Hi
I would appreciate any advice as to what any members do on a daily basis achieve desired a1c results
My last a1c was 8.6 about 3 months ago and I don’t think my method is useful
I just went recently for blood work so it might be better then three months ago but any suggestions would be useful in enabling me to achieve my goal
Thanks
Continuous glucose monitor + pump. My CGM alerts me if my BG hits 7.0, and I take small corrections almost every time if it does (0.3 - 0.6 units which you need a pump to do). Since both the pump and CGM are discrete compared to shots and a glucometer, I will do this at work, on the subway, wherever I am so my blood sugar stays in target range as much of the time as possible.
Before I got my CGM, I relied on frequent testing and carb counting. Without sticking to a specific diet or going low carb, I avoid foods I know will give me bad results no matter what I do, including regular pop, fruit juices, chocolate milk, cereal, most sweets/desserts/pastries (except for store-bought chocolate cookies and ice cream which I can carb count for pretty well), etc. I also try to look up nutrition information when I go to restaurants (if available) or eat things I’ve eaten before where I have an idea what the carbs are. I also use the extended bolus features on my pump for a lot of meals I know from experience will digest slowly and spike me hours later/overnight.
Lastly, I work hard on blood sugar spikes in the morning, counteracting dawn/“feet on the floor” phenomenon with temporary higher basal rates on my pump. If you’re having trouble meeting your targets I can’t stress how much a pump and CGM could help you. I do not think I could maintain an acceptable A1C on injections without significantly limiting my diet and lifestyle, and that’s no fun!
What works best for me is a low-carb diet, regular exercise 3-4 times a week (nothing crazy: walking, running, lifting weights, riding mountain bikes, etc). I use MDI for insulin most of the time - Omnipod when I travel, but still use Levemir for basal, and Afrezza for corrections. I also use a Dexcom G5. This methodology keeps me in range between 70-120 the overwhelming majority of the time, and my A1c in the mid 5% range. Last one was 5.6%, last month.
There is good advice here, but the two that have been (so far) most effective for me are:
Consistent, intense exercise. Walking is great, but triathlon training and weightlifting is better (which makes sense). For some reason, lifting heavy weights (I do Olympic training) makes an enormous difference for my BG average and A1c. Running, swimming, and biking also does good things (although have to be careful about going low).
Eating low-carb. For me, that’s less than 100g of net carbs per day. I had an A1c in the 4.0-5.0 range when I was eating less than 50g of carbs per day, but couldn’t maintain weight so upped my consumption a bit.
Jen posted some excellent tips in another thread: Do you give diabetes its due? - #25 by Jen
I second the power of the pump and CGM combination. I like to keep my CGM receiver in one pocket and my pump in the other. If my CGM alarms with two vibrations it menas I’ve hit my high target (7.5-8.0 mmol/L) and I use the touch bolus feature on my pump to take 0.5, or 1.0 units without having to take either device out of my pocket. I have done this while in meetings, sitting in class, on the bus, giving workshops/lectures, walking down the street, and in bed without even having to sit up or open my eyes if I don’t want to. If my CGM vibrates three times it means I’ve hit my low limit (4.0 mmol/L) and I’ll take anywhere between no to four glucose tablets, depending on what I’m doing, how much insulin on board I have, and whether I feel low.
That’s not to say that I never look at my pump or CGM, because I do (often). But I love my relatively recently discovered method of managing diabetes throughout the day without having to stop what I’m doing and with those around me not even knowing that I’ve done anything other than reach into my pocket of a few seconds.
I’m on MDI. I eat moderate carb (120-150 g carb/day). I weigh troublesome foods like rice, which I limit to a 2.5 oz serving. Even on days I have BG out of range, I consistently try to get it in a good range at bedtime. My reasoning is that that will give me a likely eight hours of good BG, which should help a lot toward my goal. I know that my fasting insulin stays in my system over five hours and that I can’t get a good idea of where my BG will end up for the night until five hours from my last bolus. So early on, we moved up our dinner hour to 5 PM. I know that’s impossible for most working folks on weekdays, but I’m retired.
I do try to estimate where my BG will end up after just four hours from bolus sometimes, but my results are less consistent. When I do and go to bed earlier, I usually test my BG when I get up in the night to use the loo, and make a correction if necessary.
I keep a spreadsheet of my BG and bolus amounts along with notes on what food I ate for particular meals that might be repeated. That way I can do a search later for a troublesome food like pizza and see what I did last time and what results were and adjust dosing or timing accordingly.
With these methods I achieved an A1c between 5.5 and 5.9 for four years. Then since the first of this year my BG went crazy. I think I must have suddenly become much more insulin resistant, getting a lot of pp readings in the 200s. But I still had an A1c of 6.1 in April. I’ve since adjusted my dosing up about 20 to 50% for the same meals as before and I seem to be back on track with primarily good readings.
I am on MDI, and I do not have a CGM. I have managed to get my A1C from a terrible 9.3 to 7.2 in 3 months. My plan is to get it down to 6.0 in the next three months.
I exercise 7 days a week, biking, weights, resistance and some aerobics. I limit carbs to no more than 75g per day.
I tested pre-meal and 2 hours post meal to figure out what foods didn’t raise BG over 140. I found that I cannot tolerate any bread, pasta or grains. I am a religious carb counter. I substitute spaghetti squash for pasta in dishes that call for that. I also substitute riced cauliflower when I make mac n cheese or other “casserole” type dishes. For breakfast I eat Chia pudding and that doesn’t impact my BG’s at all. There a lots of chia pudding recipes available, I posted one on another thread.
If I drink a cup of coffee, I always drink the same number of ounces of water to offset it, as coffee does seem to raise my BG if I don’t do that.
I also have a “Diabetes Library of books for reference”. Dr. Bernstein’s “Diabetes Solution” is a great book to have, as is “Think Like a Pancreas”. .
(Pretty much everything I have learned to do, I learned from TuDiabetes, as I got no guidance at all when I was diagnosed 4 years ago.)
Years ago when I decided to start looking after myself properly, I went to a three-day diabetes education session (TRIDEC, at Women’s College Hospital in Toronto) that was tremendously helpful. Many of its lessons continue to motivate me 25 years later. I see you’re in Canada. Most big cities have similar programs – there are more than 40 in and around Toronto alone – and they’re offered in many smaller communities, too. Although the internet has provided a kind of community that didn’t exist back then, there is still a lot to be said for spending time in a room with people learning similar things, facing similar frustrations, and with similar questions.
I had an A1c in that range (even in the 9s sometimes) for years, and what brought it down was 1.) CGM, which taught me I needed to 2.) go lower carb, and 3.) adding some metformin to my regimen (may or may not be applicable to you, but more T1s are doing this these days). CGM was by far the most important part since it’s helped me figure out the other pieces. Now my A1c is 6.5 and keeps going down. Hoping to get it to 6 or slightly under eventually, although my endo seems pleased as is.
Also I still use MDI (currently Tresiba and Humalog)—have considered pumping, but from what I can tell, the CGM seems to be the biggest factor in control for most folks. I think pumping likely would have some major advantages for me, but also some disadvantages, so for now, I think I’m waiting for a really good automatic system to be released before switching over. If I hit a point where I stop making progress before then, I may reconsider.
I don’t have a CGM and don’t feel it would make my control sufficiently better to warrant the cost, but I did borrow a FreeStyle Libre Pro from my endo for a few weeks about a month ago. That model doesn’t allow one to see BG in real time, only after the endo downloads results after two weeks. But it still was helpful in seeing some things I missed in my 4-8 times daily BG tests. You might want to check with your endo to see if he has one or a Dexcom G5 available for loan for a couple of weeks. Try to make it a period that you’ll have some extra time for analysis. I think you’ll find it useful.
I went on this kind of “professional” CGM for a week back in 2009 (it was an iPro from Minimed). I kept a detailed log so that I was able to tell exactly what had been happening when I looked back at the results. It wasn’t as good (for me) as a full-time CGM, but it was still extremely useful, and allowed me to break my A1c into the <6.5 range for the first time (though it was only there one time). Intermittent CGM use can be a really useful tool if you are willing to collect the data and use it to analyze your results. (I also ran “experiments” while wearing the sensor, such as eating a high-GI cereal two days and low-GI cereal two days to see the difference. Now, since using the CGM full-time, I’ve abandoned cereal completely.)
IMO the basic steps above are necessary (and often sufficient) to reduce A1c below 7 (here I am referring to T1D with no leftover internal insulin production). Beyond the basics, further helpful methods and tools include: (a) reducing carbs (b) exercise, and (c) pump. Good luck!
I think the average A1c of people with Type 1 is something like 7.5%. It seems likely that most people with Type 1 do the things you list and get an A1c in that range—that was certainly my experience for years. I think getting an A1c well below 7.0% takes extra effort for most people, such as lower carbs, pre-bolusing, or “sugar surfing” (or all of the above).
Agreed—I feel misled by much of the advice I was given by doctors/nurses/nutritionists for years that suggested that I should be able to manage things better while still eating lots of carbs, as long as I matched my insulin correctly. I wish I’d been told a long time ago that for tight control, I’d most likely to need to restrict/manage my diet considerably as one of my key tools. I don’t think there’s anything I can’t eat ever if I really want it (like, if I’m traveling in Italy, you’d better believe I’m going to eat some pasta and just do my best to pre-bolus appropriately and correct as needed), but for day to day eating, I need to go low carb.
Same for me. I believed the doctors until I started using CGMS that revealed the real impact of foods/carbs on BG.
I don’t eat breakfast and I try my best not to eat after 7:00 pm. If all works out well, I can string together 15 hours being in range. In addition, I limit my carb intake at work. For dinner I up my carbs since I’m normally at home and can be more aggressive with my insulin.
My reply was directed to the OP who quoted an A1c of 8.6%. Reading through the other replies, which seem to be focused on personal success stories, I felt some really basic points need to be spelled out. Unfortunately, as one can check at the T1D registry, most people do not do the things I’ve listed, and even 7.5% would be a good step in the right direction for many. Anyway, thanks for your note - to be more careful, I’ve replaced “well under 7” with “under 7” in my post.
Thanks everyone for advice and suggestions.
I think my short term goal of getting A1c down from 8.6 to 7,0 or under is
possible.
I eat about 90 carbs a day but need to get more exercise.
I mostly walk and try not to do anything that will agitate my retinopathy further.
I think a pump and CGM would be useful,especially the CGM.
Kind of expensive but I think I might have to look into it further and recheck extended health benefits for coverage.
diet
more testing
activity
I think if assert a little more self-discipline in these areas my A1c will improve slightly if not dramatically
Who is the author of " Think Like a Pancreas"?
what does a daily consumption pattern for the day look like when you eat 75 carbs
can you send me a day example of seventy five carbs?
times,what you ate?