It doesnt work for a lot of people Maurie.
I see huge spots at 60, cant walk or drive or do anything.
I dont stabilize until I am over 120.
A 70 on a meter isnt exact science either, it could be lower or higher. Meters are not perfect.
And for any with gastroparesis or even a touch of slow stomach emptying, pre-bolusing doesnt work.
All too often diabetics thinks what works for one will work for all.
no way, no how.
I am on the eve of my dx in June 2010 with an A1C of over 20%. All my quarterly A1Cs since then have been 5.9%.
We are all different. But since you asked, here’s what has worked for me.
- Low carb diet
- Obsessive checking of blood sugars and logging down of food. I am on a poor person’s pump/CGM and was recently offered a pump due to unexpectedly developing a different medical condition. But the doctor reviewing my case said she thought I probably wouldn’t get a better A1C with a pump so I’m staying on MDI.
- Knowing how various types of insulin affect me, and pre-bolusing as appropriate. I routinely shoot 4 units when my pre-meal blood sugar is in the 4s. Apidra will start working in 15 minutes, Novorapid only kicks in after 2 hours.
Those factors above are easily reproducible.
The ones below are rather more operating system-specific:
- although hospital tests have pronounced that I am not insulin resistant, I don’t get much value for money from my insulin. 1 unit of insulin will never drop me more than 1 mm/ol (18). This means I’m far less likely to get hypos - which often then lead to reactive high blood sugars
- I am very very lucky in that for whatever reason, despite almost zero C-peptide, my BG is fairly constant overnight. When I was on Novorapid only, I used to wake up 4 hours after my shot to check my BG and correct if necessary. Now I’m on Apidra, the tail is only 2 hours so the routine is now to check 2 hours after the last shot. Things are pretty stable overnight and I can hardly remember the last morning I woke up at anything over 5.5.
- I am also lucky in never having unexplained lows. I do however have a cunning liver which can sometimes spring spectacular surprises, like the day I got an 18 (324) out of the clear blue sky, with no food on board, no insulin on board, no stress, no hormones, no exercise, just a ketone warning from nowhere.
So it’s a mix of doing what you can to control the bits that you can control, and some of it is just individual circumstances. Like how others can flatline, or eat more than 30g carb in one sitting - I couldn’t do any of that. Don’t be so hard on yourself, each of us has such different mileage. Just do the best that you can.
My a1c has not been above 6.3 in 22 years (probably longer but I don’t keep records) and my last one was 5.7.
My system is not a conscience effort geared to a1c (since my t1 predates the test) and my methods have evolved. But there are rules I live by that have given me fabulous control for 50 years and no complications.
They include:
- Never (and I mean never) put anything in my mouth if I’m 140 or higher. (My highest “high” in the last five years is 230 and that was three years ago.)
- Highs are bad, lows aren’t.
- TDD is an important number, the lower the TDD the better the results.
- The idea that diabetics can eat anything they want, whenever they want is both silly and arrogant. We can’t. Our bodies are broken and even the best technology is laughably crude. So adapt and don’t moan about not eating that cupcake. Low carb diets work. Also … eat small. Large portions of anything are a killer.
- I do not have a CGM and do not plan to get one. I don’t need it. I have slept all night, every night (with a couple non-d exceptions) since dx in 1960. I am totally happy going to bed in the 70s or even the 60s.
- Fitness counts. If you’re in shape and active your numbers will be better.
Finally … if you’re numbers aren’t where you want them, focus first and most intensely on diet. Food does not interest me; it’s just a number. Some nights my dinner is left over broccoli, a scoop of peanut butter and a slice of cheese or cold cuts. It’s strictly math with me; if the numbers work, they work.
I put water in my mouth when my BG is high. Food still interests me a lot.
Mr. Silly & Arrogant 
My BG control improved drastically after I got the Dexcom 7+. This is what I recommend.
I would disagree about lows not being bad. They are bad if you are in the car and drop and cause a wreck (or worse). They are bad if it affects your job (my CDE’s who have gone low during our visits can attest to that not being so fun).
They are bad if you need a paramedic for assistance.
MM for years had a chart with a pendulum on it indicating the evils of highs and lows. A rise on either side indicates possible problems.
Of course YMMV but to say they are not bad, is not entirely true.
Severe lows are bad, of course. But anything above 50 is fine, even preferable for me. I’ve never had a seizure; never gone to the hospital for a d-related event or been incapacitated by a high or a low in 51 years. I have never told anybody I’m diabetic and I am convinced that the reason for my blissful life with d is that I avoid highs at all costs.
Well, I would have to disagree that highs such as 200’s are always culprits, since I know so many diabetics who have lived with higher A1C’s or little use of tools over the years who never had a single complication.
I would wager you ought to let people know, especially if you are doing so well. You might educate the general public. I’m recalling a woman I head telling her son (when they obviously saw someone checking their BG in public)…"oh honey, you dont want to ever do that. That person is a diabetic and they always die horrible deaths."
right.
But for myself and others here, a 60 is not possible to maintain. As I have stated, I see huge flashing white spots and 70’s and 60’s always fall. Never been in a hospital, never needed assistance in forty years, but living over 100 is essential for myself and hasnt proved to be a cause of complications.
I will probably be doing this as soon as the Dexcom comes to Canada and I have a full-time job (currently no healthcare in Canada covers CGM systems, so I’ll be paying for it myself).
I think this is a very individual thing.
My lowest measurable low was 1.2 (21.6) and I was happily walking and talking AND treated the hypo with a totally off-book Nutella crepe. Man, it was the nicest crepe I’ve ever had in my life.
On the flip side, I am totally impervious to highs, whereas I know some other diabetics start feeling lousy when their BG is high. Being impervious to highs is a bad thing - that’s how I landed up in DKA, one year ago tomorrow!
Absolutely it’s individual…all of it.
From our insurance coverage (or lack of), to our doctors, to our meds and what works or doesn’t.
No way any of us should be telling anyone else what works, to the degree that the person feels like they may be on the wrong track.
One thing to share experiences, another to say “Every diabetic should…”…
I’ve seen it too many time on too many forums.
Actually, I particularly enjoy the posts where people confess about the things they ought NOT to have done!
I mean, if not for such forums, I’d still be faithfully changing my lancet each time, like I was taught to do in the hospital…
Ya got me on that one.
Once or twice a year is plenty…
Thanks to everyone who posted! I'm taking note of what has worked for you and am going to try and see how it applies to me! Keep the advice coming!
Jen, I hope you've been able to get a Dex by now! It is fantastic! I am newly diagnosed (July 12th) and it has saved me many times! I can recall several times where I didn't feel a low, but checked anyway because the Dex told me to (and it was right). I was able to feel more confident going kayaking by using the alarm feature of the Dex. It is also wonderful to have learned from it that I tend to spike late after a meal (try 3 or more hours---what?!). I know from it that bagels are difficult for me, and that I don't have problems (so far) with DP.
Still no Dexcom in Canada, unfortunately. :( I've actually been considering the Minimed CGM lately (not the one connected to the pump but the standalone one) just because it seems like it may be a few more years before the Dexcom gets here. I would have to pay out of pocket, though, which would be kind of expensive ...
Hi Jen: If I could add my two cents, I would not get the Medtronic Guardian (standalone CGM) if I were you. I got one two years ago, and it was so inaccurate, so difficult to calibrate, and I was tired of blood gushers, I just gave up on the thing. Now it's Me & Dex, and I just think the Dexcom is amazing. The Dexcom and the Guardian are polar opposites.
I agree with you, from what I have read I would prefer the Dexcom (and it also has a larger screen which is important for me), but the Guardian (or the Veo) are the only options in Canada right now. I've been waiting for over two years for the Dexcom to come here and I haven't heard anything to indicate that they are any closer to doing so. :(
I am going crazy with my blood sugars and really think a CGM would help, but unless there is some way of getting the Dexcom (legally) from the U.S.—and I can't drive so getting down there isn't that easy, even though I do only live about an hour from the border—I am stuck either waiting another few years (probably) or going with something like the Guardian, which I figure even if it's bad is better than nothing ... But on the other hand, that's a lot of money to waste if it happens not to work (and I actually just checked out their website and can't find the Guardian, only the Veo pump, so hopefully they haven't taken away that option!).
Jen, I can so relate to your story. Mine is so similar that I could have written the same story. Type I for 25 years on MDI. My A1cs were in the 6.5 range until my hormones went crazy and I shot to 7.7. Now struggling to get control without much success yet. I'll have one good week and breathe a sigh of relief only for the numbers to shoot up again for no reason - same schedule, same foods, crazy numbers. So frustrating.
I also just started with a dexcom and it's amazing to be able to see the patterns, especially overnight. But I probably test even more now to check the accuracy of numbers that are out of line - sometimes the dex is right on and sometimes out of sync. Because of this, I've been testing probably 15 times per day and writing down my finger stick number, the dexcom number and any other info so I can use that to make decisions when looking at the dexcom graphs.
Until you get a CGM, you may want to try just getting some graph paper and charting your numbers. It's easier to see the patterns visually for me. You can find sample chart papers to use for tracking online such as Accuchek 360 View Tool. It might be worth a try.
Of course, all that said, I still haven't solved my own problems and plan to seek advice from my CDE this week.