Super bowl or bust! Little uncomfortable with my defense though… Good luck with everything!
If you readily recognize your lows, I would discuss lowering the target BG that your bolus wizard aims for at least throughout the daytime to early evening hours. You'll have a hard time getting your A1c down if your target BG is 110 or just over 6 in mmol/l. David does have some hypo's some nights following intense hockey practices, but he is inconsistent. At times he will be high in the evening following practice. Their is no set pattern, consequently we just always do one overnight BG check.
My sister had a simalar situation. I was diagnosed as a type 1 and have always been treated with insulin but she was diagnosed as a type 2 and likes to say that she has been on every medication for diabetes lol. She has had good luck with Apidra in her pump and has lowered her a1c. Just remember that the lower your a1c the greater risk of low blood sugars. I hope this is helpful.
All I can add is that I switched to Humulog which improved my control..Novolog actually starts a peak at 52 min and Humulog starts at 75min. This worked better for me because my digestive tract slowed down since becoming T1. My 2hrs post was always above 200 but then 3hrs it would drop..When I switched, my 2hrs are around 130-140 and I don't drop out at 3hrs..Not sure if this is an option for you but it worked for me..
Hi Doug H!
Something similar happens to me. It's frustrating... My doctor suggested me the read of another patient's blog that is in the same situation as we are. He even takes pictures of what he eats. It's kind of a diary. It is nice to know that you're not alone with all this.
If you want to take a look the address is http://controllingtheuncontrollable.wordpress.com. This may not help you to lower your A1C levels, but looking at how others cope with these situation could give you options.
Tx for the info. Checked out the other guys photo blog and noticed that he routinely takes a dual wave bolus to deal with his food intake. Maybe he is on to something since it seems to work well for him.
Interesting! I've been on pump for 15 years and haven't used Dual Bolus but maybe once for an extended meal. Maybe I'll give it a try! Thx.
My A1c didn't go down when I started on the pump either. It took much longer and detailed logging to figure it out. The two things that helped me the most:
(1) LOGGING - writing down EVERYTHING. I hate doing this. So I don't do it all the time, but I will choose about one week every two months where I write down everything (all carb counts with food weights, blood sugars, activity). My endo carefully reviews this (and my less detailed logs) and helps me adjust things correctly. It is much easier to identify patterns when you know all the details
(2) Early bolusing. I find that I need about 25 minutes for the "fast acting insulins" to begin to lower my blood sugar (this varies for each person). So I need to pre-bolus and wait about 10-15 minutes to eat. I do this whenever possible, but only when I have complete control over when I eat and I set an alarm after the bolus to make sure that I don't forget to eat, as that can lead to dangerous lows.
It took me YEARS of trying to get under 7 and I thought it was impossible (for me). But I finally got there and haven't gone back. I am by no means a model or disciplined diabetic, but I still manage. Don't give up. You can get there!
Interesting that I had the exact opposite experience. I switched to NovoRapid (same as Novolog) and found that it worked a bit faster than Humalog. They say that the experience can vary a lot from person to person.
Thanks Kristin. I hate writing things down as well. BUT … If it helps I will do it in detail. I have a one pager from my CDE that i have used in the past. Do you use paper or electronic app for logging?
With pre-bolusing, what rules of thumb do you follow (type of food, amount of carbs, BG before meal, etc)? I do this only when I am running high before I eat, but I like the idea.
My A1c was high until reduced my carb intake to no more than 40 carbs per meal. If my BS is above 120 I take my bolus and wait 30 mins before eating. For me it's like a race and I have to give my insulin a head start before takeing in carbs or my A1C & BS will lose the race. I am eating the same number of carbs just spreading them out over the day. The toast I normally eat for breakfast is consumed as a snack in the afternoon.
I do it all on paper because that is what my endo prefers. I use the log book from Medtronic. I get it free with my pump supplies or from my endo.
Click here for more details about how I do this from an old discussion on the topic. There are other replies in the discussion that may be helpful. Note that my endo and many others say this is dangerous because of the risk of BAD lows. I find it to be the only thing that works for me though. I am just saying proceed with caution and check often when you start doing this.
I do it for any meal except very high fat meals like pizza.
How did you figure out 40 carbs per meal was the magic number? Trial and error? Same thing with the bolus timing? Was documenting everything for a week or longer at a time an important part of your success?
most doctors that I have talked to say 40-50.
I have had similar problems getting my a1C down, and I am an avid gym exerciser. I found that I would have spikes after weight lifting, so I started playing with injecting .5-1 unit before exercise, and then doing my w/o off pump. Might be counter intuitive but I haven't been going low . Also, I changed my duration time to 3 hours instead of 4, upped my basals a few at a time, till I hit lows then backed off. I also dropped my carbs to around 22 a day, went grain free, and I am hoping to get out of the A1C 8s.. Though my pump still tells me my average is 178, since after eating, when I have radical spikes, it takes me a long time to bring them down. I log everything, everyday and have been adjusting my insulin settings myself, since working with my DE was just frustrating us both. I used to eat 30 grms of carb per meal as was recommended to me, I feel a lot better now on as few as possible.
Hey Doug,
I am in the same boat with you, although I did manage to get it down to 7.7 an then it rebounded to 8.4 which was a kick in the pants.
One thing we did try which seems to work is my doctor moved me to an insulin called Apidra. Not sure who makes and it is more expensive, however with it I have been able to hit my target range of 80 to 120. I am working on getting the range down to 110.
The other thing I found too, and like one of your other posts, I HATE to write things down. This weekend I made a bet with my wife that it would have no affect on me what so ever. Let me tell you, not only did I eat less (I am 6'1" and in fairly decent shape), but I watched what I wrote down and the carbs and sometimes actually thought twice about the "snack" I was going to have and opted for something that would be better for me.
If you find the magic bullet to this I would love to myself. I struggle with my travel and keeping things under control I would love to get my A1C lower.
Hi Doug,
I'm also on Minimed pump, also couldn't do the CGM because of the harpoon needles. Anyways, what stuck out for me on your post was all your cardio workouts. Now, I might be the only T1 on the planet where heavy cardio makes my blood sugars soar. My endo told me it was the 'marathoner's syndrome' where your body ends up working on overdrive thus secreting excess glucose, and my basal not high enough to compensate, so when i did bolus, I actually ended up gaining weight from exercising! I told my trainer, and we switched my program to a strength conditioning routine, heavier weights, less reps, using the prowler, short sprints, squats, things like that and my body and sugars responded fabulously! And I enjoyed that workout much more. Sugars dropped and stayed within range. I leaned and toned up better than before. So was just thinking if that would be something you'd want to try 1-2 times a week, less cardio and more weights? who knows, may work may not, but always nice to get different suggestions.
Good luck and keep us posted if something works!
Thanks for the ideas.
I do use the medtronic CGM despite its accuracy issues and harpoon insetion needle. Today for example I was feeling funky 3 hours after breakfast. CGM read 92, finger stick told me 60. Was not doing exercise at the time.
I also enjoy weight training, but had to lay off for awhile due to back issue. Doing better in that area, so plan on getting to it again 2 x per week. Funny, my weight workouts sometimes raise my BG (when i lift heaver) and sometimes drop it (circuits with little/no rest between sets). Will see the effect on my BGs and weight when I get back to it.
One thing I have started to test based on other feedback is reducing the amount of carbs I eat per meal to 30 - 40g and waiting to eat after I bolus based on my starting BG. May be on to some thing here. Will keep you posted.
Endurance exercise raises blood sugar, Resistance exercise lowers it. I am in the gym four days a week, two on hour cardio sessions and two half hour cirucit resistance session. When I lift weights, by bg drops like a stone. My endo had me go on 50% temp basal for the weight lifting sessions and it works beautifully. However, the opposite is true for cardio. If I reduce basal during endurance exercise, my blood sugar soars. With my endo's consent, I now do a half hour of cardio, take a 26 gram carb snack and then complete the second half hour of cardio with no problems at all. I researched this online and it seems clear that endurance exercise is very likely to raise bg.
Hi Doug. I have a few suggestions that may help. This is a very admirable and difficult goal, good luck.
First, consider lowering your daily carb intake. Less carbs means less insulin and less room for error (hypos or hypers).
Second, what is your upper limit on your CGM? I started using the MM CGM about a year ago and slowly walked my upper limit down in many steps from 180 to 135 where it is currently. An upper limit of 135 can be annoying because it beeps at me quite a bit, but I think it has GREATLY improved my control. I now know when my BG is drifting high or when my PP BG spike hits and when it is larger than expected. I do not go as high and I do not spend as much time high. IMHO you are only using a CGM 1/2 as effectively unless you have an agressive upper limit.
Try to keep things the same (or similar) that affect your BG. I usually keep quite good BGs during the work schedule because I wake up at the same time, eat the same breakfast and eat the same lunch. This is boring as all get out and reminds me of the R/NPH era, but it works. There are far less variables at play.
Work hard to get your overnight basals set just right. Overnight (8 hours sleep) is 1/3 of your day (and your A1C results). Getting a pump that has helped me fight my DP has greatly helped my A1Cs.
Lastly, download and review your carelink data very often (maybe daily). If you see you are running high here or after this meal, then make a change and monitor it for 2-3 days. I would recomend that you start off with small changes of one tick up or down, because theses can have bigger impacts on your trending and BGs then you may expect. Being proactive and adjusting my basal/bolus levels frequently is another big reason I think my A1C is currently 6.0. If you have questions on how to do any of this I can provide some suggestions.
Good luck. These stradegies take some time, but if you have the drive you are very likely to succede.