crazy fluctuations that I’d get if I eat first thing in the morning.
If you can fast, I’d really recommend doing it. I have an app called Zero. The app offers different fasting options and is really good for keeping track of your eating habits. Plan your fasts so that you avoid eating in the late evening and early morning. If you’re a food lover like me, having the main body of your fast be at night will help reduce those cravings.
5. WEIGHT TRAINING
I've always found weight training to have an unusual effect on my blood glucose. If I'm really pushing myself, I find that my blood glucose can sometimes elevate in the short term, but then drop back down hours later. Other times I find my blood glucose remaining reasonable stable during a workout, but then crashing many hours later. I have noticed however that depending on whereabouts my pump is on my body (or where you last injected) and what muscle group I'm working, the effects of the exercise vary. For example, my pump is always on my upper leg. If I do a leg workout or use a stair machine for cardio, I find that my blood glucose will seriously drop during or after the workout. To fix this, I set an aggressively low TBR of maybe -40/50%.
Below is a graph of my blood glucose overnight after working out my chest in the evening. As you can see, weight lifting had a serious impact on my blood glucose around 8 hours after I went to bed. You can also see where I massively over-treated the 'LO' hypo (1.7 mmol/mol)...
If you have any hints or tips about how to keep your glucose stable and shift that stubborn HbA1c, comment below!