Looking at his CGM results, his average BG is about 155. That is still a lower A1c than one would expect.
walkingonthemoon - In a live video presentation here last week, Gary Scheiner recommended exercise after meals and cutting meal-time insulin by 1/3 instead of cutting basals. I've tried it just once and it worked as he claimed. I walk for exercise so it may not compare favorably with more intense exercise activities.
I've used temp basal reductions for exercise and have had mixed results. Scheiner's meal insulin cut actually eliminates a lot more insulin than a temp basal reduction. That appeals to me, if it works consistently.
Agreed. I don't dispute that.
The question is, do we have to attribute the disparity to some type of pathology or bad A1c measurement?
I don't think so because of a couple of reasons.
1) The BG average generated from the CGM is an approximation of his true average. We can only estimate our own true average BGs from meter data and/or CGM data. There is enough inherent error around both of those type of measurements to rule out pathology.
2) Again, the correlation between A1c and Average BG, itself, is inaccurate and imprecise on a case by case basis. On the whole, to generate the correlation you need a large sample of both A1c and average BG. Our own individual chances of falling exactly on that line of correlation is small.
So, does he need to tighten up his control? No doubt.
Does he need to resolve this apparent discrepancy between his average BG and A1c? Probably not.
FHS/Terry,
I adjusted my basal setting last evening and changes are paying off so far.
Here is the summary of my basal adjustment:
Prior Settings:
12AM-6AM: 0.65
6AM- 12AM: 0.95
Adjustment:
12AM-4AM: 0.75
4-7AM: 0.85
7Am-12AM: 0.95
Since Midnight, my readings were between 80 to 150. When I woke up it was 104 around 6 and stayed 104 when I took my breakfast at 8AM.
I checked my reading at 10 and it was 95.
I think it is working..though i need to monitor and adjustment for a week or two. I will keep you guys posted.
Lastly, this discussion changed my opinion on basal and bolus in a single day. Feeling more positive now
Appreciate your help guys. :)
Good for you, walkingonthemoon! I hope your success continues. What works, works!
Fantastic! Glad we could help and definitely keep us posted!
thank you so much, FHS. the advice and suggestions people provide on this site is...'priceless'. seriously, just so grateful for all T1's who participate on this site. it's so very heplful! :)
Agreed Sarah! We are blessed to be part of this community. :)
FHS and Terry, after making adjustments to my basal settings for more than 18 days , here are the hourly statistics, glucose distribution ,and daily trends for June 6-23.
Any advise would be appreciated if it helps making my reading more consistent. :)
Did we lose the previous CGM attachments or did I just imagine that you had posted them before?
Probably should have asked before but how reliable are your CGM data? How often do you check your CGM against your meter, just when you calibrate after inserting a new sensor, or more often?
I calibrate Dexcom CGM with every other meal/ 8-10 hrs. So far, it is pretty close to meter reading (range between +/- 10). I'm posting my previous attachments (before the adjustments date i-e June 5).
Are you able to see above attachments?
857-GlucoseDistribution5272014652014.pdf (236 KB) 858-hourlystats5272014652014.pdf (118 KB) 859-GlucoseTrend5272014652014.pdf (69.7 KB)Yes, I'm experiencing the same issue with the morning readings, so I tested every couple of hours throughout the night and found a four-hour block where my BG begin to increase. I've since increased my basal rate for that four-hour block and it has helped reduce the spike. My morning readings are either on target or slightly above now and I can live with that. Best wishes!