I have been on the pump for about 2 ½ years now. I love the pump and I am doing MUCH better than before the pump. I just can’t seem to get my HBA1C down any lower. It has been running about 7.7 and I just went to the Endocrinologist today and really thought it would be down and it went up to 7.9 I test all the time and rarely go above 200 anymore, just seems like it should be lower. Doctor says all my settings and numbers look good. Anyone else feel this way? I’m not really looking for an answer, just venting.
Hi Colorado! I had a similar experience my first three years on the pump. I finally got my A1c down by bolusing early (15-20 minutes before eating). It turned out that I was high for 2 hours after eating and that was causing my A1c to be so high. You should try bolusing and measure your blood sugar every 5 minutes. When it’s dropped by more than 10 points, then you should start eating (assuming that you do not take Symlin and that you do not have problems with delayed stomach emptying). This method improved my blood sugars a lot. I use humalog, which is “fast acting” but it takes about 25 minutes to start working for me.
Here are some discussions about that:
Discussion 1
Discussion 2
Another possibility is that the A1c is just not the most accurate. I have read reports that some people will ALWAYS have a high A1c compared to others with the same blood sugar control.
Kristin, thanks for the advice, I think I will try that, I tend to check right before I sit down to eat and bolus then, I will try testing earlier and bolusing about 15-20 minutes before.
Yes, it’s frustrating!
I agree with Kristen, bolusing 10-20 minutes before you eat can help. I’ve also found that testing 1 and 2 hours after meals to determine when your peak occurs (depends on you, and what you ate in terms of type of food and quantity) is really revealing.
If you’re going as high as 180 mg/dl at your peak (ADA recommends a person with diabetes be under 180 mg/dl at his or her after-meal peak; AACE recommends under 140 mg/dl), it’s really difficult to get under 7% A1C. I’ve found that if I nail under 140 mg/dl at peak, I drop too low in the 2 hours after that. Symlin is one med that can help this kind of problem, but I haven’t started it yet.
Also, ask you doctor if you should consider switching to a different rapid-acting insulin. Each person reacts a bit differently to each rapid-acting product. Let us know how it goes!
I’ve had the same problem for 5 years. I tried Symlin once for 4 months without any improvements in the A1C. I know that the comments by others about dosing earlier before you eat are key to making an improvement. It’s just so hard to figure out the timing. I have a meeting with a CDE and a nutritionist again next week and will just keep working on it. My meter average is always about 40 mg/dL below the value that corresponds with my A1C. Undetected spikes after meals must be to blame. I even wore the CGMS for 6 months 2 years ago, but honestly at that time it didn’t help me understand where the peaks were. It should have, but it didn’t. I guess it was just too inaccurate, or else I just couldn’t see the pattern. It is frustrating, I know. Last week was my worst A1C ever: 8.2. Big red flag for me. I might try the Symlin and/or CGMS again…technology changes so much from year to year!
Check out this discussion about early bolusing. There might be some tips that help!