TIghtening control with a G4

Hi everyone,

My A1c always hovers between 6.1-6.4 (latest was 6.1). I'd love to get it a little lower because I'm planning a pregnancy. In my experience, even when I work really hard, it's very difficult to get that number under 6.

I'm wondering if anyone here has had experience using a Dexcom to take their control to the next level, or to get past a "plateau" similar to mine.

As I stated in another question, I have used a Medtronic Real time CGM in the past but didn't feel it significantly affected my control (largely because it was so inaccurate).

Any experiences with this?



I’d love some advice too since I can’t get it below 6 and pregnancy planning will be happening in the next year ish.

Ahhh, a question we all face. I use the Dex 4. But really, what do your sugars generally run? I am in the 50-70's all the time and I notice that even after heavy meals when I might reach the 150s- 170's, my A1C is still in the lower 6's. When I was a child, I always ran in the 7 and 8's for A1C's. For a long while, I ran in the 30 - 60's blood sugars always (in the past 2 years) and never got below 6. So I guess what I'm saying is if your sugars are not really low like mine - either up your basal on the pump to make them lower or be happy with the 6's. My doctor is!

I am using the Dexcom G4 right now and am also currently pregnant with my first. My A1C was 6.2 when I got pregnant, and it is now 5.6 (mostly because of all the first trimester pregnancy lows, not really because of the dexcom). I think the thing the Dexcom helps out with the most is seeing how food affects your post prandial numbers. There are foods that I have realized that I simply just need to avoid during pregnancy because while I might have a decent blood sugar 2 hrs after I eat, at 1 hr post meal that food is spiking me really high. And they aren't necessarily the foods I thought they would be, either. Also, it has helped me know when I'm trending up or down to help prevent highs or lows. I really would suggest being on one when you get pregnant, if your insurance will pay for it. It has been very helpful.

why do we target <6? It should be less of number and more of health benefit. There is no data to my knowledge that indicate that 5 is better than 6. I think we will all live a normal life as long as we keep that thing around 6.5 every other factor being equal.

The G4 has marketly helped me to see what is happening with my blood sugar. Being able to watch the effect of a 1/2 cup of ice cream or 1/2 hour of exercise makes it easier to choose the more healthful option. So to answer the question will the G4 help you tighten your control? Yes it will. Will the G4 help you get in to the 5's ? I really don't know. It is extremely accurate and far more comfortable to wear than the Medtronic sensor. It has helped me to go from 6.4 to 5.8, but a lot of other things have helped as well, like being more dilligent carb counting and exercising every day. The G4 is a tool, same as insulin, exercise, diet. I applaud you for planning ahead for pregnancy but who says your number has to be under 6 to have a healthy pregnancy?

I used MM CGMS, and had A1Cs 6.2-6.8 ish range during that time. Prior to MM CGMS I was 6.5-7.5 ish using MM insulin pump alone, with much daily variation/high SD (standard deviation).

After switching to Dexcom, I have consistently been under 5.8, and as low as 5.0. I think the goal for everyone is different for A1C, but all should strive to minimize Lows, and have low SD as possible.

Dexcom more accurately responds to BG going up after meals, and I learned quickly which foods I needed to either eliminate, reduce, delay (pre-bolus), or make sure I ate with fats/protein. With Dexcom, and changes in diet and exercise, I reduced post-meal highs, and can stay under 150 80-90% of the time, rarely over 200, and less than 1% lows under 60.

But more importantly, I can keep a relatively low SD, which some studies show is more or just as important as A1C.

From a long term perspective, there are some drawbacks in targeting an A1c in that range.
I am in my 26th year as a type 1. I always had A1c in the low to mid 6's. About 20 years into it, I lost the symptoms of low blood sugar. I would be functioning fine, then all of a sudden have a blackout period and find myself in another room, often with sugar packets and juice nearby. It was definitely unnerving. It got even more tough when I had a severe low one night that led to a siezure, my wife had to call 911 and I was taken out in an ambulance. Not the most fun evening.

After that, I got on a trial for the Freestyle Navigator, which saved me many times from not recognizing lows. Later on when they pulled out of the US market I got the Seven+ and finally the G4.

Sorry for the long post, summary points on this question (and were mentioned by others as well)

1. Targeting a low A1c may not be good, in fact I would seriously think about it and talk to your endo about it. Long term you will lose your symptoms of lows, and along the way you will have a lot of lows.

2. Dexcom and CGM's will help if you do decide to target a low A1c - the biggest way they will do that is to save you from lows by alarming early and letting you know. You can also learn a lot of other things as well - how fast does Novolog or other pump insulin hit you, better calcuation of insulin to carb ratios, better pump programming in segments.

I hope this helps. Avoid the seizure if possible, I have had it twice now and would not wish it on anyone.

Thanks for all of the responses, everyone. As far as the particular goal I have set to get my A1c under 6, it is specifically because I am planning a pregnancy (as I mentioned) and not something I intend to sustain long-term. According to the JDRF's new Pregnancy Toolkit, the American Diabetes Association recommends an A1c <6.0 for a woman planning pregnancy. My question was really meant to be more general, however--different people have different circumstances and therefore different target A1cs. I'm not so interested in people's exact A1c goals, but more whether the Dexcom G4 has helped you to get past a plateau you couldn't get past without it, whether that plateau for you is 8, 7, or whatever.

Thanks again for your responses.

Thanks, this is very helpful. I actually test 1 hour after meals, not 2 hours, per my OB's instructions. But I think the CGM will really help me see what's happening with different foods. I'm also interested to see when a bolus actually starts to lower my bg. And I am excited to have one to see what's going on at night, since I really hate getting up to test. (I think I've been convinced!) :)

Thanks for your input. I have had a healthy pregnancy, starting with an A1c of 6.2. But I also had an almost 10lb baby (at 38 weeks), born by c-section. If I can avoid macrosomia in the next baby, I'd love to do it if possible.

This is what I wanted to hear! :) I have always struggled with a lot of fluctuations (so I guess a pretty high SD). Lately I've made some changes to my diet that have helped a lot, but it's neat to hear that the Dexcom has helped you with this. Even though I had a pretty low A1c with my last pregnancy, I'm sure my SD was huge.

Good luck with your pregnancy. I think reducing SD is really important. My goal was really to reduce that, and the lower A1C was a side benefit, not the goal.

Here's an interesting link related to SD.

With 48 years of T1D, and some vision loss due to retinopathy, I'm doing all I can to preserve what I have left.

I agree on all that you've said and having had it 49 years now, I am also noticing a loss of memory with alot of low Blood sugars. I'm doing alot better now that I'm on the Dexes - G4 now - and wouldn't trade it for the world. From flying out of bed and passing out on a ceramic tile floor - I was done! Injuries! I thought I was going to lose my job after 2 of these seizures and the Dex people straightened me right up! Love it!

My son born at 37 weeks in 1990 was 5 pounds 1/2 ounce. We took him home at 4 1/2 pounds, I have cooked chickens bigger than that child ! But I sure didn't start out with my A1C in the 6's at best it was mid 8's but by the time I delivered my A1C was mid 5's of course it hasn't been back there since then.

Yes, I know higher bgs can be linked with small babies, too. In my case apparently I grow big babies. My OB said it was highly unlikely for me to have a smaller baby next time, but I want to try.

I agree. It has always seemed strange to me when my docs aren't concerned with bgs all over the place, as long as my A1c is good. Since I've made the dietary changes and have reduced my SD, I definitely feel better. It can't be good for your body to be swinging up and down constantly (as I used to do).

Good for you for taking control of your health. I've had diabetes for 20 years and hope I'm still as motivated after 28 more years as you are.

Thanks for the link, too. I'm going to see if I can find more info on SD--it's an interesting idea that makes a lot of sense to me.

very informative