A1c1 levels

I am a t2 diabetic with my a1c1 at 9.3 have tried everything to get it down. My doctor yells at me because its not coming down. As my weight has gone up as well. I am also on an insulin pump and take a shot at night. He tells me i eat way to much food. So i keep a diary of my sugars and what i eat. Im only allowed 60 charbs total for every meal. when i went to him he saw i eat a tortilla half sausage an one egg for breakfast with black cofee. Told me im eating to much. I dont eat anything with sugar in it, read everything to make sure of that. I dont have any kinds of breads at all. mostly veggies and meat. Yet no wieght loss but my boulus is 6.75 of insulin. how can i get my ac1 down please and in the good? When my sugar is below 200 i vomit all day and have a headache. Am very frustrated been fighting this for years on this pump well 2 going on me.some advice would be nice thank you

With a pump the theory is that you take the amount of insulin based on the amount of food. If your blood sugar is elevated, it would seem that you are not getting enough insulin and have to adjust the balance of carbs to insulin. If breakfast is a tortilla (15-20G, and it's helpful to read the label and know exactly how many carbs it is...), sausage (maybe a couple, I'm not really, sure) and eggs isn't a lot but it needs to be balanced.

The same thing goes for basal insulin, the hourly "trickle", if your BG is high before you eat, maybe there's not quite enough of that.

If the doctor didn't explain those parts of using your pump to you, you may want to shop around and see about finding a new doc? I am never a fan of docs who yell at people.

I'd say though that becky seems to know what she's doing foodwise as the tortilla/ egg/ sausage combo would likely be less than the doc rx'ed so, even if the #s aren't there, that part of the plan is a step in a good direction. I am totally conservative about what I eat as I have very similar food most days during the week. That way it makes it somewhat easier to figure out "is this insulin too much, not enough or, as Goldilocks said, 'just right'?"

I haven't heard of vomiting all day from being low, I thought that was generally associated with highs so maybe there's some other problem. I would try to find another doc though, get a second opinion and maybe as was in another thread recently, spend the time to interview the docs to see if you can find one with a beside manner that is more pleasant, or more pleasant than the description here.

Oh, my gosh your endo sounds awful!

My advice is cut the carbs--60g per meal is way too much. Diabetes isn't about how much food you eat, it's about how many carbs you eat and how to balance them with the fat and protein in your diet. Your body doesn't need 60g of carbs per meal.

I recommend a new endo and a dietician--preferably a CDE rather than some moron with a degree.

As far as blood sugars under 200 are concerned, you need to lower your BG slowly--like everyone else said. It'll help keep your symptoms under control and keep you from feeling too awful.

To quote Helen, you're doing your best with very poor assistance.

this pump is giving me 6.75 every hour no matter what sugar is if i eat or not. that therein is my issue with my docotr i dont think i need so much ty for the advice

Ive done some many of there diets that ived starved myself as i am now. I dont eat a lot an do eat healthy. thank you

the60 charbs count my drink condiments and every thing i eat. i dont eat that many carbs most are very low. but i have to add everything in drink.ketchup everything ty

I was there too and canned the endo.

I dropped my diet to 1200 calories, ,low glycemic and restricted grains , rice breads and flour. That was not enough. Then I working with Doctor adjusted the meformin doses and timing and the combination of the metformin, diet - 1200 calories and upping the exercise did finally drop the numbers from 13.3 down to 6.4.

If your liver is leaking excess glucose it can be extreme challenge to arrest numbers down. STandard metformin is a bet here at least worked miracles for me.

I also had been on the glimperide pills and some 75/25 humalog insulin.

Canned the dam glimperide pills and ilk, switched to humalog lispro - 4 hour

insulin and finally had mess running reasonably. Long lasting pills like glimperide et all and 12 hour insulin are a right pain in butt under which you have to eat sufficient to prevent lows.

It can be extreme challenge to get numbers down from a1c in the higher 10's and up. It can take 2 years fighting to get er down.

Also eating to your meter checking 2 hours after a meal will help give feedback about what you are eating and quantity!

Becky, the problem is your insulin dosage and use of the pump. And I agree the problem is your doctor is an idiot. You say "this pump gives me 6.75 an hour regardless of what I eat". The pump gives you what YOU set it to give you. YOU need to be in charge of your insulin management, not your doctor and not a machine. The pump is a wonderful device but only as good as how it is programmed. BY YOU. I encourage to read Using Insulin and Pumping Insulin by John Walsh. You can (and should) program your basal insulin (the hourly) to different amounts for different times of day and for the amounts that will keep your blood sugar in range. Then you need to figure out your I:C (insulin to carb) ratio and take the right amount of insulin bolus for the food you are going to eat. As well as the hourly basal rate you need to bolus before meals. Please, read the books and get another doctor, one who won't yell at you but will work with you. I'm glad you're here. People on here are great and can help.

I think the vomiting and headache is caused by lowering your blood sugar too fast. My wife had the same trouble at first. We lowered her blood sugar slowly over the course of three months, so that her body could get used to normal blood sugars.

It doesn't sound like you are eating too much, to me. But it sounds like you aren't eating the correct balance of foods for your condition. When you get the balance correct, things will be better.

My wife was able to get A1C down to 4.5%. She eats 15g of carb at each meal, She only eats two meals a day. Each meal includes five ounces of protein and 5 tablespoons of butter/coconut oil. The bulk of the meal is vegetables. (You can see here diet here.)

You said you don't eat bread, but you mentioned the tortilla. A tortilla is just a flat bread and makes no significant difference when it comes to blood sugar control. Once that tortilla breaks down in your intestines, it's turned into sugar. All starch becomes sugar in the bloodstream. It's just a matter of how fast it gets to the bloodstream.

If you're gaining weight then it's a pretty clear sign, in my opinion, that you don't need so much carbs in your diet. 60 carbs per meal is very high -- more than I eat in a day (and I'm not diabetic).

I'd recommend cutting out all the grains. No tortilla for breakfast. Eat a whole sausage ( ot half) and two eggs, along with some low-carb vegetables cooked in butter. Eat the same breakfast every day until you can fine-tune the meal bolous dose so that your blood sugar is the same before and 2 hour after the meal.

How many meals (big or small) do you eat a day? What kind of vegetables are you eating? Do you eat tubers (potatoes, yams)? How much protein do you eat per day?

In addition to an insulin to carb ratio, my wife and I have found that you do need a insulin to food volume ratio. The more the intestines expand the higher the blood sugar will be irregardless of what she eats (whether it contains sugar or not).

For every ounce of meat (or eggs or cheese) my wife eats she requires a 1/2 unit of Regular. For every 4 ounces of even low-carb vegetables she needs another unit of Regular.

One of the reasons she discontinued using her pump was because it didn't account for these other factors.

It's very easy to find out how much you need per hour -- just don't eat anything for a day. Just drink water. If you can't fast a whole day, then skip different meals each week until you figure out your basal needs for that time of day.

If your blood sugar goes lower than your target while fasting you know you need less insulin. If it goes higher than your target then you know you need more insulin.

It's really not a matter of opinion, it's a matter of testing.

I suspect you are correct and your basal dose is too high. It's likely covering glucose that wasn't covered by your meal bolus.

Second everything Zoe said. Another book that will help you get a handle on what YOU must to to achieve good control is

Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)

My heart goes out to you. You've really been struggling. And you have your doctor doing the "blame game" with you and nobody has given you good advice and guidance. So I really feel for you. But I am going to be frank with you. I'm going to tell you stuff you won't like and you may initially reject what I say and call me names. But perhaps, over time, what I say will help you.

First, the only person that can save you is yourself. You have diabetes, it will never ever go away and the only person that can keep you healthy is yourself. And unfortunately, some of that is going to involve hard choices and personal compromise. This becomes more than your personal immediate feelings of hunger or desire, this is about your life, your daughter and your husband. If you get your priorities straight, you can do anything.

That being said, much of what you have been told by the medical profession may just be plain wrong. The diets, total baloney. The idea that you can just inject huge amounts of insulin and it will be ok, again baloney.

First, your diet. As a a T2 already on insulin, then 60 grams of carbs per meal is just totally inappropriate. Whoever told you that should be slapped upside their head. You need to go on a very low carb diet. At least until you regain control of things and probably after that. I recommend the steak and salad approach. I am a real fan of Dr. Bernstein and his diet as discussed in Diabetes Solution. You should not be eating 60g of carbs per meal, you should be eating more like 5-10g of carbs per meal. This isn't about counting ketchup, it is basic choices. Your meals should be primarily fat, protein and 5-10% carbs. Your carbs should be from broccoli and other veggies. You have no need for bread, rice, potatoes or pasta and nothing with flour. They should have no part of your diet.

Second, you need to move markedly towards normal blood sugars. If you have high blood sugars you have set yourself up for weight gain and insulin resistance. It is no surprise you have gained weight with the high blood sugars and taking so much insulin. You need to establish increasingly aggressive targets. Don't whine about your hypo symptoms, they will go away. Set yourself a target, first 200 mg/dl 2 hours after eating. And "correct" if you are not at target. Then when you reach that target, set a more aggressive target. Whether it is 150 mg/dl or 175 mg/dl, set a goal to progress towards. Move towards a target that is really a normal blood sugar, you deserve it. And understand that constantly running high blood sugars and injecting large doses of insulin make you insulin resistant and leads you to gain weight. Test your blood sugar, use 10-12 strips a day and correct anytime you need correction.

Have faith. You may feel hypo lowering your blood sugar. But those feelings will go away. You may feel you are being denied foods. But I know from experience, you can eat wonderfully on low carb (lobster tail here I come). You just need to understand what can lead you on a path to better health and make your own choices to go there. No doctor can give you a non-diabetic pill, but you can choose to lead a life with your diabetes under control and lead a long, healthy and happy life.

I think we need to be careful of telling people, "you need to do exactly this" or "you must do this", especially when it comes to food. There are people on here that eat Bernstein low carb, people that eat standard American carb load, and everywhere in between. And there are people that do well on various levels. I don't know about Becky, but if someone told me to go from eating 60 carbs a meal to 5 and to never eat certain foods, I'd probably rebel. I would certainly be overwhelmed.

Having said that, very low carb has been a godsend for many people on this board. I myself eat medium low (between 40-80 a day) and do well with that. But we are all different, and we all must find our own path, especially with something as personal as diet.There are many more factors that don't fit into a standard formula of "this is what you must eat" whether it's 60 carbs or 5. Some of those factors include weight, personal preferences, religious and cultural facters, family situations,cooking abilities or interests,and dietary preferences and restrictions such as eating disorders, allergies, vegetarianism, etc. What I suggest, Becky is to "eat to your meter". What that means is when you eat something and bolus according to your I:C ratio, see how you do two hours later. If your BG is almost always high you may find you can't eat that particular meal or can't eat it in that serving size.

But I feel before you are able to experiment and fine-tune your diet, you need to learn the basics of insulin dosing. I absolutely agree that the whole "eat what you want and bolus for it" is a miserable failure for most of us. But you can't determine if a food works with your usual I:C until you clarify what that I:C is! From Becky's description I'm not clear she's taking mealtime insulin at all. Which makes "eat to your meter" kind of a moot point right now.

Thank you Zoe, I "assumed" that she had gone beyond simply doing a basal, but that was perhaps a leap. And I agree that Becky should eat to her meter. But I do think she has been deceived that she can just eat 60 g of carbs per meal. It isn't working out so great. Maybe she can move to eat higher numbers of carbs once she is under control, but blaming her when she has been given such blatantly bad advice is shameful. Despite that, she should be working to set blood sugar control targets and using her pump to work towards those goals.

Thank you and no i dont take comments harshly. For i know they are from the heart of someone trying to help me. I am new to this and have a lot to learn still about being t2. When they told me i was diabetic all they did , was give me insulin and send me home. When they put me on the pump they set the basal amount rate. Then told me 60 carbs and add what i eat for the bolus. Never told me what to really do. As i am new and still learning it is over whelming.But I know now there is a lot of help out there for me to learn. I have set my BG rates for morning fasting and rest of the day. Am learning what to eat and count carbs. Finally have an endocronologist to co to. Spelled that wrong. Thank you

great work Becky. Keep marching. This problem is a work in progress and you are taking the right steps, effort, learning and website contact to assist your good efforts Congratulations and good luck with your health. Finding the right technical help that is compatible to your situation and needs is most critical.

It took me 26 years to get back on right track and arrest mess. There is nothing easy about this problem and far too little helpful data from folks one would expect to be fully knowledgeable.

Becky, I truly think you need to find a dr. that is more caring to your needs. Maybe you can say what area you live in and people can suggest a dr. in your area that they like.

yes i agree i have to find and figure out what works for me. No one is the same so i learn by trial and error.. But I know with the help of God i will get there. No its not easy but the person i am would have it no other way. I'm not one to just lay down and let it win. This is my body and i refuse to let this get the best of me.