I went to see my endo yesterday and saw the dietitian. She told me to decrease my correction factor to 25 from thirty, but i feel like my 30 correction factor worked really great. I had a really high A1c but I know that the 30 works great. She also suggested that I eat the same amount of carbs at every meal. I only did this when I was first diagnosed nine years ago for a few weeks. I never met this one dietitian before and I don't really agree with her at all. I don't know what to do but I don't want to go against doctors orders either. I don't feel like she really knew what she was doing. So aggravating......
You have been a PWD for some time now and you probably have a good understanding of how your insulin works...what do you think caused your really high A1c??. ..You probably know what needs to be done to lower your A1c...You also understand that no one will ever understand you like you understand you...;-)
You may want to consider reading or re-reading "Think Like A Pancreas". My A1c is not where I want it to be either but if I followed what my Dietician tells me to do (as in eating more carbs per day), I would be roller coastering all over the place.
When I'm feeling overwhelmed, I find it helps me re-focus to re-read this book (and also "Pumping Insulin"). Then I "start over" with testing correction factor at different times of day and all the other ratios and rates.
Hang in there, Sam. The Dietician and the endo aren't the ones living with *your* diabetes. You can do it. Just step back and take a fresh start.
I agree with the folks above...good control requires the ability to self adjust insulin.
I think eating the same amount of carbs for every meal is an ancient way of doing things. With proper carb counting, well-tuned I:C ratios, and modern insulins this is unnecessary.
Now, if the RD or endo saw that you were on a roller coaster, they might suggest this to stabilize things while tuning basal, bolus, etc.
Thanks for the replies. I just bought the book you mentioned on amazon. I'm trying hard but sometimes it just isn't enough, but I am hopeful for bringing down my A1c!
I agree with the others that you probably know your body and how it is affected by insulin. But your A1C, as I'm sure you know, is dangerously high. What you don't say is if this is something that just happened recently or has been going on for quite awhile. I'm sure your endo is motivated to make the changes to help you get your A1C down, but she may not be choosing the right changes for you, and the dietician surely is in the dark ages, but again, may be motivated by the urgency to get your numbers down.
If you have had a good experience in the past with this endo I would try and work with her, not blindly "obeying doctors orders" but dialoging with her as to your concerns. The questions to bring up would be why you feel 30 was working well, and why she thinks 25 is better. Is she just randomly suggesting more insulin to get your A1C down or has she actually looked at your data and seen that when you correct you don't in fact bring your blood sugar down enough. How about you? When you do a correction do you check back 2 hours later and see significant progress towards target blood sugar? Three hours? If you are still too high after correction then she may be right that you need to go down to 25.
If you have never had a good experience with this endo, or she won't listen to your explanations and questions, then it is time to look for a change.
My guess is you do have a lot of knowledge after so many years living with Type 1, but you are also in trouble at the moment and need help, so you need to work with the right person to help you. I also second the idea to read or re-read books like Using Insulin and be open to making some changes in your management.
You list your A1C on your page as 13.4. Whoa!! Holy A1C batman! Yes, that is high and you know you need to work on getting that down. But go slow, take baby steps if you need to.
What do you think is causing your A1C to be so high? Is it just one thing? Or many things?
Also, keep in mind that if you're under the age of 20 (I don't know your exact age), hormones are still wreaking havoc throughout your body. Those hormonal surges (growth hormone, sex hormones, etc) can cause your BGs to go to crud for no apparent reason. Most of us T1s have horrible A1Cs throughout our teenage years. However, walking around with an A1c that high for any significant period of time is really bad for your body.
Also keep in mind that as you bring your BGs down, you may feel low. A lot. Even when you're not low at all. When I worked to get my BGs back under control years ago, I had an endo completely dismiss my "I-feel-low-even-though-I'm-not" complaint. It's one of those things that PWDs know well, but endos/docs aren't always aware of. You may find that you have to ride out a few days or weeks of not feeling too hot as you bring those BGs down. Don't worry, the feeling WILL go away.
One thing that lots of folks recommend on here is that when you feel your in a D-slump, pick just ONE thing about your D care that you want to change and start changing it now. Just one thing. Maybe it's testing first thing in the morning, or bolusing correctly for years. A couple of years ago, I fell off the D-wagon big time and was being really bad. I was eating out constantly, SWAGging wildly, and just not testing like I should. So, I changed just one thing - I started bringing my lunch to work instead of buying out. That one little change cascaded into a bunch of other changes...I started testing more and bolusing correctly and went back on the pump. I am doing much better with my care, but I needed to make that one little change to know that I really could do what needed to be done.
You've lived with T1D long enough to probably have more wisdom about insulin and food and blood sugar levels than any dietician or endo. You need to use that wisdom to get things back on track.
Hi -
I am going to go against the general trend of advice you've been receiving. Many of us eat pretty much the same breakfast every day. One of the ways to get a handle on your blood sugar is to get a handle on a series of meals and stick with them. I certainly try to keep my total number of carbs per meal fairly constant because it makes it easier to learn how your bolus will work and makes it easier to tell if a high is just really out of the ordinary. If you eat about the same number of carbs at a meal you don't have to worry quite so much about how well you're balancing your basal and bolus. Maybe you are using basal to cover; maybe your bolus includes a bit of correction for a slight basal shortfall. If your total number of carbs fluctuates widely the basal/bolus balance better be right or you're going to find yourself in trouble more often.
What does it mean that you know a correction ratio of 30 works great? Does a correction based on that ratio bring you back down to 120 or so within 4 hours on a consistent basis? If it doesn't, why not try a bit more insulin to get better results.
Your A1c is what one would expect for someone newly diagnosed. Why not use the more rigid framework to help get under basic control and then spread your wings. You'll feel ten times better if you do.
Good luck,
Maurie
LOL that's when I smile and nod my head, leave the office and change my pump setting back to where I want them to be...my CDE was trying to tell me it was perfectly OK to be 180 2 hours after eating, and I'm like ok WHATEVER, lol.
I think we ALL know our own D better than any doctor or CDE can ever know, BUT your A1C as you know IS high, and definately needs to be lowered. Start making some small changes in that direction, your basal/bolus rates MIGHT need some tweaking.
Sam - There is already and lot of good advice to you here. What I think you need to do is to become an expert on how food, insulin, and exercise uniquely affects you. The best way to do this is to keep a daily log for a few weeks or even a month. Of all the things that have helped me regain control when things go haywire, this is the best one.
This log should keep track of the carbohydrate content of everything you eat, your insulin doses, and exercise duration and intensity. The log should also note the timing of every event. A grid form that lists carbohydrate grams, insulin units, and exercise as the rows and every hour of the day as columns would work.
It's a bit of a record keeping burden but it's been well worth it to me. What this allows you to do is to learn how your body reacts to various combinations of food, exercise, and insulin. It allows you to spot patterns that would otherwise go unnoticed. It's like missing the forest because of all the trees.
This method has never failed me. Whenever I do it and reap important benefits, I always wonder why I put it off! I know this isn't easy but if it helps you to take control, wouldn't it be worth it?
By the way, your insulin sensitivity factor (ISF) range can be estimated by dividing your total daily dose of insulin (bolus + basal) into 1500 and 1800. For example, if a diabetic's total daily dose of insulin is 100 units, then the ISF is estimated to range from 15 (1500/100) to 18 (1800/100). I learned this calculation in Gary Scheiner's Think Like A Pancreas.
I absolutely agree with the logging. It is the single most important thing we can do to manage our D; whether it's old school notebook or some modern type app or software. It's the only way to see if our I:C ratios, basal rates, ISF and the carbs that we eat are working or need to be tweaked.
On that note, I disagree a bit about using the ISF formula. While I find formulas interesting I think we are too individual for them to be precise guidelines. If I do the above calculation, for example, my ISF would come out to between 60 and 72. That actually matches my night time ISF of 62, but is far afield for my daytime ISF of 42! Considering that our TDD is based on many factors such as insulin resistance or lack of IR, size, and number of carbs we eat, it is just too varied to use a formula. I feel the same way about the 50/50 balance of basal and bolus, though mine isn't that far off that one.
I strongly encourage trial and error and logging as the way to see what I:C ratios, ISF and basal rates work. This takes time and effort but is so worth it!
I'd wonder what your definition of "really great" is? Sometimes I think that doctors don't encourage people to aim to improve their numbers because any situation that's not in their "manual" makes them just bail out. That being said, if your BG's are high, adjusting the correction factor is an interesting idea. I don't usually adjust mine. I use the before meal BG to adjust basal rates and post meal to adjust bolus ratios and leave the correction factor alone. Maybe I'm missing benefit or something but I've found that this works pretty well, both in terms of low labor costs and decent results?
I deliberately used the word "estimated" to describe this formula to allow for the inevitable variability that we diabetics often describe here as YDMV. I also don't see it as a precise guideline that will provide the answer. At least it gives someone a place to start. You make a good point to note that your experience led you to using an ISF during the day that falls outside this formula. My experience confirms the validity of this formula. As you noted, the daily log can help any insulin user, by real world experience, to determine a customized ISF.
I've left my correction factor alone too, that is the one ratio I just haven't tweaked. I mess with my basal/bolus raitios all the time depending on what's going on and how things are changing. Literally about 2 days before we got hit with this onslaugh of horrid hot weather, my overnight ratios just out of the blue started dropping me too low in the AM...first night I thought maybe user error on my part, lol but it kept happening so I dropped the rate a bit and now I'm right back in range again.
On what are you basing your belief, 30 is the "right" ratio? If we do not agree with someone; husband, wife, dietitian, endo, if we WANT to be in that relationship, we have to compromise sometimes.
At minimum listen to their thinking, their reasons. Make them explain, and they in turn will make you explain in reverse. Been diabetic too long, numbers never phase me but yours are unsafe IMO. If what we do "works", the numbers will be much, much lower.
The ancient straight-jacket approach is designed solely to remove the variables, the "what if" factors. Measure it, carefully write it down, restrict it and the food pieces of our high numbers disappear as contributing factors because they are restrictive, timed, and closely measured.
Its not a long-term approach, its short term and temporary
If you trust your endo I would try adjusting your correction factor for a few days. My endo has suggested changes to my basals that I thought were goofy, but I decided to try them and I was pleasently surprised. I dont think there is any harm in trying out a new correction factor for a few days. If you still don’t like it you can always change back?
Dr. Bernstein's followers and low carbers take a straight jacket approach to carbs often with great success over the long term.
I agree 100% with this advice.
Repeating meals and sticking to the same carb counts at the same time everyday whenever possible was crucial for me to get my A1c down from 11.3% at diagnosis to 6.5% in 3 months.