Open to tips to lower A1C

Hi Cayla,
Good news that you have decided to own your diabetes. The long term consequences of an a1c of 14, or even 10, are something you absolutely do not want. So my first advice is to study the hell out of it and become an expert - but always remain open.
Myself - I spent 30 years rollercoasting. My A1c was never more than 7 as far as I can remember, but I never ever felt ‘in control’ of my condition. Daily swings to 250 or above told me this was not right. I had fights with doctor - them telling me I was doing great, me saying no, not really.
I never found a doctor I trusted and so I kept doing the same thing. Then by chance I found the Diabetes Solution, and even though it took me 2 years to implement it I can say with my hand in my heart it changed my life.
Learning to live without carbs is like giving up smoking (that too took me years), but once you are home free you wonder what on earth took you so long. Now, for me it is so easy, and I am so very happy about it. And the more you learn about low carb the more I realize that this is not just for diabetics, but for everyone.
So my best advice to guarantee a diabetic complication free life, and become healthier than your non diabetic friends, I’d say embrace and implement Dr Bernstein, then join typeonegrit, the Facebook group consisting of the most knowledgeable group of diabetics, hands down.
If you like podcasts, then listen to the PeakHuman podcast series on nutrition. Not specifically T1 but definitely related (skip episode 1). So much fantastic info.
And then, you will be healthy, fit and in control of your diabetes. That’s pretty much a promise :slight_smile: my a1c is now 5 with a Standard Deviation of 23. I am working on bringing both down further - the process is ongoing.
Sorry for the long winded advice :smile:


you have so many tips as it is I don’t think you would need to hear mine. but here goes… count every carb you eat and use your new pump to determine your bolus. don’t stack your bolus’s… try to only bolus every 2++ hours or could cause lows. if you get your basals correct you should be able to live any life you want (well within means I guess) I found once my basals were leveled out I could go with steady BS all day. and then once you start eating and seeing your spikes or lows then adjust your carb ratios and ISF… only change one thing at a time… change carb ratio’s then 2 days later change ISF because if you change to many things all at once and things fall apart you wont know which part you changed is messing you up. I am still ol school I write down ALL my basals and carbs I eat all my BS and I still do finger pricks 8++++ times a day and record everything and then at the end of the day sit down and look what has happened… and then when you see it all right there you may be able to find some flaws… My A1c use to be in the 12’s and 13’s and when I started pumping they went down to 9’s and 8’s now I am lower 7’s… I am supper anal and use to use Animas pump work sheets to keep track of everything, but I make books (sew bindings and page prints) so I created my own log books with new crisper ideas So I use those. but I write everything down to all the foods and Blood sugars and basals and bolus’s and site changes and ISF … I record everything…… and last see your Diabetes Team nurse and doctor REGULARLY… they will help you lots

sorry I am not a writer so might have rambled and please remember things that work for me might not work for you our bodies will tell us what will and wont work. my diabetes is super touchy abit of stress and BS rise abit of an itch in my throat(winter cold season) and my BS rise. not going to bed early enough and my BS rise…
Best of luck would be cool to hear how things work with you
Mike McDougall :wink:

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Hi! I was also an adult onset. With bgs so consistently high I would encourage you to have your c-peptides checked. As your dx progresses this number will continue to drop till you become insulin dependent. Are you losing weight too? That’s a big red flag. For me when I hit the same weight that my 12 yo daughter was at the time, that was my ground zero and friends were incredibly concerned. At that time I only checked a couple times a day at best.
I wear a Dexcom and Omnipod now and have learned how to cover my spikes by prebolusing. I wish you the best and check out the Beyond type one app if you haven’t already

So many wonderful people to cheer you on, help you troubleshoot and lift you when you’re having a bad day-bc there will be plenty.


In January 1977 I bought my first blood sugar meter after a phone conversation with a guy named Richard Bernstein. He later became a doctor because the medical profession wouldn’t listen. I tried to follow his recommendations, but his early books were really light on tasty meals! I tried the bran crispbread and Farmer’s cheese, etc, but that’s not a REAL life. However, partially following his recommendations helped a lot.

More recently, I’ve been following recipes suggested by those on a keto diet. I’m not trying for ketosis myself, but these recipes keep the carbs low and the meals tasty. A year ago my A1c was 7.8, but my last two lab results were in the 5.8 range.

So there’s my anecdotal results and my vote for Dr. Bernstein. I agree with others that he is strict, but even aiming toward his approach has benefits. Some have noted that they can consume more carbs and still get good results. We are all so different!


You have the tools to get you on the right track. Stay well hydrated. That really helps. Also, get as much sleep as you can while going to school. Remember, you are what you eat!

Hang in there. Do the best you can; but do take your disease seriously. You have support, here.

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Hi, @ellercl! A lot of great lifestyle and management tips have already been brought up, so to not repeat too many of them, I will offer up some exercise advice. Try to exercise as consistently as you can incorporating both cardiovascular training and weight lifting, with an emphasis on the latter. You will need to get a feel for how your body responds to exercise, but the sooner you can get on a consistent exercise routine (even if you are already actively moving around the hospital/classroom all day), the sooner you will be able to glean the blood gluocse stabilizing benefits that exercise can provide. Helping others exercise with Type 1 Diabetes/LADA is a specialty of mine, so if it is something you would like to discuss in greater detail, I would be happy to. But the number one thing is going to be to start doing it consistently.


Seems like you have a good set of tips to work through. The only things I’d add is that don’t come down too quickly. You can develop TIND/Insulin Neuritis from dropping A1C too quickly. Make sure you work with your endo on how quickly he/she wants you to go.

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You’re a busy woman- listen the the ‘Juicebox’ podcast to/from school/work. You might try listening to the episode ‘Complications are Complicated.’ Serious motivation right there. I find just listening to it makes me think about my diabetes more- I check my CGM more and am generally more interested in it. Find ways to make your ‘work’ work for your diabetes. Do you share the fact that you have diabetes with your friends/co-workers/students? If so, it could be motivational for you and for them to see you checking your libre and counting carbs. My husband is a FM doc and all day long he sees sad complicated diabetes patients that are out of control. It’s good motivation for me to stay on top of it. Tell yourself that you’re going to be the kind of PA who happens to have a chronic condition who is a badass diabetic warrior. You can be the face of a positive diabetic in a place where doctors and medical professionals see a lot of sad stories. I don’t know- that’s my take on it! Way to go for deciding to make a change. That’s the first step.


So happy to know you are working at getting a handle on your diabetes. Obviously, you are very smart lady to be a PA and studying anesthesia. Im sure you know how important it is to have your diabetes under control especially, if another life may be in your hands. It becomes not only about you, but others as well. I’m not saying this to beat you down, but hopefully to keep you motivated. My daughter was 11 when diagnosed in March and I must say it isn’t easy and honestly I never knew what all went into trying to control BS. I’m sure you know so much more than myself. I do know her having the Dexcom was the 1st thing that helped us tremendously. We are still working with the Omnipod to get that better. Still has a few highs close to 400 and she had a low this week of 36. What you guys go through is tough. Only advice I have is follow your BS and treat when needed with your Pod. Our Dr told us anytime she had a high to treat bc the Pod will not let you over treat. It will allow you to give too much insulin if you enter wrong information , but treat. Every time my daughter eats she does a bolus. Her A1c isn’t the best it could be. Last visit it was 7.
It sounds like you are one the right track. Also, remember stress affects your BS and I’m sure you have your fair share of that. I truly wish you the best. You are so smart with so much to offer. We need folks like you around a long time. Good luck and I would to know how you are doing in the future.:heart:

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We were diagnosed about the same time a few months apart, my heart goes out to you. I was a 12.2 with triglycerides over 1200…

Diabetes management is much simpler than people think, just hard to maintain the momentum of discipline.

Here are my thoughts that keep me going:

Simply put the problem isn’t me or my pancreas it is all the carbs I put in my body that it is NO LONGER EQUIPED to handle. So if I was trying to put a fire out but kept putting gas or more wood on it… Lower your carb intake and your A1c will follow.

The problem with Blood Sugar is this: high blood sugar acts like an abrasive think sandpaper and inflames your arteries. Inflamed arteries are what the fat sticks to. Fat isn’t the problem it is high blood sugars in the presence of fat that creates the atherosclerosis, plaque, hardening of the arteries and further complications of cardiovascular diseases.

The other problem is insulin, it is built to store energy. It is just pulling blood sugars down and storing them as fats. Triglycerides go up, fatty liver diseases, spare tires, visceral fat all stored energy. Why are you storing so much energy? Less carbs & insulin resistance = less insulin intake.

Eat right for your condition. There has never been a better time to be a diabetic. There are all kinds of monitoring devices, food alternatives to comfort you and medical information available to us.

So stop making your excuses (we are all guilty of this on some level), set your priorities (lower your A1c), identify the variables driving the bad outcomes (low sleep, carb intake, lack of excercise) and execute RUTHLESSLY on a plan that eliminates the variables and creates the good outcomes. (take a step every day toward your goal, EVEN if it is TINY). And relish the progress you will make.

Diabetes doesn’t accept your Med School excuses, it won’t wait until you have graduated or have time to “fit” something in. You are trading your long term health for an education? To what end? So you can afford your medical bills in your later years while still dying way too early? I once heard it said that it is like having the MOST IMPORTANT part time job that you never get a day off of. Time for you to clock in :wink:


@halvdan Great A1C :grinning:

I’m curious … are you on a low carb diet, or perhaps keto?

I’ve had T1D 55 years, and finally discovered the benefits of LCHF / Keto diet 3 months ago.

I’m looking forward to seeing my A1C in the high 4 range in another month

Hi @Jimi63 how many net carbs do you eat per day? Do you count the carbs in things like say, an egg? The box of eggs I have list 1 carb, so I count it, but I don’t know if I shouldn’t count it (just really getting into low carb).

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Hi Jim,
Awesome that you have discovered LC eating. It took me 35 years and I slap my forehead when I think about it. How come it took me so long? It is so damn obvious. The body does not need carbs at all. There are no essential carbs, and by becoming fat adapted and using fat for fuel everything changes for the better. The difference is astonishing. I can easily go 20 hrs without food for instance and I don’t really feel depleted and often not even hungry. That fact alone frees me up to eat when I want to. As for my glucose control it is now better than ever. My a1c is lower than my wife and one of my daughters, both non diabetics. One daughter has a lower a1c but I am getting closer :slight_smile:

What I practice is very similar to Keto, but Keto is an ambiguous term with many interpretations. As a T1D I focus on my condition first and foremost - in other words my glucose control. I never measure my ketones for instance. What I do is follow the Dr Bernstein protocol which to all intents and purposes is a form of Keto. His protocol says no more than 30g carbs per day - 6 for breakfast, 12 for lunch and dinner each. Those amounts are allowed because even leafy greens and low glycemic fruits such as cucumber and avocado, as well as nuts contain carbs. Primarily the protocol focuses on protein. You match your protein level to what works best and the fat is whatever comes along on the ride. In other words you don’t worry about the fats but you don’t load up on them either. So the Bernstein diet is more LCHP, than LCHF. As far as fat goes, children and teens can eat far more than adults. There are lots of baked good alternatives that use almond flour and full fat cream etc, that are delicious. In fact there probably is more than one low carb alternative for ever high carb food out there. Pizza, cookies, ice cream, chocolate cakes, waffles, you name it. But as an adult all those extra calories will count. Just because carbs are what tends to make us fat it doesn’t mean that by dropping the carbs you cannot gain weight. :frowning:



I eat less than 15 grams of carbs per day. I count carbs in everything, although the carbs in fibre are essentially indigestible. So yes, every single carb (in eggs, cheese, etc). I use MyFitness Pal (free app) to track and calculate macros. :smiley:

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Like you, I’m dumbfounded at how obvious the low carb way of life is. I’m just about 60, and have had T1D since I was 5. I’ve learned more about nutrition in the past 3 months than I have in my lifetime.

We are in the same boat. I am 61. I only got t1 when I was 22, but long enough. The mazing thing is up until 3 years ago I only ever read a book I got when first diagnosed. I never spoke to anybody about my diabetes in any detail, not family, not friends, nobody, and I never even met a diabetic in my whole life. The one thing I knew was that doctors were useless and mostly I knew more than them. I always adjusted my own insulin and figured it out as I went, with small tidbits of information to add to the arsenal of knowledge whenever I went to a diabetes clinic (in the UK), during the first years. One day about 3 years ago I was looking through the Apple Book Store and up came the Diabetes Solution by Dr Bernstein and for some odd reason I went for it. The man is very impressive and what he said made absolute and total sense. I then heard about CGM’s and got one of those. Then I learned that there were Facebook groups that focussed exclusively on both CGM’s and Low Carb, and my diabetic world turned upside down. I now talk to anyone that will listen and I feel I have been given a new lease of life. Pretty incredible. I too, have learned so much about nutrition over the last year or so I am driving my family crazy. In case you are not familiar check out Ted Naiman at and watch his two videos. Just great :slight_smile:


Thank you for the tips. I really think the first one impacts me greatly. I get very little sleep due to my schedule but I notice on the weekends when I actually get more than 4-5 hours my numbers are much more stable.

This is probably my biggest obstacle. I used to run everyday and even taught cycle classes at the YMCA up until around 3 years ago. I stopped running last year when my energy levels finally dipped so much I could barely make it up stairs without being light-headed. I really struggle with exercise now. I am always so exhausted (which is ironic since I know exercise helps me feel more energetic). I wake up at 4 AM and don’t even get home until around 6 PM when I am so tired from being in the OR all day and then I still have to study. I know I should find a way to work in exercise time and used to be so good at that, but now I don’t have the motivation to do so anymore. I tell myself regularly that I am going to start an easy to maintain routine, and then never follow through.

I’m embarrassed to admit it, but the biggest frustration in dealing with my new diagnosis was the idea of weight gain. I lost upwards of 30 pounds when I was diagnosed and I loved it. I have always been slim, weighing around 130-140 pounds at 5’11", and now I weigh 160 and absolutely cannot stand the way I look or feel in my clothes. I am always starving, despite the fact that I try to stay away from carbs and eat foods that will keep me feeling full. I take 70 mg of Vyvanse, 150 mg of Wellbutrin AND 1000 mg of Metformin to try to suppress my appetite and still I am always hungry and thinking about food. I know your original post was about exercise, but I think the combination of no energy and then the fixation on my hunger prevents me from truly having good control. I worry this will always be a limiting factor for me. I talk to my endocrinologist and my psychiatrist about these issues, but nobody really seems to be able to address it any better than I have. :frowning:

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Thank you for your kind words :slight_smile:

The hunger is probably a symptom of high BG or stress eating. I think a lot of us deal with this issue (myself included) and the only thing that works for me that doesn’t spike my BG’s too badly is having plentiful low carb snacks like hard boiled eggs or cheese and lunch meats ready to eat so that I’m not tempted to nosh on crackers or sweets, etc.

When you get your BG’s down to more normal levels for a while and you are still having uncontrollable hunger then you might want consider getting a thyroid panel done as weight gain and hunger can be symptoms of that as well. If your thyroid is okay and your BG’s are fairly normal then I would look to stress reducing techniques. Stress is a huge factor in being able to control our diabetes. Everything from BG spikes to over eating is affected by stress.