I’ve been type 1 for 24 years and have recently hit a brick wall with my A1c. It’s been a 9-8.5 for about three checkups now and I feel I’ve tried everything to get it down. I’m getting discouraged because my husband and I are trying to get the green light to try to conceive for the first time. Any advice, besides getting an insulin pump on trying to get those numbers down. #workhardgettingdiscouraged
Why don’t you want to try a pump?
Have you done basal testing to get your basal set right? What insulin are you on? Do you know how to do corrections?
Many here find that a lower carb diet helps greatly in management.
If you are insulin resistant oral medications like metformin may also help.
Prewar describe what you do, and ask questions. This site offers great support from very experienced. Members.
I would recommend some books: bernstein diabetes solutions and think like a pancreas.
Many reasons, but mostly the feeling of being attached with an active lifestyle, hearing about malfunctions and causing soaring 600 blood sugars. Several doctors have tried to pressure me into one, but my dad is type 1 and has been on insulin shots his whole life with great success, so I know it can be done, just desperately searching for what will work with me.
Thanks for the book recommendations! I’m a big time reader, so I’ll have to look into them. I’m on humalog with a sliding scale. 1:10 ratio and 1:50 sensitivity, is what I’ve been in for awhile. How do you test to see if your basal is right? Here’s the situation with my basal… I take 20 units Lantus before bed and HAVE to go to bed with a bs 200-250 because it dramatically drops at night. I will wake up 130-80 going to bed with those numbers. It seems like whenever and whatever I eat (a lot of salad and whole wheat) my numbers soar afterwards (2-3 hours).
Sounds like you are swinging all day. What are your highest and lowest bs levels typically seen? Have you had a chance to work with a diabetes educator on how to finetune your insulin dosing?
Sliding scale insulin is replaced by basal bolus. The books recommended describe how to test. You may wish to ask your Dr about the new long acting insulin tresiba which has a much flatter profile than other long acting insulins. There are discussions on tresiba ongoing here.
Are you eating low carb? While what is high carb. Do you eat enough protein? Are you on low fat diet? High fat, moderate protein, low carb May be worth a shot. If you need less insulin to cover food other requirements may get flatter.
What is the timing of your last meal and fast acting insulin relative to bedtime? How much fast acting insulin do you, take each day?
There is likely no reason you can’t teach yourself techniques to get your BG under better control. While it is true that some people have factors about their unique situation that make it more difficult than others, the mere fact that you are taking such excess amounts of basal that it forces you to go to bed at such at such a high BG level shows that getting just that alone corrected should improve your control considerably.
My PCP treated me as a type 2 for a year and a half before she finally referred me to an endo. I had one appointment with him, he diagnosed me as a type 1 (LADA), showed me how to inject insulin and gave me a starting number for basal and bolus. Then he was going to turn me over to my PCP. I knew that she was basically useless as far as teaching me anything about diabetes control, and besides I was going on a trip across the country alone in three weeks. I had to learn what I was doing FAST! So I got the book Using Insulin by John Walsh and adjusted my doses with the instructions given in it. The book Think Like a Pancreas covers much the same material, but you might want to check out both books. Perhaps your library has copies.
I’ve been able to keep an A1c between 5.5 and 5.9 ever since the first full 3-month period after I went on MDI. And I didn’t have to go to any classes, see a CDE or get any real help from a doctor to do so. Those books and the suggestions from people on boards such as this were what helped me. Now it is entirely possible that control might be easier for me than for many others. I’m long past the years that monthly hormone shifts would have caused the BG problems they sometimes do for younger women. And I’ve never noticed that emotional stress affects my BG at all, even though it sends my blood pressure to the stratosphere. But even if it might be a little easier for me than for many, I’m totally convinced that most diabetics can get their BG under at least reasonable control by learning how to adjust their own basal and bolus and learning some of the things besides food and injections that need to be considered.
You can do it. And probably within a few months.
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The way you test your basal is to eat dinner no later than about 7:00pm, then eat nothing until 7:00am. When 11pm rolls around, test your BG. It needs to be between 80-250. If it’s higher or lower, stop the test and either correct your high or treat your low.
If it IS between 80 and 250, you go to sleep and set the alarm for 1:00am, 3:00am, 5:00am and 7:00am. Test your BG at those times. Do the test a few times, and see if there is a pattern. Your BG should not rise or fall more than 30 mg/dl during the testing period. If it does, the results should point out what needs to be done.
I wish there was a way to show pictures on this site. I have a chart of my nighttime basal testing. It shows that my BG has a tendency to go down 50 points from 11pm to 3am. So I lower my basal rate on my pump at that time to keep it from dropping so much. On MDIs you’re aiming for the same thing but you’re doing it with one or two shots.
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I have a CGM (as well as a pump), and basal testing is MUCH easier with a CGM. I just stop eating at 7pm, go to sleep and eat breakfast at 7am. My CGM is accurate, so I can read the trends off of my CGM graphs on my computer the next day. Also, the pump’s basal rates can be changed for different times of the day, so the fix for my BG going low from 11 to 3 was to lower my basal rate during that time by 0.1 units of Novolog per hour.
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Start with the basal testing to get that right,
Basal testing
A workbook (the certificate ran out but the site is safe) this will help with the bolus and corrections, try cutting your carbs to 40g a meal and 10 for snacks ?
Gosh, it sounds like you have not gotten the best help from your healthcare team. As others have said, your basal looks way off. Dropping 100 mg/dl overnight suggests that your basal is too high. You may even need to split your basal dose to uneven and time doses to get thing managed. So certainly follow up with up with basal testing.
I would also suggest returning to this as a new student. Maybe you could take the courses in Type1University? If you are on a vicious roller coaster of highs and lows surrounding meals then are many things you can do about that including restricting carbs in meals, learning to pre-bolus, post-bolus and split bolus. You can learn how to deal better with variable levels of activity by adjust your regime. And you can move from a fixed set of factors to ones that more closely match your body and the nuances of what you are doing and eating. For instance I am very insulin resistant in the morning and insulin sensitive when active. And if you are like many of us and suffer from Darn Phenomenon you can develop ways to manage that so it doesn’t start off your day with poor blood sugars.
You can do this, you just haven’t been given the tools.
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Another point. Lantus is not approved for pregnancy. Levemir is. Please ask your dr about this in preparation. The benefit of levemir is that it is dosed 2x/day and you can dose differently for each dose, as required . For example, i take 12 units at night just before sleeping, then my second dose is 6 units as soon as i wake up. Typically this means i take bedtime dose about 9 pm, and morning dose about 6 am. I also increase or decrease my bedtime dose depending on both my activity level as well as how much i ate that day - particularly if i ate a big dinner. I’ve learned all this through 7 years of experimentation and adjustment.
I can keep my blood sugar in range of 70- 100 most of he time with this approach.
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Hi There,
Have you tried keeping a food log so you can look back to see what causes your blood sugars to go up etc? My 16 yr old daughter has had t1D for 5 years. We kept a food log for 2 years while we figured out bg trends in association with the foods she ate. It was extremely helpful. She is super active and started on an Omnippd pump. There is no tube which is great for her activity level. The best part about a pump is that instead of taking Lantus, you set a basal rate. Every hour the pump gives a small dose of insulin. You can adjust these by the hour if you know when you have lows, like after exercise or spikes etc. i agree with consulting more with a diabetes educator. I find that the ones who have t1d themselves or a close family member usually have better first hand knowledge to share. Doing most of my own research on this website community and online have actually been the most helpful for us. I hope this helps. Have a beautiful day.
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My son is on a pump, but sometimes takes a break and we go back to MDIs. We always found that we could not give him all his Lantus at once. We split it over a 12 hour period. He required less at night and more during the day. I noticed LookinGood does something like that. I understand not wanting to use a pump. My son is an athlete and doesn’t wear his pump while playing football. If you don’t like dealing with tubing (we use Medtronic) consider the Omnipod which is tubeless. If you really don’t want to use a pump, consider a continuous glucose monitor. However, we went 6 years without one and maintained an A1C between 6-6.7.
(if you’d like to send @MomofType1 a private message, click on her avatar and you’ll see a large button that says “Message”)
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I definitely understand the not wanting to feel attached to a pump. I have been a Type 1 for over 22 years. It took me the longest time to get past that. I guess for me having a pump would be a constant reminder of my diabetes. Well I started having complications and just couldn’t get in control. I would go from over 400 to 20 in day. I switched to a nurse practitioner at my Endocrinologist and she helped me a lot. My other Endo didn’t realize that the long term insulin wasn’t working for me and didn’t last 24 hours like he thought. So the NP switched me to 2 shots of the long term which helped some but I still couldn’t get where I wanted. Well I finally decided to start using a pump and Dexcom CGM over 5 years ago. I really wish I had these sooner and definitely when I was pregnant 13 years ago. I normally average with my pump A1C’s in the high 6’s and low 7’s.
I do have to say my Dexcom gives me the most peace of mind though. So if you aren’t thrilled with the idea of a pump maybe start with a CGM if you don’t have one. I actually did that and it helped me so much I got over the not wanting to be attached thing.
Also, my Endo told me that my insulin was no longer working as well as it used too. I’m not sure how long you have been on your insulin but maybe your doctor would know if there are different options that would work better.
Take care.
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your basal rate is key and actually, even more than that, in my opinion, carb counting and intake is even more important… must be done… it’s a pain, but we have to do it… T1 or T2…
I have been t1 for 79 years
Used to be on Minimed pump
Now mdi
If very hi bg at mealtime I bolus for high bg & eat a low carb meal
Then retest 2/3 hours later & readjust
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I wish I was still on pump but have other medical problems like memory, etc…
Otherwise I 'm still ok
After 2 hip replacements
Hello to every one at tudiabetes
Love to all
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SHOSH!!! nice to see you!!!
@shoshana27
so what insulins are you taking now?
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