AskNadia: How Can I Get off My Medications When My A1c is 12?

Dear Nadia,

I’m a type 2 diabetic and have lost over 30 pounds in the last two years. I am on medication and insulin and would like to get off of them, but my A1c is at 12. I eat right and exercise (haven’t been for the last two months like I should) What am I doing wrong?

Thank you,

SK

Dear SK

Sometimes it is hard to ascertain what is not working. Your question is not as simple as it may seem. There are many components that need to be addressed. Let’s break your concerns down by your A1c, losing weight, medication, medication adherence, testing your blood sugar and exercise.

Your A1c

Your A1c is the first thing that needs to be addressed. You need to see your healthcare professional immediately to bring down your average blood sugar.

Blood cells form and die within in a 90-day period. The A1c test records the memory in the blood, giving an average reading that correlates with the percentage.

The recommended A1c is 5.7 to 7. An A1c of 12 means your average blood sugar is 298 mg/dl.

“The American Diabetes Association classifies blood sugar as high when glucose levels are above:

180 mg/dl one to two hours after you eat

130 mg/dl before you eat

100 mg/dl when fasting”

It is unrealistic to go from a 12 A1c to a 5.7 overnight. It requires supervision and a team effort.

Losing Weight and Ketones

If you’ve lost 30 lbs. over two years, still have excess weight despite your loss, that will have a direct effect on your numbers. But if you are losing weight because of high blood sugars, meaning that your body does not have enough insulin to balance your blood sugar for fuel, energy is drawn from your fat cells. When fat is used for energy, it gives your blood a high acid content also known as ketoacidosis; a diabetes complication.

If you have diabetic ketoacidosis you may experience stomach pain, feel tired, out of breath, unable to make decision, crave liquids and go to the bathroom frequently. The ketones may also make your breath smell like fruit.

I recommend buying ketone strips to make sure you do not have a high level of acid in your blood. People are hospitalized for ketoacidosis.

Medication

What medications are you on, and what type of insulin are you taking? Basal? Bolus? Both? Are you taking enough insulin to control your diabetes? If your A1c is 12, your numbers would suggest that you do not have enough insulin on board. What other medications are you taking and in what doses and frequencies?  With a 12 A1c, it’s very likely that despite your hope to stop taking diabetes drugs, you will have to continue taking them until your A1c results are lower.

Medication Adherence

Whatever medication dose you are on- if you are taking it as prescribed, then your healthcare professional will have a strategy on how to bring your blood sugar down. If you are inconsistent in taking your medication this will cloud your healthcare professional’s treatment. Their recommendations are made with the assumption that you are taking your medication as prescribed.

Testing Your Blood Sugar

How often do you measure your blood sugar levels? Do you measure your fasting, post-breakfast, lunch, post-lunch, dinner, post-dinner levels, before or after exercising? The pattern there will help you and your healthcare providers scope out your patterns and gain useful insights into your condition.

Exercise

People with type 2 diabetes generally respond quite favorably to increased exercise with a lowered blood glucose value. A simple activity, such as walking 20 minutes or more per day, can effectively improve glucose tolerance and induce weight loss. Proper exercise can be effective enough to lower or eliminate the need for medication. This will take time. Working with your healthcare professional with this goal in mind will help you set a new A1c goal while learning what is realistic for you.

What Are You Doing Wrong?

First and foremost- when your blood sugars are consistently high, you need to see your healthcare provider immediately. Never wait until your next appointment. Have ketone strips handy to ensure the acid level in your blood is not too high. If you cannot see your healthcare provide in person, call them on the phone to get advice. Have a log of when you took your medication and at what dose. Keep a food and exercise log. Have all this information for your healthcare professional handy so they can provide you with a new treatment that will bring your A1c down. Don’t forget to discuss the type of exercise you are doing, the intensity and duration.

Some people go into the hospital to bring down their blood sugars. I wrote an article last year about a man who went into the emergency room to bring down his blood sugar upon his healthcare provider’s recommendation. Since then- his A1c has dropped.

Learning to manage your diabetes is a trial and error process. No right or wrong. The question you want to ask yourself is which treatment and lifestyle change do I need to make to achieve my target A1c , am I committed? and how can I stay on tract when I feel discouraged?

To succeed I would recommend that you have a strategy in place by having a team of people to turn to. Don’t be a stranger with your healthcare provider, join a support group, ask your family and friends to encourage you to stay on track.

Most importantly be realistic and patient with yourself. Remember, forming new habits take time and practice.

I hope you found this helpful.

You may also be interested in reading another article about a high A1c and low blood sugar.

Sources:

Diabetic ketoacidosis

 Diabetes – tests and checkups

 Insulin, Medicines, & Other Diabetes Treatments

 Type 2 diabetes – self-care

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2017 by Healthline and with 23 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.

Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

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