In addition to monitoring your blood glucose levels, the most important aspect of your health is to know your "ABCs."
If you have diabetes, you are at high risk for heart attack and stroke.
Heart disease is more likely to strike you—and at an earlier age—than someone without diabetes. But you can fight back. Be smart about your heart. Take control of the ABCs of diabetes and live a long and healthy life.
The A1C (A-one-C) test—short for hemoglobin A1C—measures your average blood glucose (sugar) over the last 3 months. Suggested target: below 7
B is for blood pressure
High blood pressure makes your heart work too hard. Suggested target: below 130/80
Bad cholesterol, or LDL, builds up and clogs your blood vessels. Suggested LDL target: below 100
Ask your health care provider these questions:
The A1c test is an important diagnostic test for people with diabetes or who may be at risk for diabetes. An A1c test measures the Average Blood Glucose (ABG) in the body over the previous 90-120 days. Although monitoring your own glucose levels at home on a daily basis is crucial for people with diabetes, an A1c test complements self-monitoring by offering a more complete picture of how your treatment program is performing over the long term.
The A1c test is also known as a hemoglobin A1c test. Hemoglobin is an oxygen-carrying protein found in red blood cells. Red blood cells live for about 120 days, or the lifespan of a red blood cell, and then are replaced by new ones. Each red blood cell carries a “memory” of daily blood glucose levels throughout its lifetime. When surplus glucose is in the bloodstream, it hooks up with hemoglobin, causing higher A1c levels. These A1c levels are “remembered” by the red blood cells and can be analyzed by an A1c test. Specifically, the A1c test shows whether your ABG is above normal by measuring the percentage of glycated hemoglobin. In a non-diabetic person, about 5% of all hemoglobin is glycated (or, attached to glucose). In a person with diabetes, this percentage can jump to 25% in extreme cases.
When too much glucose is in the bloodstream, hemoglobin cannot deliver as much oxygen as is needed by the body’s cells. Without oxygen, the cells suffer damage. Numerous studies have reliably linked above-normal A1c results with complications such as nerve, eye, kidney, and cardiovascular disease.
If your diabetes treatment program is not working effectively enough, an A1c test alerts your healthcare team that further adjustments are needed. Diabetics should have an A1c test at least twice per year. In some cases, it is advisable to perform the test every 3 months, such as when you’ve begun a new medication or when your blood glucose readings are not yet under control.
Although the A1c test is an important tool for diabetes management, it is vital to emphasize that the test is not a replacement for daily monitoring of blood glucose levels. An A1c test can’t help you adjust your insulin dosages, for example. Check with your doctor to determine how the A1c test should fit into your diabetes management.
Q. What is blood glucose monitoring?
A. Your diabetes care team may use this term: Self Blood Glucose Monitoring (SBGM). SBGM means checking your own blood sugar or blood glucose levels. Diabetes patients prick their fingers and place a drop of blood onto a test strip. A test strip is inserted into a machine called a "glucose meter." The glucose meter will provide a result in a few seconds. With the results, you may make changes in your management of diabetes to keep your blood glucose levels as close to normal ranges as possible.
A glucose meter is used by persons with diabetes to check what the blood glucose level is at the moment. Glucose monitoring also checks if the blood glucose level is too high or too low, and how your blood sugar is affected by food, exercise, medications, illness or stress.
ADA Blood Glucose Target Recommendations*, **
American Diabetes Association Guidelines
| Time | Goal |
|---|---|
| Pre-meal | 90-130 mg/dl |
| Post-meal (1 - 2 hours after) | less than 180 mg/dl |
Three (3) month average blood glucose: A1c Test Result: 7.0% or lower
* FOR SAFETY PURPOSES: Lower targets may be recommended for persons who have lower risk for low blood sugar (hypoglycemia). Higher targets may be recommended for persons who have frequent or unrecognized high blood sugar (hypoglycemia).
** The American Association of Clinical Endocrinologists (AACE) recommends fasting blood glucose levels below 110 mg/dl, 2 hour post meal values below 140 mg/dl and A1c levels less than 6.5%.
Q. A1c Question: Why is it necessary to check 3-month blood sugar level averages?
A. The A1c test is a medical test that is done routinely as a preventative measure to detect potential medical problems early, so complications can be avoided. This proactive testing helps slow or reverse damage before any organ impairment has affected a body function. The American Diabetes Association (ADA) recommends on average most persons with diabetes should have A1c levels tested four (4) times per year.
The A1c test shows average blood glucose levels over a 3-month period. The results reveal overall control. When your physician monitors overall control this result is helpful to show blood glucose averages. With daily blood glucose monitoring, single tests are performed to show the blood sugar level at the exact time of the testing. These results are helpful, but not the best way to check overall control.
It is important for your physician to know how your meal plan, exercise and medication work together to control your diabetes. A1c numbers of 8.0% or above generally reflect poorly controlled diabetes. A1c numbers can be changed or lowered only after weeks of good diabetes control, which includes careful attention to exercise, stress management, medication schedule, and healthy meal plan.
Q. When is frequent testing of blood glucose necessary?
A. During times of stress, illness, trauma/injury, or surgery frequent blood glucose monitoring is recommended.
More frequent blood glucose monitoring is recommended during exercise. Exercise causes insulin to work more effectively, and exercise uses up blood glucose, thus lowering blood glucose levels.
Persons with diabetes needs to refrain from exercise if there are ketones in the urine and the blood glucose level is 250 mg/dl or above. If there are no urine ketones, but the blood sugar levels are 300 mg/dl or above, then exercise should be avoided until blood glucose levels are within the target range.
Q. What can I do to avoid low blood glucose during exercise?
A. Here are some ways to avoid low blood glucose while exercising:
More information about Diabetes & Exercise.
Q. How do I record blood glucose results?
A. Write down the following information for each blood glucose level test:
Blood Glucose Meter Log Books generally have a self-assessment page. Complete with your physician the sections on individual goals for individual targets.
Q. What are the benefits of recording the results of my blood glucose tests?
A. Your log will help you communicate your blood glucose results to the health care team. Take your blood glucose log book to all physician and health care team visits. You can review problems that are occurring at certain times of the day with high or low blood sugar levels with your health care professional. Changes in treatment plans can be made if necessary. By monitoring your blood glucose levels regularly, you will be able to see how different lifestyle factors such as food, exercise, illness, and stress affect your numbers.
Write the blood glucose results in a notebook or glucose meter logbook each time you test. If any changes are necessary in meal plan, nutritional intake, medication or activity plan, your health care team members can effectively evaluate this from your recorded results. Your health care team member will assist you with understanding the blood glucose results, and individualize your care plan.
Also, it is important to remember that you will feel your best when you keep your blood glucose within the recommended target range(s). With well managed blood glucose levels, improvements in blood pressure and cholesterol levels generally result. This allows you to greatly lowering your risk for diabetes complications such as vision problems, kidney disease, heart disease and nerve damage.
Often times, people with diabetes focus so intently on monitoring their blood sugar that they forget to keep track of other important health indicators. Cholesterol is one of those things. Checking cholesterol levels is important for everyone, since too much cholesterol can lead to heart disease. People with diabetes are already at risk for heart disease, so they should take extra care to monitor their numbers when it comes to cholesterol. Testing at least once a year is recommended.
What is Cholesterol?
Cholesterol is a waxy lipid that is found in foods like meat, eggs, and dairy products. A lipid (incorrectly thought of as a synonym for fat) is a substance that dissolves in fat. The body needs cholesterol to build cell walls and to produce things like hormones, vitamin D, and bile. But when excess cholesterol is in your bloodstream, it can cling to your arteries, making them harden and get narrower. This is called atherosclerosis, a serious condition that can lead to heart disease.
Cholesterol is carried through the blood by proteins. Together, the molecules form what is called a lipoprotein. There are two kinds of lipoproteins:
A third substance which is usually monitored during cholesterol testing is triglycerides, a fat found in vegetable oil and animal fats. High triglycerides increase your risk of heart attack and stroke, so you want your levels to be low. For people with diabetes, aim for numbers that are less than 150.
Your cholesterol levels can be affected by many factors such as smoking, alcohol, and certain illnesses. Some medications can hurt your cholesterol levels, too. These include beta-blockers (a blood-pressure drug), oral estrogens (birth control), and thiazide diuretics (another blood-pressure treatment). Check with your doctor to find out what you can do about optimizing your cholesterol levels—your heart will thank you!