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Can Insulin Lower Your A1c?

Insulin For Type 2 Diabetes: When, Why, And How

Insulin For Type 2 Diabetes: When, Why, And How

Blood sugar control is one of the most important parts of type 2 diabetes management. Although you may be able to treat the condition at first with oral medication and lifestyle changes, such as exercise and weight loss, most people with type 2 diabetes eventually need to take insulin by injection. "There are several scenarios in which insulin treatment should start, including in patients with significant hyperglycemia who are symptomatic," explained Alaleh Mazhari, DO, an associate professor of endocrinology at Loyola Medicine in Maywood, Illinois. "In these cases, the need for insulin may be short-term. Other situations include patients who are on multiple diabetic medications with uncontrolled diabetes, and uncontrolled diabetes in pregnancy, to name a few." Here's what you need to know about taking insulin in the short term and the long term. Insulin for Short-Term Blood Sugar Control Doctors use a blood test called a hemoglobin A1C test to measure average blood sugar control over a two- to three-month period. The treatment target for most people with diabetes is an A1C of 7 percent or less; those with higher levels may need a more intensive medication plan. "The American Association of Clinical Endocrinologists recommends starting a person with type 2 diabetes on insulin if their A1C is above 9 percent and they have symptoms," said Mazhari. Symptoms of type 2 diabetes include thirst, hunger, frequent urination, and weight loss. Research published in February 2013 in the journal The Lancet Diabetes & Endocrinology reviewed several studies that focused on the temporary use of insulin to restore sugar control in people with type 2 diabetes. The results showed that a two- to five-week course of short-term intensive insulin therapy (IIT) can induce remission in patients Continue reading >>

How To Lower Your A1c For Insulin Users | Diabetic Connect

How To Lower Your A1c For Insulin Users | Diabetic Connect

There is no magic formula for achieving a "perfect A1c" or super food that will fix blood sugar levels in a flash. The most important thing to remember is that it takes daily dedication and sometimes several months before you will see any significant improvements in your A1c level. Because your A1c results are a reflection of your blood glucose readings over the past three months, ultimately getting a lower A1c is all about keeping your blood glucose under control daily. Eating a healthy diet and exercising regularly are key to keeping your blood sugar under control, but some of these tips may also help you keep your A1c results on target. Take mealtime insulin before eating. The goal of mealtime insulin is to lower your blood glucose level just as your food is raising it so that your numbers dont spike. A study done by the Davis Center for Childhood Diabetes and Diabetes Technology and Therapeutics found that taking bolus (or rapid-acting) insulin 20 minutes prior to a meal resulted in significantly better glucose control than when insulin was given immediately before a meal or 20 minutes after a meal. It may take a little bit of experimenting to find the exact amount of time before a meal that works best for taking your insulin, but timing bolus insulin correctly may greatly help you increase your blood glucose control. Be careful that while you take your mealtime insulin before you eat not to take insulin too long before eating as this can result in hypoglycemia (low blood sugar). Also, if your pre-meal blood sugar test is low, you should not give insulin before beginning your meal as you may experience a dangerously low blood sugar. Fine tune basal (or long-action) insulin. Where bolus insulin is meant to counteract blood glucose rises from meals, basal insulin kee Continue reading >>

How Will Insulin Help Lower A1c?

How Will Insulin Help Lower A1c?

Q: My doctor wants to put me on insulin. I have type 2 diabetes; my A1C was 8.2. I don't want to take shots. How will insulin help? A: An A1C of 8-9 percent equates to an average estimated glucose level of 183-212 mg/dl. Long-term glucose levels in this range drastically increase the odds of developing a complication such as kidney failure, vision loss, or damage to blood vessels or nerves that can lead to heart disease, stroke, and neuropathy. As type 2 diabetes progresses, the pancreas makes less and less insulin. Many oral medications can help control your glucose levels early on. But once insulin production declines to a certain point, insulin is necessary. Today's insulin needles are super thin. You may find injections hurt less than blood glucose testing: The place you inject (abdomen, preferably) has far fewer nerve endings than the fingertip. Keep an open mind about insulin as your diabetes therapy. Set up a one-on-one session with a diabetes educator who can coach you through that first injection and teach you how to best time your doses. Virginia Zamudio Lange is an R.N., M.S.N, and CDE. Continue reading >>

5 Simple Ways To Lower Your A1c This Week

5 Simple Ways To Lower Your A1c This Week

The A1C blood test is a simple test that analyzes your glucose (blood sugar) levels by measuring the amount of glycated hemoglobin in your blood. Hemoglobin is a protein in your red blood cells; when glucose enters the blood, it attaches to the hemoglobin. The result is glycated hemoglobin. The more glucose in your blood, the higher your glycated hemoglobin. The A1C is a valuable indicator of how well your diabetes management plan is working. While your individual A1C goal will depend on factors including your age and your personal medical profile, most people with diabetes aim to keep their A1C below 7 percent. By keeping your A1C number within your target range, you can reduce the risk of diabetes complications. While it is important to develop a long-term diabetes management plan with your physician, there are several steps you can take right away to help reduce your A1C. Small changes add up, so consider trying some of these strategies to lower your A1C this week. 1. Try Short Sessions of High Intensity Exercise According to research presented at the American Heart Association's Scientific Sessions 2015, type 2 diabetes patients who did 10 minutes of exercise three times a day, five days a week at 85 percent of their target heart rate had a twofold improvement in A1C levels compared to patients who exercised for 30 minutes a day at 65 percent of their target heart rate. Be sure to check with your doctor before trying high intensity exercise, and wear a heart rate monitor so you don’t overdo it. 2. Shrink Your Dinner Plate Instead of a large dinner plate for your meals, use a smaller salad plate. This simple swap can trick your eyes and brain into thinking you’re eating more than you really are, and you’ll feel satisfied with less food. It’s especially helpfu Continue reading >>

Questions And Answers - Medication And Insulin

Questions And Answers - Medication And Insulin

Questions and Answers - medication and insulin Q:I have type 2 diabetes and have been on insulin for a year now. I have lost some weight and my A1C has dropped from 9.5 to 6.5 but I am having a lot of lows ranging from upper 40's to 60's. I am wondering if maybe I might be able to get off insulin. I feel that my oral med is starting to work better now that my beta cells have had a rest. Can that be true? A:Yes, your cells are also in a better position to uptake glucose from the bloodstream now that you have decreased body fat. You should see your physician ASAP to get this adjusted. 40's are a dangerous range to be in. He/she may start weaning you off insulin, watching your levels along the way. Q:How much is blood sugar decreased for every unit of novolog insulin? A:A starting point is to consider that one unit of insulin will lower the glucose 50 points. This can vary from 30-100 points, depending on one's insulin sensitivity, exercise habits, food choices or other variables. Time will tell for you as you test and track your numbers to see if a pattern evolves. Q:What medication is used to replace metformin when liver enzymes are high and the endocrinologist discontinues this medication? A:Much will depend on the advancement of your diabetes and other medications you might be taking. Your physician might choose a meglitinide such as Prandin or an alpha-clucosidase inhibitor such as Precose. Insulin would be another choice. There are other meds and newer ones always in the mill. Some physicians keep their patients on Metformin if the enzyme levels are not too high. If your numbers are not too high and you are otherwise healthy, focus on lifestyle management. Losing body fat, if needed, can help to get things under control. Q:My bottle of insulin will expire next month Continue reading >>

How To Lower Your A1c: The Complete Guide

How To Lower Your A1c: The Complete Guide

How to Lower Your A1c: The Complete Guide We are always told that having a low A1c is an important goal in our diabetes management, but do you actually know why? Do you know what a good A1c target is, how to lower your A1c, and how quickly you can lower your A1c safely? These are the questions I will answer in this comprehensive guide on what A1c is, how to lower your A1c, and why achieving a low A1c isnt the only (or necessarily the best) goal when it comes to diabetes management. 8. My perspective on A1c as a person living with diabetes A1c, hemoglobinA1c, HbA1c or glycohemoglobin test (all different names for the same thing) is a blood test that measures your average blood sugar over the last 2-3 months. Its not an even average, but an average where your blood sugars over the last few weeks count a little more than your blood sugars 2-3 months ago. According to the National Institute of Diabetes & Digestive & Kidney Diseases ( 1 ): The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1c test reflects the average of a persons blood glucose levels over the past 3 months. The A1c test result is reported as a percentage. The higher the percentage, the higher a persons blood glucose levels have been. A normal A1c level is below 5.7 percent. Its important to note here that the term normal A1c level in this context refers to people without diabetes. I will get back to what a normal A1c level is for people living with diabetes below. Your doctor or endocrinologist should test your A1c regularly (typically every 3-6 months). The doctor simply pricks your finger (or ear if you prefer that) and ta Continue reading >>

5 Ways To Lower Your A1c

5 Ways To Lower Your A1c

For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>

Blood Sugar And Exercise

Blood Sugar And Exercise

If your deductible reset on January 1, there are new programs to help you afford your insulin prescription| Learn more There are a few ways that exercise lowersblood sugar: Insulin sensitivity is increased, so your muscle cells are better able to use any availableinsulinto take upglucoseduring and after activity. When your muscles contract during activity, your cells are able to take up glucose and use it for energy whether insulin is available or not. This is how exercise can help lower blood sugarin the short term. And when you are active on a regular basis, it can also lower yourA1C. Understanding Your Blood Sugar and Exercise The effect physical activity has on your blood sugar will vary depending on how long you are active and many other factors. Physical activity can lower your blood sugar up to 24 hours or more after your workout by making your body more sensitive to insulin. Become familiar with how your blood sugar responds to exercise. Checking your blood sugar level more often before and after exercise can help you see the benefits of activity. You also can use the results of your blood sugar checks to see how your body reacts to different activities. Understanding these patterns can help you prevent your blood sugar from going too high or too low. People taking insulin or insulin secretagogues (oral diabetes pills that cause your pancreas to make more insulin) are at risk for hypoglycemia if insulin dose or carbohydrate intake is not adjusted with exercise. Checking your blood sugar before doing any physical activity is important to prevent hypoglycemia (low blood sugar). Talk to your diabetes care team (doctor, nurse, dietitian or pharmacist) to find out if you are at risk for hypoglycemia. If you experience hypoglycemia during or after exercise, treat it Continue reading >>

7 Ways To Lower Your A1c Level, Even If You Don't Have Diabetes

7 Ways To Lower Your A1c Level, Even If You Don't Have Diabetes

You've probably had your blood glucose level checked — a quick prick of the finger and a drop of blood reveals how much sugar is in your bloodstream. This is a helpful tool for diagnosing and managing diabetes, but it only shows your blood glucose level at that moment. Unless you've fasted and timed the test correctly, it's not an accurate way to know how your body processes sugar all the time. Your A1C level is your average blood glucose level over the past three months. Knowing this number helps your doctor find and treat diabetes (and prediabetes) before you experience serious complications. Why Your A1C Level Matters Diabetes is the seventh leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. Most cases of type 2 diabetes can be managed with diet, exercise, and medication, but uncontrolled blood glucose levels increase the risk for heart disease, stroke, eye problems, foot and leg amputations, and kidney failure. Approximately 30.3 million Americans have diabetes — that's about 9 percent of the U.S. population. Of those living with diabetes, 7.2 million are undiagnosed. Another 84.1 million American adults have prediabetes, meaning they're at risk of developing diabetes without medical intervention and lifestyle changes. Regular A1C testing would help your doctor catch the disease early, often while it's preventable. If you've already been diagnosed with diabetes, your A1C tells your doctor whether the current treatment plan is working. What the Numbers Mean The A1C test measures how much glucose is attached to the hemoglobin in your blood. The results are reported as percentages. To diagnose diabetes with an A1C test, physicians use the following scale: Normal: below 5 percent Prediabetes: 5.7 to 6.4 percent Diabetes: Continue reading >>

6 Ways To Lower Your A1c Level

6 Ways To Lower Your A1c Level

Diabetes is a serious, chronic disease that can lead to many complications. When managed properly, diabetes does not have to control your life or ruin your health. Getting tested, especially if you are at risk for developing type 2 diabetes, is a proactive measure you can take for yourself and your future. In the early stages of diabetes, there are no symptoms. An early diagnosis helps you get treatment before complications occur. The A1C test is a blood test that checks for type 2 diabetes. It is also used to see how well you are managing your diabetes if you have already been diagnosed. The test provides information about a person’s average levels of blood sugar over a two- to three-month period. The number is reported in the form of a percentage. The higher the percentage, the higher your average blood glucose levels are, and the higher your risk for either diabetes or related complications. A1C is one of the primary tests used for diabetes diagnosis and management. It can test for type 1 and type 2 diabetes, but it can’t test for gestational diabetes. It can also be used to predict the likelihood that someone will get diabetes. The A1C test measures how much glucose, or sugar, is attached to hemoglobin, the protein in red blood cells. The more glucose attached, the higher the A1C. This test is groundbreaking, as it 1) doesn’t require fasting, 2) gives a picture of blood sugar levels over a period of days and weeks instead of at just one point in time like fasting sugars, and 3) can be done at any time of day. This makes it easier to administer and easier to make accurate diagnoses. According to the National Institutes of Health, a normal A1C is below 5.7 percent. If your score is between 5.7 and 6.4 percent, the diagnosis is prediabetes. Having prediabetes put Continue reading >>

Rethinking A1c Goals For Type 2 Diabetes

Rethinking A1c Goals For Type 2 Diabetes

Treat the patient, not the number. This is a very old and sound medical school teaching. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health. Uncontrolled type 2 diabetes (also known as adult-onset diabetes) is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients. One easy, accurate way for us to measure a persons blood sugar over time is the hemoglobin A1c (HbA1c) level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months. Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people (not necessarily including the elderly or very ill), with a lower goal closer to normal, or under 6.5% for younger people. We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didnt meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still werent at goal, then it was time to start insulin injections. While all this sounds very orderly and clinically rational, in practice it hasnt worked very well. I have seen firsthand how enthusiastic attention to the A1c can be help Continue reading >>

How To Lower Your A1c Levels: More Steps You Can Take

How To Lower Your A1c Levels: More Steps You Can Take

You may be familiar with the “ABCs” of diabetes: A1C, blood pressure, and cholesterol. This acronym is part of a larger diabetes campaign called “Know Your Numbers,” and hopefully you’re aware of all of your numbers — what they are, what they should be, and how often to get them checked. Obviously, knowing your A1C and knowing what you can do if it’s not at goal is a big part of diabetes management. The focus last week and this week has been on all things A1C: what it is, what the general goal is, why it matters, and ways to get it to where it needs to be. What else does it take to lower your A1C? Figuring out how to lower your A1C to whatever your personal goal is can sometimes seem like solving a puzzle. You try something and it may or may not help, or it helps but not enough. Then you try something else. Yes, it can be frustrating, but eventually you’ll hit on a strategy that works for you. Last week, we looked at how a healthy eating plan (including keeping carbs consistent and sticking to an eating schedule) and a physical activity program can help. Research shows that an eating plan can lower A1C levels by 1–2%; physical activity can lower A1C by 0.6–1%, according to various studies. But what if these two strategies aren’t enough? Then what? Time for medication? Diabetes medicines generally lower A1C levels anywhere from 0.5% to as much as 3.5%. The A1C-lowering effect of medicines can vary from person to person, however, and the effect is often dependent upon how high the A1C is to begin with. Insulin. We know that people who have Type 1 diabetes must take insulin. Insulin can be delivered using a syringe or an insulin pen; it can also be administered using an insulin pump. How you decide to take your insulin is a decision best made with you Continue reading >>

Elevated A1c? Don't Automatically Raise Insulin; Consider Lowering Insulin

Elevated A1c? Don't Automatically Raise Insulin; Consider Lowering Insulin

This Disaster Averted is not just about one patient but about many who take insulin. Most think high A1C means one needs to increase insulin. Not always! Remember, A1C is an average. Just because someone has an A1C of <7% doesnt actually mean glucose is managed. Patient after patient whom I see who has an elevated A1C often has frequent low glucose levels. How do I know? Not usually by fingersticks; one misses so much information by just using fingersticks. I have learned by CGM. Often I will see hypoglycemia followed by hyperglycemia. Often this is due to higher basal insulin than is actually needed. Sometimes it is because the insulin to carb ratio or the correction is not accurate. Main learning: Just because A1C is elevated does not mean you need to increase the insulin. It could mean lower insulin, but make sure you have the information first. AIC is an average. It does not give the whole picture, neither do fingersticks. Fingersticks are a picture, CGM is the film. If a patients A1C is elevated, do not automatically treat with more insulin. Get more information before changing treatment. Whether it be food, activity, meds or the many factors that can influence glucose levels, get more information, including the use of CGM to see the whole picture. Review with patient and together make decisions on how best to treat the patients glucose levels. If you have a Diabetes Disaster Averted story, please let us know! If we feature your Disaster Averted in our Diabetes Clinical Mastery Series e-newsletter, you will receive a $25 gift card. Please click here to submit a short summary of the incident, what you feel you learned from handling the incident, and your name and title. If you prefer to remain anonymous, please let us know, but still give us your name and address ( Continue reading >>

Relationship Of Insulin Dose, A1c Lowering, And Weight In Type 2 Diabetes: Comparing Insulin Glargine And Insulin Detemir

Relationship Of Insulin Dose, A1c Lowering, And Weight In Type 2 Diabetes: Comparing Insulin Glargine And Insulin Detemir

Go to: Abstract A pooled analysis of randomized controlled trials of individuals with type 2 diabetes mellitus (T2DM) was conducted to compare dosing and impact of two basal insulin analogs, insulin glargine (glargine) and insulin detemir (detemir), on weight and hemoglobin A1c (A1c). Twenty-two studies of at least 20 weeks in duration in individuals with T2DM initiating glargine/detemir were included. Results were combined using a weighted-average method and a bivariate random effect model. Outcomes included changes in weight, A1c, and insulin dose from study start to end. Results One study was head-to-head comparison of glargine and detemir. Detemir (four studies) was administered once or twice daily, with 50% starting on detemir once daily but needing therapy intensification. Glargine was used once daily in all 22 studies. The Egger test was borderline significant for change in weight over the course of the treatment for glargine (0.29; 90% confidence interval [CI] −0.01, 0.58), and heterogeneity was not observed for detemir (−0.18; 90% CI −0.59, 0.23). Heterogeneity was observed for change in A1c over the course of the treatment (glargine, −1.19, 90% CI −1.74, −0.63; detemir, −2.65, 90% CI −4.86, −0.45). Nonheterogeneity for change in A1c over the course of the treatment was achieved by excluding five studies for glargine and one study for detemir; however, all studies were included in subsequent analyses. In the unadjusted model, glargine and detemir showed similar results for mean A1c change (−1.4% vs. −1.4%), weight gain (2.5 vs. 1.7 kg), and weight/A1c (1.8 vs. 1.2 kg/%). A significantly higher detemir dose was needed to achieve the same A1c change (51.5 vs. 38.8 U/day). Although absolute weight gain was higher with glargine versus detemir, Continue reading >>

Your A1c Goal And Switching Insulin Treatments

Your A1c Goal And Switching Insulin Treatments

No matter how long you’ve been following a prescribed insulin treatment plan, circumstances beyond your control may ultimately require a change in your insulin. This can happen for a number of reasons, including hormone changes, aging, disease progression, changes in diet and exercise habits, weight fluctuations, and changes in your metabolism. While it may seem like a daunting task, the transition is probably easier than you think. Your A1C Goal The A1C test, also called a hemoglobin A1c test (HbA1c), is a common blood test used to gauge your average blood sugar level over the past two to three months. Specifically, the test measures the amount of sugar attached to the protein hemoglobin in your red blood cells. This test is used when you’re first diagnosed with diabetes to establish a baseline A1C level. It’s then repeated as you start learning to control your blood sugar. People without diabetes usually have an A1C level of between 4.5 to 5.6 percent. For diagnosing purposes, A1C levels of 5.7 to 6.4 percent on two separate occasions signify prediabetes. A1C levels of 6.5 percent or higher on two separate tests indicate that you have diabetes. Talk to your healthcare provider about the appropriate A1C level for you. People who have previously-diagnosed diabetes are usually encouraged by their endocrinologist to aim for personalized A1C levels below 7 percent. How often you need an A1C test depends on a number of factors, including prescribed changes to your insulin treatment and how well you’re keeping your blood sugar level within your target range. During changes in treatment plans and when your A1C values are high, it’s recommended to have an A1C test every three months. When your levels are stable and at the target you’ve set with your doctor, testing Continue reading >>

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