To all of you in the 5% club

Diabetes Technology Glucose Monitoring
1

I know it is not wise to obsess over a number and that a 0.3 either side isn't the end of the world..

But I am currently trying to get my HbA1c under 6, just to see if I can. Worse goals to have I reckon...

Anyway to those of you who are able to steadily keep your HbA1c between 5-6%, how do you do it...

Be honest, are you constantly fighting off lows to get there?

I want to find a target that minimises my chances of long term complications, that is sustainable and that doesn't mean daily lows? Am I asking too much?

Thanks in advance..

Just wanted to say thanks to everyone on this site as well , since joining I have reduced my HbA1c by 2.2%, generally feel much healthier, less depressed and more in control of my life and diabetes.. So thanks for all your advice, it's working :)

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I would have said that I wasn't but, in the interest of fun and entertainment, I've started using this app called "Lose It" to sort of track what I'm eating, maybe cut out some carbs and uh, tighten things up pantsometerwise/ less wear and tear on the knees, etc. In so doing, I notice that I am almost always hitting 3-7 jelly beans and various other *purely medicinal* snacks sort of all day long! I've started dialing back some basal rates to see if I can cut that out but it seems to be pretty regular, like instead of going with the storm, I was steering into it and throwing jelly beans into it to get hailed back at me?

Last night I was still running low at bedtime and had snacks so I am running up a bit (170! eek!) when I woke up so my initial reaction was to just cancel the reduction but now I'm like "wait, that was one day and you had a late dinner and crashed out because I panicked at a post-parandial 120, hit it again, despite IOB...argh, back to the drawing board. Tonight, dinner will be at a normal hour, although perhaps a bit more than usual as we are going out for steak. Should be ok but I will have to try to pace myself to go to bed more stable, to find out if the rate adjustment works.

That being said, if I can stay where I am and have to eat 10-20 jelly beans/ day, it's not exactly PAINFUL

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we have a Group called the5Club

http://www.tudiabetes.org/group/the5club

you are welcome to join, even if you don't have an a1c in the 5s.

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I should have added that I'm not a huge fan of having a "club" as it smacks of elitist "antlerism". I suppose I wave my antlers around too but it's not like once you are "there", you can stop. It requires constant work. Although my theory is that it also requires constant work to be at 7% or 10% but that the work may be different. I'd like to see doctors "figure it out" and tell everyone but I dunno if that's gonna happen any time soon?

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Goals are very personal things. Some of us struggle against great obstacles and an 6% alone is a truly noble achievement. And to summarize our lives into a single number which is known to have great variability is perhaps not good. We always need to remind ourselve that the A1c can vary from individual to individual by more than 20% and that it is only assured to be about 7-8% accurate.

I think there are many that can achieve an A1c in the 5s. There is no secret, there are things you can do. But they all require work and as you note, there can be some downsides like hypos or less freedom.

But before you raise the bar on yourself, perhaps you can turn around and look at yourself and just bask in a little glory. After all reducing your A1c by 2.2% is a truly monumental achievement. And then should you choose to go a little farther, we are here.

1 Like
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Thanks for the reminder. I just joined!

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Is that +/- 7%-8%? I've wondered about the margin of error for those tests...

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Mine has been under 6 many times but have no idea how or why. I was probably having more lows. I just try and keep it within range and avoid highs and lows. Been on the pump for about 2 years after 36 years of D. Last A1c was 6.3 or .5 or something like that, (that's how much attention I pay to it) As long as it's not out of control and accessibly high I guess I don't worry about it!

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Most labs are working towards central standardization against a reference standard and ongoing certification. The current goals is to reduce the 2011 and 2012 certifications to +/-7%. So a 7% A1c would have a possible error of +/- 0.5% and could be a 6.5% or a 7.5%.

Yes. I can hear your shock from here. Most A1cs are more repeatable, but across labs, you can get some differences.

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I'm not shocked, I would think any test would be +/- *something* but one doesn't hear a lot of discussion of A1C tests. There was an ***enormous*** thread about 25* at the fantasy baseball forum I used to hang out at

.

I suppose I could say my A1C is 5.6*? Hee hee...

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I'll share my "roadmap"

Biggest sacrifice:
- Cut out 90% of my snacking and random meals. When I do snack,I won't touch carbs unless they are in the form of dark chocolate, or almonds, or pistachios. Anything else, and I have to dose for it, and I hate random dosing. I just don't have the self-control to even entertain the thought of snacking.

Insulin dosing:
- The biggest change to my care was going over to a pump. That allowed me to get aggressive with my settings and dosing. My target range is beteen 80 and 140 (80 fasting and premeal, 140 postmeal).

- If I'm going through a period of higher BGs because of a site change, or change in activity, or change in moon phases, I'll adjust my dosing accordingly. If I'm going through a period of lower BGs than usual, I won't touch my adjustments unless it happens consistently through 2 site changes.

Diet and Exercise:
- Both are crucial for me. I have to keep a consistent exercise scheduale and matching meal schedule. This is not a sacrifice for me at all. It's probably the easiest, emotionally, for me to deal with. When these are out of balance, I feel like crap, and my BGS will reflect it.

Bottom line, these strategies allow me to, generally, anticpate when to expect highs. I target those highs aggressively. I found the most impact on every measure of BG control, including A1c comes from aggressively targetting highs.

Do I have lows? Yes. Do I find them unmanageable? No. I drop into the 60s a lot, at least 2 or 3 times a day. I, personally, don't find BGs in the 60s to be uncomfortably low or a problem. They are easy to correct and I can continue my activities (except driving) while correcting. I'll occasionally drop into the 50s, a couple times a week, depending. If I find myself dropping lower than that, which happens occasionally, I'll dial back my settings accordingly. Way more important than the number of lows I'm having is the time of day i am having them, most are fasting and come within an hour of meal-time.

So, my last 90 day numbers see about 75% of my BGs falling within all my target ranges. I'm low (below 60) about 12% of the time, and high about 13% of the time.

All that being said, I'll echo what others have said here. These are my own personal goals. I believe everybody should have achieveable goals to help manage our condition. However, there are lot's of caveats to keep in mind if your goal is to "keep your A1cs below 6". It just so happens I got there by targetting my highs and setting a BG range for myself.

Good luck!

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Congratulations on your improved A1c already, Buckley83! You are not asking too much. The best way to be in the 5% club is to keep your bg in a normal range as best you can at all times and concentrate on that rather than a 90 day goal. My A1c is simply a result of that...I do not constantly fight lows. I also do not constantly fight highs. I jumped off of the "club" concept a long time ago when I noticed that the A1c was becoming a more important goal for diabetics than bg results. The bg results are far more important to me to manage my day (my A1c result won't tell me how much to bolus for dinner). And also I noticed that folks who are in the club get accused of being low and receive lectures often. acidrocks23's description of the low at bedtime and then the running up a bit is an excellent indicator of how folks get in the club with lows and highs. The A1c will not tell you that you run low at bedtime and high later..

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Well, the bedtime low followed by high scenario is also influenced my MrsAcidRock and me being tired of the thing bleeping in the middle of the night!! I'll give it another go tonight as dinner is on for 7:00 instead of 9:00 on Fridays as Junior has late class Fridays. I don't do that very often at all but it was an unfortunate set of circumstances, like most of the times it runs wild. I'll go all week without going much above 140. It was some interesting data. I'm not sure how much of the spike was from DP and how much may have been from food. I should have just had jelly beans but well, there were some tastier things lurking around...

I get the lectures all the time, the doc's like 'there are still a lot of lows..." and I'm like "yup"

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Cheers guys..

I think I will just make a few more tweaks, mostly I will be reducing carbs, I still eat about 150g a day, so will be halving that over the next month or so, hoping this will reduce my insulin requirements and hypos. Maybe I will just have a zero carb breakfast and a no more than 25g lunch and maybe go a little crazy in the evening and have a 50g blow out in the evening...

I did follow Bernstein for three months in 2007... Lost about 15kg, had great sugars, but was so tired, I was also in ketosis as I was burning fat and found running hard going. Also got tired of eggs for breakfast, chicken for lunch and fish for dinner..

I just downloaded bloodsugar 101 via amazon and was really impressed with it, the author recommends having a blow out meal regularly. So I think I am going to try to be really strict most of the time and every second Friday, I am going to take a big bolus, have the fries, the bap with my burger and a piece of cheesecake ha..

I also snack too much, especially since I started the pump. Too easy when I know I can press a button on a remote control and bolus for it. So some self discipline will be required here.

I am quite carb tolerant, I know alot of you guys follow Bernstein's recommendations and have about 35g a day, but I think I would waste away, imagine running for more than 45 minutes at a time would be tough as well.

Like you say, people's mileage will vary and I will get there with time. I will try to get a little better each week and see where I end up. :)

Exercise after meals will help me as well I think, I still tend to spike too high 1-2hr after meals. I am always back in target after 3hrs, but feel that this is an area I can work on.

It was a great feeling to get a 6.2%, I actually felt quite emotional about and pleased that all my hard work was making a difference. but looking through my data there have been alot of lows and I've also gone through 3kg of Jelly Beans in 4 weeks ha ha..

It is still early days on the pump though, I only started on it late November 2011..

I have a feeling 2011 has been a real turning point for my long term health though, I always used to put other things ahead of my diabetes, e.g career, fun, relationships, sports.. This is the first time it has been my primary focus and I have to admit it has all been worth it :)

Thanks again, wishing you all well for 2012..

Buckley.

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Great plan!

Only thing I'd perhaps say to reconceptualize would be "I will just make a few more tweaks" as the tweaks never stop.

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That's a good point, AR, I was hung up for a long time on the "I'm almost there" idea, and kept getting frustrated when "there" moved away again!

I don't know if I would qualify for "the club" (not that I would join it) because I've only had one A1C, my most recent, under 6.0, but I'll chime in on what works for me (if only to remind myself!)

I don't eat low carb, a choice I made based on being a vegetarian and a foodie, and not caring for "substitute foods" (no offense to those for whom this works!). But I usually keep it under 100 a day which I call "moderate/low". I eat three meals a day and nothing in between (a habit I got into when I went into recovery from my eating disorder). I never eat sugar...except for those pesky glucose tabs of course! I don't eat fast food by personal preference and avoid "problem foods" - ones that are hard to bolus for which for me are rice, cereal and to a lesser extent bread and pasts. (I eat pasta sometimes when I go out, never rice or cereal and usually only double fiber English muffins). I don't exercise much. I try to go for hikes but always find something else to do. At age 63 I don't think I'm going to make any serious inroads into that habit, but I'm still trying.

What else do I think reduced my A1C? Definitely the pump which I've been on for a year now. I can more precisely target my boluses, basals and corrections. I test frequently - routinely 8 times and more if warranted. I correct if I'm high at the 2 hour postprandial (unless there is enough IOB to cover it). I think prompt and accurate correcting is one of the most important things for me, insuring that I don't stay high for too long. I don't have a lot of lows. I need to clarify I only consider below 60 a low; they only time I worry about 60s or 70s is before bed. I tend to have clusters of them occasionally then none for awhile. Unfortunately one of the things I think helps my D management is that I have a lot of free time; I'm mostly retired. So I can plan and cook meals (I love to cook), test, correct, etc. I say unfortunately, because many people have very busy lives and D management has to come in the crevices. Emotionally I feel better when I have busy periods like that but I know that when prolonged they make management hard. I don't eat out a lot, because it is too hard to find acceptable foods and bolus accurately. I usually reserve it for social occasions.

That's me. But I'm with everyone I think your decrease of over 2 points is amazing and your A1C excellent. We definitely need to not over react to these numbers. I'm not saying I don't enjoy when I got kudos from my ophthalmologist (and his nurse) on my 5.7 yesterday. But like I said I'm not joining any clubs. #1 it is not a central factor in my life or even my diabetes and #2 I could end up kicked out of the club with my next test. Who knows!

A puzzling thing, said ophthalmologist (that is a hard word to spell!) asked me how high my A1C had ever gone. I didn't have one done when first diagnosed but I had a 7.2 when I had just begun insulin after the oral meds stopped working and my numbers were climbing. He gave a surprised exclamation which I interpreted as "that high? But when I think about it 7.2 is not all that high and most doctors are ok with 7ish A1C's. Now I wonder if he meant, that's all? Hard to read doctors.

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I would guess that he meant "that's all"

I think that with other doctors, they are sort of "relieved" when they perceive a 5 in your chart, as that shows that you "get it" and can "do it" which means a "slam dunk" for them, get in get the job done and they're done.

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Well, to justify not trying for lower BG's at the risk of having alot of Hypo's, that just aren't worth it..
Been there, done that..
-Ever think that how come so many before us, lived for so many yrs, side effects free and aver much higher A1c's?
-While others? With Very Good Control, still got alot of complications.
-Some studies from the DCCT showed only about 11-20% of our complications are controlled by our BG's, while the rest? Not so much.. But they're working on it, of course..

Even that is True? When we only have this BG issue to Control, then that's what we do and hope for the best..

After having 3 Eye Hemmoarges and other problems, all after having 6 to 6.5% A1c's for yrs? and then and only then did the Endo's and others Finally admit, tight BG's are not the only answer, in fact only about 25% of it..

The CDC and all the others Don't even Either Know or want to Admit How many Have Insulin Pumps.., back in 02' it was about 160,000, some guess it's about Double that now.. thus only a Minute % of the T1's in the USA.. Eventhough They Know they are currently, the Best Chance at contoling one's BG's and Life and Sanity..

And I agree, that having a More Consistant level of 130's day and nite is far Safer vs Alot Of hypo's that are not just Dangerous when Driving to trying to do anything else? It ruins a good 1-2 hrs of the day recovering.. And get them Overnite? Everthbough you catch them and they wake you up? You can kiss goodbye having a Decent Bowel Movement ..So your better to keep it in the 120 range over nite at least.

It's the Auto Immune disease part that is the Bigger Issue.. LIke Pack Woman running around eating up all your Good Cells and attacking your Organs, that's It's Job..

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I disagree. I can park in the 80s all day and get the hang of it, get to 110, go for a run or indulge in some food and run up a shade but I'd rather have the 80s "on board. It doesn't *always* work but I look at it like a "bank" and I'm banking the good numbers as a hedge against turbulence...

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I hear you on that...

As I left the endos office and was walking home, I was feeling good, as my goal for 2012 was to get my HbA1c under 6.5%.. So there thinking there is that goal achieved Buckley, well done you, go buy yourself a gadget and a giant biscuit.. Suddenly dawned on me that I am going to have to work just as hard to keep it there ha ha ha and the biscuit wouldn't be worth the high, the correction or the guilty feeling ha..

Have to say that's probably thing that I dislike about Diabetes the most, its relentless nature.. Always there..

Hearing you on the diet Zoe. I have stopped buying bread, pasta, cereals. I think long term I will struggle with food. I do love food, always have, one of my base pleasures..

Although all I really eat nowadays is eggs, cold cuts, bacon, chicken, fish, steak, salad and green veggies.. Usually without dressings/sauces. I do miss roast potatoes, mash, yams.. Fresh Pasta, Italian Pizza, Sourdough Bread, Desserts, Bananas, Grapes, blueberry pancakes, muffins.. Gah!!! Must stop..

It's getting very, very boring and I am starting to see food as part of an equation and as fuel.. Which is a shame I think..

Have tried looking at diabetic recipes, but they were all seemed pretty nasty, loads of sweeteners, flax seeds and other bland, horrible ingredients. But will use the search function and see if I can find anything nice on this site :)