When your A1C results are still too high 😣

If you’re frustrated that your HbA1c (A1C) hasn’t gone down despite your best efforts to exercise more, eat fewer carbs, and check your blood sugar more often, there may be one sneaky habit you haven’t noticed: what you consider an “okay” blood sugar is actually a “high” blood sugar that needs correcting with a bolus of insulin. Your A1c is the culmination of your blood sugar levels over the course of the prior 2-3 months, which means an A1c of 8.0 percent translates to eAG” (estimated average glucose) of 183 mg/dL. If your blood sugar is 183 mg/dL, this means that for a large part of every day, your blood sugar is either a little lower or a little higher than 183 mg/dL. Meanwhile, an A1c of 7.0 percent translates to 154 mg/dL. Merely a 30-point different, sure. But it has a tremendous impact on your A1c and overall blood sugar levels!

High vs. High 

The trick, in this scenario, is to adjust the way you think of "high" BG. Sure, we all know 300 mg/dL is "high." But, if you're looking to get that 8.0% A1C down to a 7.0%, 183 mg/dL should now resonate with you as "high" as well. It sounds so easy! But when you try putting it into practice, it can actually be quite tricky. So you see a 183 mg/dL on your meter screen; what do you do to correct it? It's not high like a 300 mg/dL high, but it's still, technically, "high" if the goal is to get to 7.0%. But are you registering it as such? If not, it's OK! Here are the steps to take to change that mindset, and reach your A1C goal. 🥅

Step 1: Get to the root of the problem 

You can’t fix something until you know (and understand) what the root cause of the problem is. Ask yourself: “What have I been considering a ‘high’ blood sugar that deserves an insulin correction?” Perhaps you need a week of observing and getting to know your honest answer to this question. By the end of the week, you might learn that you’re often around 200 mg/dL after lunch, or you spend the majority of your entire workday around 150 mg/dL and you never take a correction for it, because you’re used to that being “your normal.”

Step 2: Set a new standard of success (aka high BG)

Decide on your new standard of "high blood sugar." In an ideal world, we’d all aim for that perfect, non-diabetic range of 70 to 120 mg/dL all day long. But, as you and I know all too well, that is pretty darn stressful! And fairly unrealistic for everyday life with diabetes. (The exception being those who are pregnant or eating The Bernstein Diet). Instead, you might decide that you’ll aim to correct any blood sugar over 140 mg/dL (based on the logic, of course, of how long it’s been since your last injection or bolus, to prevent “stacking” your insulin). Whatever your new goal is, write it down (tape it into your glucometer if you have to!) and embrace your new range as your new goal. ⭐️

Step 3: Establish your correction factor 

Establish your Correction Factor ...and use it! Your correction factor (CF) is the number of points 1 unit of insulin will reduce your blood sugar. For instance, the common CF is 1:50 or 1:75. Once your CF is established as 1:50, for example, when you see a 150 mg/dL on your glucometer 3 hours after lunch (when your meal bolus is past its peak), you could take a ½ unit of insulin to bring your blood sugar down 25 points. (Remember that certain variables like exercise and stress can impact your CF in that moment. Exercise would cause you to need less insulin for that correction, whereas a stressful conversation or work event could cause you to need more.)

Step 4: Tighten up fasting BGs

Take a look at your overnight and fasting blood sugars. If you’ve been seeing 160 mg/dL on your glucometer in the mornings and don't do anything about it, that’s going to be a big contributor to your A1c frustration.< That means you’ve spent all night with a blood sugar well above the range of your target A1C. That alone can explain why your A1C is so much higher than your goal, even if you've been staying closer to your goal range during the day. Nighttime is 8 hours of your A1C result! Nip that one in the bud by studying your overnight blood sugars more closely and adjusting your insulin and medication doses.

Step 5: Increase background insulin doses

If you aren’t getting enough background/basal insulin, your efforts to lower your A1C will be pretty pointless. When was the last time you did a little basal testing? Evan a small increase of 1 additional unit per day in your background insulin dose can have a huge impact on your overall blood sugars. If you're seeing habitual spikes and/or long-term high patterns in your levels, rethink your basal settings. Consider that your overall background/basal insulin doses need an increase. It's an easy fix!

Step 6: Pinpoint other BG trouble spots 

For example, if you usually exercise with your blood sugar around 200 mg/dL because you’re terrified of going low, that’s going to be a daily portion of the day when you’re well above your goal range (if you’re trying to achieve an A1c of 7.0 percent). Learning how to exercise with in-range blood sugars isn’t easy. In fact, it’s a lengthy process of trial and error and more learning, but it can be done! Here are a few resources to help you expand your knowledge around exercising with type 1 diabetes or type 2 diabetes using insulin: ● Fit with Diabetes eBook by Diabetes Strong ● The Diabetes Athlete’s Handbook by Sheri Colberg, PhD ● Fasted Exercise with Type 1 Diabetes by Ginger Vieira ● Bright Spots & Landmines by Adam Brown ● Dealing with Diabetes Burnout by Ginger Vieira

The ongoing science experiment 

In the end, it’s all just learning, studying, improving and adjusting! The lifelong science experiment of life with diabetes. 🙌 You may have recently come out on the other side of a stressful divorce or been managing the diagnosis of something incredibly stressful like breast cancer--and those stressors in life had caused you to let your blood sugars run higher for a period of time. Hey, it happens! To any of us! (Mine, for example, was the addition of a 2nd child to keep alive on a daily basis! Parenting! Oy vey.) But when you’re ready to focus on reducing your A1c, make sure that your idea of a “normal” blood sugar vs. a “high” blood sugar lines up realistically with your goals.