Need help lowering A1C

Type 1 and LADA
1

Hello everyone,
I just joined tudiabetes in hope to find advice on controlling my blood sugar and leading a healthier life. I am a 19 year old female who has been living with type-1 diabetes for 13 years. When I was diagnosed, I went through what they call a “honeymoon-period” and it was almost as if I did not have diabetes because my blood sugar was always picture perfect. About a year after I was diagnosed, I got the flu and ever since then, my blood sugars have been out of control. My blood sugars are always either high or low; never right where they’re supposed to be. Right now my A1C is 10 and I’d really like to get it down to 7 or 6.5. If you have any advice, I’d absolutely love to hear it.

Thanks in advance,
Ashley

2

Hello and welcome,

Are you having trouble controlling your blood sugar because you’ve been ignoring it or because as hard as you try you can’t get the results you want? If it is the latter, you might pick up Gary Scheiner’s “Think Like a Pancreas” and John Walsh’s " Pumping Insulin". Both books provide a great deal of knowledge and helpful advice.

If it’s the former - you’ve already made an important first step in coming here and asking for help.

You need to test a lot to make progress. A pump is a great tool but you need lots of information to get the most benefit from it. Many of us test 10 times per day and up.

I’m sure other people will have many more helpful ideas.

Take care,

Maurie

3

You really have to try and pinpoint the reason for your highs and lows. Keep in mind that for many T1s, puberty (which lasts most of our “teen” years) can really wreak havoc on BGs. The hormonal surges cause us to become insulin resistant, and this is made even more difficult when you’re a women and your hormones are changing on an almost-daily basis.

Are you properly matching your insulin to your carbs? If your I:C ratios are off, you will get lots of highs and lows. Keep in mind that your I:C ratios may be different at different times of the day.

Your profile says that you’re using a pump and I know for me the pump has given me better control. I still get highs and lows, but they are not as extreme. A high for me is now about 200 and a low 50. When I was doing shots, my BG would range from 40 to 350 on an average day. For me, this was because (as an adult) I am fairly insulin sensitive. HOWEVER, fine-tuning the settings on my pump has been a lot of trial and error (and mostly error). I’ve had to do a lot of logging and tracking and adjusting. It takes time, and I’m not sure how long you’ve been on your pump. It may be that your pump settings need adjustment. I’ve seen the biggest changes in my BG following changes in my basal settings, so you might want to work with your endo and look there.

Another thing that has helped me is sticking to a fairly low-carb diet. I eat about 100-150 grams of carbs per day. I avoid the foods that I know are problematic, such as white rice, pasta, and bread. Yes, I love those things and I know in theory T1s should be able to eat those things as long as they are properly matching their insulin to their carbs. But, for me, it just doesn’t work. I was able to get my A1C to drop a whole point by simply eliminating those foods from my diet. So look at your diet and see if there are foods that are causing you trouble. High fat/high carb foods are my worst enemy. I can eat high fat provided there aren’t too many carbs with the meal. I am sure this is different for everyone.

Finally, as Still_young_at_heart recommends, “Think Like a Pancreas” and “Pumping Insulin” are amazing books that will provide you so much information. Don’t Just Read Them Once!! Read them again and again…I had to read Pumping Insulin three times, and I still go back and read specific chapters on a regular basis. If you’re pumping, it’s a MUST READ.

Finally, realize that your BGs will never be perfect. You can get them into that good range which will give you the A1C you desire, but they are never probably going to be “normal people perfect.” That’s just how we T1s roll :wink:

Do you have a supportive endo? What is your endo recommending?

4

Do you use the Carelink software? For a long time, I’d just give it to the doc and not really think about using it to work towards improving things but the reports have some information that can suggest where to start? I found the “Modal by Period” report useful, in that it shows you “AVG” and “std dev” for each “period”, basically broken down by meal times and post-parandial times. Looking at this, you can see which part of the day is the most out of whack. If you fix that time of day first, and get it closer to where you want to be, you wll “make up” lost ground most rapidly, since you’d have the most room to make up ground towards whatever your goal might be.

The other thing that happened with me is that my mornings were pretty much ruining my whole day for years and, once I got the morning more in line, the benefits percolated through the rest of the day?

Still Young and My Busted Pancreas also have useful ideas. Think Like a Pancreas and Pumping Insulin are very handy books to have, sort of like owner’s manuals with lot’s of tips about how to fix stuff.

5

I think you have gotten a lot of suggestions. But first off, I guess I have to ask exactly where you are in taking ownership of you insulin dosing and eating? Do you feel like you understand and do accurate carb counting? Do you use your pump to figure out specific meal dosing? Do you have a strategy for correcting high blood sugars? Do you change your pump settings or do you depend on your doctor or educator?

If you answer no to all/most these questions then there are some “low hanging fruit” ways that can help you with things

6

That’s a good term for it!! Is the lower-hanging fruit higher in carbs b/c of the weight of the juice pulling it down?

7

My father-in-law used to run an orchard. It just means the easier to pick. The ones really ripe and high in carbs fall and they are called “drops.” My father always took special care to pick up the drops, they were unusable, but if they stayed on the ground they would ferment. And the bear would come by. Nothing worse than a drunk bear.

8

Love it

9

Pinkmnstr! Cute name! 4 steps.
#1 you have to know your basal insulin is keeping you even round the clock first. That means fasting for one meal a day and testing during that time.
If your basal doesn’t last 24 hours, it needs tweaking the total into two doses, less for nighttime. Get the books that have been suggested. You want your basal keeping you without ups and downs. You want to depend on it to keep you in the target zone, which I put at 90 - 120. In your case, don’t pull yourself toward the low end until you’ve been at the high end for awhile. Go slow and tweak carefully.
#2 After that’s good, eat a 4 gram glucose tab, see how far up your BG goes, and how fast. Now you know what a gram will do to you.
#3 After you know that, get your BG up to 160 mg/dl, give a unit of fast acting insulin and test at 1, 2, 3 & 4 hours to see where your BG gets to. Now you know what your correction factor is and when it’s done acting.
#4 Now test out what carbs do to you. Choose one amount, like 10 grams of cereal, see where your blood glucose goes and how fast. Using your knowledge of what one unit of fast acting insulin did in #3, and what 4 grams did, do the math & give enough insulin to pull it down.
Do likewise with other carbs, one at a time - a milk product, a starch, a vegetable, a fruit, all in measureable amounts, not high. Test out what happens. Get to know your reaction to fruit, what kind of spike it does.
And #5. Try a low carb diet in order to pinpoint how much insulin you really need. Eat enough protein to keep from being hungry. Read through the site and see what low carbers eat. And best wishes. It’s doable. You really can do it. The numbers have to be small enough to handle well.
Best wishes.

10

Hi there! Hope I can help – there’s a lot you didn’t say about how you handle your diabetes so I guess my first question would be how well do you understand your disease, and how well do you know about the various factors, nutritional and otherwise, that affect blood sugar? I just finished writing a “how-to” book for parents that describes all of that stuff and I’d be happy to send you some of the chapters, because as a parent one of the first things I discovered when my little boy was diagnosed was that diabetes was WAY more complicated than I ever imagined, and that just about EVERYTHING affects blood sugar. Carbs, of course, but also stress (makes it rise), weather (can make it rise OR fall), amount of sleep (too little = high BG), the list goes on and on. So if your goal is to gain control of your BG and get your A1c down, you need to sort out your regimen to address as many of those factors as possible. A lot of the suggestions below are very good ones, but to make use of them you need to really understand the basics of the disease and how it affects your body’s functions. I don’t want to assume that you don’t know these things, but I also don’t want to assume that you do — I know a guy with T1D who’s had it for ~30 years and had crappy control his whole life, and on a pump too, who lowered his A1C by two points just by applying a few of the things our son’s endo passed onto us, that my husband passed onto him, that no one had thought to tell him about!

So if you want those book chapters, please send me a private message with your email address and I’ll send over a PDF of the stuff that’s probably most relevant for you.

11

My only advice is short and sweet-(brakets denote my personal goals based on non-diabetic BG’s)

  1. Decide where you want your numbers to be 2 hours after a meal (I adjust to be somewhere in the 120’s), before a meal (below 110), before you go to bed (varies), and when you wake up (below 99).

  2. Select a carb ratio (I started with 15 carbs of food to one unit of insulin) for a bolus to act as a baseline.

  3. Set your basal at a rate at a number you feel comfortable with and leave it there for several days before making any changes so that your body has time to adjust.

  4. Trial and error, adjustment, and careful counting will get you to your goal (most of the time) if you stay on it. You are the only one who really knows your body so you are your own best expert.

12

Hi Ashley,

I have just 1 tip to offer:

In my 30 years living with type 1, the single most useful change that helped lower my A1c from the 10s was to stop eating breakfast cereal for breakfast. Most breakfast cereal contains tons of sugar (even corn flakes, which don’t taste sweet) + milk sugar (lactose) = super high glycemic food! On top of that, in the mornings, our bodies produce more cortisol (stress hormone), which is an insulin antagonist that basically competes with insulin. I had to take 2 to 3 times more insulin for a bowl of cereal eaten in the morning than other times of day. Now, when I do crave cereal, I eat it when I’m low or for a snack/dessert later in the day. Switching to soy milk (if you can tolerate it) also helps reduce the glycemic load.

Hope this helps!

Suzie