Maybe in Canada - perhaps you have a health system that provides great training and support. Based on the data from the Scottish Diabetes Survey 2015 (the most recent available), 94.5% of T1s had a recorded HbA1c in the past year of whom only 25% had a value of 7.5% or less. No precise average is published, but from the data shown, the median value looks to be somewhere between 8.5 and 9%!
Scotland is clearly not a shining example of a country with great diabetes control numbers (although it does lie at the top of the world rankings in terms of data recording and collation) - however, I donāt think it lies near the bottom of the international league tables either.
What this illustrates starkly is how really TERRBLE levels of control really are for the average T1 in most countries. The posters on this board are totally atypical. We really should be doing a whole lot better!
I think a CGM is the most important thing you can do right now. 90 carbs isnāt a lot, so you have to find out what is spiking you at what times and then you can do something about it. There are lots of things that can affect blood sugar other than what you eat, including stress, how fast you digest food, activity levels, etc. Dawn phenomenon is a problem as well regardless of your diet. For me it wouldnāt matter if I didnāt I eat a single carb for breakfast, I would still shoot up a to 13 unless I did something about it with insulin. Exercise is important but remember the only caveat is intense exercise can make things unpredictable, especially if you are not in the greatest of control right now. It can cause extreme lows and highs after, and Iām not sure it will help you until you start using a CGM or at least test way more often and find out what is causing you to run high so much of the time.
I donāt have any actual data, so I was being conservative in my estimate. According to the link that @Dragan1 provided (which is based on US data), only 31% of people have an average A1c over the past 12 months of 7.5% or less. What I was trying to illustrate, though, is that itās actually very difficult to get an A1c well below 7% for most people and the vast majority of people fail to hit that target. There is a major disconnect between the recommended target and the number of people able to achieve it, and I think the majority of poeple are trying (there are some people who just donāt care, but I think most do make an effort). Thereās clearly a major disconnect somewhere in the system. And, yes, those of us on this site definitely do not represent the average.
I have nothing to back this up, but I wonder if because people are told to target 7 or under, many people think 7 is doing great and so an A1C in the mid 7s to mid 8s is just a bit above normal and arenāt concerned about it. My endo always told me I was doing fantastic when my A1C was around 7 and not to change a thing. It wasnāt until I started reading more that I realized how much higher than normal an A1C of 7 is, so I wonder telling people to aim for an already high target leads to terrible numbers for some.
I believe that A1c targets are individual because, YDMV. Going too low with an A1c can be a bad thing, as well as going too high. I learned in philosophy classes a long time ago that nothing is absolute. Having an A1c at a certain value is not going to guarantee that I get no complications, nor will it guarantee that I do. I read a lot and I like to have a decent, informed discussion with my medical team when it comes to my care. When I was being diagnosed and begging for help, noone wanted to teach me about diabetes so I taught myself. Now that I have a cgm and a pump, my dawn phenomenon is gone and I have better bg #s. Iām in range more than 80% of the time. I find eating ārealā food, mostly plants, not too much keeps me in range. Starving myself and having wicked DP gave me an A1c over 8%. Now Iām in the 6ās despite eating.
If you can afford it, get a cgm. Doesnāt matter what company, just so long as you can afford it and will use it. That alone will give you a tremendous amount of data to help you make better decisions and less guessing, so you can go for a better A1c.
Hope it works out for you. I know how frustrating it can be.
Breakfast: Carb 20 grams Chia pudding with walnuts, Splenda brown sugar, unsweetened vanilla almond milk , coffee with half n half and some chocolate caramel creamer (My one indulgence) Because coffee/caffeine spikes my BG, I drink an equal amount of water, that is 16 ounce coffee, 16 ounces of water. That seems to stop the spike.
Lunch: Yogurt flip: 25 grams carb I add chia seeds to this. Decaf green tea.
Dinner: 30grams Varies as to what it is, but usually chicken, salad and a side made with riced cauliflower or spaghetti squash, Dessert: a small square of 90% dark chocolate and peppermint tea.
If I have lows I either treat with Sweetarts or a small juice box. I donāt count those carbs. I have never figured out if I am supposed to count them.
If I want a hamburger or sandwich, I use romaine leaves in place of bread.
The T1D registry link posted by @Dragan1 gave me this response when I asked the incidence of responders, upon enrollment at the registry, who had an A1c < 6.3%:
1,389 of 25,682* or 5.41% meet the criteria you specified above.
It surprises me that my results differ from so many of my peers. I donāt feel my diabetes behavior and lifestyle is extreme. I find it makes me feel good and is highly sustainable and repeatable. It does take effort but not an excessive amount.
I donāt have the answer to this puzzle. I donāt feel special or exceptional. Iāve struggled with an A1c at 8.5% and it wasnāt that many years ago. Experimenting with the tactics described in this forum by people ahead of me on the path made a crucial difference in my steps toward better control.
Knowledge, curiosity, tenacity, personal confidence, and a good attitude all helped me do better. I donāt see it as rocket science and wish more people could achieve a better A1c. Perhaps the practical solution lies with the commercialization of an effective artificial pancreas system.
I donāt have unusual readings and I split my Lantus into morning and night doses to offset elevations in morning or afternoon.
My highs are due in part to concentration on work and finances rather then health.
I guess I should have put it first instead of putting off doc appointments and proper ballence of diet,exercrise and other diabetes related stuff.
I guess I thought it was ok in a stubborn senseless way
I avoided it instead of getting on top of it and it got out of control.
Hey John. Iām sensing quite a bit of self-criticism. Donāt beat yourself up. Nobody is perfect and managing this disease is not easy. It will always throw curve-balls at you. I try to never look at missing my BG related goals as a failure, but rather a data point in an ongoing āscience experiment of oneā to learn from and adjust accordingly. Youāre taking the right steps in asking questions here and doing research. Youāve taken a great step in expressing your desire to tackle this head-on instead of avoiding it. You will do well with this attitude, and your control will improve dramatically - probably even beyond the goals youāre expressing now.
Diet and exercise are important, but itās more valuable to develop an awareness of what specific things are causing your blood sugar to skyrocket and how to prevent them. I exercise because it is good for me, but Iām not sure as a type 1 it makes my control easier. It can make things unpredictable and the release of cortisone after an intense workout will shoot my blood sugar to the moon unless I do something about it. I always ate relatively healthy but before I got my CGM I didnāt realize how high a lot of that healthy food was spiking my blood sugar within an hour after eating. If you say you donāt have unusual readings but have an A1C in the 8s, I think your biggest issue is youāre not testing enough. Splitting basal is a good strategy for dawn phenomenon, but does it work effectively? I know even with a higher basal rate on my pump in the morning I have to increase it even more or bolus the minute I get out of bed. Get the CGM at a minimum if youāre able to, and start testing a million times a day either way and making decisions based on the numbers. This will be the best thing you can do even if you donāt make a single change to your diet or exercise schedule.
For me itās micro-managing my glucose using my 530G pump and Enlite CGMs. I am trying to mimic the newer pumps abilities to adjust basal rates based on the movements of the CGM readings at any time of the day. So, if I notice an up arrow that is above 180 I will do a temporary basal of 200% for 30 minutes. If I notice a down arrow that is below 100 I do a temporary basal of 50% for 30 minutes.
After using this technique for the last 3 months my A1c dropped from 6.8 to 6.0. I expect that it may be below 6.0 on my next endo visit. This is the lowest that my A1c has been since I became type 1 over 50 years ago. About ten years ago my A1c were running in the 8s.
Run the numbers. I have also been able to get very accurate results from my Enlite CGMs by using a ratio resulting from a division of the ISIG value and the finger stick glucose readings. My ratios are now running about 4.1 which means that it is very close to the finger stick. So, my Enlites are almost always within 10-15 of the finger stick readings. Itās based on the initial calibration with a new CGM. The first one needs a normal blood sugar to set the calibration for the duration of that CGM (about 6 days). If my blood sugar is out of range (below 80 or above 180) I wait to do the calibration. I can find some documentation about this if you would like.
I get where you are coming from, but I entirely disagree with this (on principle and from personal experience). Exercise fundamentally changes the way the body metabolizes food at every level and over scales from short to long. Exercising intensely enough to deplete glycogen from muscles, for example, can have a dramatic effects on both postprandial BG numbers and Dawn Phenomenon (following morning). Regular intense exercise (aerobic or resistance, or both) can change postprandial and DP numbers persistently, even on rest days.
I think it is safe to say that the value of serious exercise is not worth the time, trouble, pain, and expense for many people, Type 1s included. But to suggest that serious exercise isnāt enormously useful just flies in the face of scientific, personal, and collective experience. It does take a lot of experimentation to figure out how not to go high or low unpredictably, but with experience the highs and lows arenāt unpredictable. I know, for example, precisely how cycling at 17 mph for 45 minutes affects my BG levels. I know how many carbs I need to eat at one hour to not get a persistent low. I also know how much my BG will rise from half an hour of heavy weight lifting. And I know some tricks to offset that rise. It took months to collect the data (BG, amount of exercise, macros consumed that day, etc.) to make sense of it, but sense it does make.
In my opinion as a T1 diabetic, a scientist, and a biologist (although not a medical researcher), exercise is one of the three primary tools for effectively managing BG at ānear-normalā levels (along with insulin and diet). It works! Itās just a lot of work
This sounds like something Iād like to experiment with. Just to clarify, do you mean a single or a double arrow (comparable, respectively, to my Dexcomās slanted and straight up/down arrows)?
If itās a single up arrow I my only increase the basal by 150% to 180% (beyond a 180 mg/dl). If itās a double up arrow Iāll increase the basal by 200% (beyond a 180 mg/dl).
Double down arrows depend on where my glucose is. If I have a double down with a glucose of 100 mg/dl or below I set my basal to almost 0%, e.g., 5% without suspending. If itās a single down arrow at 100 mg/dl I set my basal to around 50%. Each of these is only a 30 min. temporary basal.
After doing all of this I monitor my CGM readings very closely. Sometimes the rise or the drop is temporary. However, with a low glucose I may correct by eating a very small snack as needed.
āExercise fundamentally changes the way the body metabolizes food at every level and over scales from short to long. Exercising intensely enough to deplete glycogen from muscles, for example, can have a dramatic effects on both postprandial BG numbers and Dawn Phenomenon (following morning). Regular intense exercise (aerobic or resistance, or both) can change postprandial and DP numbers persistently, even on rest days.ā
I managed to break both feet (at different times), then injured my shoulder. I couldnāt exercise for 2 years as the pain was horrible. Neither foot healed right. Thankfully, my shoulder did. I started biking and doing weights and resistance training three months ago. I also got āseriousā about BGās because I was able to get insulin prescriptions refilled.
I do follow low carb diet, but even with that, I still had BGās that were higher than I wanted. Now that I exercise 7 days a week, I have lowered the amount of both basal and bolus insulin and my BGās are great! My A1C went from 9.3 down to 7.2, and hopefully it will continue to go down. I really think the exercise and building back up some muscle has more to do with the better control, than when I just did the low carb. As an added benefit, I went from 30 grams of carb per day to 75 grams of carbs per day. I think I feel better too, as before diabetes and all the injuries I was an avid exerciser. I was not a āhappy couch potatoā.
I probably didnāt state this as eloquently as I could have. I definitely understand that there is a correlation between exercise and blood sugar control. Whenever I travel I am low almost all of the time for the first few days with all the walking I am doing, and can eat almost anything I want - itās amazing! I find once I start lowering my basals and carb ratios it balances out again though, and the effect doesnāt last much. I do a lot of cycling like you do, as well as running, but again other than making me low if I donāt lower my basal rates or eat enough glucose tablets, I donāt find it makes much of a difference in the long term. I always need to bolus or increase my basal immediately following cycling/running or my blood sugar shoots up to 12, which is why I was saying it doesnāt make control easier in my experience. Regardless of how much exercise I get, I was not able to make a serious dent in my A1C until I got a CGM and better understood the impact that food, stress, dawn/feet on the floor phenomenon and so many other things have on my blood sugar. The minute I step into a courtroom for my job my blood sugar skyrockets from the adrenaline. I agree that constant exercise lessens the impact of this, but only slightly for me - it still happens and requires a strategy of monitoring my BG using my CGM and temporary basal rates and corrections to control. My point to John really was that while exercise is important for many reasons, including what youāve stated, I think he needs to have greater insight into what is causing his blood sugars to be so high much of the time and what he needs to do to manage it better overall. While I agree exercise can be an important part of that process, I donāt think getting even daily exercise is going to make a huge impact if he doesnāt have insight into why his blood sugars are what they are or how to manage all of the things that raise or impact them every single day. This is all from my experience though, my body could just be abnormal I admit!
I think weāre definitely on the same page, after your clarification. This is why I say exercise is one of the most important tools a diabetic has at their disposal. It is definitively not a cure-all, especially for Type 1 diabetics. It might, actually, be very effective for some early-stage Type 2s, but that is for another conversation. Regardless, a Type 1 has to deal with the lack of insulin in some way. Exogenous insulin is usually necessary (Iām the weird Type 1 that isnāt yet on insulin, although thatās going to change next month); changes in diet can help enormously (although many people donāt change their diets at all); and exercise can also help enormously. Iām a big fan of using all the tools available.
Incidentally, since you exercise frequently, you might actually be benefiting and not realize it! Many people find that an extended period of enforced inactivity (due to injury, illness, etc.) makes managing their BG a 1,000 times more difficult. However, you might consider adding weightlifting (or serious bodyweight strength building) to your routines! Muscle is far, far more efficient at processing glucose than other body tissues (due to the way glucose is stored as glycogen and used for energy), and can provide a real sink for blood glucose of almost any type (Dawn Phenomenon liver dumps; postprandial spikes; stress-related liver dumps). Glycogen-depleting exercise (sprinting, intense swimming, olympic weight lifting, HIIT or Crossfit, etc.) is remarkably efficient at dealing with free BG (by sucking it up to store as glycogen for the next workout) once your body gets used to it.
And the stress-related BG spikes you have from courtroom activity are real (and related to exercise highs). Stress hormones (even from āpositive stressā or excitement) causes the liver to convert glycogen and dump glucose into the blood (and also increase your bladder load). The hormones are trying to make sure you have enough free energy to do what needs to be doneā¦ for me, the culprits are: sexual activity; intense exercise; giving lectures related to work; traveling for work; and any kind of interpersonal conflict). Predictable liver dumps can be, for me, prevented or mitigated with resistant starch intake (I use 30g before exercise or giving a presentation, for example).
Just found this community after 7 years of guess and check by myself. Itās amazing the lack of resources and knowledge given at diagnosis, furthermore bad advice from ADA. Thanks for sharing here.
