Wow! Everyone!!! I thought that my A1C of 6.8 was really great until I read this thread! I just received my Dexcom 7 Plus2 weeks ago so I am really only in the starting gate here. What are you all doing to lessen the hypo and hyper events? How do I keep from getting over 180 after a meal or dropping below 70? I think my meal time highs are the worst culprit to my A1C levels not being better. I eat very modestly as the insulin weight gain has been simply awful (60 pounds over the last 4 years!!!) I just recently changed my diet to being mostly vegetables, lean protein and very low amounts of carbs - basically legumes and low glycemic carbs only. I have lost 16 pounds since December 12 with the help of my new eating and also I started riding my bike 12 miles each time I go out and I just joined a gym. (Up until a year ago, I was living in Indonesia with no chance of any type of exercise available due to safety issues and the food choices were very difficult as fresh vegetables etc were a health concern - can anyone say severe gastro-intestinal issues from parasites?)
Anyway, since I am now finally getting my food and exercise under control, how would you attack the highs and lows to make them even out more? What does everyone else here eat, especially for breakfast and lunch?
I usually eat eggs w/ spinach and broccoli for breakfast and 1/2 peanut butter sandwich for lunch. Not a lot of carbs. I splurge in the evenings a lot but I think having those "benchmarks" eating that way during the week helps get my rates and ratios set precisely. If you are taking just a shade too much or too little insulin, your numbers can vary pretty widely. When I got a pump and CGM, I noticed how much difference .05U/ hour or 1G/U of food/insulin ratio could make.
Thanks #acidrock23! I used to have a Diabetes Educator that kicked butt but she is in Dallas and I am now in the Houston area so I lost all of my guidance when we moved here. For whatever reason, my doctor doesn't seem too interested in looking at my basal rates and making suggestions. He is perfectly happy with my 6.8 A1C but if I could make it better without it being affected by too many lows, I would think that would be a much better and healthier way to live.
Hi Roadsterchic: I have been using my Dexcom7 since Spring 2011, and I love it! It has made a difference for me. I discovered that I really need to bolus at least 15 minutes before a meal. Also, a cup of coffee requires insulin, and I have gone almost carb-free at breakfast. The key to a lower A1c is to do it without hypos; that represents a worthwhile goal.
Thanks Alan...
Has your doctor recommended that you only eat two eggs a week and not together? I get conflicting info with regards to eggs so I tend to shy away. Breakfast especially is a hard meal to deal with because 90% of all breakfast foods are carbs - breads, fruits, cereals etc. It kills me because I adore fruit but I try to keep them in moderation. If I eat fruit, then there is no other carb in the meal.
I am going to try more veggies at breakfast and maybe only egg whites. Perhaps I will stumble upon something I really enjoy.
I eat Egg Beaters a lot, 1/2 for the lowfat/ low cholesterol/ low calorie and 1/2 because I'm too out of it and lazy to want to deal with shells at 6:30 AM. They're not quite as tasty but similar and, if I throw enough veggies in, not that noticable?
I made the following changes in the last year, that resulted in less post meal spikes, and improved A1C.
1. eliminate 'white' carbs, cereal, and most 'processed' foods. Increased veggies.
2. use square and dual wave bolus for meals (practice, practice, and check out the TAG group).
3. bolus earlier, depending on what starting BG is. Start with lower carb / filling items first, and eat more slowly !
4. include proteins/fats with carbs whenever possible. (The only time I eat 'straight' carbs is to counter a low.)
My favorite breakfast is a fruit smoothie, made with frozen berries, etc, and protein powder (soy/whey, low-carb), flax, greek yogurt and almond milk. With practice, I have been able to time how fast/slow to drink it (with help of CGMS), and usually stay under 120-140.
For lunch, I usually have veggies, salads, and eggs. I also like to keep cut up bell peppers, carrots, sugar snap peas, etc on hand, and hummus for dip, for mid-afternoon or evening snacks. Great replacement for chips or other tempting snack foods.
Sounds like you're off to a great start ! Keep up the good work.
I'm getting terrific numbers without post-meal highs unless I deliberately eat too many carbs--which I do once in a while, such as when invited to a friend's home for dinner and not being certain about how to calculate carbs exactly. However, I'm even finding that it's much easier to bring a high down fairly quickly than it was when I first began working with insulin. My intuition is that my body is simply used to running with a BG that's close to normal most of the time. I could be wrong about that, though!
For breakfast, which I have about 8:30 or 9:00 a.m., I eat 2 or 3 eggs, scrambled, fried, boiled or in an omelet. I usually have bacon, sometimes sausage, sometimes a slice of ham or about 4 ounces of kippered herring with the eggs. If I have any carbohydrates at all, they'll be in the handful of veggies I might put in the omelet. On Sunday mornings, we often have Irish coffee with a late breakfast, using Irish whiskey, whipped cream and liquid Splenda. I keep track of the amount of protein and fat in my breakfast and bolus Humalog for it, covering 58% of the protein and 10% of the fat. I take about 60% of the bolus at the beginning of my meal and the remaining 40% about 45 minutes to an hour later. It does mean two injections, but I don't find that to be a problem. On a pump, a dual wave bolus would take care of it easily, I understand. The thing is: protein and fat do spike my BG, albeit more slowly than carbohydrate, over about 4-5 hours, if I don't account for it. Covering the protein keeps my numbers at a nice, even level. In the last three weeks, my highest post breakfast BG was 6.2 mmol/L (112 mg/dl) an hour after I'd eaten.
Protein and fat are very satisfying for me which means that I'm rarely hungry for lunch. I may eat something around 2:00 or 3:00 p.m. Lately, I've been having two Wasa light rye crackers with deviled eggs, sliced deli meat or tuna with some cheese melted on top along with a few olives or a couple of dill pickles. Total carbs are about 12. I take the bolus about 15 minutes before I eat lunch, though if for some reason I forget or get interrupted, it's okay if I bolus when I start to eat. I don't divide the bolus for this, though I do cover the protein and fat as I did at breakfast.
Dinner is around 7:30 or 8:00 p.m. I eat meat or fish with some carb-friendly veggies, usually broccoli, cauliflower, green beans or a smallish green salad. I still cover the protein and fat, as I did in the afternoon. I may have a small piece of chocolate at the end of the meal. Recently, because I've been taking an antibiotic, I've had some sugar-free yogurt instead--I need the pro-biotics. Dinner usually has between 8 and 15 grams of carbohydrate.
My pre-dinner BG may be 6.0 to 6.5 mmol/L (108 to 113 mg/dl) because it always goes up when I exercise and I will have walked the dog a couple of miles before making dinner.
I don't eat cereal, bread, potatoes or pasta at all. I make sure to eat fat along with carbs because I notice that my BG doesn't spike that way. Carbs of any kind, by themselves, always raise my BG more. I do miss eating fruit, I have to admit. However, fruit will send my BG through the stratosphere if I eat it in the morning. Once in a while, I may have some berries for dessert in the evening, along with a good dollop of whipped cream. I drink a lot of tea without cream or sugar. I may have a glass of wine with dinner. Before going to bed, I usually have two ounces of scotch. My total daily carb intake is usually about 20 grams, sometimes as much as 30.
I notice that I have to focus on getting enough fat in my diet. If I don't pay attention to it, my BG goes up more and I have a harder time bringing it down smoothly. I'm still losing weight (I've lost over 40 pounds since October without suffering at all!), about 1-2 pounds a week, but when my fat intake wasn't high enough, the weight loss stalled for about two weeks. I don't pay any attention to cholesterol. My LDL was elevated for the first time in my life when I was diagnosed but I'm attributing that to low thyroid.
In the last three weeks, my highest BG was 7.2 mmol/L (126 mg/ml) an hour after dinner. Two hours after that meal, it had come back down to 5.6 (100.8 mg/ml) and was 4.8 the next morning when I woke up.
Scotch!? It's almost St. Patrick's day! 
I am having a very frustrating day. My blood sugars reached around 135 in the middle of the night and has not dropped even though I have taken correction boluses several times. Now, an hour after eating my breakfast, the BG reading is over 240 and is still slowly climbing. I don't know if it is the infusion set that I changed yesterday but I do know that I can't seem to get the reading to go to a normal level. Any suggestions?
Nawww... 
If you're over 250, you probably should test for ketones and take your next correction from a syringe or pen. I've just come off of a couple of days where I was bouncing too high (although always under 180) and when I changed my set this morning I had a gusher.
Good luck,
Maurie
If you are having problems getting back down, you might try giving your correction in a shot. I would also change the infusion set because that is often the problem. Do you know your ISF? When it gets into the high 200s you sometimes need more than your ISF suggests. Just remember as you correct to keep track of your IOB. If you take a shot, remember that won't be computed in by your pump wizard. Sometimes I give a bolus for that amount with my pump disconnected; that way the wizard will take it into account.
Also drink water and try and eat as low carb as you can until you can get down.
Finally got it down. After several corrections and cleaning house, it is now in the normal range. I am glad cause I hate days when no matter what you do, nothing works!
Thanks everyone for your info and suggestions!