A1c Secrets: the Riva Greenberg Edition

Ginger Vieira

What does it take to improve your A1C and maintain it? Everyone’s diabetes is different, but at DiabetesDaily we’re eager to find out just how many commonalities there are in the habits of people who achieve their A1C goals. Your A1C represents an average blood glucose number and most doctors recommend aiming for under 7.0 percent.

In the first of many in this new series, I interviewed Riva Greenberg. Riva has lived with type 1 diabetes for over 40 years, she’s the author of many books on living well with diabetes, and she’s a regular contributor at The Huffington Post.

Riva’s A1C: From Past to Present

“What was my highest A1C? I have very little memory of my A1C from way back. Today, and for the past several years, it’s been around 6% and in the upper 5′s. My most recent was 5.7 percent. I’m sure I had A1Cs in the 8′s a long time ago when we knew so little about managing blood sugar.

Most people think that if your A1C is in the 5′s, you must be having lows all the time. Without a doubt I have my share of lows, but eating pretty similarly day to day, which I know some people hate, checking my blood sugar frequently through the day, correcting when I’m high and not waiting for before the next meal like I used to do and using my DexCom CGM, particularly when I travel and everything is off, I’ve cut down on my lows, and, I’ve never been in a position where I or someone had to call 911!

I think the correcting your blood sugar in the moment is a key. Years ago if I checked in the middle of the afternoon, and my blood sugar was high, I wouldn’t do anything about it. I’d just say, come dinnertime, in a couple of hours, I’ll take a little extra insulin to correct it. But I think it’s much better if you can, to not wait.

I know most people are more afraid of being low than high, but I’m not afraid of lows. Luckily, I’m not hypo-unaware, and I’ve always been able to fix a low on my own. When I was first diagnosed, my doctor put the fear of God in me about being high. He told me I was going to get every complication known to diabetes. It wasn’t a good start, but I’m sure it’s why I’d rather fix a low than see my blood sugar skyrocket.

Riva Says What She Eats Matters Most

“I believe food is medicine. I heard Insulin for Life’s Ron Raab once say, “You wouldn’t give nuts to someone who is allergic to nuts, so why would you tell someone with diabetes to eat a lot of carbohydrates?” Like Ron, you can look at it like we have an intolerance to carbohydrates. So eating less carbs is critical to my control and keeping my blood sugar in range.

I also basically eat the same types of foods day to day. I know people hate it, but I guess I’m like a dog. Give me my favorite meal every day and I’m pretty happy. Eating the same type foods, so they have about the same amount of carb and fat, makes it much easier to guesstimate, don’t you just love that word, my insulin doses. Without a doubt, when I’m traveling and eating different foods and eating out all the time, my blood sugars are much more unpredictable and harder to manage. Then I have to check more, correct more and scream more!

When I was giving a lecture in Alabama last year, I went out to lunch with the hosts and I ordered broiled fish with collard greens and cabbage. It also came with 4 hush puppies. Basically corn fritters. I ate 1 hush puppy, the fish, the greens and cabbage and on the plane going home my DexCom was going higher and higher and higher until I realized I had just experienced Southern Cooking. There must’ve been sugar in the vegetables!

A lot of people assume I’m depriving myself eating the way I do, but my view really is, ‘What are you choosing? The momentary pleasure of a bag of potato chips or your long term health? Now, don’t get my wrong. I’m not perfect. I fall off the food wagon. I enjoy my nightly dark chocolate, red wine, good bread with olive oil and sharing a plate of fried calamari. But for the most part and at home, the choice to eat healthy is easy. And I like what I eat. The occasional times I taste something mass- produced or processed it tastes so sweet or greasy. Trust me, when you change how you eat, your taste buds change too.

It’s strange to me when someone will defiantly say, ‘I’m not gonna give up eating bagels!’ The truth is, those are often the people struggling with their blood sugars.

Also, this is important, when your attitude is that you’re giving something up, you’re making it hard, you feel cheated. Remind yourself instead what you’re gaining. Perhaps years of life, perhaps very few complications. Perhaps just feeling better most of the time.”

Check Your Blood Sugar…Check it Often!

“It helps me to keep my glucose meter in the same place all the time. I keep it on my kitchen counter. No excuses not to check, no having to go find it. I check about 6 to 7 times a day and as I said, I correct in real time.

To be perfectly honest, I got my DexCom CGM about six months ago and wear it half the time. Since my life is pretty routine, there aren’t big surprises very often. However, for people who have very varied days, I think it’s a great tool.

Then too, here’s a trick. I remember from a TCOYD conference, Dr. Steve Edelman said, ‘When your blood sugar goes up to around 200 mg/dL, you pretty much need twice as much insulin to knock it down because of the increased insulin resistance that comes with high blood sugars.’ So, knowing you need a bit more insulin, has been really helpful. Otherwise it seems to take forever to get down a high blood sugar.  And boy, if we could change one thing, I’d beg for faster acting insulin. When you wear the CGM you see how long it takes insulin to do its job.”

Riva Gets Moving

“The other part of my daily routine is walking usually an hour a day. While it doesn’t burn a ton of calories, it does keep me more insulin sensitive. I’m sure of it. I can see the difference when I’m inactive. I definitely need more insulin to get the same results.

I once heard someone say, ‘I enjoy taking care of myself.’ I thought how that put a whole different spin on taking care of our health. What an appreciative way to see our diabetes tasks, responsibilities and what sometimes feels like a burden. It makes everything lighter. So, I’ve embraced that thought and share it now often when I speak to patients.

What if you changed the game to I enjoy being good to myself by taking care of my health. I think your habits would begin to change and it would create a certain lightness. Maybe you could even thank yourself for all you do. Then we’re really changing the game.”

Thank you, Riva!

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