Replies to This Discussion

Permalink Reply by JohnG on June 21, 2012 at 7:44am

You have been a PWD for some time now and you probably have a good understanding of how your insulin works...what do you think caused your really high A1c??. ..You probably know what needs to be done to lower your A1c...You also understand that no one will ever understand you like you understand you...;-)

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Permalink Reply by smileandnod on June 21, 2012 at 8:20am

You may want to consider reading or re-reading "Think Like A Pancreas". My A1c is not where I want it to be either but if I followed what my Dietician tells me to do (as in eating more carbs per day), I would be roller coastering all over the place.

When I'm feeling overwhelmed, I find it helps me re-focus to re-read this book (and also "Pumping Insulin"). Then I "start over" with testing correction factor at different times of day and all the other ratios and rates.

Hang in there, Sam. The Dietician and the endo aren't the ones living with *your* diabetes. You can do it. Just step back and take a fresh start.

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Permalink Reply by HPNpilot on June 21, 2012 at 8:35am

I agree with the folks above...good control requires the ability to self adjust insulin.

I think eating the same amount of carbs for every meal is an ancient way of doing things. With proper carb counting, well-tuned I:C ratios, and modern insulins this is unnecessary.

Now, if the RD or endo saw that you were on a roller coaster, they might suggest this to stabilize things while tuning basal, bolus, etc.

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Permalink Reply by Sam on June 21, 2012 at 8:52am

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Permalink Reply by Sam on June 21, 2012 at 8:52am

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Permalink Reply by Sam on June 21, 2012 at 8:56am

Thanks for the replies. I just bought the book you mentioned on amazon. I'm trying hard but sometimes it just isn't enough, but I am hopeful for bringing down my A1c!

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Permalink Reply by Zoe on June 21, 2012 at 9:01am

I agree with the others that you probably know your body and how it is affected by insulin. But your A1C, as I'm sure you know, is dangerously high. What you don't say is if this is something that just happened recently or has been going on for quite awhile. I'm sure your endo is motivated to make the changes to help you get your A1C down, but she may not be choosing the right changes for you, and the dietician surely is in the dark ages, but again, may be motivated by the urgency to get your numbers down.

If you have had a good experience in the past with this endo I would try and work with her, not blindly "obeying doctors orders" but dialoging with her as to your concerns. The questions to bring up would be why you feel 30 was working well, and why she thinks 25 is better. Is she just randomly suggesting more insulin to get your A1C down or has she actually looked at your data and seen that when you correct you don't in fact bring your blood sugar down enough. How about you? When you do a correction do you check back 2 hours later and see significant progress towards target blood sugar? Three hours? If you are still too high after correction then she may be right that you need to go down to 25.

If you have never had a good experience with this endo, or she won't listen to your explanations and questions, then it is time to look for a change.

My guess is you do have a lot of knowledge after so many years living with Type 1, but you are also in trouble at the moment and need help, so you need to work with the right person to help you. I also second the idea to read or re-read books like Using Insulin and be open to making some changes in your management.

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Permalink Reply by MyBustedPancreas on June 21, 2012 at 9:51am

You list your A1C on your page as 13.4. Whoa!! Holy A1C batman! Yes, that is high and you know you need to work on getting that down. But go slow, take baby steps if you need to.

What do you think is causing your A1C to be so high? Is it just one thing? Or many things?

Also, keep in mind that if you're under the age of 20 (I don't know your exact age), hormones are still wreaking havoc throughout your body. Those hormonal surges (growth hormone, sex hormones, etc) can cause your BGs to go to crud for no apparent reason. Most of us T1s have horrible A1Cs throughout our teenage years. However, walking around with an A1c that high for any significant period of time is really bad for your body.

Also keep in mind that as you bring your BGs down, you may feel low. A lot. Even when you're not low at all. When I worked to get my BGs back under control years ago, I had an endo completely dismiss my "I-feel-low-even-though-I'm-not" complaint. It's one of those things that PWDs know well, but endos/docs aren't always aware of. You may find that you have to ride out a few days or weeks of not feeling too hot as you bring those BGs down. Don't worry, the feeling WILL go away.

One thing that lots of folks recommend on here is that when you feel your in a D-slump, pick just ONE thing about your D care that you want to change and start changing it now. Just one thing. Maybe it's testing first thing in the morning, or bolusing correctly for years. A couple of years ago, I fell off the D-wagon big time and was being really bad. I was eating out constantly, SWAGging wildly, and just not testing like I should. So, I changed just one thing - I started bringing my lunch to work instead of buying out. That one little change cascaded into a bunch of other changes...I started testing more and bolusing correctly and went back on the pump. I am doing much better with my care, but I needed to make that one little change to know that I really could do what needed to be done.

You've lived with T1D long enough to probably have more wisdom about insulin and food and blood sugar levels than any dietician or endo. You need to use that wisdom to get things back on track.

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Permalink Reply by still_young_at_heart on June 21, 2012 at 3:18pm

Hi -

I am going to go against the general trend of advice you've been receiving. Many of us eat pretty much the same breakfast every day. One of the ways to get a handle on your blood sugar is to get a handle on a series of meals and stick with them. I certainly try to keep my total number of carbs per meal fairly constant because it makes it easier to learn how your bolus will work and makes it easier to tell if a high is just really out of the ordinary. If you eat about the same number of carbs at a meal you don't have to worry quite so much about how well you're balancing your basal and bolus. Maybe you are using basal to cover; maybe your bolus includes a bit of correction for a slight basal shortfall. If your total number of carbs fluctuates widely the basal/bolus balance better be right or you're going to find yourself in trouble more often.

What does it mean that you know a correction ratio of 30 works great? Does a correction based on that ratio bring you back down to 120 or so within 4 hours on a consistent basis? If it doesn't, why not try a bit more insulin to get better results.

Your A1c is what one would expect for someone newly diagnosed. Why not use the more rigid framework to help get under basic control and then spread your wings. You'll feel ten times better if you do.

Good luck,

Maurie

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Permalink Reply by Jan74 on June 22, 2012 at 11:41am

I agree 100% with this advice.

Repeating meals and sticking to the same carb counts at the same time everyday whenever possible was crucial for me to get my A1c down from 11.3% at diagnosis to 6.5% in 3 months.

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Permalink Reply by christy on June 21, 2012 at 4:01pm

LOL that's when I smile and nod my head, leave the office and change my pump setting back to where I want them to be...my CDE was trying to tell me it was perfectly OK to be 180 2 hours after eating, and I'm like ok WHATEVER, lol.

I think we ALL know our own D better than any doctor or CDE can ever know, BUT your A1C as you know IS high, and definately needs to be lowered. Start making some small changes in that direction, your basal/bolus rates MIGHT need some tweaking.

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Permalink Reply by Terry on June 21, 2012 at 4:08pm

Sam - There is already and lot of good advice to you here. What I think you need to do is to become an expert on how food, insulin, and exercise uniquely affects you. The best way to do this is to keep a daily log for a few weeks or even a month. Of all the things that have helped me regain control when things go haywire, this is the best one.

This log should keep track of the carbohydrate content of everything you eat, your insulin doses, and exercise duration and intensity. The log should also note the timing of every event. A grid form that lists carbohydrate grams, insulin units, and exercise as the rows and every hour of the day as columns would work.

It's a bit of a record keeping burden but it's been well worth it to me. What this allows you to do is to learn how your body reacts to various combinations of food, exercise, and insulin. It allows you to spot patterns that would otherwise go unnoticed. It's like missing the forest because of all the trees.

This method has never failed me. Whenever I do it and reap important benefits, I always wonder why I put it off! I know this isn't easy but if it helps you to take control, wouldn't it be worth it?

By the way, your insulin sensitivity factor (ISF) range can be estimated by dividing your total daily dose of insulin (bolus + basal) into 1500 and 1800. For example, if a diabetic's total daily dose of insulin is 100 units, then the ISF is estimated to range from 15 (1500/100) to 18 (1800/100). I learned this calculation in Gary Scheiner's Think Like A Pancreas.

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