Never asked for help before, but I finally realized I could use it. Just joined up. Here goes:
Have always had a problem getting A1C below 8.4 Last A1C was 9.2 in November.
Diagnosed 15 years ago. Started Type 2, then migrated to insulin about 12 years ago.
Been on Minimed pump for 5 years now (moved to Revel 523 last year) using Novolog insulin. Running CGM about 1.5 years. Find that my insulin peak time is hours 2-3 post bolus.
Test myself many times per day (8-12) depending on physical activity, pump readings, etc.
Am physically fit (workout 5-6 times per week cardio running, biking and elliptical) and understand carb counting, proper nutrition including low glycemic carbs and portion control.
See Dr and CDE in NYC regularly, plus work with another CDE remotely who is also a type 1 pumper.
Honestly, besides convenience, being on the pump has not improved my BGs.
Despite my best efforts, vigilance and intense focus on trying to control my diabetes, I still cannot find the right handle on getting consistency in my BG readings to the point where my A1C shows it. So far, being on the pump is like my golf game. Flashes of brilliance, but consistent mediocrity!
Does anybody have insights based on personal experience how to turn this around. It am frustrated and not sure where to go from here. Tx
most doctors that I have talked to say 40-50.
I have had similar problems getting my a1C down, and I am an avid gym exerciser. I found that I would have spikes after weight lifting, so I started playing with injecting .5-1 unit before exercise, and then doing my w/o off pump. Might be counter intuitive but I haven't been going low . Also, I changed my duration time to 3 hours instead of 4, upped my basals a few at a time, till I hit lows then backed off. I also dropped my carbs to around 22 a day, went grain free, and I am hoping to get out of the A1C 8s.. Though my pump still tells me my average is 178, since after eating, when I have radical spikes, it takes me a long time to bring them down. I log everything, everyday and have been adjusting my insulin settings myself, since working with my DE was just frustrating us both. I used to eat 30 grms of carb per meal as was recommended to me, I feel a lot better now on as few as possible.
I am in the same boat with you, although I did manage to get it down to 7.7 an then it rebounded to 8.4 which was a kick in the pants.
One thing we did try which seems to work is my doctor moved me to an insulin called Apidra. Not sure who makes and it is more expensive, however with it I have been able to hit my target range of 80 to 120. I am working on getting the range down to 110.
The other thing I found too, and like one of your other posts, I HATE to write things down. This weekend I made a bet with my wife that it would have no affect on me what so ever. Let me tell you, not only did I eat less (I am 6'1" and in fairly decent shape), but I watched what I wrote down and the carbs and sometimes actually thought twice about the "snack" I was going to have and opted for something that would be better for me.
If you find the magic bullet to this I would love to myself. I struggle with my travel and keeping things under control I would love to get my A1C lower.
I'm also on Minimed pump, also couldn't do the CGM because of the harpoon needles. Anyways, what stuck out for me on your post was all your cardio workouts. Now, I might be the only T1 on the planet where heavy cardio makes my blood sugars soar. My endo told me it was the 'marathoner's syndrome' where your body ends up working on overdrive thus secreting excess glucose, and my basal not high enough to compensate, so when i did bolus, I actually ended up gaining weight from exercising! I told my trainer, and we switched my program to a strength conditioning routine, heavier weights, less reps, using the prowler, short sprints, squats, things like that and my body and sugars responded fabulously! And I enjoyed that workout much more. Sugars dropped and stayed within range. I leaned and toned up better than before. So was just thinking if that would be something you'd want to try 1-2 times a week, less cardio and more weights? who knows, may work may not, but always nice to get different suggestions.
Good luck and keep us posted if something works!
Endurance exercise raises blood sugar, Resistance exercise lowers it. I am in the gym four days a week, two on hour cardio sessions and two half hour cirucit resistance session. When I lift weights, by bg drops like a stone. My endo had me go on 50% temp basal for the weight lifting sessions and it works beautifully. However, the opposite is true for cardio. If I reduce basal during endurance exercise, my blood sugar soars. With my endo's consent, I now do a half hour of cardio, take a 26 gram carb snack and then complete the second half hour of cardio with no problems at all. I researched this online and it seems clear that endurance exercise is very likely to raise bg.
Hi Doug. I have a few suggestions that may help. This is a very admirable and difficult goal, good luck.
First, consider lowering your daily carb intake. Less carbs means less insulin and less room for error (hypos or hypers).
Second, what is your upper limit on your CGM? I started using the MM CGM about a year ago and slowly walked my upper limit down in many steps from 180 to 135 where it is currently. An upper limit of 135 can be annoying because it beeps at me quite a bit, but I think it has GREATLY improved my control. I now know when my BG is drifting high or when my PP BG spike hits and when it is larger than expected. I do not go as high and I do not spend as much time high. IMHO you are only using a CGM 1/2 as effectively unless you have an agressive upper limit.
Try to keep things the same (or similar) that affect your BG. I usually keep quite good BGs during the work schedule because I wake up at the same time, eat the same breakfast and eat the same lunch. This is boring as all get out and reminds me of the R/NPH era, but it works. There are far less variables at play.
Work hard to get your overnight basals set just right. Overnight (8 hours sleep) is 1/3 of your day (and your A1C results). Getting a pump that has helped me fight my DP has greatly helped my A1Cs.
Lastly, download and review your carelink data very often (maybe daily). If you see you are running high here or after this meal, then make a change and monitor it for 2-3 days. I would recomend that you start off with small changes of one tick up or down, because theses can have bigger impacts on your trending and BGs then you may expect. Being proactive and adjusting my basal/bolus levels frequently is another big reason I think my A1C is currently 6.0. If you have questions on how to do any of this I can provide some suggestions.
Good luck. These stradegies take some time, but if you have the drive you are very likely to succede.
Hey Capin. Great job with your A1C and really good suggestions. I appreciate it.
Here are the things I have started doing since I started this discussion:
1. lowered my daily carbs/meal to between 30-40g.
- This seems to be helping me keep my BG in a tighter range. Was doing 55-65g before. No snacks either way.
2. Changed the upper limit on my CGM from 250 to 200.
- A bit embarrassing to realize my setting was so lame! Spoke to my CDE who suggested taking it down a step at a time while avoiding the constant annoying beeps. Will work this down further over time.
3. Reduced my target BG to 100-100 24 x 7 from 110-110.
- A mom of a type 1 suggested this and it seems to help
4. Working hard to get my overnight basals right and being aggressive with correcting/waking up with good BGs
- will be spending more time on this important aspect
- starting a new round of overnite basal testing next week
5. Delaying eating meals after I bolus when BG is above target
- This backfired early this week. Started at 115BG and waited 25 min before eating breakfast.
- Ate usual 30g low glycemic breakfast (oatmeal and cottage cheese/greek yogurt) and crashed at 50 before 2 hour mark. Damn CGM told me I was 146BG with now down arrows. Took 50g carb and a lot of anxious moments to bring me back.
- Bad combo with low glycemic / high fiber food.
6. Eat same breakfast about same time every day, but mix up timing and content of lunch and dinner. Any suggestions of what you have for lunch thats doable every day?
So far, these changes have been making a difference. A long way to go, but feeling it is doable!
Trying to be smart about limiting number of changes I make so as not to put more variables in the mix.
Will do some more frequent downloads to carelink. Are there any specific reports that you believe gives you more insights than others?
May take you up on your offer for other suggestions. Thanks again.
Tons of suggestions here so I'll just throw my 2 cents in! First thing that comes to mind for me is maybe trying Apidra insulin. My daughter has Type 1 diabetes and we started on Novolog (2 years ago). It peaked similar to what you are describing. 2 to 3 hours out, with an annoying (to me) little "tail" in that 4th hour. Keep in mind she is only 5 so I know that your experience is much different as an adult. But when we switched to Apidra about a year ago...insulin became less scary and much more predictable! Ellie's A1C's have always been between 8.1 and 8.6, our last A1C was 7.8, but she just started kindergarten so she has just developed a "schedule" with school that has helped a lot with management. I describe Novolog as maple syrup and Apidra like water...meaning, when she was high after Novolog, we had to wait and wait to correct to be safe and not stack insulin. With Apidra, if there isn't some downward movement within 30 minutes after a correction, I know we are in for a stuborn high and have no problem correcting at an hour and a half without worring about insulin on board. YDMV of course! But Apidra goes in, works within 20 min and peaks at an hour and is gone no longer than 2 hours after. For us it gives us an opportunity to be a little more aggresive with those highs without the hard lows. If that makes sense? Secondly, I would definately check out Ginger Vieira's book, Your Diabetes Science Experiment. It is REALLY in depth, and I have had to read it twice already to really wrap my brain around all the information, but it will definately address some of the questions you have around working out, how foods that are "carb free" or low carb are not "free" once you meet a certian serving size, ect. It's a really cool book and not expensive at all. Good luck and give yourself some credit, I've only been a stand in pancreas for my daughter for 2 years...and all I can say is, this is the hardest, most emotionally taxing effort I have ever experienced in my life...and it's not even my body dealing with it! For those of you that have to do it for yourselves...it's gonna get old, and it's hard no doubt!
Thanks for the support. As of now, my Dr and two CDE believe Novolog is right for me. They switched me from Humalog about 1.5 years ago. That said, I will read up on Apidra. Anything to get my BG to A1C of 7 or better!
I was talking to a CDE / diabetic friend recently and she told me about Ginger's book as well. Will check that out as well. Thanks for the suggestions.
As a type 3, your job is almost as tough as ours. I recall the sleepless nights my parents had with my younger brother who became type 1 at 8 yo. Best of luck to you and yours.
By the way, assume you heard about the new Sentry product from Medtronic that allows you to monitor your daughters BGs from a different location.
When I read your thread, I thought - Wow! This sounds just like me. With one exception: the exercise part. I work out or walk 3-4 days per week and EVERYTIME I do any exercise I drop my BS. I set a temp. basal rate at 0.05 an hour before exercising and I still drop. My endo's latest suggestion is to turn the pump off all together when I am exercising. What do others do when they exercise? This is driving me nuts! BTW, we just did the basal testing and my basal rates appear to be accurate for me.
I have been told different things by different CDEs on this one.
The reason your BG is dropping, even with setting a temp basal one hour before, it that most fast acting insulin like Novolog works for 2-4 hours.
The problem with low temp basals or turning off the pump is that 2-3 hours later you have an upward spike in your BGs. I find that I then have to bolus to correct and am chasing it for several hours after that. There is a good book written by Sheri Colberg (a diabetic) called The Diabetic Athlete Handbook. It has exercise specific suggestions that other diabetic athletes follow before, during and after their workouts. About $15 on Amazon.