This discussion makes me wonder how many of the folks achieving A1cs in the 5s have become hypo unaware from maintaining bg under 70 for stretches of time frequently?
I went through a stretch of time a while back where I was waking up at 57 almost every morning - my female hormones were beginning to go haywire. Of course, my endo was not happy at all though my A1c was good. I wasn't that concerned at the time because they were easy to correct with one cup of coffee. Shortly thereafter I noticed that I was no longer having symptoms of lows unless I dropped into the 40s. I don't know in my case if this is because of frequent lows or just from having diabetes for 25 years. The low episode I had earlier this week actually gave me low symptoms on the way back up in the 60s so I'm hoping since my control has tightened up I will get those feelings of symptoms back.
I guess it's a personal comfort level thing but if I can't achieve 5s without becoming more hypo unaware from spending time in the 50s and 60s then I'd rather have an A1c in the 6s and not be hypo unaware. But that's just me. Being hypo unaware is scary.
I have lowered my HbA1c from almost 11 to the low 5's. It takes hard work. For me it took upping my metformin to the maximum and lowering my carbs to the minimum. My bg goals for everyday are very tight , usually 90-120. So I don't eat anything that will make me spike. Since I am a type 2, I rarely go low and never have bgs much below 80 and even 80 is unusual for me. I think if you develop a list of foods that don't spike you and stick to that list then you will be on your way to lowering your bgs. For me I try to keep my after meal bgs 105-115, if I go much higher than my HbA1c will rise.
yes, you're a type 2 not on insulin; metformin typically doesn't cause hypos. there's no comparison. we, as type 1's don't have a choice, we have to take insulin to live...one can't compare a type 2 A1C with a type 1 insulin dependent A1C...we eat and take insulin with our foods.
geeezz...i mean, do you know how many of us type 1's would love to just be able to take a pill, have an option to diet and exercise as a way to get off meds and get our blood sugars down. we have no options, i weigh 103 lbs, eat only 40 grams of carbs/day and have been a competitive athlete...makes no difference, i will always need insulin. you do understand the difference, no?
We have often gone back and forth on this. I am diagnosed as a type 2. For years, the idea of getting my A1c into the 5s seemed impossible. And it wasn't for trying. I started following Bernstein in 2006 and I went through all the medications eventually finding that even triple medications could not do it. Although a type 2 not on insulin or a sulfonylurea is unlikely to have hypos, they may not have an easy time achieving tight blood sugar control.
You might find it surprising, but for some type 2s, they would like to have a choice to use insulin. Sometimes, your only other choice is high blood sugars and the certain consequences that follow..
well, that's typically because when they had an option to manage their blood sugars with other resources - meds, diet/exercise, it wasn't done..so eventually they turned to insulin or they couldn't manage diet / food. it's true. and i was making the comparison to the poster who commented on a metformin only type 2 A1C vs. a type 1 insulin dependent diabetic who has no choice. plus, type 2's rarely, rarely go DKA, have ketones, etc...two different diseases, period..and it's a bit offending to me, frankly! even if a type 2 is on insulin..two different diseases. you also take a very large amount of insulin because you're insulin resistant....that too differs from a type 1..who too can become insulin resistant but that comes with years and years and years of d.
I think of us all as are dealing with a terrible chonic condition. It hits us from many directions, insulin deficiency and insulin resistance (and there are other other directions). As T1s and T2s we actually share a lot more things than we differ on. And for many of us (even those T1s on insulin), a central way to achieve an A1c in the 5s is through diligent work on our diet.
Well put!! I think of those of us who are late in life T1s as lucky. We miss decades of cumulative damage as compared to the more typical T1 and we are able to manage our disease with insulin which provides a very direct feedback loop.
I know I wouldn't be doing nearly as well as I am doing if I didn't work as hard as I do on diet. Hard work of course doesn't always equal low carb. What makes the work hard is that each of us has to figure out what works in our own bodies.
Well put to you, SYAH, I struggle with restricting my son's diet. He already eats about a third to a quarter of the carbs a normal teen would. And I also feel like he is the same kid that he was two years ago and is not insulin resistant (except for when teen hormones kick in), and should be able to handle the carbs as long as we get the insulin dose right. We do fairly well with that. Maybe after he gets older, he may decide to eat lower carb, just so he can have an easier time of it. Once every couple of weeks he has a bowl of cereal on the weekend and its always a wake up call to me that no matter how much we bolus and time it, we just can't cover certain foods. Hard indeed, in different ways, for everyone.
This was a CGM shot from earlier this year and is not totally atypical, I can usually get a couple of these most weeks? I am usually only going up when I eat and down when the insulin is hitting but I think I have the rates set pretty closely. One thing I've noticed is that they may be set a shade high as I sort of nudge it up with jelly beans, not a lot, like little "hits", 3-5 beans if it drifts low. It doesn't always and if it doesn't, I just sit tight. I think my sensitivity is set lower but I've never actually tested it to see if it's accurate. I had adjusted it a couple of times but I'm not 100% sure what I'm doing w/ that, it's sort of like if I perceive lows when I'm fasting, I'll turn the basal down and if I perceive highs, I'll turn it up. If post-parandials are high, I turn the C-I ratio down and if they are low I turn it up. Usually one "click" seems to work. I think that if I could split a bit finer it might be possible to get rid of the jelly beans too? A lot of my basals seem like .85 is too much but .80 isn't quite enough and that maybe .825 would be ideal? It seems sort of OCD to think of it as that precise but insulin is pretty strong stuff.
You guys are going to have to split the farm between you. I lose big time! Today's salad lunch served me well. 1 hr pp 79. 2 hr pp 79. 3 hr pp 56. HOORAY! I HUNG OUT!
Maybe I could love this lo-carb style.
Good job! FWIW, I don't exactly do "this lo-carb style" but I have played around with it enough to perceive that 1) it's works and 2) it's actually a lot less work than eating carbs and "chasing the dragon"...
OK friends, I gave you the farm... now help me with this about yesterday's salad afternoon. So we left off when my bg was at 56. I treated that with glucose tabs and went on my merry way. At 6pm, my bs was 44! (regretting I didn't catch it sooner) Does that translate into It's My Basal?
Alternatively, if all you had to eat was a salad, that's going tp be processed pretty quickly. If you didn't include a bit of slower digesting protein and fat, all you have to carry you to the next meal is your carb spike.
I am not in the 5% club, I am in the 6% club. I used to be in the 5% club, when I was on regular & NPH and had too many lows (including nighttime lows). Some people here on TuD are in the 5% club and achieve that by being in the Flatliners Club. I think that is awesome. But too many people achieve 5% by too many lows, and that is really not good, especially if you have Type 1 diabetes. There are many hazards of lows, and pushing to achieve the 5% club when lows get you there is not an achievement, in my book, it is something to avoid. I like what the Behavioral Diabetes Institute says: maintain good blood sugar control, avoid lows, and live life. When I first started at my present job, a person with Type 1 diabetes had a hypo while driving a company truck, and killed two people (he, the T1, survived the crash). Yes, that sort of consequence of a hypo is rare, but that is something I truly want to avoid.
Thanks, Melitta~ My excellent doc has a similar story about a T1 doc he knew who didn't wake up in the morning. She was a Fiver. He doesn't recommend that I become a Fiver. The thing that blew me away was TuD members saying they could "hang out" at 80. I want so much to hang out somewhere good. My bs is a constantly moving train. I thought the Law of Small #s might help me hang too.
I don't belong here :) ( the 5 % club )I am not a fiver, most of the time not a sixer but my good news almost 30 years with diabetes and no complications ...hope to confirm this with the next blood tests , A1C etc. end Jan .
I don't know what your preprandial was or what the count or bolus looked like. But I will tell you that the duration of action for insulin is 5 hours and by some estimates, 2hrs after injection you will still have more than half your insulin on board. If you really had a nearly zero carb meal and didn't bolus then it is surely your basal. But if you matched your meal exactly for the first two hours, you may have just been a victim of the insulin tail.
