I consider myself in good control. Just got an A1c of 6.1 today. However, I want to gain even better control. My endo says that studies show it's the A1c that counts when considering the risk of complications, not the individual highs and lows. However, there have been a few comments from various educators that lead me to believe my numbers could be better---AND, I would feel better about them too. So, I just want to know what is normal for T1 (versus what is normal for people without diabetes) after eating. I've heard the highest BG occur two hours after a meal, maybe that varies with insulin type?? For instance, after a meal, I can go into the 260s (average) and by the time I come back down, I'm either normal or riding low. I know this is very specific to me, but I want to get an idea of what some of you, that consider yourselves to be in good control, run 1 and 2 hours after a meal. How long does it take you to get back to your baseline? My baseline is 100, what is yours?
I wanted to cover this with my endo today, but I guess we ran out of time (I promise, I'm not a talker.) I think he just considers that my A1c is great and he thinks I know more than I really do. So, I thought I would go to the source, you guys!! Thanks.
Now, as far as where your peaks and valleys occur, like you said, what’s typical for everybody else may not be what’s normal for you.
In 25 years of BG testing, I rarely ever peak 2 hours after a meal. My peak is closer to 1 to 1.5 hours after a meal. I try to keep it under 180 and shoot for around 140 if possible. At 140 postprandial, I’ll have subsequent lows in the high 50’s to low 60’s, but I can deal with them and they are usually close enough to my next meal where it just means a lower Novolog dose to cover.
Oh, and I’m on MDI. Gonna talk to my endo about a pump next month.
It’s not just A1c, but how level BG is, a low standard deviation, because bouncing between high & low isn’t healthy. People can have the same A1c, but very different levels of control.
You may need to experiment with insulin timing so you’re not that high after meals, or switch to a different brand. If you’re taking larger doses of insulin to cover higher carb meals, larger doses act less predictably than smaller doses.
I don’t think that it’s so much that 2 hours after eating is when BG is highest. I think we’re told to test 2 hours postprandial because that’s when rapid acting insulin peaks. I’ve tested at 1 hour & it’s always higher than at 2 hours.
I aim for 140 or lower after meals. My target BG is 90.
My niece now uses a faster acting insulin in her pump, Apidra. Apridra seems to work better for her. Duration is still long, but it seems to work more up front, with less drop after the 2 hour mark, so it is safer for her. If she is at school or away, we have to settle for 200 at the one hour mark, 150 or 160 at the two hour mark and then she will go back to a normal blood sugar by the fourth hour. If with us, we can have better control by overbolusing just a bit, which will bring her down to 120 at the two hour mark. Then we feed three-quarters of the insulin on board. Since the insulin is peaking, she will not spike when we feed IOB. You can prebolus which works well for some or superbolus. As long as you do not forget to take blood sugar and cover IOB two hours after eating, overbolusing slightly works really well for us.
I concur w/ Gerri (and disagree w/ your endo) about A1c not being more important than individual highs/lows. After all, you can live a long time with an A1c of 9, but just one bad high or low can kill you. I actually just wrote in my blog today about how my goals are currently more to do with limiting variability than with a specific target range (though of course the two are linked). The fact that you’re able to achieve an A1c of 6.1 means you have an average blood sugar of around 117 mg/dl, so for every one of your 260s, you’re spending some time at a much lower reading to achieve that. Try to bring down the post-prandials gradually (I would not try to go from 260 to 140 right away, as hypo is a big concern there), and pay attention to how different foods affect your blood sugar. You may find that testing a bit more frequently (or better yet, using a CGM) will help you figure out a diet/insulin timing that helps you hit your targets.
Personally, my goal is between 80 and 90, and I set my CGM alarms at 70 and 120 (and try to stay below 140 at all times).
I agree Gerri. I was led to believe that it’s not the A1c but how level you are also. My Dr. ALWAYS checks my highs and lows. He seems more interested in those than what my A1c is. You can be jumping all over the place an come out with a good A1c.
The point of running A1C is to look at BG control over months, not days or hours. Before we get caught up with the endo suggesting that individual highs or lows don’t matter, we have to clarify if he/she is talking about occasional highs or lows or a consistent pattern of highs and lows. An occasional high or low over a period of 90 days will not drastically effect either your A1C or variability.
Are you seeing a consistent pattern of postprandial 260s followed by a consistent pattern of lows to compensate, or is it an occassional 260?
My A1c is 6.0. I’m looking at my BG over the last 90 days and I have 4 readings over 260 and another 4 over 240, all post prandial. I don’t have any readings of less than 10 to compensate and give me my A1c, so I’m thinking that I can look at them as outliers regarding my overall control. Highs and lows concern me, of course, but I’m not beating myself up over them.
If you happen to have an iPhone or Google phone, you can download BG apps that automatically calculate the Standard Deviation around your mean BG. SD is not the best measure of BG variability but it will give you an idea of how much those highs, and lows, are affecting your overall control. With my app, I can look at control over any period of time from a day to however long I’ve had my log and see how the variabilty changes with individual measurments.
That is true of course- the occasional spike is pretty much impossible to avoid if you ingest food. That said, saying you have, to use FHS’ example, 4 readings over 260, doesn’t mean that’s as high as you went, or that you only went that high 4 times, if you are testing only w/ a glucometer. One of the things I discovered when I went on a CGM was that, whereas before I would test 2 hours after a meal, see something like 175, and think “great”, my sugar may have gone as high as 275 during those 2 hours.
It depends on what I eat, but usually 120 after a couple of hours or less. My goal is to keep it near 100 all the time, but sometimes I make mistakes. When first diagnosed I was 11.4 A1C, now I stay at the 5.4 range…I take some Metformin and a little insulin. Congrats on you A!C…!!!
