For everyone who is on levemir and rapid pens

How do you keep your blood sugar in a good range? And is it possible to have a great A1C without having to be on a pump?

Yes, it is very possible to have very good control without using a pump. What do you consider to be “good control”? What A1c or BG range do you consider “good”? How does that A1c or BG range differ from what you have now?

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Think of the pump as basically an electronic, permanently attached syringe. It is convenient and easy to administer your insulin because you just push a button. You can achieve the same outcome with a pen, provided you carry your pen with you at all times (as well as your meter if you are not using a CGM). I’ve been using pens and my A1C is steady in the low fives. I keep track of everything that crosses my lips, and at what time I took my most recent shot and how many units (I write it down on a white board in my kitchen or in my notes on my phone when I am on the go). I believe the single most important factor in staying in your target range is finding a routine that becomes second nature. For some this is the pump, for me pens and taking notes works very well.

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I haven’t had my A1C checked for maybe more than a year now. I keep putting it off because I want to bring it down for a while first. The last time I had it done it was around 7.4.
I used to think that a good bg range was from 120-180, but I’ve been seeing a lot of people list their sugars as being in a constant range from about 90-120/130. I wouldn’t know how to have that tight a control.
My bg has been worse the last year for some reason. I seem to have gone down hill but am thinking of trying the low-carb diet. Its going to be hard :slight_smile:

I highly recommend getting your A1c checked every 3 months, every 4 at most. There are many ways to improve your A1c, which also means improving your BG range. IMO, the best book out there is Think Like a Pancreas by Gary Scheiner.

A good place to start is to make sure you are pre-bolusing and waiting enough time before you begin eating.

Additionally, I suspect you will need some dosage adjustments. Most people, including myself, believe making sure your basal rate is set correctly is the place to start.

Then you need to critically evaluate all the other things: ICF or ISF (Insulin Correction or Sensitivity Factor), I:C ratio (Insulin to Carb ratio) based on the time of day.

If I were you, I’d get Think Like a Pancreas, start at the beginning, and follow Gary’s instructions. I did this, and my daughter’s A1c has never been higher than about 6.8, and is usually in the low- to mid-5’s. It takes a lot of hard work in addition to knowledge; I make minute adjustments in my daughter’s basal rate multiple times every day and night in my efforts to keep her BGs in range.

As far as BG range is concerned, my goal is to keep my daughter’s BGs between 66 and 138. I correct anything over 95. Does this mean her BG never goes higher than 138? No way, not by a longshot! But I keep trying to get as close as I can to that range.

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Thank you! :slight_smile:

This is really key to tight control, the corrective actions. It’s also where being on pens takes more effort as compared to a pump: you might have to correct during the night on occasions which means getting up, testing and taking a shot. In this regard, a pump and cgm are very much more convenient because a) another person can do it for you (if you are so lucky!), and b) you don’t have to get out of bed. It depends on your routines, for myself, getting up during the night is something I do anyways.

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It’s doable. It takes a certain mindset, and I wouldn’t beat myself up about not achieving it–since I haven’t achieved it, I don’t. I do aim for 6.0-6.5, and I’ve been there consistently for many years, both on MDI and a pump. I do think you want to get down from that 7.4 if at all possible, and yes a pump would maybe help but more than anything it’s the carbs. For all that they say “you can eat anything if you bolus for it,” that’s just such a hard target because it isn’t just taking the right bolus for whatever you’re eating, but getting the timing right so that bolus comes on at the same time the carbs are knocking up your BG and it’s a bit like hitting a bullet with another bullet in mid flight. It’s just really hard not to end up on the old T1 roller coaster, and ultimately that gets reflected in your A1Cs. I’ve had this conversation with my endo many times, because conventional medical wisdom is still resistant to avoiding carbs as much as many of us do, but as I’ve told her, “I know I can, but it’s just so much simpler if I don’t.”

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Yes that’s a great analogy! It feels exactly like that. I tried not eating carbs for a few hours today and tonight, and everything went so much smoother. I can’t even count the times when I’ve brought stress on myself and others around me from just loving my carbs a little too much. Like having rapid shots too close together because I wanted something “now”, or having something I don’t know the carb amount of and guessing wrong. Then even when I do count and space my shots properly, my body seems to keep changing its mind as to how many carbs per unit I need… I was so hoping to find an easier way than the low carb thing but I’m guessing this LCHF diet gets easier with time? The more I think (and read here) about how much trouble I will save myself by cutting the carbs way down, the more motivated I’m getting to really do this. Thank you!

It unfortunately takes more work than just cutting down (or even out) carbs. Your BGs will continue to be all over the place until you are taking the right dose of basal and you dial in the correct ISF and I:C ratios. This usually involves a decent chunk of time at the beginning, but think of it as an investment in your health. The ongoing necessary tweaks are much easier once you do the more difficult ground work of basal testing, etc. Good luck! It isn’t easy, but YOU CAN DO IT! (If you felt motivated enough to come to TuD for advice and support, then I know you have what it takes for the next step!)

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Certainly it is doable.
The ‘magic’ formula is different for each person and you have to find what works for you.

For me it is a combo of learning exactly how your diabetes behaves, getting correct basal and bolus rates worked out, frequent enough testing to catch anything going awry, using diet (for me this is VLC and intermittent fasting) to minimise the amount of insulin needed and swings, and a bit of good luck (but I reckon luck is in good part having learned to recognise patterns). I target an ideal range of 70 - 100. I do corrections if I am over 100. But because I don’t swing too much (mostly), corrections are usually small. I am due for another Hba1c soon… but the last was 5.0, so I am pretty happy.

When I get it right, I can almost imagine I don’t have diabetes… when I get it wrong, I am reminded that I surely do have. :slight_smile:

And sometimes even when you do everything right, it still comes out wrong, and it’s not your fault or due to lack of trying!

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The levemir is a little tricky sometimes. Today I could have 23 units of levemir and it might be just right. Then tomorrow I have the same amount, and suddenly my body decides that’s way too much. I’ll try my best :slight_smile:

Thats exactly the point, your basal requirements change and we need to be up to date with all of that and make adjustments accordingly!
Just for the record, i switched back to MDI after 10 yrs of pumping and my A1C has practically stayed the same, was 6.6 at last checkup. Totally doable!
Good luck :four_leaf_clover:

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good news :slight_smile:

I am sorry for your difficulty I hope things turn around for you in the best possibile way.

I have been a type 1 for 42 years and consistently have a1c’s in the low 6’s high 5’s. It was not always that way; I once had an A1C of over 12. So how did I change? First, after 28 years I went to a pump. The pump was not something I longed for, actually a few high school kids talked me into it.

Today however, I am a big fan of the pump and it has helped me greatly, especially when paired with a CGM. I do believe it is possible to do this very thing using MDI, it was just not possible for me to do it. I have no illusion about the many issues associated with using a pump. i also have no illusion about the advantages of using MDI. I really liked it. but, how is the best way to lower your A1C? I have no idea. I do know using a pump was my best way.

If I can answer any questions please be sure and ask. but most important, stick with it, regardless of the method.

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If you’re type 1, then insurance might cover a Dexcom CGM - continuous glucose monitor. This will give you 'round the clock glucose measurements so you can see how you are trending – and therefore how to respond earlier to your body. For example, if your glucose is 120 and trending upward, then you probably need to bolus more short acting insulin sooner than later. If it’s 90 and dropping, then you might need a little glucose soon. Ask your diabetic educator if they can help you get a demo unit for a few weeks to try.

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Thank you :sunny:

I would very much love to have a CGM. I think it would make my life much, much easier.
I’m not covered for one but am thinking and hoping there must be some way to make that happen. I’m on disability and am going to start asking around a lot. There might be a loop-hole…

It’s doable for some people.I have seen estimates based on pump data, suggesting that about half of all T1s have basal insulin requirements that vary considerably (by as much as 2-fold or more) depending on time of day. If you are one of the lucky 50% with fairly flat basal requirements, you can manage these using one or two daily shots of long acting insulin analogs. If you fall into the unlucky 50% you can’t. However much Lantus/Levemir,you take it will always be too much or too little at certain times of the day.

Since too little basal can be pretty disastrous, the tendency will always be to go a bit higher. If you now aim for tight control you will be at risk of basal-insulin induced hypos at the time(s) of day when your requirements are low. I suspect that it is this experience that tends to drive the idea within many in the medical profession that you cannot achieve a really low HbA1c without being at serious risk of severe hypos.

In my last years of MDI, my HbA1c was actually lower than it has been on a pump. However, I was hypo pretty well every day late afternoon and overnight and several hours of BGs in the 3’s or lower will do wonders for your HbA1c.

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