My only suggestion is that you might try pre-bolusing a few extra minutes. This might enable you to avoid as large a bolus and still not spike above120-130. I’ve employed this strategy and have managed to stay at a 5.3 A1c, although I do have the occaisional hypo if my timing is off. For some reason my pre-bolus time for breakfast is around 45 minutes and reduces to about 30 minutes for lunch and dinner. You are doing great already but it might be worth a try. Good luck! Mike.
No but since I had a 90 microalbumin he put me on a low dose amount of ramipril. 6 months later my microalbumin went down to 10. He said in a few more months he will probably take me off of it.
I think we should keep in mind that T1 is a permanent condition.
Do you always want to eat that way? What if your tire blows on the highway and you have planned to eat at home? Yes, you have your snacks but unplanned physical activity like changing a tire will need a lot more fuel. The worst case would be an accident. Now you are sitting there unconscious with a lot of insulin still active in your body. Do you think your helpers will realize that?
Another thing is the high level of stress. You are dancing on a small rope and this can be exhausting. We see many people with depression here because diabetes is a permanent condition. In a way a burnout with neglecting your diabetes is more dangerous than having an A1c around 6%. In my view the risk of complications start slowly beginning with an A1c of 5.5%. Up to the 6% range this still looks good. Thus I would recommend a more balanced approach that can be integrated more easily into our lifes.
That all said I still applaud you to your A1c. If you are able to achieve that without being in the honeymoon phase then I am truly impressed.
My doctor gets on me when my A1c is this low as well, and it is super frustrating because I think I am doing well! XD
That said, I agree with some of what others have said that taking an amount of insulin that will consistently make you go low doesn’t seem like the greatest idea in terms of flexible life style and future insulin resistance!
What type of insulin are you on? Maybe a different kind would work better for you. For example, if you are on Humalog or Novalog, try Apidra. Apidra’s quicker timing and short duration works wonders for me.
Have you thought about researching Symlin to avoid spikes? It does not work well for me personally, but I’ve read from a few here that it really helps keep their post meal spikes down. On the other hand, maybe it is not the best if you are trying to gain weight? I don’t know much about that, but you might look into it if the idea of another injection doesn’t bother you.
The tire blowing is a good example! I had a flat and had to deal with it one day and it threw my plan out of whack. I don’t necessarily think that it’s impossible to do a lower A1C but at some point, you run into diminishing returns for pure A1C numbers and have to look at other things, like Standar Deviation or time to engage in hobbies or whatever that you might be able to make a whole bunch of gains in from your investment of time in fiddling with things, even a small amount.
We do this when we are at home and she is not going out, but only because the spikes are in the 250 at one hour and 200 at two hours. Basically if she is 180 to 200 two hours postprandially, she will come down to a normal blood sugar in 3.5 hours when the insulin stops working for her. We use a lower ICR, only go down by one. This method allows her to be at no more than 200 and often less one hour postprandially and no more than160 or often less at the 1.5 to 2 hour mark. I doubt if I would think postprandials are a problem if she hit 160 at the one hour and then went down to normal. Of course, this would never happen. It’s either spike and down to normal by the 3.5 hour mark or less of a spike and fill in with carbs at the two hour mark. Both our endo and any diabetes educator we have ever talked to do not agree with this and sternly advise us against it. We do it because this is the only way to get decent postprandials. Prebolusing does not have a great effect for her. We can’t do this at school or if she is not home.
I personally recommend trying to bolus even a few more minutes before eating, so that you can bolus a bit less and not have to rely on snacking later. You said you always wait 20 minutes between a bolus and eating…have you tried going to 25 or 30 minutes?
It’s not always possible for me to do this, but as often as I can I try to bolus 25 minutes in advance (30 if I needed a small correction as well). I have a 5.6% A1c.
I too am running up against an endo who feels that my control is ‘too tight’. He recommended changes about a week ago at my appointment, to my basal settings. They are laughable and I will not use them. If I used his recommendations I’d cut out all lows, but I’d be around 150 ALL the time. I think sometimes doctors don’t get it. If they don’t personally live with it, it’s hard to understand…
You do exactly what we do. Endo totally against it. Yes, have to be very careful as even a small amount of extra insulin can cause lows. I do not think it is irresponsible to adjust the ICR down by one increment. We do have to “fill-in” the carbs at the two hour mark but not stuffing her face, we just do the math and add just enough carbs to bring her to the level we want her to be in hour 2. We know the pattern of how she will drop, what number her BS needs to be two hours post so she does not hypo when the insulin is gone at 3.5 hours. We usually will have to give anywhere from five to 15 grams extra, and we usually use fruit to bring BS up. Not unhealthy at all, IMO. I set alarms and/or the timer so I don’t forget.
I cannot prebolus with Apidra. That is because she will go into the 50s while her food is digesting. Have seen it with cgms many times. Afraid that with Apidra and superbolus she may go low during the first hour. Apidra starts working quickly. Endo has told us, and for quite a few Type 1s who are diagnosed as children, spikes are higher than for adults. What their goal is 200 at the one hour mark, 150 or 160 at the two hour mark. Overbolusing, she will still spike briefly 180 to 200, then if at hour 2 she is 90, we give carbs to bring to 150, insulin is peaking strongly and shortly thereafter she will be at a normal BS. While away from home insulin has to run its course, unfortunately. She will come down to target by three hours. Not wearing the cgms often these days so superbolus seems risky. P.S. Of course it is not desirable. It is often unavoidable. Few children do not spike at some point into the 200s postprandially and many go much higher. Insulin does not match the digestion of food. Period.
I always hear “super bolus” and think of flames and skulls and other comic book imagery but I have played around w/ killing my basal more on days after I run and bumping up a meal bolus a couple clicks while doing that seems to help keep things smooth for me. I am not sure how it goes dealing with a school though as I think many schools have issues with people controlling their own situation, particularly kids, even smart kids. Which is kind of sad if that’s part of the problem.
Did she spike like this on other insulin, or just Apidra? Apidra does not work well for everyone. My son had really unpredictable results with it and went back to Novolog. I would suggest the Super Bolus also and maybe try to get some more low glycemic foods into her meals to help prevent the spiking. I don’t know how old your daughter is, and most parents seem to want to not eliminate any foods from kids diets, but sometimes things like just switching out one cereal for another helps a whole lot. My daughter used to spike a bit with cereal and milk. I read on a board that soy milk helps with that, tried it and she has been using that ever since. There are still some foods that we steer clear of because they spike her. She wears the Dex 24/7, and a spike for her is 160, which is her high setting. I would like to change it to 140, but don’t want it that low at night or she would likely get a lot of alarms right now because her thyroid is causing problems and meds being adjusted for that.