Why Is My A1C Rising?
I am a 36-year-old man diagnosed with type 2 diabetes two years ago. Until six months ago, my A1C was 5.4 percent, but now it's creeping back to 7. I am a vegetarian, teetotaler, and nonsmoker, and I take oral medication. My diet and lifestyle are unchanged. Why are my blood glucose levels going up? Would eating many small meals help my control? Vinod Bamalwa, Sarasota, Florida
Alison B. Evert, MS, RD, CDE, responds:
Studies show that the initial treatment of type 2 diabetes with a healthy eating pattern, regular physical activity, and metformin is often successful at achieving optimal blood glucose control. However, type 2 diabetes is a progressive disease. Over time, regardless of which therapies are used, the body's ability to produce insulin declines and more than one type of diabetes medicine may be required.
Control of blood glucose is a primary goal of diabetes management, and strategies to reduce blood glucose after meals are important to overall control. The carbohydrate consumed at meals or snacks is the major contributing factor to the rise in post-meal blood glucose levels.
In people without diabetes, the pancreas releases insulin following a meal or snack, keeping blood glucose in a narrow range. In people with type 2 diabetes, though, the inability to release enough insulin, use insulin properly, or both can cause blood glucose levels to become higher than normal. High blood glucose also results from the overproduction of glucose by the body as well as from the carbs consumed.
Nutrition education and counseling can help you determine how much carbohydrate you are eating. You may need to adjust your carb intake to reduce your post-meal blood glucose. If it is found that you are consuming appropriate amounts of carbohydrate, another diabetes medicine may need to be prescribed to improve your control by addressing your body's inability to release enough insulin following a meal.
Your other question about meal and snack frequency is a common one. Nutrition experts have reviewed the research in this area for people without diabetes. Unfortunately, this question has not been studied in people with diabetes. For people without diabetes who are trying to lose weight, several studies show that calories should be distributed throughout the day. It is recommended to eat four or five times per day (meals or snacks), including breakfast. Research has also shown that skipping breakfast is associated with excess body weight and markers of insulin resistance. A word of caution: Eating multiple times throughout the day when you're not hungry is likely to result in weight gain and should be discouraged. Again, these findings are for people who don't have diabetes and may not apply in your case.