It all begins at school where scores determine an academic graph. Scores even determine the jobs we get and sooner or later targets or revenues achieved establish a lifestyle. Numbers are everywhere, and no they don’t spare even diabetics.
For a diabetic is judged by a number known as his/her glycosylated Hemoglobin (HbA1c or A1c), in fact when somebody introduces a diabetic in any related gathering, it most often goes like- “meet Mr. Muslim Kapasi, his A1c is 5.7%”… now that is a number which quickly categorizes you as the Good, the Bad and the Ugly achiever within the diabetic fraternity. When your numbers depict well, reflex is to look for other shortcomings (in this case diabetic complications like angiopathy, neuropathy, retinopathy, renal, thyroid, etc.) and I quickly reply proudly- “None!” and I intend to keep it that way!
What amuses people the most is that my Vitamin D levels are in its high 50s which is otherwise considered to be deficient by default in this disorder (no matter how much sun bathing or IUs of Calciferols one indulges in nowadays). My secret? I eat lots of and all kinds of fats. (Please note, I am also completely against the use of sunscreens.)
But my A1c is categorically either too good or too ugly… unfortunately no grey areas here. Good because it falls in a range where I am no longer a diabetic or ugly because I must be having too many hypos everyday. My defense is feasible to the latter though, I am a T1 diabetic so Hypoglycemias (hypos) and Hyperglycemias (hypers) are a part and parcel of my life. But the real question to delve with here is how do I still get to an A1c of below 6 without being in a coma?
There is no rocket science behind this, or is there? Non-diabetics have an A1c in the range of 4% to 5.6% because their insulin and glucagon production is perfectly synced with their food consumption and functional needs and if I could mimic that as closely as possible, synchronize my insulin intake in the right amount for the food I eat to maintain a pattern similar to what the body maintains in non-diabetics, wouldn’t I too get closer to that number quite automatically then… and that’s the idea!
I know, it is easier said than done but let’s try… what’s the worst that can happen! Though being on an insulin pump it becomes much easier but it is very much possible even with whatever diabetic medicines and regime you are on, that is whatever medicines you are using to treat food.
So how do you do it? It’s simple! Keep the blood sugars between 70 and 140 at all times, even pre and post meals, means no hypos or hypers as much as possible. We all have bad days so lets leave those out, but this is where the timing and phasing of the medication plays the most critical role. For the sake of not getting too old too fast I err on the hypo side a bit but I am aware that I’m then walking on thin ice, more about this in my next posts!
One way to do it is to get on a Continuous Glucose Monitoring System (CGMS) else to get this timing and phasing right you will need to constantly check your blood sugars every 15 minutes after the meal until you see them reversing downwards and that’s when your medication peaked or digestion slowed. Align the peak so you would be able to keep your blood sugars tightly within the range you want them to be most of the time.
Being a diabetic you already know the long-term benefits of a great A1c, and there is nothing more important to you than not letting a disorder control your life but vice versa. Just like a great topline without a good bottom line (or valuation) has no joys or results… similarly take as less medication as possible and it should be easier to also get to or maintain the best Body Mass Index (BMI) in the process. Glow, feel energetic and seldom fall ill!
Before all this you need to better understand how your body works (this only you know best), how your metabolism shifts through the day and night, with or without stress, exercise and sleep. And of course, consult your health care professionals and especially your doctor to get you on the most suitable medication dependent to your food culture as different foods do behave quite differently in the body.
You can post your readings here with the type of meal consumed, medications, body weight and age. In case of doubts, there are quite a few diabetics here who manage this part very well for themselves and they along with me should be able to offer some guidance.
All the best and let’s control diabetes because diabetes must never win!
HbA1c Range Chart:
Normal: 4% to 5.6%
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or higher.