1. UNIT TWO LESSON 4: A1C

2. Objectives At the end of the lesson, participants should be able to: 1. State what A1C is 2. Describe the relationship between A1C and management of blood glucose 3. Explain the importance of knowing their A1C number 4. Describe their role in preventing diabetes complications 5. Set goals to maintain blood glucose control 6. Describe feelings and experiences about living with diabetes 7. Identify ways to modify everyday recipes to fit into the diabetes meal plan

3. L-esson

4. The ABCs of Diabetes People with diabetes need to know their: A1C (average blood glucose over time) Blood pressure Cholesterol levels In this lesson we will focus on A1C Knowing your A1C or average blood glucose helps you see how well you are managing your diabetes over time

5. Complications If you can keep your A1C within the target range set by your doctor you may reduce the risk for complications, such as: Blindness Stroke Kidney disease Heart disease Amputations

6. What Is A1C? A1C is also called hemoglobin A1C or glycosylated hemoglobin The A1C test is performed in your doctor’s office but can also be done in your home. Your A1C level tells you and your doctor how well your blood glucose was controlled over the past three months

7. Blood Glucose Levels Change Often When you test your blood glucose at home, it shows the glucose level at the time of testing Because your blood glucose level changes from hour to hour and from day to day, it is sometimes difficult to see how well you are controlling your blood glucose level over time

8. How Does the A1C Test Work? Your red blood cells keep a memory of your blood glucose level, whether it is high, normal or low The memory is kept for the life of the red blood cell, which is about three months

9. How Is the Memory Made? The memory is made when blood glucose attaches to the hemoglobin in the red blood cell The more glucose in your blood, the more glucose is attached to the hemoglobin The higher the A1C level, the less control you have over your diabetes

10. Level of Control A1C Test Result Normal6% or less GoalLess than 7% Take Action7% or more The A1C goal for many people with diabetes is less than 7% You should work with your doctor to decide the A1C goal that is right for you

11. Comparing A1C and Self-Test Blood Glucose The higher your A1C level, the less control you have over your blood glucose levels An A1C test of less than 7% shows that your blood glucose level is around 170 mg/dL A1C Level (%) Average self-test plasma glucose numbers (mg/dL) 12345 11310 10275 9240 8205 7170 6135

12. Why is A1C important? It is a way to take care of your diabetes It tells how well you are managing your blood glucose over time Keeping your blood glucose level close to normal reduces the chances of having eye, kidney, and nerve disease

13. Things to Remember about A1C The A1C test lets your doctor know how well your treatment plan is working The higher the amount of glucose, the higher your test result will be A high test result will increase your chances for diabetes complications

14. Interact with Your Health Care Team Talk to your doctor about your A1C goals and your self-monitoring blood glucose goals Ask for an A1C test at least twice per year Your doctor may recommend you have the test done more often

15. Interact with Your Health Care Team Ask your doctor about: Your A1C result What it means What it should be What you need to do to reach your A1C goal

16. E-mpowerment Diabetes Education Series: A1C

17. Diabetes Education Series Questions What are some of the benefits of having the A1C test done? What are some of the risks of not having the A1C test done? What are some challenges that prevent you from having the A1C test done? How do you overcome these challenges?

18. A-ction Did you accomplish the goal you set last week? Your goal is to have the A1C test done. This is a goal on your Diabetes Checklist.

19. R-eal-Life Problem Solving Jim’s Story

21. Questions about Jim’s Story What is Jim’s problem? Why is this a problem for Jim? What are some things that Jim needs to do to solve his problem? (List as many suggestions as possible.) What might be the best way to solve his problem at this point? Why?

22. Questions about Jim’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Jim’s story

23. N-utrition Menu: Turkey Chili with Wheat Crackers Fruit Kabobs

24. See you next week! Topic: Blood Pressure The preservation of health is a duty. – Herbert Spencer

25. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors