Hey guys, I just wanted to know if anyone has any tips to achieve an a1c in the 5-6 range. My a1c currently hovers at around 7 and I’m trying to get it down, besides pre bolusing is there any other techniques that will keep me in range longer? I am on MDI and use Tresiba for basal and it works pretty well for the most part. Any help is appreciated, thanks.
Do you have a CGM? That would be the most important thing. It lets you know what your BG level is doing so you can respond to it better. A Dexcom is best.
If you have one or can get a Dexcom, it has alerts you can set. Don’t set it at the level you don’t want to be at, set it earlier so you have more of a chance to respond to it. So while I don’t like to go above 160 and preferably even 140, I have my high alert set at 130. In my case if I see me trending up to a number I don’t like I get on my exercise to stall it until my insulin kicks in. I also re-evaluate if I need more insulin if I don’t drop as I think I should.
Exercise, critical for us and extremely helpful in bringing down your BG level.
Afrezza if you can get it, works faster, so you can use it to bring down those highs just a little faster. Or if you don’t want to wait as long to prebolus to eat, it’s quicker. Afrezza isn’t always covered by insurance, but they do have programs to help you pay for it. I just barely started using it about 4 months ago but my A1c has been around 5.1-5.2 for years now, so it’s not necessary to use it. Just helpful.
My biggest thing is prebolusing and it’s the timing of the prebolus that I think is the most critical. I know you said other than prebolusing, but timing is the most important thing to me. Generally I take half of what I think I’m going to eat a half hour before and the rest when I eat. That allows me to adjust the second dose to what I actually ate. But there are foods I might take in 3 steps, some that maybe are higher fat so I need a later dose. Or if I am having some pineapple, I might wait longer to eat because pineapple hits so fast. So the prebolusing timing can vary. And some people might need less beforehand or less time beforehand.
But the first things that made a huge difference for me was a CGM, followed a few months later of a pump. Then a Dexcom helped some more than the LIbre I had before it. I was already prebolusing, but seeing what my BG levels were doing at night or after I ate allowed me to adjust everything better.
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Hey Johnny-
Are there certain times of the day, certain foods, stressors, etc. that you’re having more trouble with?
There are a lot of ‘basics’ to getting your A1C down, but I’m sure you probably know most of them if you’re around 7. The trick for me to get below 7 was a pump using Loop. It handled my night time highs by itself, and that alone dropped my A1C by .5 or so. I hated messing with my long-acting insulin to control my nights as it pushed me into hypo during the day, and I didn’t want to split the long acting dosing (which is a strategy for nights).
If you can share some more details I’m sure folks here can help out with some ideas! 
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Your night time sugars are more representative than day time.
Red blood cells are produced mostly while you sleep. So if your over night sugars are high, your A1c will skew higher.
I was stuck in the mid 6 range until I started looping in Tandem.
I’m pretty much 5.5 now.
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There are several ways to lower your A1c. I am on MDI and Tresiba and have had an average A1c of about 5 for about 17 yrs. I find sticking to limited ways of eating very helpful, but I don’t know if that would interest you. Some folks like to low carb and Dr Bernstein is the expert on that. I use Mastering Diabetes which is a low fat plant based diet. I eat fruits, vegetables, legumes, grains, nuts and seeds. This diet lowers insulin resistance, so you can eat lots of healthy carbs while using much smaller amounts of insulin. It takes the body about 3 weeks to adjust to this way of eating.
Exercise can also help lower your A1c.
Lots of people really like using pumps, but I like the simplicity of MDI.
I am sure you will get plenty of other suggestions.
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Food choices and combining fats, proteins with meals/snacks can slow down the bg rise, and likely to lower A1C. Adding exercise or walking can also help.
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