How to lower your HbA1c
Tips, tricks and lessons on balancing your blood sugar levels
No-one is perfect, but it's time to strive for perfection
We’ve developed some tried and tested ways to get your blood sugars down and to also minimise the risk of hypoglycemia and hyperglycemia.
We now know that the longer we can sustain a good blood glucose level in the target range, the more likely we will reduce the chances of getting any diabetic complications. It’s simply a case of risk management.
So what can we be doing on a day-to-day basis that can help us achieve perfect blood sugars?
Ditch High Carb Foods
Don't ask why healthy food is so expensive. Ask why junk food is so cheap.
This is not a popular choice, but to increase our chances of better health outcomes, we must make better nutritional choices. Your body cannot cope with high levels of carbohydrates and if it wasn't for synthetic insulin, carbs would simply increase the probability and speed up the onset of blindness, kidney failure and a host of other complications.
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Examples of foods that are highly processed and refined carbohydrates are:
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Bread
Pasta
Fast food (pizza, burgers etc)
Fruit
Oats
Grains
Starchy vegetables (Potatoes, Corn)
Cereal
It is a good idea to remove or minimise the above foods as much as possible. They will all require you to inject much larger amounts of insulin to cover the blood sugar spike when eating them. None of the foods mentioned are essential to a healthy diet and are often accompanied by ingredients that are good for you but when combined with the carbohydrate it becomes dangerous for a diabetic.
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It is a great idea to start swapping high carb foods for low-carb alternatives. After no time at all, you’ll be used to these choices and your blood sugars will thank you for it. Here are some alternatives (Australian brands):
Aldi 85% low-carb bread
Zucchini noodles instead of pasta
Lettuce cups instead of burger buns/cauliflower base pizza
Small amounts of berries (Strawberries, blueberries, etc)
Peter’s no sugar Ice cream
Well Naturally sugar-free chocolate
Quest protein bars and cookies
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You will see a huge change in your insulin requirements and in your blood glucose levels almost overnight. You will need to modify your basal and bolus insulin when you remove carb-heavy foods, so make sure you have spoken to your diabetes medical team to get the tools first.
If you want to know more about carbohydrates and the effect on the body of a type 1 diabetic, please head over to our diet page HERE.
Exercise
Exercise is a celebration of what your body can do. Not a punishment of what you ate.
Not all of us enjoy exercising. Many of us will go through our entire lives never setting foot in a gym, but no-one can deny the positive impact it has on our health.
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When you exercise, it makes your body more sensitive to insulin, so you don’t need as much to cover your food intake. You will also notice that your blood sugars will remain more stable for longer over the day and often into the following day.
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We’re not talking about training for a marathon or setting off up Mt Everest; it’s about getting out and doing something active. That could be walking, running, weights, hiking, swimming or cycling, Even shopping or cleaning the house may drop your blood glucose levels if you do it for long enough.
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Key things to remember;
Slow and steady exercise over a longer time period will drop your levels. (i.e. hiking, slow jog for 1 hour)
Intense and short term exercise will increase your blood sugars initially and drop them after exercise. (i.e. heavy weights or high-intensity interval training (HIIT)
Both types of exercise will result in more stable blood sugars over the day and will often result in lower sugars into the next day.
The more often you exercise, the less insulin you will need (basal and bolus)
Combining exercise with a low-carb diet will result in fewer hypos and hypers because you will require less insulin and your blood glucose levels will stabilise.
Making exercise part of your daily routine will result in lower and more stable blood sugars. It will also benefit other aspects of your overall health, including cholesterol, cardiovascular system, stress, and weight management.
You will not increase your chances of diabetic ketoacidosis (DKA) if you follow an exercise plan and a low carb diet. DKA only occurs if you do not have enough insulin in your body. Make sure you are disciplined with your insulin regimen and you’ll be fine.
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Healthy is happy, happy is healthy
The trick to starting and maintaining a consistent exercise routine is to try different activities and keep doing what you enjoy. Many people hate the gym and join with all the best intentions but within a few weeks, they’ve stopped.
If you can’t think of anything you enjoy, keep trying new things. You must get out there because we’re not designed to sit in front of the TV for hours on end. Diabetes or not, a sedentary lifestyle knocks years off our lives.
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Without our health, we have nothing. 
Many people don’t place their health at the top of their list of priorities, and we can’t blame them for this. But we have the benefit of going through a life changing event which gives us a greater understanding and perspective of what life is like when you also have to manage a chronic illness.
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When we implement a routine of exercise, a healthy diet, regular social interaction, and practice mindfulness, we are increasing our quality of life to such a degree, it’s likely we’ll be more healthy than many non-diabetics. When you know that you cannot be doing more for your body and mind, it will have a profound effect on your happiness.
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Goals, Goals, Goals
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Set yourself small achievable goals constantly. It will mean you’re moving forward and lay a foundation of positive results. If you love to run, sign up to charity fun runs and combine time goals with raising money.
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If the gym is your thing, see how strong or muscular you can get or join 8 or 12 week challenges created to test strength and endurance.
Hill walking is a fantastic activity as it combines enjoying beautiful scenery with a longer exposure to exercise. Being in a natural setting has a lot of beneficial effects on our mental and physical health.
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By setting small exercise goals, we’re making big steps to a longer, happier and healthier life. The rewards far outweigh any short term fixes like staying in bed an extra hour or having a pizza on a Friday night. It is empowering to be in control and to know you’re helping yourself.
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The pain phase: Starting a new exercise plan is tough. The first few weeks will likely hurt as your body becomes used to using and building muscle (anaerobic and aerobic training). You will likely get DOMS (delayed onset muscle soreness). This is a good thing and it’s very important that you embrace this new you. Soon, you will start to enjoy exercise as your body releases happy hormones like serotonin during and after working out. Your body shape will change and your confidence levels will sky-rocket.
Sleep
Don’t give up on your dreams. Keep sleeping.
Getting enough sleep is so important it may outweigh almost all other positive lifestyle changes. When you sleep, your body repairs itself; not just physically but mentally as well. Your brain flushes out harmful toxins that build up during the day and also helps memories form.
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Pick up any number of business management books, entrepreneur guides, or ‘how to be a millionaire’ manifestos and you will have a chapter on sleep. We now know that it is vital for humans to get enough sleep to help us get through the day as effectively as possible. So how much is enough?
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You may hear 8 hours touted around the media and this is pretty much our best guess. Some people need less, some more. Women apparently need a little more than men. To be honest, there’s no point reading it then following that number. It’s best to just go with how you feel when you wake up. Try and be as kind to yourself as possible by not staring at screens till the moment you close your eyes. Maybe have a bath before bed to relax and read a book. It will always benefit you to avoid stimulus before bed and also caffeine and alcohol.
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The Alcohol Myth
When you drink alcohol, it can certainly help to relax us. It may also help you to fall asleep faster, But it will not help you sleep better. You will wake up earlier; you may have to wake up in the middle of the night to run to the bathroom; you will not have a deep sleep that importantly, requires rapid eye movement (REM). You may also wake up with a hangover and we all know how that plays out. As a diabetic, we need consistency and routine to function at our best and create an environment where our bodies can run as efficiently as possible. To do this, we need rest and recuperation.
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What happens when we don’t get enough sleep
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When we do not get enough rest, our bodies immune system is impacted. We become more susceptible to picking up any number of viruses, and as we are all aware, being sick is a nightmare for our blood sugars.
If you continually go without enough sleep, your body becomes seriously compromised. It can even make you prone to serious medical conditions such as obesity, heart disease, and high blood pressure. As we are already at an increased risk of these conditions, don’t push your luck by not getting enough sleep.
Routine
The secret of your future is hidden in your daily routine
Human beings thrive on routine. Our minds and bodies cope well when we know exactly what’s around the corner. It also helps to minimise stress when we are confident we know how our day is going to go.
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As a diabetic, when we have routine, we have consistency, and with consistency, our body is able to predict patterns of behavior. This is very beneficial for our overall health but also our blood sugars.
"I have found that exercise is fantastic to control my blood sugars, but I don’t see the full benefits until the 3rd or 4th day in a row. Only then do I notice a reduction in insulin requirements; an increase in insulin sensitivity; the ability for my body to process food better; an increase in energy; my sleep improves; my mood improves."
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Without a routine, you will not see the full benefits of living a healthy and active life, and it will go a long way to help you see a consistent low blood sugar.
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Barriers to a Positive Routine.
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Avoiding certain ‘lifestyle’ habits can make a big impact in creating a routine that will set you up for success. Here are a few things to try and stay away from:
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Weekend fast food: Yes, we keep coming back to it, but having that fried chicken or pizza will set you back and reinforce negative habits that will only send your blood sugars on a rollercoaster. Stable life = stable blood sugar.
Stress: We go into this next, but by evaluating your life for stress markers, you can remove things or people that will only put your blood sugar up, as well as your blood pressure.
Work: It’s important to take pride in your work and continue to be ambitious, but not at the expense of your health. Professional success will not come if you’re ill or incapable of working to your potential. Tell your managers and colleagues of your condition and how you manage it. If they cannot help you, look at other companies and roles. Keep your options open to new careers that minimise stress, inflexible working hours, toxic colleagues, etc. Shift work, in particular, makes it very difficult to have an effective routine. See if you can change this to suit your new life with diabetes, not the other way around.
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There are, of course, many other things that are specific to you and your life but this should hopefully get you thinking about what’s good for you and your condition.
Encompassing a routine that involves daily exercise, healthy eating, socialising, rest and fun will make huge in-roads to keeping your blood sugars and your overall health balanced and on track.
Stress
Stress is wanting something to be the way it isn’t.
We cannot overemphasise the importance of minimising and avoiding stress. It will only ever add further complications to your life. However, it’s not easy to identify stressors and find ways to remove them. Start by evaluating the big things in your life and then breaking them down further.
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Work
Friends
Family
Money
Health
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Firstly, stress can’t always be avoided. If a loved one becomes ill or you lose your job then it is simply inevitable that you’ll become stressed. However, how you deal with that stress will determine how your body (and your blood sugars) cope with it. At these times, it’s vital you maintain your own routine – if this breaks it increases the chances of you breaking.
The first principle of stress must be ‘if you cannot control it, don’t let it control you’. Learn to let things go if they’re out of your hands.
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Work
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Company
Management
Colleagues
Culture
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Do the above points match your needs, morals, and ethics? nothing is perfect, but if you allow negativity, toxic people, unscrupulous work practices, inflexible hours or toxic people to dictate your time at work then this will only increase your stress and make your life harder than it already is managing a chronic disease.
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Sit down with your managers and discuss how to create an environment whereby both parties are getting what they need. Don’t be demanding; they still hired you to do a job, but you must expect them to be flexible for you and if they aren’t or are unwilling to try, then find a way to negotiate or move on.
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Friends
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Other than you, your friends are the most important aspect of your life in helping you deal with your disease. Ensure they all are fully aware of what life with diabetes entails, how you must manage it, the importance of routine, exercise, diet, etc. If you find that some friends aren’t helping you be the healthiest you, then don’t be shy about it and bring it up. If they continue to be a barrier then distance yourself.
Friends are only friends if they allow you to be who you are and encourage and empower you to be who you want to be.
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Family
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Much like friends; family is the crux of your existence. They have been there since the beginning and will be there at the end, so cherish every moment with them. But also like friends, they must be educated on your disease. They must understand how it makes you feel, how you manage it, and how they can help and support you.
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If the family doesn’t know, they can’t help. If they do know and they still don’t help, then let them know how it’s affecting you. After that, there’s not a great deal you can do, so live your life. Open your doors to friends that understand and are willing to support you. It isn’t easy but sometimes friends and family are interchangeable.
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Money
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Money doesn’t buy you happiness. It will help though
If money troubles are adding stress to your life, then your work must be re-evaluated. Income can be generated these days from multiple sources, and finding these is important. If your job doesn’t cover the bills, either make sure you have fewer bills or get a new job. E-commerce is also a very exciting way of generating additional income and you don’t need thousands in capital. Starting a website and selling products is cheap and could add up quickly. Even if it covers a few bills or pays for your diabetes medication, then it’s worth it.
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Talk to your bank and accountant who can help with your finances. You need help to understand these aspects of your life, but once you do, it will empower you to make better-informed decisions with your money and where it needs to go.
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Do not borrow. Do not put money into investments you don’t understand. Do not spend money you don’t have and set yourself a budget. It’s not fun or exciting but it will go a long way to helping you become more financially secure.
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Having diabetes isn’t cheap. You’ll need to learn about private health insurance (PHI) as this can be a huge monthly expenditure. Remember, many PHI’s now offer insulin pumps on a basic hospital cover. You also don’t need extras, so if you don’t use them, don’t spend more than you need to. You’ll still have hospital cover but won’t pay the health cover loading 2% in Australia.
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Budget for a CGM or flash monitor. They’re not cheap at roughly $100 per fortnight in Australia, but the impact it has on your ability to see trends and effects on your blood sugars is invaluable.
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Health
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It’s important to mention health as a stressor as you already have health worries. Try and not add to them by living an unhealthy life. When you have your routine of diet, exercise, socialising and fun, you can concentrate on adding to these things. When you have health worries on top of your diabetes then the positives will decrease as you concentrate on resolving the negatives.
Feeling healthy is liberating and empowering. It’s addictive as well. Your body releases endorphins and serotonin when you exercise and have fun. So make sure you pursue activities that you enjoy and people that make you happy. This will benefit your physical and mental health.
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You cannot guarantee perfect health. The most diligent and health conscious people still get sick, but that is not the reason to throw caution to the wind. Life (like diabetes) is about risk management, and it is irresponsible excuses or logical fallacies (e.g. my father smoked all his life and never even caught a cold) to justify living poorly. Make no mistakes, it will catch up to you if health isn’t a priority.
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You have an increased risk of many other health conditions. Live well and don’t push your luck. This will only add further stress to your life.
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Illness
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Everyone will become ill at some stage. All diabetics must have a concrete sick day plan and ensure you stick to it if you get ill. A sick day plan looks something like this;
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Rest as much as possible.
Increase your basal insulin by 20% and assess its impacts over 24 hours. If this isn’t enough increase by a further 10% and reassess.
Increase basal insulin by 10% and assess. If this isn’t enough increase by a further 10%.
Drink plenty of fluids. A minimum of 100ml every hour.
Ketones may be present when ill. If over 1.5 - check them every 2 hours and continue to drink plenty of fluids. If blood sugars are over 13mmol and ketones are over 1.5 contact your medical support team.
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As you can see; a sick day plan is integral to minimising stress caused by elevated blood sugars and ketones. Knowing how to manage this will save you from further stress or even a visit to the hospital.
Education
There are no secrets to success. It is the result of preparation, hard work and learning from failure.
First things first, leave Google alone and sit down with your medical team. They certainly know the basics of managing diabetes. Particularly, if your endocrinologist or diabetes educator has diabetes themselves.
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You will need to know where to go for help; how to access advice on your insulin regimen; sick day management; using and trialing diabetes technology; setting up regular check-ups for your HbA1c and how frequently you need to check your eyes, feet, and teeth. Perhaps, the first thing you will discover though is that the medical professionals charged with educating you on your disease are often inconsistent or even wrong in their advice (dietary advice in particular).
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There is no short and easy way to find out why this is; It is convoluted and incongruous. Therefore, it’s up to you to learn about diabetes and to not stop. The more you know about this disease, the better the health outcomes.
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When you know better, you do better.
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State-owned and run diabetes websites.
Their info and guidance is updated regularly and will provide a fundamental understanding of the basics of diabetes. The sites are;
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Diabetes UK, in particular, is very forward thinking and is already publishing a lot of research on the benefits of a low carb diet for diabetics.
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Privately owned or not-for-profit diabetes websites.
You’ll need to be careful navigating these potential minefields as the info can be dangerous if you were to follow it blindly. If it doesn’t sound right, consult your medical team or do more research. By and large, the info is sound and is written by diabetics themselves so use it to increase your general understanding.
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Social media.
Join groups on facebook dedicated to living with diabetes. There is a wealth of support and good advice via this platform, but bear in mind there is also a lot of less sound advice as well. As with all social media, it’s important to remember not all people are supporting and empathetic, and certainly don’t expect a friendly person to help you all the time. In general, though, they are a fantastic resource. Also, there are more specific groups dedicated to following a low carb or keto diet, as well as parents of diabetics and charity or foundation run groups like the JDRF.
