My HbA1c has never been terrible over the years but nor has it been particularly exemplary. At an all time high of 10.1% last year I decided to spend a bit of time and effort bringing it down for the next result. Here are some of the simplest and biggest factors that helped me.
1. Pre-bolusing properly
Pre-bolusing is taking fast acting insulin before eating, rather than at the same time. This concept is widely known and common practice for most diabetics, but most of us aren’t seeing much of a benefit, if any, because, like so much of diabetes, it’s easy to forget and hard to balance with the rest of life and we commonly inject only a few minutes before hand. Since even the best fast-acting insulins take at least 10 minutes to start working and don’t reach peak for about an hour, this means we’re essentially gaining a fraction of the benefits to consistent blood-sugars that we would be if we pre-bolus earlier.
I spent a bit of time builidng the habit of bolusing before I even start cooking- typically 30 minutes before hand but sometimes as much as an hour if I know my blood sugar is a little high and I know I’m not going to be interupted or have to do anything between injecting and when I eat. This is important because it’s all to easy to go too far with this practice and start suffering way more hypos because you forget to eat or get distracted by a friend at the door or any other event but with practice and consistency you can build this into your routine and pre-bolus by a lot longer for at least one meal of the day.
2. Eating less carbs
This is probably the first thing I’d recommend for early (but not new) diabetics suffering from high a1cs and high blood sugars. Carbs are the single biggest factor when it comes to insulin and blood sugars and nothing will have more of a positive effect than getting this right. The dietary recommendations in most western countries recommend high amounts of carbs (60% here in the UK) mainly because of fibre, and I could discuss and soapbox in length why I think this is a ridiculous and unhealthy recommendation but suffice to say I’ve personally found no good reason to consume anything more than 5-10% of your diet as carbs.
The internet is awash with low-carb diets and some work better than others for different people. I’ve tried most of them and have concluded that, for diabetes, they’re all different angles with the same principle- less carbs. No matter how you go about it- whether you prefer high protein, high fat, both or any other variation just keep your carbs generally low. Keeping the guidelines as wide as possible leaves you with more room to eat what you want and in my experience, less chance of falling back on high or refined carbs.
Dr Bernestein recommends less than 10g of carbs per meal and the Keto diet tends to recommend less than 50g or 20g of carbs per day. Again, I don’t recommend being so specific because everybody is different, as an 86kg power-lifter recommending 20g of carbs per day for both myself and say a 45kg young girl who does light exercise doesn’t make sense. Eat less carbs and adjust over time to suit your needs and find what you can consistently stick to and you’ll reduce your a1c over time as a result.
3. Eating more fibre and fat
As I said above, other than some circumstances for specific types of people, I find sticking strictly to diets usually doesn’t make sense and eating carbs is still a regular part of my diet, albeit in small amounts compared to most people, but by eating fibre and fats along with the carbs I do eat, I blunt the small blood-sugar spikes even more. For example, I like to eat small amounts of carbs both before and after gym workouts to keep my muscles fueled by glycogen. For this, I choose to eat oats, lentils and other foods which have a combination of high fibre and slow-acting carbohydrates resulting in a very low GI. I then add more fats and fibre wherever possible to effectively lower the GI even further- with oats this might mean coconut oil, pumpkin seeds or macadamia nuts. With savoury meals like lentils or beans this might mean more leafy or fibrous green vegetables, broccoli and the likes.
Other useful high fibre foods or high fat foods that can be included in many simple dishes include flax and chia seeds, avocado, many types of nuts and even some berries.
4. Setting my standards higher (or lower)
Another important thing that helped me lower my a1c wasn’t a physical thing at all but a mental shift. When I was first diagnosed diabetes was still uncommon and advice was sketchy at best. I was told by some doctors that an ideal blood sugar level was between 5.0mmol/L and 7.0mmol/L and others that less than 9.0mmol/L was perfectly healthy. It wasn’t until years later that I came to terms with the fact that the only truly healthy blood sugar range was that of someone with a functioning pancreas, that of someone without diabetes, which is a resting blood glucose of 4.0mmol/L and up to 7.8mmol/L an hour and a half after eating, which means an a1c of below 42 (6%). This is lower than the recommended level for diabetics, presumably because preventing dangerous hypos is a big consideration, but to aim for higher blood glucose levels as a result rather than aiming to be more tight with them seems to be throwing the baby out with the bath water.
Understanding this and coming to terms with the fact that I should be aiming for an a1c of 6% or less and resting blood glucose levels as close to 4.0mmol/L as I could manage suddenly made sense and I no longer felt like I shouldn’t try as hard just because I have a non functioning pancreas and I’ve been labelled as diabetic- in fact it means the reverse, that I should try harder.