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Permalink Reply by Zoe on June 11, 2011 at 12:21pm

Out of the things you mentioned, I would work on the basal testing first. If your basals are off, then nothing else works well. If you are having highs between meals, at waking and at bedtime than that indicates the basals are too low. If you are high 2 hours post prandial, then you need to look at the I:C ratios for your meals. Do you also correct highs? Knowing your correction factor and testing and correcting highs really helps get those numbers (and hence the A1C) down.

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Permalink Reply by Bug74 on June 11, 2011 at 2:11pm

Looks like you are headed in the right direction. Starting is more than half the battle. What were A1c in the past? And the big question.......What do YOU think has elevated the bgs the most?

I agree with Zoe.....test the basals first. Even if you need to skip a day or two of excercise here or there you need to test the basals.

One thing I did was stop snacking so much between meals. I would bolus for the carbs, but I figured I wasn't ever giving my bg the chance to come down before the next meal. This helped a great deal.

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Permalink Reply by Baby Tee on June 11, 2011 at 2:50pm

Hey Honeybear,
You definitely need to get your basal rate set up first. Remember that menses creates different basal rates. I have 3 different basal rates each month. One is for about 3 weeks and then the other two are 3 to 4 days each. Not sure if it applies, but If you have started menopause, I have no advice. Also allergy meds affect my bg so if I take my allergy meds, I have different basal rates than when I don't. Also, weather affects my bg. These things don't affect everyone, but some people are affected by them.

To figure out your basal rates and bolus rates, you should probably read the parts of Pumping Insulin and / or Think Like a Pancreas that apply. When I set my goals, as recommended by those authors, I started with evaluating my bg at dinner time and watching carefully so I would have a good number by the time I went to bed. That made having a good morning number easier and made me less likely to have lows during the night.

Remember, an A1c of 10.1 is an average bg of about 243. Don't start by trying to keep your bg between 80 and 160 all the time, because you'll probably fail.
1. Be patient with yourself and take small steps. Remember that every improvement is still a step in the right direction, so even though an A1c of 8 or 9 is bad, they are much better than 10.
2. Start by trying to keep your bg between say 120 or 160 and 240. If you start dropping too low you will feel low when you are not and that will be discouraging. Also, if your body is used to a lot of sugar, your mind not work as well if you suddenly drop bg levels.
3. After you feel comfortable with that, try to keep your bg between 100 and 200. Give yourself at least a couple of weeks to get comfortable and consistent.
4. Keep yourself between 80 and 160.
5. Consider taking a mulitvitamin, as well as Vitamin D supplements. A study came out a few weeks ago that said if your A1c is above 8, it is likely yoru vitamin D levels are deficient. More than Calcium absorbtion is affected by Vitamin D deficiency.
6. Don't get upset if you start to gain some weight. As your bg returns to normal, it is normal to gain a little weight, at least until your body gets used to being able to efficiently absorb the food you eat.

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Permalink Reply by Honeybear on June 11, 2011 at 4:52pm

Hi Everyone. Thanks for the great advice!

Zoe - I do use a correction factor. I have a Minimed Paradigm pump with the insulin wizard, and I have different carb ratios for different times of day, different basal rates, different correction factors, etc. The problem is somethings not right and they just aren't working for me right now.

Bug - my A1C's have always been too high, but in the 7's and 8's, not 10's before this. I think what happened is I got crazy with work about a year ago and allowed that to take over and I ended up with some bad habits - one of which was snacking instead of eating real meals (except for dinner) on most days. Right now I have gone back to 3 meals a day. So I think you are right about the snacking. While I bolus for it all, its not the same as eating 3 meals a day. With the snacking I have also let my carbs creep up, so I have recently cut out processed carbs like white bread, crackers, chips, pasta, etc. Instead I am eating quinoa, whole beans, fruits, veggies, and dairy. The closest thing I eat to bread is a corn tortilla once in awhile - which is only 6g of carb.

I also think that when work is crazy I stop focusing on me, and what I have to do to stay healthy as a diabetic, and instead just get caught up in what the daily fire is. I basically stopped paying attention. The other thing that happened was around the same time my PC died and I got a Mac to replace it, and since then I can't download my Dexcom graphs, so instead of having the weekly over view of what my BS was doing, I was only looking at each number by itself. The return to logging should give me a better concept of trends.

Baby tee - Thanks for the reminder - I'll go pull out my copy of Pumping Insulin read it again. In terms of vit. D - I do take a supplement every day. I was tested in January and found to be very low. And on the weight gain - I am trying to turn that around as well! I am seriously limiting my food and hoping that this will help me to lose, not gain. My goal right now is: BS under 200. I know that's not very aggressive, but I think it is more doable. And thanks for the reminder about hormones and the monthly cycle. I do have a different pattern for certain times, but lately I haven't been using it. Allergies and allergy meds are also a good thought. It has been a bad allergy season here and I have been taking zyrtec every day for as long as I can remember. I am still suffering, even with the meds. I think the immune response to all the pollen may factor into this as well...

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Permalink Reply by Brian (bsc) on June 12, 2011 at 8:42am

Snacking. Sometimes you have people tell you that it is "better" to eat 6-8 times a day. Well they aren't diabetic. If you are having frequent bolusworthy snacks during the day instead of eating, it can become impossible to correctly bolus and correct. No pump can properly account for "stacking" of insulin and carbs. Most can take insulin stacking into account for corrections, but that is it.

One strategy that may really help is to eat only three bolusworthy meals, this will give you a good amount of time between meals to see how you are at 2-3 hours, correct if needed and accumulate data on whether your carb and correction ratios need adjustment. You may still feel compelled to have a snack, but try to select one that is very low carb.

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Permalink Reply by acidrock23 on June 12, 2011 at 8:49am

I have been a snackaholic for years but mostly eat cheese these days. I bring along a bag of pretzels in case I have a "tail" sneak up on me and need a couple of carbs but most of the time the 28G serving of pretzels will last for like 2 weeks with a pretzel or two, here and there.

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Permalink Reply by Scott G on June 11, 2011 at 4:39pm

I'm gonna suggest not exercising when you test your basal rates.

When you were using the Dexcom, what kind of trends were you noticing? I use 3 different basal programs, each having 4-5 different basal rates based on my sleep pattern (I work 3rd shift).

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Permalink Reply by Kelly WPA on June 11, 2011 at 4:53pm

I am another vote for getting the basals straightened out first. You can put a nice well-built house on a crappy foundation & it will cave in - your basals are the foundation to your BS control. Once you get that set, you can work on testing your carb ratios & correction rates. Look at the duration of insulin in your pump - we are all different and just because someone else has theirs set at 4 hours doesn't mean 4 will work for you.

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Permalink Reply by veterandiabetic on June 11, 2011 at 8:08pm

ok. you are doing a lot of stuff. I may sound cliche but, how about things you don't think about. If you live in a warm environment, maybe your insulin went bad. Also, SOMETIMES exercise causes highs, believe it or not. I usually go into the high 180s, or even the 200s after I exercise. Also, are you having pump problems with the tubing or the cannula not inserting. Just some thoughts, also, I am curious as to what your doctor or nurse says in response to your dilemma.

Another thought, It does seem as though you have a lot of stress in your life. Maybe you can try to incorporate some non-stressful things into your day. For instance, when remodeling, (while doing something like wall papering or painting) play some relaxing or tranquil music. Or, when working from home, every two hours, for 30 seconds to draw a pretty picture or color, some people find coloring or drawing relaxing. If you don't, choose something else. Maybe lighting candles? Good luck. It IS difficult to get diabetes under control in times of stress.

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Permalink Reply by acidrock23 on June 12, 2011 at 4:29am

I am totally lazy about formal "basal testing" but might just turn it up like a notch and see if it helped the numbers improved across the board. If you get your reports, I like the idea of trying to fix a particular timeframe first, often times breakfast is a good one for me as it always seemed to be my most challenging area.

Veteran Diabetic's comment about exercising is also an interesting observation, particularly since you mention "high intensity intervals"? I think that anything where you are going at or near 100% will cause adrenaline spikes which, since they don't include carbs, can be challenging to work around. I get rises after I run all the time and correct them but it is a tedious chore. I run pretty regularly but when we got our puppy last August, walking her 4-5x/ day pounded my BG down and seemed to help a lot. When my BG runs up, I like to take a CB and take the dog for a walk. That seems to help more than just walking and I don't have to do the whole "get ready to work out" ritual that is a pain in the butt for me. Plus it makes the dog happy!

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Permalink Reply by RacheEH on June 12, 2011 at 8:48am

The best way to establish basel rates. Any opinions?

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Permalink Reply by Zoe on June 12, 2011 at 9:42am

Personally, I'm like AR when it comes to basals. I could tell from the highs or lows at different times of day what times my basals weren't right, so I just kept tweaking those "time zones" (2 hours before the time needing change) until they were in target. I'm sure formal basal testing works well and probably takes less time and effort than the way I do it, but my way works well for me.

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