6.9. I have had a CGM for just over a year - what a revelation! I am perimenopausal, and unstable hormones mean unstable BGs. My pre-CGM A1c (using Humulin N and R!!!) was usually around 8.3.
I got a 670G pump in September, and totally failed at auto-mode. For auto mode to work, you have to have a “normal”, and I just don’t. It bases it’s behavior on the previous 7 days, and the previous 7 days might be slightly different, or they might be as much as one-third higher or lower basal levels. Try going from 0.75 U/hr to 0.45U/hr (for the same time of day) in less than 2 days … or even 2 hours sometimes. Auto mode can’t figure it out. You only have one basal pattern, and auto-mode keeps giving the wrong micro-boluses, and demanding more BG tests. (ARGH!)
But, with the assistance of the CGM, I have learned how my body’s hormones effect the BGs. With 5 basal patterns and the use of temp-basals, I am now 81% in range. Woohoo!!! Each time in the last year that I have had labwork done, my A1c has gotten 0.2 to 0.5% lower.
Progress is being made! My doctor is happy with my being below 7.0%. I would like to get lower, but my hormones make it tricky. My CDE says that I am a nervous patient, because I do major note-taking, and I keep going over the notes to find patterns, and making small adjustments and experiments. With my hormones, I told her, I don’t consider that to be nervous. It’s how I learn.
When I was using 15+ strips/day, before the advent of CGM, I know various doctors and their staff looked at my treatment habits as obsessive. It’s all just a matter of perspective. From my skin-in-the-game position, it didn’t seem like over-the-top behavior to me. I was motivated to keep my eyesight, kidneys, and limbs.
I wouldn’t characterize making “small adjustments and experiments” a nervous trait. I’d see it as reasonable curiosity and and a rational reach for an optimal quality of life.
Thanks Terry4 and MM1! She gennerally doesn’t try to discourage my very detailed notes, but does seem to think that they are over the top a bit.
I, on the other hand, am able to give Medtronic Tech Support very detailed information when ever one of my sensors fails before the 7th day (about 2/3 of the time they fail on the 5th or 6th day - my body chemistry interferes with them, apparently). Also, I am figuring out what does and doesn’t change as my hormones shift.
This morning I came to the conclusion that I need to alter my carb ratio when my hormones increase my insulin resistance enough. I already have 5 basal patterns (the maximum on the 670G), but my BG rises too much (above 180) after meals when I am at a PMS hormone level (Basal Pattern 5). I already change my carb ratio from 10 to 11 when my BGs drop (Basal Paterns 1 & 2), now I am thinking that I need to go up to 9 when my BGs rise enough.
If I don’t take notes, I don’t have solid data on which to base my decisions to make these changes, and I don’t have documentation on what worked and what didn’t. Also, I am noticing that what worked a few months ago, doesn’t always work this month, and visa-versa.
I am being very open on TuDiabetes about my fun with perimenopausal hormones because when it started about 3 years ago, all I could get from anyone (endo, GP, online diabetes community, etc.) was that perimenopause is different for everyone, and that I should check my BG often (as if 8 to 12 per day wasn’t rediculous enough). … Soooooo not helpful!!! Kaiser wouldn’t give me a CGM then because I wasn’t unstable enough (ARGH!). They changed their minds in Jan 2017, but I didn’t hear about it until April (AFTER my co-workers had to call 911 when my BG dropped almost 180 points in about 25 minutes, and I all but passed out (managed to eat 20 glucose tabs, and my BG only rose to about 120 afterward).
Perimenopausal BG shifts on Humulin N & R, and without a CGM, is no laughing matter. (Can you tell that I have strong feelings about this?) I hope that this information will be helpful to someone going through similar craziness.
You appear to learned an important diabetes lesson that took me many years to value. Diabetes is a dynamic disease. The static formulas coming from diabetes educators and doctors seem to argue that you simply need to home in on the perfect set of ratios and factors and then your blood glucose will behave. That’s appears sensible but it doesn’t work in the real world.
As I said, diabetes is dynamic. Your customized five basal patterns show that you have taken this to heart. Don’t ever let any medical provider tell you that your wandering blood sugars are unusual, at all. If you haven’t read this book yet, I encourage you to get a copy, hard or digital, of Sugar Surfing by Ponder.
Dr. Stephen Ponder has lived with T1D for 50 years and practices as a pediatric endocrinologist. His appreciation that diabetes is dynamic underlies his entire treatment philosophy. He also has a nice manner and a good sense of humor.
Your attention to your treatment details and writing them down will distill lots of learning into a very short time. You won’t have to do this forever as you subsume that knowledge into habit. Good luck to you!
Thanks again Terry5! I’ve been T1 for over 31 years, and noticed after about 10 years that things do change, or maybe evolve is a better word. After I got my CGM, it was much easier to see the direct links of cause and effect - though the flood of information was overwhelming at first.
My CDE gave me good feedback as to what information was medically useful in notes, and what was just needless complication. I have very bad short-term memory, though, so I write a lot down on a notepad that doesn’t make it into the notes that I pass on to my CDE.
Also, I have noticed what questions the Medtronic Tech Support people ask, so I always note down things like that (BG when “sensor update” started; the MMT, lot, and experation date of every sensor; when “warmup” started; etc.)
I am documenting sensor stuff in case I need (in the future) to support a case with Kaiser for having enough sensors to change them every 5 or 6 days, instead of 7. (Though Medtronic keeps replacing them, so I have no real problems there at the moment.) There are a lot of reasons to document things other than “how many carbs per day?” versus “how many units of insulin per day?” The official way of doing things seems to leave out a lot of useful detail.
mine were 5.3 and 5.7. I eat super low carb and walk off any highs. I just figured out what sugar surfing meant and I’m guilty there. My goal is between 5.7-6.3 don’t think it’s good to be too low
I’m the exact opposite. I hate being high, and I don’t worry about lows. Today I was low most of the day and I was very active, to boot. I’m so busy some times (a LOT of the time), that I just can’t be bothered to treat lows in a timely fashion. I can function at a much lower level than I’m sure many of you would feel comfortable at. I much more productive when I’m low–I go from doing things quickly (that’s my normal speed), to doing things in hyperdrive mode.
I don’t want my A1cs to be over 6. I would never ever strive to raise my A1c by ANY amount.
This is what most people do to become successful in their control. So you are doing the right thing. Keep on doing it. (CDE and Doctor’s opinions are taken with lots of grains of salt, in my case). Most people here, specially the successful ones (control-wise), prefer to do the control themselves personally. There are a lot of information available, through the internet and text books and personal experiences from communities like this. Get all the information available and be confident that YOU CAN DO THE CONTROL PART BY YOURSELF. Then talk about it here in OUR COMMUNITY. YOU CAN DO IT. WE CAN DO IT.
My blood sugar problems started about the same time perimenopausal symptoms started. Blood sugar kept getting worse along with the hormone problems. And I got really bad with my hormones!!! But one thing that did a major help was realizing that my thyroid was starting to go nuts too.
My Dr and my endo at that time said I was type 2 ( but I was LADA.) She and the endo at that time also said my thyroid was fine. The endo I have now, first thing she did is test me for type 1 and a more intricate test for my thyroid, which turns out is also not okay.
But when my thyroid is off my hormones will still go off. Paying attention to my thyroid really help/helped my menopause symptoms.
4.6
It’s been consistently in the mid to upper 4s range in the past 3 years or so…
I’ve been T1 for over 32 years now, no beta cell function, just watching what I eat, testing often (on top of using CGM data), being very on top of it with my insulin, plus exercising regularly.
Important to say that I use and apply the great information in Dr Bernstein’s book Diabetes Solution. His videos are also great.
Just had my 2nd round of blood work after getting the CGM, and I am at my target of 5.3 - I am THRILLED that I got here, and will continue to do the work, watch the data and control my eating. Also down over 25 lbs now.
I find that my A1c runs about 0.5% higher than my CGM glucose average. Now I know that there is no discrete single average that a specific A1c translates to, but instead it translates to a range of values.
One study that I saw, for example, showed an A1c of 6.0% actually translates to people who experience an average glucose ranging from 100-152 mg/dL with 126 mg/dL occupying the center value.
@Terry4 I average at around 80-85 most of the time on both my meter and CGM but my SD is also low (20 or less). I also test often still even with a CGM.
I don’t know how reliable A1c is. I once had my PCP test my A1c without my knowledge even though I had it tested at my endo’s office, less than 3 weeks before and I got a 4.2 (at opposed to 4.6 at my endo) and during those few weeks my average actually went up to 90 in those few weeks, while 4.2 would suggest an average of 74. I chucked it to a different lab. I find that at my endo’s office which is located at the hospital, I get much more consistent results.
@Sam19 you can achieve a lower A1c while not practicing low carb way of eating as well and I also achieved it in my past, but the standard deviation is much greater and then it’s more of an average of lows and highs rather than consistently stable BG levels over long periods of time.
Thanks for this. For years I’ve used this reference - Nathan et al (2008) - for A1C-BG relationship, which seems very close to the chart you posted:
AvgBG(mg/dl) = 28.7 * A1C - 46.7 (r^2=0.84)
Some standards for comparison:
@MayaK in upper 4’s, that’s just amazing to me. I try to keep it at 6 or under. Eating out, exercise, stress and all the rest just don’t seem to allow me to get that low. But…
Typical nondiabetics can be in the low 5’s.
FWIW, the Amer Assoc of Endocrinologists says 6.5 is a good target, and the ADA says 7.
I’ve found A1Cs to vary considerably around what I thought they would be based on prior 90-day CGM data, so my general goal is to hang in there, do my best and don’t sweat the details.
I’m able to keep my SD below 20 according to the Dexcom, but I really don’t feel like the Dexcom reflects reality that well in my case… seems pretty glitchy for me
All in all I’m able to keep it pretty stable though… it’s a lot of work and there’s never a day off… I also think I’ve just found all the best tools too though
Yeah I don’t rely on it at all. It’s a great tool for sure but I find that every now and then there are random discrepancies (and not just in the first 24 hours but throughout) and then the differences are 30-50 points mg/dL off.
My A1c was between 4.7 and 5 for a couple of years before I even got my first CGM, just by testing between 10 - 18 times a day, eating low carb (and similar meals everyday) and keeping a consistent schedule.
