#Control Your Blood Sugar Using #Lean #SixSigma

HbA1c (Glycated Hemoglobin)

A1C is the measure of the average blood glucose control over the past 3-4 months; the ideal range is <6.5%. Tests are conducted by a lab in conjunction with a health care provider.

Blood Glucose Level

Blood Glucose Level is the measure of the amount of glucose or sugar in the blood at the time of testing. They are usually self measured with a blood glucose meter. Normal pre-meal range is 70-130 mg/dl.
RESOURCE: http://www.aafp.org/

According to the European Diabetes Association these are the normal levels.
RESOURCE:http://en.wikipedia.org/wiki/Glycated_hemoglobin

HbA1c		eAG (estimated average glucose)
(%)	(mmol/mol)[25]	(mmol/L)	(mg/dL)
5	31	5.4 (4.2–6.7)	97 (76–120)
6	42	7.0 (5.5–8.5)	126 (100–152)
7	53	8.6 (6.8–10.3)	154 (123–185)
8	64	10.2 (8.1–12.1)	183 (147–217)
9	75	11.8 (9.4–13.9)	212 (170–249)
10	86	13.4 (10.7–15.7)	240 (193–282)

Exercise Calories

Exercise Calories are being defined as a measure of the calories expended in day in excess of a sedentary day. Although the measurement is subjective due to the various potential calorie calculators available on the internet, the data is being used to determine a daily or relative comparison and is not intended to be absolute.

The Glycemic Index

The glycemic index of food is a ranking of foods based on their immediate effect on blood glucose levels. Carbohydrate foods that breakdown quickly during digestion have the highest glycemic indexes. Their blood sugar response is fast and high. Carbohydrates that breakdown slowly, releasing glucose gradually into the blood stream, have low glycemic indexes.

Type II Diabetes

Type II Diabetes is a condition where either the body does not produce enough insulin or the cells ignore the insulin. Insulin is necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the sugars and starches into glucose. These are the basic fuel for the cells in the body. Insulin takes the sugar from the blood into the cells.

Project Results Summary: Controlling Blood Sugar

Project Wins

• Improved daily average blood sugar from 210 mg/dl to 105 mg/dl.
• There was a 3 KG weight loss, and a loss of 5 cm in pants size, but more significant is an overall increase in energy and an ability to slightly relax dietary restrictions.
• The improved blood sugar measurements will not, due to statistical history, make a major change in the A1C reading for another 2 months; the measurement is a median of the past 120 days. A confirming HbA1c test is scheduled for the end of March. Baseline HbA1c was 8.1, the current is 7.6 and the desired is <6.5. Based upon current data and trends the expected result should be a measurement of 6.1.

Context

It is critical to control high blood sugar levels to reduce the potential long term health risks. These can include; heart disease, kidney damage, nerve problems and loss of vision.

• Project Timing: 60 day analysis
• Start Date: 16/01/15
• End Date: 17/03/15

Business Case

Over the past year controlling Type II diabetes has been attempted with medications and changing diet, also by avoiding high glycemic index foods. These have been unsuccessful in controlling blood sugar levels to the acceptable range. Developing a long term alternative to increasing medications is highly desirable. Maintaining blood sugar levels is necessary to reduce long term health risks.

Problem Statement:

Current blood sugar levels range from 160-180, they should be less than 120

Goal Statement:

Increase physical activity to reduce average blood sugar levels to 100-135 or an HbA1c of <6.5 by 17 March 2015.

Define Phase

In Scope

• Increase daily activity by going to the gym regularly;
• Continue after meal walks;
• Continue to avoid high glycemic index foods.

Out Of Scope

• Increase medications
• Additional and more strict dietary changes
  • Avoid holiday meals and parties

Measure Phase

• The January 15th 2015 HbA1c test had a measurement of 7.2; indicating the prior 2-3 month Blood Sugar average to be 185.
• Blood Sugar Level data for October 2014 was obtained from the historical register of a glucose meter. The data was logged onto a data collection sheet to capture the blood sugar level along with the date and time of measurement.
• Data was filtered by rounding to the nearest multiple of 5, this was necessary to create a baseline of meaningful data. The exact values were not critical as the data only needs to be relative to the desired goal.
• Baseline measurements indicated the VOC goals were only being meet 8% of the time.
• An HbA1c test was taken Feruary 7th, the results were 6.8. After consultation with the doctor it was decided this test would be ignored due to the statistical nature of the HbA1c being a 165 day median. Not enough time or data would be available to offset the prior statistical median. . The test result was a validation of the decision to use the January 15th test for the basis data.

Improve Phase

A simple root cause analysis on the differences between the AM and PM readings indicated that activity, or more specifically the amount and type of activity, had a direct effect on the Blood Sugar Level, and therefore activity would be the best and most measurable option in improving the process.

Description of the process change:

• The Blood Sugar Levels were measured in the AM and PM prior to meals, thus eliminating the variable effects the type of meals could impart on the measurements.
• Increasing the daily activity by 400-500 calories per day, this equates to approximately 30-40 minutes of exercise, exercise included 20-30 minutes on a bike, treadmill or elliptical with a heart rate of at least 150 BPM, plus 10- 20 minutes of resistance weight training.

Control Phase

After the initial 30 days there was a trending towards the goal. A decrease in the amount of exercise was attempted to determine if the trend would be maintained with less effort. After this initial test, it was determined that 4 days of exercise per week was required, allowing for two days of rest to maintain the blood sugar levels at the desired range. The rest days should not be back to back.

• The initial 30 days were inconsistent in terms of results, but a trend of lowered blood sugar was noticed on days following when the activity included weight training.
• The second 30 days show a significant improvement in terms of trends and consistency in the lowering of the blood sugar levels.
• Specific habitual changes needed to be altered.
• Exercise sessions were most beneficial if they were later in the day, either before or after the evening meal.
• Exercise sessions needed to include 20 minutes of strength training, either weights or at home resistance training, i.e. pushups, sit-ups. These need to follow some type of cardio to increase the heat rate to the “target” level.
• The need to continue a glycemic appropriate diet is still crucial to maintain the desired results.
• Days with high activity can replace a day’s exercise session: such as walking a round of golf, extended periods of yard work, heavy house/garage cleaning or similar activities.

Next Steps

• There are various methods to control Blood Sugar Levels. The most common are the types of food consumed, exercise and medication. The simplest option is with medications. The problem with this method is it takes a long period of time to determine the correct medications and doses. The dependence on medications is undesirable and can be costly. A combination of medications and diet are very effective but these lead to lifestyle changes that are at times difficult to maintain. Fast food and quick meals are not often glycemic appropriate meals. The most difficult and perhaps the best method is a program that includes medications, diet and exercise. The inclusion of exercise allows the body to transfer sugar from the blood to the muscles, increasing the body’s insulin-sensitivity. This could potentially allow for the reduction in medications and dietary restrictions.
• The next steps in the process are to maintain the plan and obtain a desired result to the May 2015 HbA1c test. It is the goal to continue the effort to remove the need for dietary restrictions and medications. The viability and level of these reductions will not be known for another 3 months.