I just got a Dexcom seven last year and have been trying to lower my a1c which has risen from 7 to 7.5. Well I just ordered an upgrade for the seven plus and I want to be able to lower my a1c with this. With the arrows and other new features, I am wondering what can I do specifically with the seven plus to help me lower my a1c? My next endo appointment is in a couple of weeks. I am pumping with a omnipod.
Hi, Erika.
The most valuable thing for me, with my Dexcom, is using it to spot trends. For example, I’ve been fighting some morning phenomenon the last few weeks. When I go to bed, my bg is 95 - perfect. When I woke up, it would be 150, which is higher than I’d like to be on waking/fasting.
So, every few days, I download the data from my Dexcom. What I look at first is the Modal Day chart, and I use the dropdowns at the top to only show me the last week worth of data. Then, I look for trends. I can see that my blood sugar begins to rise at 3am, so - on my pump - I increase my basal rate at 3am. Wait a few more days. See that I’m stable until about 5am, when another lift occurs, so I program in another basal boost at 5. And so on. Over the course of the last few weeks, I’ve brought my waking bg down from 150 to 100 by reviewing the charts and making small, incremental changes to my basal program.
Since your next endo appointment is coming up soon, I’d make sure you’re using the Dexcom continuously, and bring the data in for your doctor. I download everything to my laptop, and then I just bring my laptop to my doctor appointments, but if you don’t have that kind of portability, print out your charts and bring them.
If you’re not tremendously comfortable reading the Dexcom data and making adjustments to your basal rates, lean on your doctor for that. She or he should be able to look over your Dexcom charts and make recommendations for immediate changes to your basal rates, and help you formulate a plan for making further incremental changes to fine tune your pumping. Take charge of your appointment. Walk in and say “Here’s my Dexcom data, I’m unhappy with my a1c, let’s review this and make adjustments.”
My best suggestion is to be willing to deal with lots of alarms and set your “normal range” to pretty narrow. I find if my “normal” range is set to 80-140 I’ll often see sugars of 150 or 160 before I worry. When I drop the “high” value down to 120 then I get worried if my sugars get to 140. It is a trade off between how often you can stand to have to adjust and have it alarming at you (when it’s set to 120 it goes off EVERY meal!) but I do find that if it’s alarming I take action where as if it’s not I’ll be happy with higher sugars.
I also second Andrews comments about watching trends and adjusting basals. The way the Dexcom receiver is set up you HAVE to download it to get any useful information to base changes off of. If you’re not downloading at least once a week chances are you’re not making the best use of it. I’ve found that the reason my A1C’s were in the low 7’s throughout college when I didn’t do nearly enough testing and ran high a lot was because I only need about 1/3 as much insulin during the night as I thought. I’ve had the 7+ since September and we’re still working on lowing my nighttime basals, they started at 1.2 units and are down to about .85 (at the lowest) but I’m still having night lows. This information is even more pertinent to my safety than spotting the highs.
Good luck with your 7+, I love mine (well, we have a love hate relationship really) and now that I have it I can’t imagine living without it. I hope you see a significant improvement over the 7 and that you successfully reach your A1C goals!
Erika,
A good way to lower your A1C is by setting a goal. Not an A1C goal, but a highest bg goal. Your goal could be to spend as little time as possible above 160. Set your alarm to 160 and when the alarm goes off instantly analyze what went wrong. Did you bolus too late, bolus too little or was the amount of carbs too high? Come up with a plan on how to avoid the same mistake the next time. Track your progress with the DexCom software. I especially like the Glucose Distribution graph. This should be sufficient to push your A1C below 7.
I skyrocket after meals unless I take my insulin about 20 minutes before hand. Even with today’s “fast acting” insulins it does still take some time for them to get into our system. Again, with the 7+ you’ll probably be able to see when the food starts hitting and when the insulin starts hitting (after a little experimentation) and adjust to meet your needs.
I’m not sure what to tell you then. Perhaps you need a different insulin to carb ratio. Most of the one’s I’ve heard on here wouldn’t work for me at all. My doctor finally set me up for 1 unit to 5 grams of carbs for most of the day but at dinner I’m 1:3. This results in some huge looking boluses but keeps my sugars inline. I hope when your 7+ comes, with the help of your doctor, that you can get everything back to where you want it.
Where is it 2 and 4 hours after the meal? There are certain foods (breakfast cereal with 2% milk) that will boost my bg at the 1 hour point, but then I’m back to a reasonable number at 2 hours, and back to normal at 4. For instance, before eating the cereal, my bg might be 100. At 1 hour, it’ll be 200. At 2 hours, it will have dropped to 140, and then be back down to 100 at the 4 hour mark.
Are you keeping a food/carb/insulin/bg journal?
hi my name is roy i see you have the omnipod how do you like it im getting it now does it work good for you thank you roy
Roy, I’ve got an Omnipod and love it. Check out the Omnipod Users forum (http://www.tudiabetes.org/group/omnipodusers?xg_source=activity) for more info!
You can’t make a quick response to an unexpected rising trend which you didn’t see. So, if I were you, I’d set the high alarm at 140 max. Maybe even as low as 120. This low figure doesn’t mean that you have to take more insulin, it’s only to remind you to take a look- and if the rise isn’t “too strong”, you will often choose to leave it alone. But if it’s showing an unexpectedly sharp increase, then you’re catching it sooner. Now, with that said, Here’s a couple of ideas which I have about “can’t get the timing right” problems:
First: you’re using extended bolus now, and you’ve apparently tried pre-bolus (as Rebecca discussed in her post of January 8, 2010 at 6:47am), but have you used both together? Pre-bolusing helps with early spiking, in the range of 30-90 minutes, by bringing on insulin action sooner. But extended bolus helps more with avoiding later “crash then rise” problems, where the insulin is all done and gone but you’re still digesting and creating bG. For many people, in the area of 2-5 hours, depending on how much fat was in the meal. (YMMV of course).
Extended Bolus, by injecting half of the insulin more than 15 minutes “late”, is making your first hour spike worse. You might try both techniques together-- extended bolus for smooth response, but starting earlier so that you’ve got plenty of insulin action when that early peak hits.
Now my other idea. Andrew sort of touched on this on (his post of January 8, 2010 at 8:27am), but I’ll going to describe it differently. The Glycemic Index of the foods you’re eating is possibly responsible for a big part of your unexpected post-meal readings (both high and low). Andrew described a meal of cereal plus 2% milk, most cereals have a very high Glycemic Index. (They come on very fast.) His use of 2% milk, rather than the skim milk I always drink, is a bit of a moderating influence, because fat slows things down. But his example is a really good one: A carb-dense, high-GI cereal, like raisin bran, is going to cause a spike just like the one he’s describing if you eat a full serving (approx 40 grams) all at once. It’s utterly impossible to handle decently without:
(a) shoot in a bigger dose of insulin, which prevents the extreme peak but absolutely requires a “back-fill” snack at about +90 minutes to avoid crashing later; or
(b) using the same insulin dose but eating the “meal” as two separate events: one half of the cereal with the shot, spiking only to 150 mg/dL, and the other half after you’ve fallen to less than 120 mg/dL. (This is really the same “solution” as alternative “a”, but avoids adding all that extra insulin and food.) Or, as I do,
© change the meal. Instead of a High GI, carb-heavy meal which comes on too fast, and then also disappears too fast,
switch to a meal which matches the insulin timing a lot better: Maybe half as much cereal and milk, plus a scrambled eggs with Salsa? Leave out one of the yolks, if your LDL makes that necessary-- but be sure to start with the eggs. In a hurry? Grab a handful of mixed nuts. But 40 grams of breakfast cereal, including “healthy ones” like low-fat granola, or Grape-Nuts cereal, is simply impossible for me… even with today’s relatively “fast” insulin analogs.
Maybe I’m privileged in having a too-long history of matching up food to “R” and “NPH” (which often seemed to be an acronym for “Not Particulary Helpful”). Before the Analogs were invented, we all had to “graze” our way through the day, because “R” was the fastest thing we had. But If timing is a problem for you now, bringing that tactic back into your battle plan might be a great idea.
BTW, if you’re looking to improve from a figure of 7.5, that’s going to be pretty easy: Unless your lab is quite far from “typical” calibration values, that corresponds to an average bG of nearly 190 mg/dL. So don’t cuss yourself about the 140s, or 150s, or even the 160s: A level of 7.5 occurs because of long or frequent periods above 200 mg/dL. (Or, of course, somewhat less frequent and lengthy periods at even higher values.) Fix those treatment errors, and the value will fall nicely. :)))
I no longer pay much attention to the A1C measurement taken at the office. Having kept an eye on my monitor, I can always predict the value (within about 0.2%) before the test is even done. It’s totally uninformative. They still need their blood-letting, though, because they’ve got to have an A1C test result to put into my Medical Record (sigh).
Hey, Rick - I feel much the same way as you about the A1c; that my Dexcom success report is a much better metric of how much time I spend within my targets.
As for high glycemic index foods and prebolusing: My experience has been that I can no longer drink 2% (or skim, for that matter) milk in the morning; nor can I eat breakfast cereals that don’t have a pretty high fiber content. Some of the Fiber Ones work well, as does a high fiber / pecan cereal sold at Costco, and the Wheaties high protein. Instead of milk, I usually have it with soy or almond milk - these tend to be higher in protein, higher in fiber, and lower in carbs than real milk.
I still find that I have to pre-bolus in the mornings, though. My routine is I check my bg as soon as the alarm goes off, and then administer a bolus to cover my breakfast. Then I get out of bed, let the dogs out, put on the coffee, and brush my teeth. It actually does manage to kill about 20-30 minutes, which is the right amount of lead time that I need in order for the pre-bolus to take effect.
Erika, I want to stress this point one more time - are you keeping a food/carb/bg/insulin journal? If you’re trying to troubleshoot a problem, nothing is going to be more valuable to you and your endoc than this data.
Sorry to hear that you lost a Pod. This may have been the cause of your problem: Skin Prep must be absolutely, TOTALLY dry before you attach an appliance. Don’t just “wait a while”, you really need to use a hair dryer. If you don’t see tiny cracks in the film, then it isn’t dry enough.
But it’s also possible that the Pod adhesive is a lot different from that used in other products, in which case you’ve already done the best possible thing: skin-prep protects your skin from the Sticky Stuff, while Sticky Stuff helps the Pod stay tight by adhering to both Pod Adhesive and Skin-Prep. A++ for you!
Now, I’m going to give you a little poke: you’ve had your high alarm set at 200 in the past, and that’s led to an average bG of about 190. If you set it at 180 for the next 3 months, then I would not expect to see an average bG much better than 170 in your next A1C. I don’t like that number, not at all. How about setting it at 160?
If it frustrates you too much with NAGGING alarms all day and all night, it takes only a few clicks to move it up to 180 and “out of the way” for a few hours. And then move it back. I’ve had a few nights like that, where DW or I decide that “we’ve had enough!!!” and we take a break until morning.
Great post, BTW.
My breakfast now, if I wake up over 100, is full fat plain yogurt and a sliding scale of whole grain Trader Joes O’s (up to 1/3 cup of O’s). I cannot tolerate anything with a high glycemic index in the morning.
Im following this thread too and wondering what sort of journal do you keep - do you have a successful way of recording all this data ? I typically use a note book and find it to be difficul to go back through and make sesnse out of .
Here is a log sheet that I got from my CDE. It is one page per day, so it is lots of paper. Because of that, I initially didn’t like it, but now I am used to it. What I do like is there is plenty of room to record everything. I used to have an Excel spreadsheet with one row per day with columns for Breakfast, Lunch, Dinner and Snack. I had to write so small and abreviate that sometimes I couldn’t figure out what I had eaten.
Now I copy the sheet duplex to cut down on the number of pages, and use one for Sunday alone. That way I can staple an entire week together.
I like to have as much information in one place as possible, so when I download my data from my OmniPod PDM into CoPilot, I edit the carb data to document what I ate. There is no good report of carb data from CoPilot. The only report that has it is the Diary List report which has everything on it. Even using the Data Filter functionality doesn’t let me filter out pump insulin data, so I found a work around. I export the data to a tab delimited file that Excel can read. I wrote a Visual Basic program to only show carb data and delete unwanted columns. That gives me a clean report to bring to my CDE and Nutritionist.
I saw that you are using a Minimed pump. I don’t know what kind of software you have available to you to download either from the pump or from your meter, so my method might not work.
6820-GENERICPATIENTDAILYLOG.xls (26.5 KB)
Erika, it’s interesting that this Thread became active again. I have another suggestion, very simple: Reduce your “high alarm” again. Exactly like before, when you had your alarm at 200 and an overall A1C which you didn’t like, the alarm needs to catch more of your “out-of-range” time.
You’ve gained 1/3 of a point with the “160” value. I’d now drop it to “140”. With each alarm, you should think “OK, why did that happen?”. Patterns will emerge, and you should be able to improve even more. You just need the buzzer, or the vibrating pocket, to tell you – WHILE IT’S HAPPENING. For many people, looking at reports and log books days or weeks later is more difficult.
Erika, does your high bG usually occur as an “moderately high, all-day-long” thing, or is it more of set of “totally whacked, over 300 mg/dL” events disrupting otherwise-decent values? (Different problems, different solutions.)
Another question: In long-term reports, does there seem to a “monthly cycle” in your bG readings? You might need to create different basal profiles for different parts of the month.
Rick, I have long wondered whether alarm settings are a self-fulfilling prophecy. My mean BG is exactly in the middle between my high alarm and my low alarm. I wonder whether this is true for other people too.
My mean BG is not in the middle of my alarms, but my high alarm is set for 120. It alarms nearly every time I eat BUT I know when it goes off and it’s often there for a while… I wish I could set it to 130 but that’s not an option, 140 is to high (I’ll let my sugars sit at 135 if it’s there, 120 makes me correct it to a reasonable place. (right now my average is about 115 to 120).
Not mine. Low alarm 90, high alarm 140, so I’d be living with an A1C right around 5.4 if I could “fulfill the prophecy” in this way. My average is much closer to my high alarm value.
:((
Too bad. I thought that I had found an easy way to lower A1C.