If you have diabetes, the idea of lowering your A1C to a number less than 7.0 may seem impossible without acquiring some sort of diabetes management obsession. Diagnosed with type 1 diabetes (and Celiac disease) when I was a teenager, I'm here to tell you, it doesn't. While I certainly don’t want to give the impression that it’s a simple or easy goal to obtain, I've been able to maintain an A1C of 6.0 for most of my adult life mostly by following a proven path of tried and true strategies.
By far the most helpful thing for me has been to structure my nutrition so I'm eating fairly low-carb throughout the day and "save" my carb servings for dinner or dessert. This way, managing my blood sugars in a tighter range requires significantly less effort than when I do eat my carbs in the evening. Here, a few other rules I live by:
1. Care about the quality of food you eat. This simple principle is terribly important. Consuming a diet that is made mostly of real food—whole food—that you chopped and prepared and cooked yourself will have the greatest impact on your blood sugars and your sensitivity to insulin, whether you’re type 1, type 2 or have prediabetes. You don’t have to be a brilliant chef to cook delicious food in reasonable amounts of time on a reasonable budget—but you do have to be willing! Dive in, learn, take your time—enjoy it! Your blood sugars will thank you for the effort. Start by taking a closer look at how much of your current food choices are highly processed!
2. Find an activity you enjoy and become more active in it. You don’t have to be an athlete or a hardcore Cross-fitter to benefit from exercise. Just walking 30 minutes a day will have a powerful effect on your overall sensitivity to insulin and your blood sugar levels. I used to be a competitive powerlifter—training, setting records and challenging my body taught me a lot balancing my blood sugars during intense training. Today, I'm a mother to a 17 month-old baby. Lucy and I do a lot of hiking through the woods with our dogs. I periodically mix in some light strength-training with hand weights, too. In order to see results at your next doctor’s appointment, the key is to make it a real habit most days of the week. You don’t have to join a gym or train for a marathon. Buy a couple pairs of dumbbells and just move while you watch your favorite TV show every night! Keep it simple and realistic.
3. Check your blood sugar and adjust your medications. If you’re currently frustrated with your A1c, it’s probably time to start checking your blood sugar more often—particularly between meals. If you recall that the blood sugar range of 100 to 152 mg/dL is essential to a 6.0 A1c, that means that your blood sugar needs to be in or below that range before you eat and after you eat as much as possible. Checking your blood sugar more often will help you determine if your insulin doses or diabetes medications need to be adjusted with your doctor’s guidance and in your food choices. Even a 1-unit increase can have an incredible impact on your blood sugars—the little details matter!
4. Sleep with in-range blood sugars. If your blood sugar is above that 100 to 152 mg/dL range for the 8 hours of the day you’re asleep, it will be very hard to reach a 6.0 A1c since your overnight blood sugars are 1/3 of your total blood sugars per day. If you’re currently going to bed with high blood sugars, then it’s time to take a closer look at your evening medication doses and food choices. And the same goes for if you often wake up with high blood sugars in the morning.
5. Pre-bolus your insulin doses. This applies only for those who take insulin, but it’s crucial. Most of today’s fast-acting insulin is designed to begin working in the body approximately 15 minutes after injecting. This means that when you’re eating a meal that contains anything over 10 grams of carbohydrate, you’ll want to wait at least 5 or 10 minutes if not 15 minutes between taking your injection and eating in order to let the insulin keep up with the rate at which your body is digesting those carbohydrates. Meals high in both fat and carbs are a little trickier, and may need a delayed dose of insulin. Hess Fischl notes that sometimes dosing up to 30 minutes before a meal may be needed to reduce the spike after certain meals. “This is very individualized though.”
These may sound like guidelines you’ve heard a hundred times before, but the truth is that the secret to achieving a 6.0 A1C isn’t a secret. It’s about the straight-forward basics of good diabetes management. If trying to apply all 5 right now to your diabetes is overwhelming, pick two you feel the most positive about and start from there.