Whats the key to getting glyco hemoglobin A1C's in the 6's?

Hello Yancey:



IMHV couple things to keep in mind.



The magic A1C is only an average. To get the LOW (sic ideal A1C) number, that low average we run the real risk of crashing and burning because we need to force ourselves lower and lower in order to keep it that “ideal range”. It is a real problem we must be fully aware of…



I propose that MOST of us, even with this degree of serious expereince have the bad habit of being too agressive at times The concept of “rage dosing” and so forth. Regardless you hit whatever the reading with excessive insulin, even just a little too much… and then have to chase the BG bouncey-ball, rarely getting it perfectly. You get close but not the desired ideal.



I’ve been “non-symptomatic” many times in my life and shrug my shoulders never finding what changed to achieve it…I believe one factor in doing what you can and STILL not hitting the target… yet seeking it none the less is careful slow scrutiny. Take your pick where you start.



Exercise, what does the habit buy for you?

How much does it bring you down? Cause any problems re: too low?



Insulin: long acting. Can you increase it a single unit without causing any trouble? Can you increase it two units, with no harm? If so you’ll buy a chunk of lower A1C doing it. Preaching to the choir here I’m sure.



Short acting insulin… uggggh. There are a lot of ways to play. Prefer real, real gentle myself.



Food is impossible to get right even with the listed ingredients. Always was, always will be. Fat interferes with breakdown, extending what should be a simple decent spike. Protein does the same. Combine all three and I do not believe it can be measured-covered correctly with a simple “carb formula”.



Look forward to this discussion, asked many times before, never found a good answer.

Stuart

Robert: Hi. I just saw my endocrinologist and for the third straight visit, I have had an A1C in the 6’s…this time 6.2. I went on the pump just over a year ago. Previously, with MDIs and carb counting, I could do no better than something in the 7’s. So, the pump has done if for me. However, I have become very fanatical about testing and correcting and carb counting like I never was on MDD with the pump. I do not skimp on the carbs, as others apparently do. I eat what I want…300+ carbs per day. I do exercise…play tennis 3 times a week, bike in good weather, go to the gym and do cardio stuff. That helps a lot too. You just really have to watch your numbers and make adjustments constantly. I test like 7-9 times a day and do basal checks if I cannot figure out an issue within two days of it cropping up.

Yes 6"s are possiblei have twice gome from bad to 6’s. When first put on pump I did mot even know what A1c was. I was an 11 and even before carb counting with an old metronic “dumb” pump, i was able to get to a 6.9. And that was the old sliding scale before we knew what carb counting was. Over a period of years, I got careless and the A1C’s crept up to 8.8. After investing in a CGM and better attention to what I eat (my cgm is my policeman) I have again got into the 6"s after 2 months of use and looking at my averages, I now expect a low 6 so yes its doable!! Is it easy??? Nope. Is it worth pursuing? Well I think so - some day I would like to see my grand Kids!!!

I don’t ever remember being below 7 until I got my CGM to use with my insulin pump. The pump helped me get down into the 7s and 8s, but the CGM kicked me over the edge to a 6.8 :slight_smile:

I started carb counting in the 1990s and established my insulin:carb ratios and my insulin sensitivity levels by the year 2000. That was the single most important factor in my getting my A1c’s below 7.0. More recently I have refined my ratios and sensitivities and found they vary throughout the day and night. That was another important discovery. It was all done by using a lot of trial and error. After getting all that into play I have been in the 5’s for many years now. It is true that having low A1c’s can lead to more frequent, and troublesome hypos. I had some seizures during the time that I was perfecting my ratios and sensitivities, but I also had seizures beforehand as well. I test 15 times per day, and when on vacation and traveling, even more often. Frequency of testing is absolutely necessary to have the good control I am now experiencing. Several years ago I stopped needing assistance with lows in the 40s, or even the 30s. My body is not at all stressed unless I am below 50, and very little in the 40s. I used to feel the stress and discomfort, but not now. I feel relaxed and am perfectly capable of caring for myself. I may drop below 30 once per month, and see the 40s about 3 times per month. I am still hypoaware, feeling low when I am in the low 70s. Pumping for me started in 2007. My A1c’s were already in the 5’s before pumping, but the pump narrowed my range and the number of lows and highs greatly decreased. That also lowered my standard deviation. I used a CGM for 8 months in 2010 and that also helped further reduce the number of highs and lows. There was a change in my health insurance and now my Dexcom CGM is no longer covered, so that is why I have these occasional BG’s in the 40s and 30s.



My adjusting to lows, so they no longer cause me any problem, makes my control run very smoothly. I cannot guarantee that it would work out as well for you, so I am not recommending this to you. Perhaps adjusting to lows would be much more difficult for you. I made my adjustments very slowly so my body became accustomed to the changes more easily. I have not needed help with a low since July, 2007, and my wife appreciates that very much.

Well, here’s a little update. At my last dr. visit I was 7.9. I told my doctor that if I hadn’t mastered the A1c, meaning, gotten it in the 6’s by April, that I would look at beginning using a pump. I was very reluctant to the whole pump thing since mdi’s had worked for 35 years so far. However, I started on a CGM about 18 months ago, and so I was already used to having little bandaid like devices attached to the belly. So, two weeks ago I started on my new Animas Ping and I really like it. I can hide it in my pocket so the whole world doesn’t have to know I’m connected to tubes unless I want to show them. I really like always having everything with me whenever I need a bolus. The “EZ Carb” feature is awesome. Of course,without having good ratios, good test results and good carb counting it work. I found an awesome App that’s available on Android and Iphone that is called “MyFitnessPal” if you don’t already have this you need it! it makes carb counting soooooo easy. It even has a bar code scanner if you want to search for items by scanning the wrapper.

Anyone want to guess what my next A1C is going to be?

I try to keep my A1C between 5.7 and 6.3%. I can achieve this window without too many lows, and no severe lows, which I think is what’s most important for me and feeling like I’m doing well. Type 1 for just over 30 years, heading to 31 years this December…
I don’t restrict carbs at all. I stink at exercising regularly. What I do well is test frequently well, count carbs well, and utilize features on my pump to remind me to test 2 hrs. post meals I’m ‘guestimating’ on, and combo bolus (same as dual wave). I pay a lot of attention to the timing of my insulin with different types of foods/meals. Things that break down into sugar and dissappear fast? I pre-bolus ahead of time as long as my pre-meal BG is 100 or more. Things that break down into sugar at a ‘normal’ rate? I bolus shortly before I eat. Things that are pretty high in saturated fat/trans fat that will break down into sugar over several hours? I add insulin on (at least 50% and use a combo bolus. I also change the active insulin time in my pump to 3.5 hrs. instead of 4. It allows me to correct a smidge more post meals. I made a deal with myself: active insulin time 3.5 hours means no manual post meal corrections. Cuts down on me stacking insulin and inducing lows from begin overreactive to highs.
The more I’m paying attention, testing, counting, and matching the timing of my insulin, the better my A1C. When I’m ‘slacking’ (i.e. focusing on the rest of my life a little more than me), my A1C trends up.
For me, less than 5.7% means too many frequent little lows (50-60s) and an occasional big bad low (where you feel like you just might die), so I don’t try to push it that hard anymore. I like living! Ha ha! Hope this info helps you some how.
Others have said it: the key is stability. Too low does not equal good. You have to balance your A1C with your life and not have too many lows…