Is there added benefit to getting A1c lower once it's already < 7%?

Excellent point!!! I am an MDI T1. Once I eliminated carbs my standard deviations plummeted. I can cruise at 60 (right time of day) for hours and subjectively feel a LOT better under 100.

Not suggesting I have an answer for you - just sharing. I am MDI without a CGM. It wan't until I started testing 10 times a day (alternate site)and charting the data in Excel that I was able to begin the experiments to get control. Found two things going on. I pretty routinely was experience gluconeogenesis which meant my Lantus wasn't fully active for the full 24 hours. Split dose into twice daily. Numbers were still extremely variable until I went on a fat fast (no carbs) while testing 8-10 times a day. BG numbers went totally flat so I was able to calculate new ISF and I:C ratios. After that I got under 7 for the first time in 42 years. Last 4 were 6.0, 6.4, 6.0, 6.6, (I also TAG.)

Dave I guess my main problem (I agree with your comments about treatment lagtimes) is being patient. As people here have been subjected to many times recently, my hypo-scared new Endo changed all my settings and I was 280 at 3:00 am, I corrected and reached 385 at 7:00 am. That never used to happen. I can't wait to change my pump stings (all of them basals, I:C, ISF) to where I had painstakingly tweaked them. After all, I am the one who has to live with any impacts (not just the major complications) of overly high bg's. I have a right to do the best for me that I can and to have the best labs as I can. I'll step down off my soapbox now.

Artwoman, why don't you change them back now ? Is there some compelling reason to keep them at a level you are not comfortable with ? Luckily my endo wouldn't know what buttons to push to change my pump settings and I have them all stored on my computer anyway.

The doc's normal recommendation of 6 to 6.4 is a nice sound level without the complications from both ends of the spectrum of highs and the lows. And isn't as dangerous as pushing for skirting along hypo territory when trying to get a "normal" persons 5 to 5.4 range (under exceptions they can get below that but a "normal" persons A1c is in the lower to mid 5's). So having us skirt fractionally above that is a nice safe place. Any lower and you are skirting hypo levels all the time which is again compound damage. Add a spanner in the works, be that someone tweaking a recipe, the weather, or stress and exercise and you are doing serious damage through a hypo. There is a reason the A1c charts put the "safe" green band from 6 to 6.4 and it's not just for colour coding them.

I second Clare's question! The thought of anyone, especially someone in a white lab coat, changing my pump settings hits an emotional hot-button for me. In general, I see that idea as patronizing, condescending, and ignorant.

Now I know my view is not representative of all PWDs, but how can a doctor that sees someone for 15 minutes, 4 times per year, think that they're doing their patient any good with that? Shouldn't every physician's goal be enabling more and more informed independence on the part of their patients?

In fact, I think it would be great if all endos were required to spend 100 hours interacting with a computer model simulator that allowed them to input food, insulin, and exercise and the computer responded with a BG line. It would be even more fun giving this assignment to dietitians! Oh, to be a fly on the wall for that... In fact, I think a great by-product of that exercise would come a newly found respect for what we do 24/7/365. Never a moment, minute, day, or week off!

I'm glad you appreciate my point about BG variability, beechbeard. Cruising sideways, under a 100, for multiple hours feels great, both physically and emotionally. I think the we PWDs, as a group, forget what this simple metabolically normal state feels like.

You must have your MDI routine dialed-in well. Congrats on that.

Wow! You were above 7% A1c for 42 years and then implemented a system that brought your A1c down to the low 6% range. You'd think that modern medicine practitioners would be all over this and trying to replicate it with their other patients.

It's more likely that they'd dismiss your story as anecdotal! Nothing to see here folks, move along. ;-)

I find it very depressing that those who are supposed to help us achieve better health & well being turn around & discourage us from trying to achieve the optimum levels. Pre- pump my A1Cs were between 7.0 & 9.0, since going on the pump in 2007 I've been between 5.7 & 6.3, took me 6 months to get there. Now I'm told that as I'm getting older, 71 now, 6.3 is too low & I should be nearer 7.0! Why? I've never been to the ER with low blood sugars, very very rarely (like once a year) am I confused enough to need help correcting a low BG. Then the eye doctor tells me to keep my A1C low to stop any more retinopathy, which I've done, still no sign of anything in the right eye & I aim to keep it that way.

I just find it insulting that I am now too old to want good health. Sorry my soapbox.

I mostly agree with you, Nyadach, with a small exception. Docs need to concede that reducing BG variability permits lower A1c's without increasing hypoglycemia. This fact doesn't often occur to doctors.

Off-topic:

Add a spanner in the works...

I love the diversity of the English language. I take it "spanner" on your side of the pond is equivalent to "wrench" on ours!

I feel like the odd type 1 who's had particularly good a1cs since I started having them taken. Granted, I was not given one at diagnosis, so I have NO idea what that would be. My highest was obtained by starvation however , once I was put on insulin I've been 6%, 5.5%, and my most recent is 5.7% . I'm aware I'm not the norm , but I'm sure there's other people out there like me. I eat what I want (though I eat very healthy) , I rarely go too high or too low unless I mess up on an insulin dose or get too active (that'll make me low fast) , and I use MDI (I hated the pump) . I've never had an ER trip over blood sugar either way since diagnosis (though had close calls on the pump) and have never had hypoglycemia that required assistance. I consider myself super lucky. If I stay this way for the rest of my life, I will have no complaints and I hopefully will avoid complications. I'm happiest around 5.5-6.5% I'd suspect.

It is hard though, I still get frustrated, I still have bad days , it's not an exact science ever. Just never beat yourself up for your a1c and try everything you can to feel good and healthy. If it means having a higher a1c than 7%, then do it?

LOL!

I actually took my data and what I call my Diabetes dashboard into a new doctor (cardiologist) and blew him and the office staff away. "You really do this?"

Second surprise was an echocardiogram showing ZERO cardio disease. I asked him if I should have an annual checkup. His response was don't bother you won the genetic lottery. Apparently he doesn't see many ZEROs.

My endo's comment when I asked him why we had never talked about it before said that I just hadn't cared enough about the 7+'s for him to aggravate both of us.

I actually liked his approach and he said if I wanted to go for 5's he would hook me up with Dr. Bernstein.

hey sensorium, I asked this on another post but was curious as to why you hated your insulin pump, was it tubed or POD? If inclined, I was also wondering if you're on lantus or levemir, do you split your basal dose? Do you have DP (if so, how do you work through that on MDI)? What do you typically target as bedtime and wake up at? Did it take you a while to get stable on basal (MDI)? I really want to stay on MDI, for some reason it feels safer for me, compared to a pump...but I can't for the life of me figure out my levemir doses? How does one know if it's the correct amounts? THANKS!

I just find it insulting that I am now too old to want good health.

Annabella, I would listen to your gut sense on this one. You've concluded that the balance between hypoglycemia and acceptable BG control is set to where you are comfortable. Are you or your doctor the best person to make this assessment?

Love a flat line!

I'll throw out an old term, here....brittle. I have't seen that word used on this site for a while (not that active, so maybe it's been discussed more than I know.) Obviously, you flucuate more than some do Jen, despite your very admirable efforts. Perhaps some of us are just more prone to that. I hate that you were made to feel frustrated. I'd say you are doing way better than most....to be commended.

I'll drop you a message with this , okay? Just accept my friend request.

You go GIRL! Lumping a person into a group by age is just as bad as lumping by gender etc...

I'm currently gradually changing my settings back to where they work for me. I am of the school., small changes, wait a bit and change some more. That's how I got them to be where I was successful before. I just have to remember to change them back to his before I see him again. What a pain!

Maybe you could tell him, "Your settings didn't work. Mine do. Don't change them!" You could back yourself up with some good BG readings during the week before your doctor's appointment. Then you could redirect his attention to some issue which you could really use his help.

Is your doctor willing to take a middle-of-the-night call from you when your pump settings need to be changed? I don't mean to offend you, really I don't. I'm sorry if I have. But I don't understand your deference to this doctor. Are you afraid he'll fire you?