How do you do it? What kind of a daily range are you achieving?
How often do you go high (and how high)?
If you don’t have a CGM, do you get up at night to test?
I am not attempting to get my A1c this low right now. I tried for years to get it below 6.5 and never could and ended up totally burning myself out. I would still love to, but for the moment I’m just trying to get it down into the high 6s where it used to be (and then keep it there and NOT burn out).
Lately I am being extremely careful about food and sticking to a routine, which has definitely helped with very high numbers. But I still am having highs that are totally random. Lows I can almost always connect either to activity or misgauging food and bolusing too much (in an attempt not to under-bolus), but the highs just come out of nowhere and of course they are what affect the A1c more than lows.
For example, last night I went to bed at 7.0 (126) having basal rates that are on track (as far as I knew!) judging from good morning numbers the past few days, and making a point not to eat because I’ve discovered eating before bed almost always means I wake up a bit high even though I bolus correctly. Yet I woke up this morning at 11.2 (202). Very annoying, especially since I could have been that high for hours for all I know!
Also, after I eat it is impossible not to spike to 8-10 (145-180) an hour or an hour and a half after eating. I still don’t get how people maintain nice flat blood sugars there. Even a salad will do this for me, even though bolusing for 15g of carbs is much better than bolusing for 50g, I still get a very noticeable spike that goes pretty much to the same BG, just with less insulin.
I’ve also noticed if I try and aim for a blood sugar of, say, 5.5 (100) at two hours I will crash low by three hours. I am thinking this is where pre-bolusing might help, but how can you pre-bolus when your pre-meal blood sugar is only 4.2 (76) to begin with? Seems I am often starting meals with blood sugars in the 4s, which is good except for that pre-bolusing thing.
Also, surrounding exercise it is impossible for me to not spike. I tend to reduce my meal bolus before exercising and this always always works in that I don’t go low, but I also start out with a high blood sugar. Even my endo doesn’t like me doing this because it’s purposefully causing highs. He thinks I should just eat before exercising, but to me that sort of seems to defeat the purpose of burning calories if you’re just replacing them with food!
I guess stuff like this is why I can’t understand how T1s who say they never go over 200 or 150 or whatever actually do it. Are there really people who do this or is it exaggeration? Especially people who have had T1 for a few decades? I can only guess these are the same people who have an A1c in the 5s. How do you get such fine-tuned control when there are sooooo many variable, some unknown, that affect blood sugar?
Jen, I would like to have 5.0, got a 5.7 on MDI for one three month period in 2003. If I can remember,. I ate before exercising ( rriding bikes and cardio) and did not do very low carb at all, just did complex carbs and exercised every day. I have gotten older and have spina lstenosis and other cricks and pains and have a bit more trouble with extended exercises, but will be walking and biking this summer . I am aiming to get to 6.0. I was at a 7.3. last a1c… too high for me. But I know how you can get a random high… stop trying to judge yourself by the A1c number… I have type One for 43 years and NO major complications… and I definitely do NOT have a history of a1c’s in the 5’s!!! I wan it under 6.5,(close to 5.9 if I can)and am aiming for it…but I will not sweat( fret, worry, ask why me?) that spike over 200 that may or may not hit me a couple of times a week. It is just par for the course.
God bless,
Brunetta
It took me FOREVER to get my basal rates down…and they continue to change. I have to be very very reactive to weekly trends. If I’m trending a certain way for more than 3-4 days (too high at a certain time of day, too low at a certain time of day…) I make changes to my basals. I’ve also started making more informed changes to my I:C ratios, which used to all be set to 1:10. I couldn’t figure out why just changing my basals wasn’t fixing my issues. I finally figured out what works for me…for now.
I still battle DP. My basals are usually good, but my liver really hates me. Sometimes it’s like it doesn’t want to dump the expected glucose and so my basal rate ends up being unnecessarily high and I end up going low around 4am. Other times I’m right on. Yet other times my liver goes into overdrive and despite high basal rates I wake up with blood sugars of 200+. So I’m especially motivated to get the REST of my day as ‘normal’ as possible.
I also spike very very high when I eat. It’s not uncommon for me to spike upwards of 250. (I wore a rudimentary CGM when I was 16 through the Children’s Hospital of Wisconsin. It didn’t tell me my blood sugar levels but did record it in a device (in which I also had to input insulin given and carbs eaten) which was then downloaded after 3 days. They discovered that after any food I was spiking very high. I’d always come down…but the spikes were there!)…because I know this about myself I use the ‘super bolus’ a lot (giving some of your basal up front with your bolus instead of extended over that time). I do this to correct highs and/or if I’m eating more than 30g carbs in a meal.
Between really watching my basals, I:C ratios, and using ‘super boluses’, this is how I’m (for now) achieving A1cs in the 5s.
I am not aiming for an A1c in the 5s, just really curious how people can do it.
If I can get back to a 6.8 or so I will be happy with that. May try for lower at some point in the future, but am not going to burn myself out to get there.
Mostly this post is out of curiosity than anything. 
You sound a lot like me. I have a strong DP and before I got the pump I was routinely waking up with blood sugars of 17+ (in the 300s) despite going to bed in range. I try to adjust basal rates but when I get to adjusting more than about once a week it feels a bit ridiculous … Maybe I need to start doing this.
I went on a CGM a few years ago (the temporary Minimed one) and it showed that I can start in range, spike up to 14-15 (250+) and be back down in range at two hours. That’s what really got me paying more attention to glycemic index. It seems (from that experience) that GI has a bigger impact for me than the actual number of carbs I eat, as long as I bolus accurately.
It took me five years several years ago to get my A1c from an 8.7 to a 6.6. Then I totally burned out and within six months it was back up to 8.5! I am hoping getting it down again will not take five years this time around!
I currently have all my ratios set to 1:10, too, and have not experimented with super boluses. Something to look into!
I have found ,Jen. that I do need to get up at night to test if I have that “funny” feeling that almost ALWAYS wakes me up, even when the not exactly-reliable-for-lows Minimed CGMS does not alarm. If my basal is not set just right, if it is just a smidge off, I can go low at 3am.:. I found out that ithis low t is a precursor to a rebound high in the morning.(forgot the long name for this, Symogi effect)?.That, combined with the rising mrning blood sugars on arising (Liveglucose r dumping) makes getting those morning numbers n order very hard You also have to know exactly when and how much, or how little little to raise the early morning pre-dawn basal. lI am working on that very same problem with yet another overnight basal redo this week, or next…this added to the problem io occasional f crimped cannulas if i roll over when wearing the long tubing…It’s a blast isn’t it (LOL)?
God bless,
Brunetta
I have no idea how my HA1C is 5.5. I am assuming it’s because I am honeymooning (dx’d in sept at 11.3). I know that working out 4-5 days a week including weight training keeps me lower and I am on symlin for carb-heavy meals. I think my 5.5. is an unhealthy one. I am in the 70s 2-3 times a day but I am also high enough to even that out. I don’t have CGM so unfortunately I don’t know exactly what is always going on. So… only thing I can say for sure is symlin and exercise.
I’ve only been at this as a T1 for about 4 1/2 years and have been in the 5s more often than not. I’m probably still getting an assist from my residual beta cells so what I say might not be that helpful.
I weigh just about everything that goes into my mouth. I wake up most nights and will test and correct if I’m not in a fairly tight range. I eat a moderate carb, high fat, high fiber, very consistent diet. Same breakfast and lunch pretty much every day. I actually tend to go low in the first couple hours and then tend to float higher (or a little too high) by hour four.
My insulin needs have changed (increased significantly over the past four years and like Kari I am constantly looking at my numbers and seeing where improvements might be made. I’ve found it very helpful to actually write all of the stuff down rather than allowing my pump to be my principal log.
One of the ways that I try not to burn out is by allowing myself treats. I enjoy sweet things and eat fruit most meals. I eat dark chocolate every day.
Maurie
Dark chocolate is how I indulge too!
And definitely…weighing all of your food is a big help. After I started weighing my food I discovered that before that my ‘guesstimating’ skills had been horrible!
One test at a time? I have a CGM and still test pretty regularly to make sure it’s behaving itself. I also am very regular in my habits during the week, mostly because I’m very busy at work and it’s easier to toss 1/2 sandwich down the hatch than make lunch plans, drive 20 min to eat crap, etc. Eating pretty much the same thing every day gives me very good control during those times (breakfast & lunch 5x days/ week…) and also gives me a pretty good clue when things change? 3 days in a row of an off number and I’ll adjust stuff.
I hope you don’t mind me piping in here. I think you are very hard on yourself. There is clearly more going on here than just some fine tuning around your meals. If your HbA1c is 8.5, then your blood sugars are spending a lot of time over 200. I don’t know, maybe you are going very high overnight, maybe you are high during exercise or spiking from meals. Maybe you need to set you ratios to different than 1:10. Maybe you need some better overnight basal ratios. But if it were easy you would have made the necessary adjustments long ago.
In my view, you are an “ideal” candidate for a CGM. You care about this, you are devoted and diligent. And a CGM could make a huge difference. Is there any chance you could get a CGM and have it help you? At the very least, could you borrow one from your endo?
Jen, I was told I was brittle, and I was going 200 up and 50 down. That’s over 10 years ago now. It took a CGMS for awhile, and finally, determination to eat low carb (6-12-20) and to eat within a definite group of foods that put the A1c in the 5s comfortably for a couple years now. I am persistent about it; I do not spend a lot of time on it. I do not eat fruit much; very little rice, only low carb bread, only 1/2 dinner roll, & no unwieldy uncalculable pasta. I do test at night a couple times monthly so I know nothing is happening then. My basal 2-shot regimen is highly off center: 3x as much in the morning as at the evening dose. I’m best when I give my dinner bolus a half hour prior to eating. All this evolved. I didn’t suddenly wake up and do it. It takes time to learn what works with DP. For me it was giving enough basal at bedtime to keep me from going low, never eating before bedtime unless I needed a half a glucose tablet to get me to 100, and eating about 4-5 hours before bedtime. Best wishes on what you choose to do. One thing at a time so you can control it.
+1
Hey, thanks for your comments! You’re right, I am hard on myself, and that extends beyond diabetes!
My A1c is actually not 8.5 at the moment. It was 8.5 last August and 8.2 at the beginning of February. At the time my average was, indeed, over 200. Right now my 60-day average is 9.2 or 166, and I expect my A1c (which I’m getting done this week) will probably be in the mid 7s. I test 8-10x most days so my average approximates my A1c pretty well.
I agree that I think a CGM would make a huge difference for me! Unfortunately the only CGM available in Canada is the Minimed one integrated into a pump. Since I use a different pump, that one’s out. Plus, I wouldn’t have the money to pay for one right now, anyway. I do have a hospital-based diabetes clinic near me which has CGMs they lend out, so I could see about borrowing one from them, but it’s only a three-day (or maybe five or six days now, not sure) one so I am not sure how much that would help. I think part of my problem is that I get things set so they work well for a week and then they change again.
I can’t wait until the Dexcom comes to Canada and is integrated into the Ping pump. As soon as that happens I will be upgrading, assuming I have a full-time job by then as neither private insurance nor our provincial healthcare will cover them.
“I can’t understand T1s who say they never go over 200 or 150 or whatever actually do it. Are there really people who do this or is it exaggeration?”
It is not an exaggeration! I won’t say never, but I will say I rarely go this high, and if I do I know it quickly because I test often, and I fix it immediately. I’ve had D for decades, maintain A1c in the low 5s. I do not and never will use the A1c as my measure of control. I use the numbers on my meter, and try to keep my bg in my preferred range at all time, less than 120 and more than 70.
Simple? Not always! Doable? YES!!
It’s not doable if you are one like myself, who cannot stay at 100. My bg has never stayed there, always dropped and it doesnt matter what I do.
Some of us could never exist at lower numbers.
Wow, would love to have an A1C this low, but I tend to be really insulin sensitive, so if I aim for this, I’m likely to go low. A lot. I tried it once, but the lows were debilitating. Right now, I aim to keep my A1C in the 7s and low 8s. I know that’s higher than some would like, but it’s what is realistic and safe for me. Also, I tend to look less at my A1C and more at my daily logs, beause for me those logs are a better indication of how I’m doing. I’d rather have steady, mild highs than lots of really high highs and low lows.
I will let you know how to do it if I ever get there! I suspect that I would be low a lot of the time if my A1C was in the 5’s. I am kind of new to being “good” about diabetes and recently just brought my A1C down from the double digits to the 6’s this year.
I’m probably getting an assist from residual beta cells, too, and have no DP to speak of. But still: pe-bolusing has been huge for me. I learned it from this site! You have to be careful: only do it at home at first, and don’t pre-bolus by a lot if you’re eating something super-rich. But don’t worry about starting in the 70s – or, well, OK, sure, worry about it, but don’t let it stop you from experimenting!
Two reasons.
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for those of us aiming at tight control and A1c in the 5’s, a pre-meal reading in the 70s isn’t low; it’s just an “I’m hungry and it’s time for dinner” reading.
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The goal is not to start dropping and then eat; the goal is to basically line up the drop from the insulin with the rise from the food. For me, the insulin really only starts to kick in at ~ 15-20 minutes, or even more. So if I pre-bolus by 15 minutes, even with a reading in the 70s, I don’t go low. (Again, that’s for a carby, not too fatty meal: I’m finding that kind of food affects the timing of the pre-bolus way more than my starting blood sugar. Oh, better – kind of food AND insulin on board. If I bolus for dessert after already bolusing for dinner, I don’t pre-bolus; I just dive in. )
The meaning of starting in the 70s varies person to person. If I start in the 70s, there is a significant possibility that I’ll end up low. Take this morning for example. I was 71 before breakfast; had my standard breakfast;; bolused a little later than usual; postponed an additional .3 of a unit of insulin on top of my normal deferral of 1.1 units; back corrected for the 71 and still ended up at 47 at 1:45 post.
Starting on the low side works for many people but it doesn’t work for me and I prefer to come to a meal between 85 and 110. I get my lower numbers at other points in the cycle.
Maurie