A1c Tip: Change What You Consider a “High” Blood Sugar
Making a noticeable change in your HbA1c isn’t easy. When you first decide you want to lower your A1c, it’s hard to even know where to begin
Should you try to eat a healthier diet? Should you exercise more often? Should you vow to never eat bread or chocolate ever again?
Instead, it could be more useful to start by looking at where your A1c and blood sugars currently are compared to where you want them to be.
How your A1c translates to an eAG (estimated average blood glucose)
Every A1c result translates to a blood sugar range and an eAG (estimated average blood glucose). Your eAG is the blood sugar level you’re at or around the most often. You can use the American Diabetes Association’s handy calculator to translate your recent A1c or take a look at this simple chart:
12% = 298 mg/dL (240 – 347)
11% = 269 mg/dL (217 – 314)
10% = 240 mg/dL (193 – 282)
9% = 212 mg/dL (170 –249)
8% = 183 mg/dL (147 – 217)
7% = 154 mg/dL (123 – 185)
6% = 126 mg/dL (100 – 152)
The real work begins when, for example, you are looking at your most recent A1c of 9 percent, and your goal is an A1c of 7 percent.
According to the translation chart above, an A1c of 9 percent means your blood sugars are frequently near or higher than 200 mg/dL.
If you’re striving to achieve an A1c of 7 percent, that would require your blood sugars to be frequently around 154 mg/dL.
Simply wanting a lower A1c and trying to get there by eating more vegetables isn’t enough. To make a real impact, you’ll need to make a real change in where you let your blood sugars sit all day long.
Changing your idea of a “high” blood sugar
If your blood sugar is frequently at or higher than 200 mg/dL with an A1c of 8 percent, that means two things: 1. You likely aren’t getting enough insulin with either your meals or background (basal) insulin — or both.
And 2. Your habit in what you consider a “high” blood sugar worth correcting with insulin is likely too high — and greatly contributing to your A1c frustration.
Adjusting insulin doses with your healthcare team
The first issue can be addressed by talking to your healthcare team about making a small boost in your current insulin dosing regimen. Even just an increase of 1 to 3 units over the course of a few days can make blood sugar goals so much easier to reach! (Of course, you can also make improvements in nutrition and exercise to help lower your insulin doses, but we’ll save that for another article!)
You should also talk to your healthcare team about your “correction factor” — the amount of insulin you take to correct high blood sugar. Everyone taking insulin should have a good idea of how many points 1 unit of insulin will drop your blood sugar by.
For instance, mine is usually 1:75 which means 1 unit of insulin will bring my blood sugar down by 75 points. In the morning, when I’m more insulin resistant, I know my correction factor is more like 1:50. What’s yours? Is it accurate?
When you correct high numbers
The second issue is about when you take action to correct those higher numbers on a day-to-day basis. Your healthcare team can’t help you there because you’re the one looking at that glucose meter or CGM (continuous glucose monitor) every day.
You’re the one who sees a 160 mg/dL two hours after eating breakfast and decides whether to say, “That’s good enough” or “That’s too high — I’m going to take a correction dose to bring it down into my goal range.”
If you’re striving for an A1c of a 6.5 percent, for example, then hanging out over 160 mg/dL between meals is simply never going to help you get there. Taking the time to for that simple extra dose of insulin to bring your blood sugar down closer to 120 mg/dL will help you get your A1c well under 7 percent.
When too many corrections lead to “stacking” your insulin…
If you find yourself constantly correcting high blood sugars during the day in an effort to get your A1c down, that definitely means you are not getting enough insulin in the first place.
Sometimes, correcting highs can lead to a lot of lows which can leave you thinking that you’re getting too much insulin. Too often, the issue is that you’re not getting enough background (basal) insulin.
If your current background (basal) insulin dose is shy by 4 or 5 units of what your body actually needs in order to get your blood sugars into a healthier range, then it really wants that insulin dispersed gradually throughout the day — rather than in larger chunks via correction doses.
These larger correction doses can lead to “stacking” your insulin which means you’re taking too many boluses too closely together. Fast-acting and rapid-acting insulin stay in your bloodstream for up to 4 hours, which means taking correction doses closely together with your next meal, followed by another correction dose a few hours later can easily create a stacking disaster of super lows, over-treating, then super highs.
Take a look at how often you’re now correcting high blood sugars — and if you’re getting caught on blood sugar roller coasters as a result. Most likely, you need a good boost in your background insulin.
At the end of the day, it comes down to giving your body the amount of insulin it needs when it needs it! There’s no right or wrong amount of insulin — everyone is different. And our insulin needs change at different times in our lives, too, based on stress, diet, activity level, hormones, weight changes, and so on.
Check your blood sugar often, keep an eye out for patterns, and take action sooner when you’re higher than your goal range! Blood sugar management is never simple. Take a deep breath and consider it a lifelong work-in-progress.