Nel,
Tools can make a difference. Before I got my CGM I thought it was impossible to avoid 200+. Now it is normal for me to stay below 160. My bg control was about the same for 25 years. Then it changed.
I’m also a dual-waver! Before I went onto the pump tho’ - and on MDI (poor mans pump ) - I would give small amounts of insulin over a period for the carbs I was eating. Again, like the pump with the dual-wave, it stopped any spiking of BG’s.
I met a 75 year old last week who is on 4 needles a day (I can’t recall the rapid insulin he used, but he used Levemir for his basal). His A1C (and Nel knows about him - she missed seeing him at the IDF congress in Montreal which is too bad as he had amazing stories to tell). Well, he had an incredible 5.1%. He doesn’t use a CGMS, just tests his BG’s frequently.
Helmut - I try to stay within 4.0 - 6.5 mmol/l - I feel in my HaPpY ZoNe there ! I wouldn’t mind giving the CGMS a try again. If the Dexcom ever makes it to Canada (got to play around with it at the congress last week) - I’d really like to try it. Or as a NZ doctor told me who has Type 1 diabetes, he comes to the States to see an American doctor. Picks up his pump supplies (he was wearing an Omnipod / Dexcom) , etc. and takes them back to NZ, as they are like us, don’t have all the bells 'n whistles the USA. I might try that as I’m only an hours drive away from New York state, but not sure how my private insurance from work would react to that, something I’ll have to look into…
Helmut , I am sort of a bionic woman …MM pump ,CGM tools …NO diabetes related effects, that my Health Team and I am aware off , other than a bit slow in the brain area ( I think ) …I try my best and will continue . Never visited the Emerge because of LO , neither HI …are n’t we all different with this disease ? …regardles I love reading and learning about/from Champions such as you , Anna, Danny and others.
An interesting discussion !.
I almost made it. My last A1C was 5.0.
Thanks.
What is this dual wave bolus technique you are all talking about? Do you bolus before you eat but do a 50/50 split for all meals? I use the dual wave for pizza and some other foods but not for all meals.
at 5.8% I get a few mild lows imagine at 4% it would need a strict bernstein approach.
Wonderful! So, please do share how you achieved this.
For me, an A1c in the 4’s would be absurd. I see where some T1’s achieve this through strict diet and a bit of exercise. I couldn’t live a life that restricted. I’m healthy, happy and eat a ton of carbs when I exercise - through a carefully regimented plan. But you can’t go climb a mountain, run a race, kayak a river, load a truckload of hay, build a child’s swing set, mow a huge lawn, or a zillion other things on less than 200 grams of carbs per day. So for some, and me in particular, and A1c in the 6’s is A-OK.
BTW- I eat 150 grams of carbs in the first two hours of a good exercise session - cycling. Mmmmmmm!
I would be surprised if there were more than one or two true Type 1s who can consistently manage to stay in the 4s. Mid-fives would be incredible if you can swing it without a lot of lows. My niece is usually in low to mid sixes. She can get to the high fives if she uses cgms. I’m sure she could go lower if I lowered her night time target or she did not artificially raise her BS throughout the day so it hits 100. But we aim for safety first. Question: Why do you not feel the low or mid fives to be an acceptable range? I think an A1c consistently in the 5s is awesome.
My A1C was about 5.8% before I got the dex. This was not an easy achievement. I pricked my fingers about 12 times a day and still had many highs and lows.
Then came the dex. I repeat what my friend Danny said: "Adding a cgm (Dexcom) was a real diabetic game changer in my A1c world. "
Being able to see what my BG does all the time made my life so much easier. All the anxiety about what the next BG test will reveal is gone. I prick my fingers only twice a day for calibration which is very nice. My A1C is better with less effort.
My low A1C is a side effect of my primary goal: Having my BG stay in the range of 70-120 mg/dl all the time.
I still refuse to use the miracle weapon: low carb. A quick calculation shows that on my moderate carb diet I have no chance of staying in my BG target range without corrections. My correction factor is 40. I use about 30 units for bolus. This means that my food intake pushes my BG up by 1200 mg/dl per day and insulin needs to bring it down by 1200 mg/dl within 20 mg/dl. There is no way that I can count carbs and control my daily activity with that precision. Corrections must be part of the plan.
Highs I correct with Apidra with an onset of 30 minutes and a duration of 4 hours.
Lows I correct with OJ with an onset of 5 minutes and a duration of 30 minutes.
My strategy is to tilt the odds of exiting my target range towards the low end. This allows me to correct with fast-acting OJ instead of slow-acting insulin.
I’ve been able to keep A1c’s in the mid to high 5’s for years on MDI with no complications. I have no clue how I did it! I’m with Joe, I can’t live without carbs and have eaten them all my life. I’m hoping between my CGM and my new pump I can get it down to low 5 without the lows but if I have to give up carbs to reach 4- forget it. It’s just a number. How you feel, avoiding complications and enjoying life is more important. There’s nothing like a freshly baked slice of whole wheat bread and I’m not about to give that up! 
When I was in the mid-5s, I was having frequent lows. I suspect my A1c is now in the low 6s and I’m OK with that. I’d rather have the higher bgs than suffer serious lows even more often.
The pump is a convince and the only 1 factor not attainable by MDI is the square wave bolus (bolus over time). Additionally, scar tissue and IR from site build up can be a major issue with a pump. Ive been on one for 10 years now, myself.
Hats off to you Mommy! That is some amazing routine and discipline youve got there.
I think ultra tight control is all very dependent on lifestyle and your environment. My numbers sit around 90mg/dl with PP of 90-120. Im T1, eat 30-35 carbs a day, am on a pump, test 10-12 times a day with CGMS, work in an office 9-10 hours a day, eat out for lunch daily, and my Wii is my gym. It just goes to show YDMV. Granted my control has only been this good for about 4 months now.
There are many ways it can be done, its just finding the way you can adapt to.
Totally agreed. Without the Dex there is a whole lot of spikes I might have missed. When I started eating low carb my body started to really break down proteins into glucose more than Id ever seen before. The Dex keep me abreast of the trends so I was able to catch this phenomena 90% of time and correct for it. Really I think the Dex has got to be one of the best additions to D care since insulin.
For those of you that would rather treat lows (quickly) than highs (less so,) are you still aware…no hypo unawareness? I have a fair amount of lows trying to keep my averages good but I worry that any day I will all of a sudden not feel the low coming on. Is the GCM the only way to achieve such a phenomenal A1c?
Although I use a CGMS and I find it is invaluable, I think with a strict enough diet, and exercise regiment coupled with the law of small numbers, you can achieve uber tight control. The theory is less carbs make for less glucose. Less glucose requires less insulin and smaller doses. Those smaller doses lead to smaller mistakes and thus smaller fluctuations, less lows, etc.
So, if your average is 100 mg/dl and your only dosing .5u at a time, even an over shot of .5u should only drop you 15 points or so with a 1:30 insuline to BG ratio. It does take a pretty darn strict eating regiment though. I attempt to practice this theory, but my fluctuations are closer to 30± with an avg of 90mg/dl.
I think the T1s in the 4s have residual beta cells reducing their blood glucose variation.
Oooh! Love “Uber!” I keep forgetting that word… (smile.)
I agree, the law of small #'s is the best way to keep things under control, but I fail at living it most of the time. It seems that it would be a struggle for me to control the lows if I was hovering in the 70’s a lot. I don’t really feel the lows until I am in the 60’s and if I am distracted, I can ignore them until I start sweating in the 40’s or 50’s.
Thanks for the reply.
Dex does not really change my niece’s A1cs by much, but her numbers are better overall. We did get to the high fives a few times. But never could stay there. I do, however, artificially bump her up to 100; do not let her hang out in the 70s and 80s if she is not about to eat; also artificially bump her up to 120 or 130 when I go to bed; Sis does the same thing. So those two factors may explain why we can’t stay in the 5s. Now hanging out in the 4s most of the time, would that be possible without going low carb? I do believe you can achieve A1cs in the 4s as an adult if you have a very low carb diet. Amazes me that a Type 1 could consistently keep their A1cs in the 4s, even with Dexcom, without a lot of lows with a normal diet. Also wonder what the point would be, since an A1c in the mid-fives is in the nondiabetic range.