A1c

Hello everyone.I started on the pod in July 2009…and my a1c has actually gone up…It is now 7.8…from 7.6.My Dr.actually ask me if I am being truthful with all my b.s. numbers…On a high note,my cholesterol was great…my weight is stable…etc…but.I am feeling so dissappointed right now…I expected my a1c to reflect how much better I have been feeling…and it has gotten worse…Has any else ever experienced this?

Patti, I completely understand the disappointment but remember that the A1C is not a complete picture of your control. It is very possible that your blood sugar is now undergoing less variation which is both very healthy and a positive thing. If you’ve managed to cut down on your low blood sugars but are still sometimes seeing highs (I often find these as post-meal spikes!) then you’ll feel better but your A1C will go up a little. I know that waiting three months to see what’s happening again is a pain but I wouldn’t overly worry about one A1C rise. I will say that if you’re looking to make a difference in your A1C I would suggest a continuous glucose monitor. My Omnipod didn’t make much difference to my A1C but I’ve dropped almost a whole percentage point (6.8-ish to around 5.9) after a few months on my Dexcom. The most important thing is to never let one lab test tell you how your feeling and to take the number and figure out what to do to make it better next time. Good luck with this!

Patti,

Some people refer to bg variability as the ‘quality’ of the A1C. In other words, diabetics with the same A1C but lower bg variability end up with less complications.

http://www.mendosa.com/minimal_variability.pdf

It is more likely than not that you have lowered your risk of complications by switching to the pump even that your A1C is about the same. I echo Rebecca’s recommendation to get a CGM. The CGM is a game changer. I value the CGM higher than the pump. You will be amazed how easy it is to improve your bg control once you are able to ‘see’.

Even without getting a CGM you can help yourself a great deal by testing BG more often and at varying times (ie, don’t test at the same times every day). When my HbA1c dropped to 6.2 (from 7.0+ before OmniPod), I attributed that to the increased testing I was doing as much as to the better basal control.
Use the BG reminder feature (I always set a reminder to test 1.5-2 hours after EVERY bolus), force yourself to test at unusual times (even in the middle of the night), etc. After a while, you will probably see the times/situations where your BG is higher than you think; then you and your Dr. can make adjustments to compensate for that.
And above all, remember that diabetes management (with a pump or without) is a journey, not a destination. It is a continual process as you learn, as technology progresses, and as you body changes (yes, our bodies change how they react to food and homones like insulin!).
Don’t be discouraged; it’s a journey.

I want to thank you all for your replies…It makes me feel like someone really understands what I am going thru…and Eric, I love your words about this being a journey not just a destination…Thanks again to all of you…Patti

I remember that my A1c didn’t budge or went up slightly during my first years on the pump, but control was still somehow easier. My biggest “mistake” was that I was much more lax about how I was eating (how much and how often) after starting the pump. I don’t know if you can say the same.

The best advice I’ve ever received about my A1c though is that the highest numbers in your day are the ones at 1 hour post-meal and therefore are the ones that skew the average higher. By bolusing my insulin 20 minutes before I start eating and by monitoring my post-meal numbers and trying to keep them below 140 as much as possible (without going low later), I watched my A1c plummet into a healthier, tighter range. I’m in the 5’s now, but it took me nearly a decade as a pumper before anyone clued me in on those little tidbits.

Eric - Would you mind teaching me how to set the BG reminder for 1.5 hours after EVERY bolus? I’m just not very tech savvy and I must admit that my CDE set up my PDM for me :-/ Thanks in advance.

My doctor’s still send me to the lab to get bloodwork done every three months for the A1C. Even the instant one costs a bit so I’m surprised your insurance covers it without a minimum of 2 months in between. I wish I could get my doctors to do the instant, I hate the vampires in the lab (they’re actually not bad, I just don’t like needles, which I realize is absurd for a diabetic). I don’t know about the accuracy though, I’d be interested to hear more about the instant A1C test.

You have to first set up the PDM to offer the reminders to you. Assuming the “new” PDM:
From the Home screen, select Settings > System setup > Alerts/reminders. Turn on the “BG reminder” option (first one at the top).
Now, whenever you bolus it will ask you if you want to set a BG reminder; select Yes and tell it what time. The PDM will do it’s beep-beep-beep, beep-beep-beep at that time and keep doing it every couple of minutes until you acknowledge it. It’s very annoying, but that’s what makes it useful :slight_smile:

Patti…I am sorry you are feeling discouraged. I guess I should be too but for some reason I am, like Eric, looking at it as a long learning curve…I feel like I will get there…especially with all the help and support here. Part of me feels as though I know what I need to do (lower carb intake and test more,) and until I get there I will not see the A1c I had hoped for. Mine did not go up, but it didn’t go down as I had hoped. For me, like others, the ease of the Opod has me eating more of what gets me in trouble. I think that we can eat whatever we want to some degree but that it takes a lot of skill, awareness and discipline to control our #'s. We all can do it. Being on this site and being on the Pod are huge first steps. Good luck to you.

Thanks so much!! I will try that this evening…maybe even ‘old dogs’ like me can learn a new trick…:slight_smile: :slight_smile:

Patti -
I understand how you can feel disappointed as my first few A1C’s after starting the OmniPod were higher also. My CDE told me that people with good control (anything <7%) often don’t see a big difference until they have been on the pump for a while. If you feel better and your cholesterol is good as well as your weight, I would ignore your Dr’s comment about “being truthful with your b.s. numbers”. He obviously is not a diabetic person, nor a very compassionate Dr. IMHO. Give the OmniPod some more time and keep up the good work.

Already I’ve learned that one (1) single oatmeal raisin cookie has a far bigger impact on my bg than I previously thought. Note to self - must watch portion control and find a more healthy snack. :-/

While my A1c went down dramatically once I started on the OmniPod (my first pump), I did want to pass along a piece of information I got from my CDE. She says that a big key to lower A1cs is to make sure that you go to bed with a good BG and that it stays that way all night. Since eight hours is a third of your day, simply having controlled BG while sleeping has a big impact.

I read you reply and the word “Married” jumped out. I’m willing to wager that it’s the change in life style that changed your insulin, eating and exercise patterns. As much as I love my OmniPod and I understand that some people like to think tubed pumps lead to better control there is no reason why either of them will give better or worse control. They are just little machines that do our beckon call. We alone are responsible for out results.

Andy

That’s excellent advice, Janet. This is something else that the BG Reminder feature can help a lot with - the last time you bolus for the evening/night, just set a BG reminder to go off at your usual bed time. Those reminders are hard to ignore :slight_smile: