There are a number of members who have been able to keep A1C numbers below 5.5. Some people theorize that such a number is too ambitious and can only be achieved with significant risks of hypo events. Others would argue that it’s possible to maintain such levels without a lot of lows. I call the latter group the “Type A, Type 1’s” since they seem to be driven by ambitious goals and are quiet obsessive. Some have prevailed through using a very low carb diet, others by fine tuning pump strategies. For my part I’m somewhere in between but my 5.2 has brought with it some lows although they have become less frequent as I have become better with my regimen. I’m interested to hear from those who have been able to achieve low A1C’s on a regular basis without experience a lot of hypos - and to hear their strategies. Thanks.
I am close to your group and have a very strange method. My last A1C was 5.6. I have only ever had one low where I have woken up to the paramedics and very few (read three) where I have become “combative”. My strategy is morning Lantus - 29 units and eat when I need to, which usually ends up being 7am breakfast of toast and coffee, lunch with carbs and protein and salad, carb snack in the afternoon and a healthy dinner before 7:30. There are times in the month where I have to use Humalog to keep this regimen in line, but it usually only lasts 3-4 days. I also have to push 200 to go to bed and make it through he night without a low. I exercise 3x a week, am not obsessive about anything but my TV shows and don’t let diabetes rule my life. I rule my diabetes. Been doing it for 36 years. I truly think that every body (not everybody) is different and that each strategy for success is different for each individual. I would never recommend my method as a “correct” method, but it works for me.
Do not feed Diabetics after 19:30, LOL.
Seriously - If something went wrong I can make a correction before my sleeping period begins. The distance between the last meal and going to sleep should match the insulin profile (2-3 hours for NovoRapid and 4-5 hours for Acctrapid even more hours when gastroparesis comes into play). This distance will guarantee that the BG has stabilized and no active insulin is remaining when I go to bed. At this point a decision can be made whether to correct or not. This will bring me in a good starting position for the night and this is the key for a good value in the morning.
In the night we can not correct and will be high for hours. So having a good night and morning value, without lows of course, will be responsible for 50% percent of your A1c success.
Excellent advice. For me the toughest part of the day is from 7-10pm as it seems dinner bolusing is the most subject to variation. If I can be stable and go to bed with readings of 80-90 then I’m assured that I will wake up in the mid 80’s - and as you say, this accounts for 50% of the A1C number. This is the benefit of doing accurate basal testing overnight - to make sure that all periods of the night are adequately covered by basal. Thanks for your response and it will encourage me to cease the feeding at 19:30!
I’ve only been under 5.6 once in my diabetic life and it was after my 1st child was born. My blood sugars were continually low because of my pregnancy and I’ll admit, very uncomfortable. I don’t think I’ve ever been to the point where I want to do that again. Yet. But I’m curious how someone can do it without always being low.
In my case I believe that thorough basal testing has been the difference. Based on my testing I can be confident that without any eating or exercise my BG will stay in a tight range. From there it’s just a question of bolusing correctly. By staying relatively low carb, and being fairly agressive with square waves for most meals, I’m able to back off the tail end of the insulin if I see myself starting to slide (all courtesy of the Dex). Conversely I react very quickly to any post-prandial uptick by correcting even when I’m not yet high but simply based on the trend and slope I am seeing. I find myself looking at the Dex a lot (call me obsessive) but it enables me to be proactive on impending lows and highs. I’m sure there are many other ways - some of which don’t require as many corrections.
Thanks for the response. It sounds like you are using the lantus to cover both basal and bolus which is the first time I’ve heard of this from a type 1 who eats three meals a day. I’m assuming you stay quite low during the day in order to make up for what sounds like a relatively higher starting number at night. What is your BG generally first thing in the morning? It sounds like you’ve found a formula which works well for you and which has been relatively stress free - congratulations.
Clearly you have excellent carb counting and pump skills. These must be your keys to keeping your SD impressively low. What’s interesting is that you are able to attain these good numbers without experiencing many lows. Thanks for your post.
I do not try for below 5.5. I don’t think I’d make it. But I do stay between 5.5 and 5.9 without lows. I can’t remember the last time I had a low.
Very low standard deviations of 11-15 (high). I target the amount of food I can eat with the rise it will cause and if insulin will cover it so I will not go over 140 at one hour pp. I take two shots of Lantus daily; Humalog for meals. A snack of 3 grams + protein is as high as I go for snacks. Otherwise it’s a meal complete with Humalog. 15 grams raises me 100 so it has to count as a meal ( so I add more to it so it’s a good one).
I eat fairly low carb, am obsessive about counting carbs, and love trying new ways (blanched almond flour, flaxseed meal, DaVinci, Trivia, lots of protein whey, low carb bread) in recipes for comfort foods. I have competition for everything I make: my husband eats it often before i get to it, whether or not the recipe is a good one as long as it has chocolate in it. So I have to keep cooking. I eat 4 meals a day.
Staying at <140 pp and keeping the SD low seem to be two consistent themes among this group. I daresay there’s also a degree of obsessiveness in this group also - something which I conclude may also be one of ingredients for success. Thanks for sharing your thoughts.
Christine, how often do you measure your bg?
I’ve been diagnosed type 1 for about a year now. I was diagnosed at age 42. Not LADA but Type 1. I was put on Insulin the day after I was diagnosed. My fasting BS test when I was diagnosed was 457 (Only had water for 20 hours).
So since diagnosis I dived right into figuring out what I needed to do to keep myself healthy and keep from have complications later in life. My CDE worked with me on getting my BS values down to about 75 - 90 pre-meal.
We went for 2 hours after meal to be around 120 - 145.
So for about 11 months I’ve tried to stick to this as much as possible. I do have bad days. Days I forget to take my Insulin when the family is out and eat anyway. I also travel 70-90% a month for my job and eat out alot.
I try to keep each meal down to 45-60 carbs per meal. I take .5 units of Novalog for the amount of Carbs I eat. So I usually take anywhere from 28 - 34 units per meal. I keep to this for Breakfast, Lunch and Dinner. I rarely have snacks. But If I do I try to keep it around 15 carbs. I like meat so I do snack on Jerky when I’m getting hungry. Also pistachios and almonds I’ve found are helpful as well.
I take 32-34 units of Levemir in the morning around 7am. I’ve been having morning values of 115 - 155 when I get up. But my values at 3 am are usually 80. So I’m fighting the Dawn Phenomenon and it seems to go in cycles. But so far I’ve just been adjusting the amount of carbs I have for breakfast keeping my Novolag shots to about 30 units for about 30 carbs.
My A1C values from last year were - Diagnosis 14.3. The next 3 checks were each at 3 months apart. The A1C’s were 5.2, 5.1 and 5.4.
I also take 30mg Lisinopril for Blood Pressure. 40 mg of Pravastatin for cholesterol. Baby Aspirin and mens multi-vitamin. And I’m also taking 2gms of Niacin in the morning and 2gms prior to bed.
One last things is I’ve been using the Dexcom 7+ for the last 6 months. It’s been great at catching lows and highs. And helping figure out those foods that rise faster or slower than the Novalog curve.
I don’t really try to balance every meal out with Protein, Carbs, Veggies, Fiber… etc. I’m the Father of 4 kids that are 17, 14, 12 and 9. So my Wife tries to keep my needs in mind but does tend to cook for the whole family. So nights that it’s pasta night… I just decide to eat less carbs and have a salad… or take more insulin and eat like the big boys.
It’s all a give and take… and as long as I watch my BS closely I’ve not really had any bad episodes. I will admit though in the first 6 months I did have a few lows a week that went down to the mid 40’s and even a couple of high 30’s. I was working out alot at the time as well and was having post workout lows in the evening. Also it seemed sometimes I would go low around 2am. So I backed off the gym workouts for awhile (as well my job got very busy and kept me from working out as much).
So I just passed my 1st year anniversary and everything on my last Labs was great except I’m fighting getting my triglycerides under control yet. But no other issues are showing up. I do think I might be starting to have a problem with my Thyroid so the Dr. pulled blood last Friday to check. Hopefully I’ll hear something this week.
Well - Hope this helps you a bit. But like I read in an earlier post… keeping the low range 70 - 90 and the postmeal value about 40 to 50 higher seems to be what helped me the most.
Jimmy: Thanks for your response. Like you I was diagnosed as type 1 later in life (age 47) and placed on an insulin regimen right away. Sounds like you do a great job of carb counting which ensures your success in achieving low A1C numbers. Most people who are able to maintain A1C’s in the low 5’s share this ability to accurately bolus which prevents postprandial lows and highs - and keeps numbers from generally exceeding 140. When I was on mdi I also struggled with the dawn phenomenom which held me back in achieving lower A1C nubmers starting the day. Eventually I yielded and got the omnipod which I currently enjoy. However, even though my A1C improved, I think I was overall much more disciplined and diligent when I was on mdi. I surmise that mdi makes one particularly attuned to dosing correctly whereas with the pump it’s so easy to make corrections and to become lazy. There are many people using mdi who have been successful in attaining low A1C’'s which shows that it’s not all about the technology, but more importantly about the user. Good luck with fine tuning your treatement regimen. Mike.