I just wanted to ask about the a1c on people who are like me. I am of course a type 1 for 33 years, with a pump (of course)
Now is the curiosity, I also have gastroparesis. I do my bolus almost always dual wave, and always try to calculate the fat, the carbs, and everything else. but I have a hard time bringing my A1c down. it has been staying at 6.9, but my blood sugar always is worse than a yo-yo. I just wonder if anyone else has this, and what they do.
I have gastroparesis also, but don't have a pump. Know your frustration because it's a hair-pulling trying to manage with unpredictable stomach emptying. Mine is worst with dinner & I get little sleep waiting for the inevitable spike sometimes 6 hours after eating. I'm careful about not eating a lot of protein/fat in the evening, but hard to do regularly. I test frequently. As soon as I see a rise of 20 pts, I bolus. I take a small bolus 1-2 hours after eating & another larger one hours later to cover protein. Not an option with a pump, but I've also used Regular along with Apidra since it's moderate acting & lasts longer.
I also have gastroparesis. Like Gerri, I also test a lot – I test about 18 times a day. I try to test hourly so I can watch when my BS is starting to go up and take small doses of insulin. I also do MDI – I did use a pump for awhile but my A1c actually went up with the pump because of all the problems I had with it. I have been able to keep my A1c below 6 since about 2008 when I first found the DOC. I just had an A1c in March it was 5.7. I thought for sure it was going to be higher because of some insulin problems I had back in Jan.
Apidra is my insulin of choice because it only lasts about 2 ½ hours so makes taking frequent shots easier. Depending on what I eat, I average about 3 shots per meal. I also try to avoid having too much protein or fat with dinner.
I was able to get a Dexcom but having trouble with sensors now. When I can use it, it beeps when I am above 120 or rising fast so I know I need to take insulin.
I think a cgm will do you a world of good.
I was running about 6.9 % because i was always afraid of going too low at night,
After I started my cgm I realized that my meals were peaking way ahead of my bolus.
I would soar to 200 then back to 110 and when I checked, it looked fine.
I was able to bring mine way down, Just bolusing 30 min PP instead of 20. Also I don't fear going to bed with normal glucose levels like I used to because I get an alarm if it goes too low or high.
I never disconnect it, unless I am charging the transmitter.
I'll 2nd this suggestion. Like Timothy said, the CGM gave me lots of insight into what was happening at mealtime and during sleep. I was able to tune my overnight basals to give me good flat overnight numbers and I stopped worrying as the Dexcom will wake me up if things start going awry (but once things are set right this shouldn't happen too often). Second, when I eat at home and I can be sure what and when I am going to eat, I do as suggested above and pre-bolus about 30 minutes. You will have to tune this by seeing when the insulin starts to kick in and time it to when it starts to rise from the food. This produced much lower peaks.
I went from 7% on MDI to 6.6 on the pump and while I haven't had a new A1c yet since using the Dexcom, the numbers I download from the pump and CGM show I should be able to hit 5.8-6, and I am still learning.
I would be very careful with pre-bolusing in someone with gastroparesis. By definition, gastroparesis is “slow digestion.” That means what you ate for lunch yesterday might still be sitting in your stomach today. People with gastroparesis tend to go low after meals because the food they took insulin for doesn’t digest so they go low, not high. Hours or days later, the food decides to start to digest. The only item I ever pre-bolus for is coffee and that is a liquid.
My point is not pre-bolusing, per-se, but that with data from a CGM, you can see *when* the food hits your system , relative to when the insulin is hitting, and adjust the relative timing...so if someone with gastroparesis sees the food is hitting, say , 50 minutes after eating and you see the insulin starts to act 30 min after injection, you can make a relative adjustment and delay the insulin., etc.
I agree about the CGMS, I mentioned it in my first post. However, it isn't like a normal stomach that one day it might be 50 minutes because the same meal might take 24 hours the next day. It does alert you as soon as you start going high so you can take insulin before you get too high - I have my high alert set at 120 for that reason.
I am not a gum chewer, so I can't say whether or not that helps. His article was the first one I read years ago that said to limit protein at dinner like Gerri does. That was a big help. I already did limit fiber prior to reading his article - foods with a lot of fiber in are the hardest ones to digest and the most dangerous. I never tried his suggestions of exercise because I am more of a treadmill person than other stuff.
I'm not a gum chewer either, so can't comment on that. I take digestive enzymes, betaine HCL, but can't say with certainty that helps.
I've tried the exercise Dr. B suggests. It didn't speed things up for me, but worth a try. Imagine it depends how severe or mild gastroparesis is whether these things assist.
Okay, Thank you all very much, Now comes another question that I wanted to ask. When I do a dual wave bolus, what setting should I use? I currently use 60/40 2 hours or 1 depending on what I eat. what time should I do the square wave? 1,2,3 etc. hours? what setting 50/50 60/40, 40/60 etc.
I am learning, but I found most of the books that I see talk about the old way they did it. Any recommendation?