One of our diabetic patients (female; 65 years of age) were able to lower her HbA1c levels to the lowest it has been in eight years within 6-weeks after starting with us.
The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. To put it in simple terms HbA1c is sugar-coated haemoglobin; think of a toffee apple (the apple being the haemoglobin and the syrup-coating being glucose).
Glycated haemoglobin (HbA1c) provide an overall picture of what your average blood glucose levels have been over a period of weeks/months.
It is important because the higher the HbA1c, the greater your risk of developing diabetes-related complications.
When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time.
Red blood cells in the human body survive for 8-12 weeks before renewal. Measuring glycated haemoglobin (or HbA1c) can consequently, be used to determine average blood glucose levels over the last 12-weeks thereby, providing a useful gauge for clinicians of the patient's ability/successfulness to manage/control his/her blood glucose.
Two large-scale studies - the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) - demonstrated that improving HbA1c by 1% (or 11 mmol/mol) for people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) cuts the risk of microvascular complications by 25%.
Microvascular complications include:
· Diabetic nephropathy (kidney disease)
Research has also shown that people with type 2 diabetes who reduce their HbA1c level by 1% are:
· 19% less likely to suffer cataracts
· 16% less likely to suffer heart failure
· 43% less likely to suffer amputation or death due to peripheral vascular disease
How do you lower your HbA1c levels?
The answer is by shifting your focus from controlling your glucose with insulin to controlling your insulin levels with diet and exercise. Don’t think glucose control think insulin control.
It is is a crucially important concept for diabetics and people who want to lose weight to understand.
The body release insulin to lower glucose. T1DM’s don’t produce enough insulin while T2DM’s are resistant against insulin. What most people don’t seem to realise is that it is the insulin that drives the insulin resistance. The practical significance of this (for both T1DM and T2DM) is that the more insulin you use, the more resistant you become against insulin.
Type 1 diabetics that don’t control their glucose intake will require more and more insulin over time because the more insulin they inject, the more they become resistant against it. It is a vicious cycle; the more insulin you inject, the more insulin you are going to need over time.
Every time you eat your glucose spike. High glycaemic, sugary or starchy foods will create higher spikes requiring more insulin. The slower the body to lower the spike due to insulin resistance or not enough insulin the longer glucose will stay elevated. The longer your blood glucose stays elevated, the more haemoglobin becomes sugar-coated and the higher your HbA1c.
Again, the key concept to understand is that your focus should not be on controlling your glucose with insulin. Rather focus on reducing your insulin needs by managing the type and amount of food you put in your mouth.
Another way to control or lower your insulin needs is to exercise. There are three primary things to consider if you want to maximise exercise effect on diabetes and HbA1c, namely:
1. Exercise intensity
The intensity at which you pitch your exercise has been shown to be important to maximise training effect on glucose control. High-intensity interval training (HIIT) or sprint interval training is a strategy that is intended to improve performance with short training sessions. A HIIT session involves a warm-up period, several short, maximum-intensity efforts separated by moderate recovery intervals, and a cool-down period. All studies that have assessed insulin response to HIIT recorded significant improvements of between a 23 and a 58% increase in insulin sensitivity. Insulin sensitivity has typically been assessed by measuring fasting insulin and by glucose tolerance tests.
In healthy, nondiabetic individuals, the improvement in fasting insulin and insulin resistance after HIIT ranges from 23 to 33%, whereas in individuals with T2DM, two studies have reported greater insulin sensitivity improvements of 46% and 58%.
It is potentially dangerous for unfit individuals to start-off with HITT training. It is best to seek professional advice and help with your exercise programme if you have not done any high-intensity or physically challenging exercises for longer than 5-years.
There are ways to optimise exercise intensity to maximise the effect on glucose even in those who are very unfit, but it is best to do it in a controlled/supervised environment.
2. Type of exercise
The type of exercise you use and the way you structure your exercise session has also been shown to be important if you want to maximise programme effect on glucose control.
3. Timing of exercise
A 20 to 30-minute brisk walk after a meal will lower you’re your glucose levels significantly and speed up the time it takes your body to normalise your glucose levels.