A1C in the 4s

If your A1C is in the 4s please tell me how you achieve that. True T1s only.

After my 1st pregnancy, my A1C was 5. It was painful to have it that low. To get to a 4 would be insanity, if you ask my unprofessional opinion. You’d be running incredibly low all the time. A safer number would be in the upper 5s to 6.

I agree… 4’s may be possible for some T2’s, but I don’t personally believe it safe or even a worthy goal for a T1 unless you want to risk death. I do think mid-5’s are possible for some T1’s… not all, since we are all different.

I have no intention to play with fire. Let’s say I want my bg average to be 2 standard deviations above 50. If my bg standard deviation is 30 I should aim for 110 mg/dl = 5.5 % A1C. With a bg standard deviation of 20 I could shoot for 90 mg/dl = 4.8 % A1C. Maybe I should have asked: “If your bg standard deviation is less than 25 please tell me how you achieve that.”

Having a good A1c number is all about trial and error, like everything else with diabetes. You learn what works best for you and your body. I agree that achieving below 5-5.5 is dangerous and for T1’s usually means you are running low most of the time. I knew someone who was newly diagnosed in my high school whos A1c was 4.5, and she was in the 50’s and 60’s almost constantly. The doctors wound up slashing her insulin at incredible amounts.

As always, the best way to treat diabetes is frequent testing, carb counting, healthy diet, and exercise. Implementing all of these things gives you the best opportunity to achieve good A1c results.

4.7 previously. Strict diet, exercise and followed my dosages to the T.

Here is my thread A1C and diet

I frequented lows quite a bit, my a1c right now at 5.3 is perfect.

Mommy to twin monkeys, do you know what your bg standard deviation is? I looked at your meal plan expecting a low carb diet. I am surprised. How often do you measure? What do you attribute your good bg control to? Is there one factor that is much more important than others. Or do all stars need to be aligned?

I wear a CGMS and test 18-20 times a day if not wearing a CGMS - if I wear a cgms I test 12ish times. I am also an insulin pumper.

Just because I am a type 1 diabetic, does not mean I need to eat low carb. It just means I need to be smarter about what I put in my mouth and how I follow through with my exercise plan.

I calculate all carbs. I weigh EVERYTHING. If I’m dosing for a 4oz banana, I’m eating 4oz. not 5 or 6 oz.

I rarely, if ever, eat out.

on a good day 90-120. it’s VERY rare I see over 150, and if I do, I’m either ill, or I did not calculate the carbs properly. Right now, I have the flu - so I’m in the 300’s. I won’t be up there much longer though.

Helmut - I just about jumped out of my seat when I saw this posting! Interesting discussion tho’.

I am like others, not sure about having an A1C in the 4% range. If I use this calculator, and I input the value of 4%, that would mean I would have to keep my BG’s around 3.8 mmol/l (68 mg/dl).

Now, maybe an A1C of 4.5% would be alright - which means my BG’s would be around 4.6 mmol/l (82 mg/dl) to attain that level - but still - I might be taking the risk of hypos with such tight control. If any of you are nodding, I think you are like me where I hate with a passion going low. I’d much rather correct a high BG instead with a correction of insulin.

this is one reason I stopped going for the 4’s. Mid 5’s are much more comfortable.

Thanks. Do you think that you could achieve the same control without pump?

I’ve been pumping for so long, I can not answer that question. I’m sorry. I think I obtained my first pump… 1996ish…

Anna - The calculator puts me into the 4s at 4.9999 % A1C = 97 mg/dl. I never meant to say 4.0000 % A1C.

“I hate with a passion going low. I’d much rather correct a high BG instead with a correction of insulin.”

I am the opposite. Here is my reasoning: Let’s say that I would like to stay in the range of 70-140. If I leave this range on the upside and correct with insulin then it takes about one hour to get back into range because there is no fast-acting insulin. If I leave this range on the downside and I correct with one glucose tablet then it takes about 5 minutes to get back into range. I prefer to be back in range in 5 minutes versus 1 hour.

I am still on shots. I have gathered enough courage to ask for a pump. I hope my insurance will pay for it.

Danny, what made you change?

I second exactly what Danny has said. I also am a dual-waver Danny has a wonderful thread on this.

I can’t wait to join the dual-wavers. This morning I did a manual dual-wave. I injected like normal when I got out of bed and then another 5 units just before I ate breakfast. The line on my CGM was so straight that I could not tell from it that I ate. I am not sure whether this qualifies as dual-wave. Ideally I want to tell a pump: Here comes my bagel, you know what you need to do: dual wave, triple wave, quadruple wave. The CGM should measure my body’s response to a bagel and perfectly offset it with spaced little doses of insulin. This is 101 filter theory. Not difficult to do.

In an ideal world that would work, but with the CGM being delayed, and the delay in rapid insulins, any “feedback” based system would be painfully slow to correct or adjust any BG levels… or even titrate an extended bolus based on BG response.

I really like my CGM and appreciate the info it gives me, but there are many times where I feel like I’m almost expected to be able to predict the future.

Sarah, I was not thinking of feedback at all. Rather a “Learn from your mistakes and do better next time kind of approach”. The pump should be able to learn how to best deal with a bagel. Is the insulin needed 5 minutes before or 5 minutes after the first bite? Would it be better to use half the amount 5 minutes before and the other half 5 minutes after the first bite. Should the amount be split into 3 or 4 doses. This requires simple postmortem analysis. I expect to see this in a product within the next 5 years.

I would not even dream of a A1C of 4 or there abouts …27 years living with diabetes( age 69 ) and being higher probably saved me numerous times from not going off to Emerge .I am clear I am a TRUE 1