Understanding the Numbers
Diabetes management involves monitoring and understanding so many different kinds of numbers. Glycoslated hemoglobin. Weight. Fasting blood sugar. Blood pressure. Insulin-to-carbohydrate ratios. Even the phone number to your local pharmacy. Keeping these numbers tracked and in check can be a challenge. It’s important to make sure you understand what all these numbers mean so that you can be an effective and involved caregiver.
What is A1c?
An A1c is a test that measures a person's average blood glucose level over the past 2 to 3 months. Also called hemoglobin A1C or glycosylated hemoglobin, the test shows the amount of glucose that sticks to the red blood cell, which is proportional to the amount of glucose in the blood.
The American Diabetes Association A1c goal is less than 7%. The American Association of Clinical Endocrinologists AACE goal is 6.5% or less. Work with your loved one and their medical team to find a goal that works best for their individual diabetes management plan.
Blood Sugar Testing
You know they’re testing their blood sugar, but what do all those numbers mean? While individual goals will vary, there are some general guidelines that are suggested by diabetes professionals.
The American Association of Clinical Endocrinologists (AACE) recommends the following general blood glucose testing goals for adults with type 1 and type 2 diabetes:
• Preprandial* (fasting, or before a meal) - <110 mg/dl (6.1 mmol/l)
• Two hours postprandial (after the start of a meal) - <140 mg/dl (7.8 mmol/l)
The American Diabetes Association (ADA) suggests slightly different targets:
• Preprandial* – 70-130 mg/dl (5.0-7.2 mmol/l)
• Postprandial* (1-2 hours) - <180 mg/dl (<10.0 mmol/l)
Many people with diabetes – up to 65% - also suffer from hypertension, or high blood pressure.
Normal blood pressure is defined as 120/80 mmHg for people without diabetes and <130/80 mmHg for those with diabetes and/or chronic kidney disease. Since high blood pressure is frequently a "silent" condition with few to no symptoms, it's important to make sure your loved one has their blood pressure taken every time they visit your diabetes care provider. You can also purchase a blood pressure cuff device to take home readings. Talk to the doctor about recommendations for equipment and testing.
Cholesterol, a soft, waxy substance found among the lipids (fats) in the bloodstream and in all cells, is another number value for people with diabetes to keep track of. Cholesterol comes in several forms, most notable of which are “good” and “bad” cholesterol.
The National Diabetes Education Program (NDEP) recommends that diabetes patients maintain cholesterol levels of:
• LDL (bad cholesterol) < 100 mg/dl (and <70 mg/dl for those considered “very high risk”)
• HDL (good cholesterol) > 40 mg/dl in men and >50 mg/dl in women
• Triglycerides < 150 mg/dl
If your loved one is dealing with high cholesterol, there are both lifestyle changes that can be made and drug choices that are available. Talk to your medical team to find out more.
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...