A1c:  What does it mean to me?

A1c: What does it mean to me?


Before we talk about your A1c, let’s talk about donuts.  I know I’m odd, but I don’t really like them.  They smell great, but the taste never measures up to the smell for me.  Lest you think I’m one of those people who just doesn’t like sweets, rest assured that there are days when I’d drive 20 miles for a chocolate bar!

What I do like about donuts is using them to explain hemoglobin A1c, and that’s what I’m going to do now, on Day 3.

Diabetes and Hemoglobin A1c

Hemoglobin is the medical word for “red blood cells.”  The “A1c” means “glycated”, or covered in sugar.  To put it simply, the hemoglobin A1c test measures the percentage of your red blood cells that are sugar-coated.

Every day, your body makes new red blood cells, and every day, old blood cells outlive their usefulness and get destroyed.  The lifetime of a red blood cell inside your body is about 3 months.

Your red blood cells are donut-shaped.  Think of them as plain, unglazed donuts.  If you have a healthy amount of sugar in your bloodstream, just a few of your red blood cells will become glazed with sugar.

As your blood sugar rises, more and more of your red blood cells will become glycated, that is, more and more of your “donuts” will become “glazed.”

Think about a box filled with a dozen donuts.  Imagine that a person with well-managed diabetes has only one glazed donut in her box, while another person with poorly controlled diabetes might have 2 or 3 glazed donuts in his box.

Why do I need to control my A1c?

Those glazed donuts, or sugar-coated red blood cells, damage the tiniest of blood vessels in your body, the ones in your eyes, your kidneys, and your hands and feet — all the places where people with diabetes have complications.

What’s a normal hemoglobin A1c?

A person without diabetes will have an A1c of 5.6% or less.  The prediabetic range is 5.7-6.4%, and a level of 6.5% or more is high enough to diagnose diabetes.  For people with diabetes, the American Diabetes Association‘s recommended goal is to keep the A1c under 7%.  This helps prevent longterm damage to the eyes, kidneys, and other tissues.

How often should my doctor check my A1c?

Getting a new A1c test every couple of weeks isn’t useful, because most of the same red blood cells are still floating around in your bloodstream, and once they become sugar-coated, they stay that way.   Remember when we said that each red blood cell lives in your body for about 3 months?  That’s why your doctor doesn’t run this test more often than every 3-6 months.  If you have diabetes and your A1c is good, your doctor will probably wait 6 months or more in between tests.

How can I lower my A1c?

The best way to lower your A1c is to lower your daily blood sugar readings.  If your daily blood sugar levels are good, your A1c will be good, too.  (You’ll only have too many glazed donuts in your box if you have too much sugar in your bloodstream most of the time.)  So, you can’t change your A1c today, but you can start to change your blood sugar today.

Ready?  Let’s do it!

Day 3 Action Items:

  1. Remember those shoes you put in a very convenient spot yesterday?  Time to put them to use.  For today, walk at an easy pace for 5 minutes, stop and stretch for 2 minutes, and then walk at an easy pace for another 5 minutes.  When you’re finished, give yourself a gold star.  You deserve it!
  2. Do you know your A1c?  If not, dig out your last lab report, or call your doctor’s office and what your last A1c level was.
  3. Enter your most recent A1c into the calculator below to figure out what your average blood sugar level was for the 3 months before your last test.

That’s it!  You made it through Day 3!


This post is part of a series, 30 Days to Tame Type 2 Diabetes.  To go to Day 1 of the series, click here.

Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

How Coronavirus Impacts People with Diabetes

How Coronavirus Impacts People with Diabetes

How does coronavirus impact people with diabetes and other chronic medical conditions differently? What should people with diabetes do to prepare themselves for a long period of “social distancing”? What if a person with diabetes or a member of their household gets infected with coronavirus?

People with Diabetes are (Rightfully) Anxious about Coronavirus and their Health

If those of us who are healthy are experiencing fear and anxiety, what’s happening to others who are already dealing with a chronic condition day in and day out? A friend posted this statement on her Facebook page recently, “I am disheartened. Many of my friends and colleagues have chosen to practice “selective social distancing”… still hanging out with buddies, a few neighborhood happy hours, letting their kids see a couple of close friends. This is not ok. In fact, as someone who is immunosuppressed, I find it terrifying….While you may only experience this virus as a cold, some of us could die from it. Please stay home and please keep your kids home.”

This friend is right, of course. When any of us chooses to ignore the CDC’s guidance for social distancing, we choose to put others in harm’s way. I’m a Dietitian and a Diabetes Care Specialist, and I moved all my clients to telehealth appointments this week. A few chose to reschedule their appointments to a time when I can hopefully see them in person, but the majority were grateful to have the option to stay at home and avoid possible exposure to coronavirus.

My clients with diabetes fear for their health and safety, and rightfully so. Here are my best answers to some of their most frequently asked questions:

Are People with Diabetes More Likely to Get Coronavirus?

The American Diabetes Association says that while people with diabetes are not any more likely to become infected with coronavirus, they are more likely to have “serious complications and death.” Any time a person with diabetes gets an infection, whether it’s viral or bacterial, blood sugars tend to rise as a consequence of the inflammatory process. When blood sugars rise excessively, a serious complication called diabetic ketoacidosis can occur, especially in people with type 1 diabetes.

What Supplies Should People with Diabetes Have on Hand During the Coronavirus Pandemic?

As always, people with diabetes need to be prepared to take care of it at home. This means keeping a supply of:

  • Insulin

  • Oral medications

  • Glucose testing strips or supplies for your continuous glucose monitor

  • Ketone testing strips, especially for people with type 1 diabetes

  • Juice boxes, glucose tabs, or hard candy in case of low blood sugar

  • Water, in case your blood sugar is high and you need to push fluids

  • Soap & hand sanitizer to prevent the spread of infection

What Should I do If I Have Diabetes and I Think I Might Have Coronavirus?

If you develop symptoms such as fever, dry cough, or shortness of breath, call your doctor right away. Whether you feel sick or not, if you get a blood sugar reading of 240 mg/dl or higher twice, check your urine for ketones. If you have ketones in your urine, call your doctor.

Visit the Emergency Room if you develop these symptoms of Coronavirus:

  • Difficulty Breathing

  • Blue lips

  • Chest pain or pressure

  • Confusion

Are my Family Members a Danger to Me During the Coronavirus Pandemic?

The American Diabetes Association recommends that people with diabetes separate themselves from other family members inside the house if possible. For example, if you can confine yourself to your room most of the time, that would be best. Your family members should assume that they are contagious and could pass the coronavirus on to you at any time, even if they feel fine. They should wash their hands frequently. All households, whether they have a family member with diabetes or not, should be sanitizing doorknobs, handrails, tables, kitchen counters, and light switches regularly.

What if Someone in My House Has the Coronavirus?

If at all possible, give the sick person his or her own room, and keep the door shut. Have someone who is under 65 and who doesn’t have diabetes or another medical condition take care of the sick person.

I’m Worried That We’ll Run out of Insulin due to Coronavirus

Major insulin manufacturers report that they are running on schedule as usual and that they don’t expect Coronavirus to slow their production of insulin. Some pharmacies, including CVS, has started delivering medications to patients’ homes. If the pandemic has affected your income and you are concerned about the cost of your insulin, try insulinhelp.org.

I’m Feeling Overwhelmed

When we’re overwhelmed, we tend to stop taking care of ourselves. Maybe we stop exercising, stop eating as well, and spend a little (or a lot) more time on the couch. Many friends and clients have mentioned recently that they feel like they’re in a period of mourning. It’s OK to feel however you feel, and it’s also important to remember that at times like these, we need to take better care of ourselves than we ever have, for our mental health as well as our physical health. Maintain your regular diet, keep up with your regular physical activity schedule, and adjust your insulin as required with the help of your health care team.

Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

What’s the Best Kind of Milk for Diabetes?

What’s the Best Kind of Milk for Diabetes?

Have you been to the dairy aisle lately? There are a lot more choices than there used to be. We’ve come to the point where choosing milk requires a not-insignificant amount of thought. If you’re overwhelmed in the dairy aisle, I’ve put together some information that might make picking up a carton of milk a little easier.

Cow’s Milk

Regular, whole cow’s milk has 150 calories and 8 grams of fat per cup. That’s a lot. Whole milk is a good choice for 1-year-old children who need lots of fat for their growing brains. It’s also a good choice for people who are trying to gain weight…but that’s not most of us.

Believe it or not, 2% milk is still considered a high-fat food. So, it works for people who are working their way down from whole milk to low-fat milk, and for people who need extra calories.

Skim and 1% cow’s milk are the best cow’s milk choices for most of us, including people with diabetes and heart disease. When milk is skimmed, the cream is removed from the top. This takes away most of the heart-clogging saturated fat and cholesterol. Since people with diabetes are prone to heart disease, those who prefer cow’s milk should definitely choose skim or 1%.

Lactose-free milk is still a cow’s milk product. It can be found in whole and lower-fat varieties. The sugar, or lactose, in lactose-free milk has already been broken down into its components, glucose and galactose. This doesn’t mean that lactose-free milk is a better choice for people with diabetes. Lactose-free milk contains the same amount of carbohydrate as regular cow’s milk, and it will still cause a rise in your blood sugar like any other milk.

Soy Milk

Soy milk is comparable to cow’s milk when it comes to protein content. The fat is soy milk is unsaturated, which is heart-healthy. Soy milk is a good choice for people who don’t tolerate cow’s milk or who prefer not to consume animal products.

Almond, Rice, Cashew, & Oat Milk

Need something to wet your cereal? Any of these will do. But…they have limited protein, so they are not a good choice for small children, people with poor appetites, or others who struggle to take in enough protein from other sources like meat, eggs, and beans.

Pea Milk

Pea milk is made from flour made from yellow peas. (It doesn’t taste like peas or milk, if you ask me.) Like soy milk, pea milk is a good alternative to cow’s milk. In some cases, pea milk has more protein than cow’s milk. This is a great choice for someone who is allergic to both dairy and soy as well as for people with diabetes who want vegan alternative milk.

How to Choose the Best Milk for You

As the number of choices at the supermarket continues to expand, remember what to look for in your milk:

  • Does this milk have at least 7 grams of protein per cup?

  • Is this milk fortified with vitamin D?

  • Is the amount of saturated fat in this milk 2 grams or less per cup?

  • Do I need low-calorie milk or high-calorie milk?

Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

How Sitting Affects Your Blood Sugar

How Sitting Affects Your Blood Sugar

I’m sitting as I write this, but maybe I shouldn’t be.  This week, I want to tell you about a new study published on Monday in The Journal of the American Heart Association.  Researchers studied more than 500 older (post-menopausal), women.  The women wore devices to measure their activity during the study.  They had an average age of 63 years and an average sitting time of 9 hours each day.  The researchers found that insulin resistance increased by about 6% for each hour of sitting and that every 15 minutes of uninterrupted sitting increased insulin resistance by about 9%.  This was true regardless of the person’s weight.

What’s the bottom line?  Sitting increases your risk of diabetes.  If you already have diabetes, sitting makes it worse. 

What can you do?  Here are a few tricks to help you get moving:

  • The high-tech option is to wear a Fitbit or a similar device.  If you haven’t taken your desired number steps in an hour, you’ll get a little buzz on your wrist that reminds you to get up and move.

  • If you don’t want to wear a Fitbit, you can get the same effect by setting a timer on your cellphone to go off every hour.

  • Even more low-tech:  use the timer on your microwave oven.  Set it for an hour.  When it beeps, you’ll need to go turn it off and then you can set it to go off again in another hour.

  • When you’re watching TV, stand up and take a lap down the hall every time there’s a commercial break.

Speaking of standing up, I’d better do that now!

Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

5 Easy, Healthy Breakfast Ideas for Diabetes Type 2

5 Easy, Healthy Breakfast Ideas for Diabetes Type 2

It’s been said that breakfast is the most important meal of the day. If you have diabetes, it can also be the most challenging. Breakfast is typically heavy on the carbs and light on veggies. That can make it hard to get full without going over your carbohydrate budget in the morning. Here are five yummy breakfast ideas to mix and match. They’re quick, they’re nutritious, and they’re filling. Best of all, they won’t load you up with too much sugar.

Overnight oats. Oatmeal is full of soluble fiber, which slows your digestion. As a bonus, oatmeal helps lower cholesterol. Since many people with type 2 diabetes also have high cholesterol, that’s a nice benefit. As the name implies, overnight oats are prepared ahead of time and ready when you get up in the morning. Try this simple recipe for strawberry overnight oats:

Strawberry Overnight Oats

·     6 ounces low-fat Greek yogurt

·     1⁄3 cup rolled oats uncooked

·     1⁄4 cup sliced almonds

·     1⁄3 cup strawberries

·     1 teaspoon vanilla extract

In a small bowl, combine ingredients. Add the ingredients to a sterilized mason jar. Cover and store in the refrigerator overnight. (42 grams carbohydrate).

Who can resist peanut butter, bananas, and granola all rolled into one? This recipe takes less than a minute to put together, and it tastes delicious!

Blueberry Peanut Butter Yogurt Bowl

·     3/4 cup plain Greek yogurt

·     1 tablespoon peanut butter

·     1/2 banana sliced

·     1⁄4 cup blueberries

·     1 tablespoon granola

Scoop yogurt from the container into a serving bowl.  Top yogurt with fruit, then nut butter, and lastly with granola.  Bon appetit! (22 grams carbohydrate).


Have a few minutes in the morning? Homemade breakfast tacos just might hit the spot. These Mexican-inspired breakfast goodies are chock-full of veggies to start your day off right!

Veggie Breakfast Tacos

·     2 corn tortillas

·     cooking spray

·     1⁄8 onion chopped

·     1⁄4 summer squash chopped

·     2 cups Swiss chard chopped

·     2 eggs

·     2 teaspoon cilantro

·     1-ounce queso fresco

·     1⁄8 cup salsa

1.    Warm the tortillas in the oven or microwave and wrap in a towel until ready to serve.

2.    Heat a pan with cooking spray and sauté the onion until translucent.

3.    Then add the summer squash until cooked throughout.

4.    Stir in the greens and continue to cook until tender, about 2 minutes.

5.    Meanwhile, beat the eggs in a small mixing bowl.

6.    In a non-stick pan, scramble eggs and cook throughout.

7.    Spoon eggs and vegetable sauté onto warm tortillas and sprinkle with cheese and cilantro. Serve with salsa.

8.    Suggested serving size: 2 tacos per person. (2 tacos have 31 grams carbohydrate).


Another yummy egg-based recipe: One-pan BLT skillet frittata. This one takes a few minutes to bake, but you can put it in the oven and come back in 15 minutes to find a mouth-watering breakfast.

One Pan BLT Skillet Frittata

·     5 eggs

·     1⁄2 cup milk

·     1⁄2 teaspoon dried basil

·     1⁄2 teaspoon dried oregano

·     1 dash salt to taste

·     1 dash pepper to taste

·     2 slices bacon chopped

·     1tablespoon olive oil

·     2 cloves garlic diced

·     15 ounces diced tomatoes drained

·     2 cups raw spinach

·     1handful fresh basil chopped

1.    Preheat oven to 425 degrees.

2.    Whisk together your eggs, milk, basil, oregano, and salt and pepper to taste. Set aside.

3.    Cook your chopped bacon until crispy.

4.    Add olive oil, garlic, and spinach to the skillet and cook until the spinach is wilted, about 3 minutes. Add in the tomatoes and stir to combine.

5.    Pour the egg mixture over the spinach and then stir in the bacon. Stir the entire skillet once or until well combined. Let sit (without stirring) for about 2 minutes, just until the edges are set.

6.    Place the entire skillet in the oven and cook for 15 minutes, or until the eggs are set and slightly golden.

7.    Top with some freshly chopped basil if desired.

8.    Slice and serve. (1/2 the frittata has 14 grams carbohydrate).


Do you have less than two minutes to deal with breakfast, but still want to take care of your diabetes? Make a smoothie and drink it in the car on the way to work or school. I guarantee it’s faster than going through the drive-through and much healthier too! The avocado in this Green Machine Smoothie lends a smooth, creamy texture.

Green Machine Smoothie

·     1 cup of frozen spinach

·     1⁄2 banana frozen

·     1 1⁄2 cups milk

·     1⁄2 avocado

·     2 tablespoons chia seeds

Combine everything into a blender and blend until well combined, about 30 to 60 seconds. Makes 2 servings. (1 serving has 30 grams carbohydrate).


Do you have a favorite breakfast that’s moderate in carbohydrates and keeps you full all morning? Leave a comment and let everyone know what works for you! For more information on diet and diabetes, subscribe to my newsletter, and read about the best diet for diabetes.

Julie Cunningham is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Julie is the owner of a nutrition counseling service in Hendersonville, NC. She works as both an in-person and an online nutritionist.




Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.

5 Diabetes Check-Ups to Schedule Now

5 Diabetes Check-Ups to Schedule Now

Diabetes can feel overwhelming. It helps to have a team on your side. Here’s a rundown of the experts you need to visit at least once a year to make sure you’re on track with taking great care of your diabetes.

  1. Schedule a checkup with your family physician, internist, or mid-level provider (physician assistant or nurse practitioner).

    This person serves as your primary care provider (PCP). He or she can help you coordinate your healthcare with other providers. Your PCP can also order labs or other tests that need to happen on an annual basis, like your Hemoglobin A1C. If you have health insurance, the Affordable Care Act allows for a yearly checkup with your primary doctor at no cost. If you’ve had Medicare Part B for more than a year, you can get an annual “Wellness” exam once every 12 months. The Part B deductible does not apply to the Wellness exam, so there should be no cost to you.

  2. Arrange for an eye exam.

    An eye exam is recommended every year for those with diabetes. Your eye doctor isn’t just checking to see if you need glasses. He or she is checking for diabetic retinopathy, which is damage to your eyes from poorly controlled blood sugars. Medicare will cover an annual eye exam every 12 months if you have diabetes.

  3. Find time for a foot exam.

    Your primary care provider may do a foot exam during your annual checkup. If not, you’ll need to see a podiatrist for a foot exam every year. A foot exam includes a visual inspection of your feet as well as the use of a monofilament. A monofilament is a very thin, flexible probe that your doctor will touch to different parts of your skin. This painless process is used to make sure that you have adequate sensation in your feet.

  4. See your Registered Dietitian (RD).

    Your RD will help you determine whether you need to adjust your eating plan to make sure that your blood sugars stay in range. Most private insurance companies cover Medical Nutrition Therapy (MNT), which is the name of the service provided by a Registered Dietitian. Medicare covers three hours of MNT initially and two more hours every year after that. Medical Nutrition Therapy is fully covered under Medicare; there is no 20% copay.

  5. Don’t delay on Diabetes Self Management Education & Support (DSMES).

    DSMES is a program designed to help people with diabetes to understand their condition and to make choices that better their health. DSMES is proven to help improve the health of people with diabetes. DSMES consists of ten hours of group or individual education the first year, followed by two hours of additional training every year after that. DSMES is covered by most major insurance carriers as well as Medicare.

Does this list seem overwhelming? Don’t worry, you’ve got all year to spread out your appointments. Consider making just one phone call a day until you’ve scheduled all your health care visits. If you need a handy guide to hang on your fridge and help you keep track of your progress, you can get one here. You’ll be well on your way to staying well in no time at all.

p.s. Wondering about artificial sweeteners? Read this article.

Julie Cunningham is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Julie is the owner of a nutrition counseling service in Hendersonville, NC. She works as both an in-person and an online nutritionist.

Julie Cunningham

Julie Cunningham


I believe people with diabetes can enjoy good food and good health without feeling ashamed of their bodies.