Managing Diabetes: The A1C Test

Managing Diabetes: The A1C Test What Is the A1C Test? Using your glucose meter helps you track your blood glucose every day. But you also need to know if your treatment plan is keeping you at your A1C goal level over time. An A1C (glycated hemoglobin) test can help. This test measures your average blood glucose level over the prior 2 or 3 months. Staying at or near your A1C goal can help reduce your risk of developing complications of diabetes. The A1C Test The A1C is a blood test done by your health care provider. You will likely have an A1C test every 3 to 6 months. Healthy red blood cells have some glucose stuck to them. Your Blood Glucose Goal A1C has been shown as a percentage. But it can also be shown as a number representing the estimated Average Glucose (eag). Unlike the A1C percentage, eag is a number similar to the numbers listed on your daily glucose monitor. Your health care provider will help you figure out what your ideal A1C or eag should be. Your target number will depend on your age, general health, and other factors. If your current number is too high, your treatment plan may need changes, such as different medications. Sample Results The general goal of less than 7% appears reasonable for many adults with diabetes. That s an eag less than 154 mg/dl. Higher or lower A1C goals may be appropriate for other people. Ask your health care provider about the A1C target that is right for you. A high A1C means that too much glucose is stuck to the cells. medical care. Always follow your health care professional s instructions. This information has been modified by your health care provider with permission from the publisher. DIAB-1174903-0000 03/16

Hyperglycemia (High Blood Glucose) Too much glucose (sugar) in your blood is called hyperglycemia or high blood glucose. High blood glucose can be a serious problem if you don t treat it, so it s important to treat as soon as you detect it. Possible Causes of Hyperglycemia Eating too much food, especially carbohydrates Being less active than usual Needing a change in diabetes medication Being sick Being under stress Symptoms of Hyperglycemia Hyperglycemia may not cause symptoms. If you do have symptoms, they may include: Increased thirst Frequent need to urinate Feeling tired Losing weight without trying Itchy, dry skin Blurry vision Feeling hungry Wounds or skin infections that don t heal What You Should Do Regularly check your blood glucose according to your health care provider s instructions. Drink sugar-free, caffeine-free liquids such as water or diet soda. Don t drink fruit juice. Check your blood or urine for ketones as directed. Talk to your health care provider about when to call if your blood glucose and ketones do not return to your target range. When you are sick, check your blood glucose at least 4 times a day or as recommended by your health care provider. If you take insulin or diabetes medications, follow your sick-day plan for taking medication.

JourneyForControl.com 02 Hyperglycemia (High Blood Glucose) Preventing High Blood Glucose To help keep your blood glucose from getting too high: Follow your meal plan. Eat only the amount of food on your meal plan. Follow your exercise plan. Take your insulin or diabetes medications as directed by your health care team. Also test your blood glucose as directed. Control stress. When you re ill, follow your sick-day plan. Other Things to Do Carry a medical ID card or wear a medical alert bracelet. It should say that you have diabetes. It can provide critical information about your health status in case of an emergency. Make sure family, friends, and coworkers know the signs of high blood glucose. Tell them what to do if your blood glucose gets very high and you can t help yourself. Talk to your health care team about other things you can do to prevent high blood glucose. Special note: Drink plenty of sugar-free and caffeine-free liquids when you feel symptoms of hyperglycemia. Call your health care provider if you keep having episodes of hyperglycemia. DIAB-1139496-0002 03/16

Faces of Hypoglycemia Low Blood Glucose What is it? Also called low blood sugar or hypoglycemia, low blood glucose is when your blood glucose levels have dropped too low, usually less than 70 mg/dl. Each person s reaction to low blood glucose is different, so it s important that you learn your own signs and symptoms, and that your loved ones and friends know what those are. Signs and symptoms of low blood glucose usually include: Nervous Sweating Chills or Shaking Confusion Blurred Vision Dizzy Hungry Sick to Stomach Tired and Weak Headache Irritable

JourneyForControl.com 02 Faces of Hypoglycemia Low Blood Glucose What do I do? Symptoms may be mild at first but worsen quickly if not treated. Check you blood glucose right away if you have any symptoms. It can happen if you ve skipped a meal or snack, eaten less than usual, or been more physically active than usual. If you don t take steps to raise your glucose levels, low blood glucose can lead to unconsciousness (passing out) or seizures. 1. If your blood glucose level is less than 70 mg/dl, it s too low. 2. Eat 15 grams of simple carbohydrates to quickly raise your blood glucose: Glucose tablets (see instructions) Gel tube (see instructions) 4 ounces (1/2 cup) of juice or regular soda (not diet) 1 tablespoon of sugar, honey, or corn syrup 8 ounces of nonfat or 1% milk Hard candies, jellybeans, or gumdrops (see food label for how many) 3. After 15 minutes, check your blood glucose again. If it s still below 70 mg/dl, have another serving. Repeat until your blood glucose is at least 70 mg/dl. 4. Don t forget to talk with your health care team about when and how it happened. They can suggest ways to avoid low blood glucose in the future. DIAB-1013427-0014 04/16

Exercise to Help Control Your Blood Glucose Being physically active every day can help you control your blood glucose. That s because an active lifestyle can improve your body s ability to use insulin. Daily activity can also help reduce the risk of complications of diabetes. It can help you maintain a healthy weight. And it s a great way to relieve stress. If you aren t normally active, be sure to consult your health care provider before getting started. How Much Activity Do You Need? Try to do a total of at least 150 minutes per week of aerobic exercise spread over 3 or more days. If daily activity is new to you, start slow and steady. Begin with 5 to 10 minutes of activity each day. Then work up to at least 30 minutes a day. Do this by adding a few minutes each week. It doesn t have to be done all at once. Each active period throughout the day adds up. Just Move! You don t have to join a gym or own pricey sports equipment. Just get out and walk. Walking is an aerobic exercise that makes your heart and lungs work harder. Walking requires only a sturdy pair of sneakers and your own feet. The more you walk, the easier it gets. Schedule time every day to move your feet. Make it part of your daily routine. Walk with a friend or a group to keep it interesting and fun. Try taking several short walks during the day to meet your daily activity goal. A Pedometer Makes Every Step Count A pedometer is a small device that keeps track of how many steps you take. You can clip it to your belt (or a strap on your arm or leg) and go about your daily routine. At the end of the day, the pedometer shows the total number of steps you took. Use a pedometer to set daily activity goals for yourself. For instance, if you walk 4,000 steps a day, try adding 200 more steps each day.

JourneyForControl.com 02 Exercise to Help Control Your Blood Glucose Adding Resistance Exercise Resistance exercise (also called strength training) makes muscles stronger. It also helps muscles use insulin better. Ask your health care provider whether this type of exercise is right for you. If it is, your health care provider can help you work it in to your activity plan. Be Smart When You Exercise Being active may cause blood glucose to drop faster than usual. This is especially true if you take certain medications to control your blood glucose. But there are things you can do to help reduce the risk of low blood sugar levels. Keep these tips in mind: Always carry identification when you exercise outside your home. Carry a cell phone to use in case of emergency. If you can, include friends and family in your activities. Wear a medical ID bracelet that says you have diabetes. Use the right safety equipment for the activity you do (such as a bicycle helmet when you ride a bicycle outdoors). Wear closed-toed shoes that fit your feet well. Drink plenty of water before and during activity. Keep a fast-acting sugar (such as glucose tablets) on hand in case of low blood glucose. Dress properly for the weather. Wear a hat if it s sunny, or wait until evening if it s too hot. Avoid being active for long periods in very hot or very cold weather. Skip activity if you re sick. Notice How Activity Affects Blood Sugar Physical activity is important when you have diabetes. But you need to keep an eye on your blood glucose level. Check often if you have been active for longer than usual, or if the activity was unplanned. Make it a habit to check your blood glucose before being active. And check again a few hours later. Use your log book to write down how activity affects your blood glucose. If you take insulin, you may be able to adjust your dose before a planned activity. This can help prevent lows. Talk to your health care provider to learn more. DIAB-1139497-0002 03/16

Diabetes: Understanding Carbohydrates, Fats, and Protein Food is a source of fuel and nourishment for your body. It s also a source of pleasure. Having diabetes doesn t mean you have to eat special foods or give up desserts. Instead, you can learn how to plan meals to suit your body. To start, learn how different foods affect blood glucose. Carbohydrates Carbohydrates are the main source of fuel for the body. Carbohydrates raise blood glucose. Many people think carbohydrates are only found in pasta or bread. But carbohydrates are actually in many kinds of foods. Sugars occur naturally in foods such as fruit, milk, honey, and molasses. Sugars can also be added to many foods, from cereals and yogurt to candy and desserts. Sugars raise blood glucose. Starches are found in bread, cereals, pasta, and dried beans. They re also found in corn, peas, potatoes, yams, acorn squash, and butternut squash. Starches also raise blood glucose. Fiber is found in foods such as vegetables, fruits, and whole grains. Unlike other carbs, fiber isn t digested or absorbed. So it doesn t raise blood glucose. In fact, fiber can help keep blood glucose from rising too fast. It also helps keep blood cholesterol at a healthy level. Did You Know? Even though carbohydrates raise blood glucose, it s best to have some in every meal. They are an important part of a healthy diet. Fat Fat is an energy source that can be stored until needed. Fat does not raise blood glucose. However, saturated fats and trans fats can raise blood cholesterol, increasing the risk of heart disease. Fat is also high in calories, which can cause weight gain. Not all types of fat are the same. More Healthy Monounsaturated fats are mostly found in vegetable oils such as olive, canola, and peanut oils. They are also found in avocados and some nuts. Monounsaturated fats are healthy for your heart. That s because they lower LDL (unhealthy) cholesterol. Polyunsaturated fats are mostly found in vegetable oils such as corn, safflower, and soybean oils. They are also found in some seeds, nuts, and fish. Polyunsaturated fats lower LDL cholesterol. So, choosing them instead of saturated fats is healthy for your heart.

JourneyForControl.com 02 Diabetes: Understanding Carbohydrates, Fats, and Protein Fat (continued) Less Healthy Saturated fats are found in animal products such as meat, poultry, whole milk, lard, and butter. Saturated fats raise LDL cholesterol and are not healthy for your heart. Hydrogenated oils and trans fats are formed when vegetable oils are processed into solid fats. They are found in many processed foods. Hydrogenated oils and trans fats raise LDL cholesterol and lower HDL (healthy) cholesterol. They are not healthy for your heart. Protein Protein helps the body build and repair muscle and other tissue. Protein has little or no effect on blood glucose. However, many foods that contain protein also contain saturated fat. By choosing low-fat protein sources, you can get the benefits of protein without the extra fat. Plant protein is found in dry beans and peas, nuts, and soy products such as tofu and soymilk. These sources tend to be cholesterol-free and low in saturated fat. Animal protein is found in fish, poultry, meat, cheese, milk, and eggs. These contain cholesterol and can be high in saturated fat. Aim for lean, lower-fat choices. DIAB-1139498-0002 03/16

Diabetes: Sick-Day Plan When you re sick, even with just a cold, your blood glucose level may rise. Ask your health care team to help you develop a sick-day plan for controlling blood glucose. Here are some guidelines. Don ts Don t stop taking your diabetes medication unless your health care provider tells you to. Don t take other medications, such as cold or flu remedies, without checking with your health care provider first. Do s Stick to your meal plan. If you can t eat, try fruit juice, regular gelatin, or frozen juice bars as directed by your health care provider. Try to eat or drink 50 grams of carbohydrates every 3 to 4 hours. Drink lots of noncaloric liquids, like water and other sugar-free liquids, to keep from getting dehydrated. Check your blood glucose as often as directed by your health care provider. Look for sugar-free cough drops and syrups. Ask your health care provider if it s okay for you to take these. If you use insulin, adjust the dosage according to your sick-day plan. Don t skip insulin. You need insulin even if you can t eat your normal meals. If you take pills, take the normal dose unless your health care provider tells you to stop. Ask someone to check on you several times a day. Call Your Health Care Provider If: You vomit or have diarrhea for more than 6 hours. Your blood glucose level is higher than 240 mg/dl after you have taken extra insulin (if recommended in your sick-day plan). You take oral medication for diabetes, your blood glucose is higher than 240 mg/dl before a meal and stays that high for more than 24 hours. You have moderate to large amounts of ketones in your urine. You have a fever and/or you aren t better after a couple of days. DIAB-1139797-0002 03/16

Long-term Complications of Diabetes People with diabetes can develop complications over time. Over time, high blood glucose levels can damage blood vessels. This can lead to health problems (complications). Keeping your blood glucose in your target ranges can help reduce your risk of complications. Brain Why Manage Diabetes? You can take an active role in your health by managing diabetes. You can manage diabetes by controlling your blood glucose, blood pressure, and cholesterol, and by eating healthy, exercising, and taking medication as directed. Long-term Complications Managing diabetes can help you reduce your risk of serious complications, such as: Eye problems, including damage to the blood vessels in the eyes (retinopathy), pressure in the eye (glaucoma), and clouding of the eye s lens (a cataract) Tooth and gum problems (periodontal disease), causing loss of teeth and bone Heart and blood vessel (vascular) disease leading to circulation problems, heart attack, or stroke Problems with sexual function Kidney disease (nephropathy) Nerve problems (neuropathy), causing pain or loss of feeling in your feet and other parts of your body High blood pressure (hypertension), putting strain on your heart and blood vessels Serious foot infections, possibly leading to loss of toes, feet, or lower limbs DIAB-1139491-0002 03/16