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
I have a similar problem with moderate intensity exercise. The only thing I have worked out with it is to bolus less fore a meal before exercising and/or eat a snack on my way to the gym (granola bar usually). This way I avoid post-exercise highs and mid exercise lows.
I have these unexplained highs 3-6 hours after I eat if I eat something like chicken wings. I think it's the fat in them that causes this. I eat very low carb and loosely follow Dr. Bernsteins diabetes solution. however, being a woman in my 40's I find that hormones play a HUGE roll in night time highs. not sure how that works for men....but it may be something to look into. at night sometimes, I'll wake up to my high alarm going off. I haven't eaten in many hours so the only explanation is hormones. arghhh. frustrating as I try to do everything right like you!! this is what is working for me, I set my high alarm at 110 now....anything over 110 gets a bolus. my last A1C was 5.6 so it's working for me. perhaps set tighter perameters on your pump like i did? I also bolus for TAG (total available glucose), so many are taught to just bolus based on carbs, this does not work for me. even fat and proteins turn to glucose in your body eventually,just at a smaller rate. so it only makes sense to bolus for all of it. this has made a huge difference for me and is keeping my A1C at 5.6 so I'm happy with this protocol. I hope this helps. this disease is very frustrating, and I feel your pain. I just also want to mention that I workout regularly also and find that exercise skews things as well. when I lift weights (my passion) my BG levels sky rocket, but cardio brings them back down...so now I lift first and finish with cardio to bring my levels back down.
I almost always do a dual wave bolus. I give , for example, 2 units immediately to cover the carbs and another 2 units over a duration of 1.5 to 2 hours to cover the later proteins/fats. it's not always perfect, my ratio is 1 unit per 8 gr. of carbs, and then I take the ounces of protein and figure up an approx amount of insulin to give for that. everyone is different. I find I require more insulin than a lot of people. some take 1 unit per every 15 grams of carbs, and I take one unit per every 8 grams. you just have to find what works for you!! I NEVER allow my glucose to go above 140...EVER!!! I'm a bit OCD , ha ha....and get frantic when I see it rising!! that's why my high alarm is set at 110 and my low at 65, I really try to keep it within those parameters. My A1C at diagnosis was 14.9 (nearly dead)....so I've come a long way and found Dr. Bernsteins books very helpful. I dont follow his plan to a T, as I found I was getting highs due to all the protein hours later....so I've found what seems to work for me which is lots of lower carb plant based foods and some lean proteins. I never eat anything that contains flour or sugar....so I eat no bread at all...but that's ok....I don't need it!! :)
If you are having trouble with protein it could help for you to try TAG. Protein eventually turns into sugar
it just happens hours after a standard bolus has ran it's coarse. Protein converts to glucose at a rate of
about 2.5 to 1 (40%) 10g of protein = 4g of sugar...YMMV This is a well known fact but when food
exchanges and carb counting started to be the preferred way to calculate a dose of bolus insulin our diets where 50+ percent carbs and only about 20 percent protein. The medical profession decided we would only be off 20% if we did not include protein in our bolus calculations. This was good enough for insulin therapy in those days.
When you bolus using the TAG method you are doing a bolus for the Total Available Glucose in your meal. I think there is a TAG group on TU, I have not been active on the forum for about a year. When I tried to go low carb it did not work and my BG was unpredictable and all of the protein and fat just put my BG on a long slow boil... As soon as I started TAG my A1c started dropping and my bolus calculations where more predictable.
Someone in the TAG group posted a good bolus calculator if you cannot find it email me and I will send
you a copy of the Excel file I have used in the past.
Years ago I asked a Doctor what can I eat and he looked at me smiled and said if it tastes good spit it out!
Thank you Doug for starting this thread. I started doing square/ dual bolus after each feeding and I find it helps a lot for me too.
Hey Doug, How is it going? I just had my first A1C under 8 since I was a kid: 7.7! I know I still want it to be better but it feels like I broke an invisible wall. Hopefully I can keep the trend going.
How I did it so far: Still no Dexcom (fighting the insurance fight), but I did do extensive basal checking. I basically spent a few weeks skipping meals every time my BG was below 250 and found my basal was way too aggressive in the afternoon. I have been trying to cut down on carbs per suggestions here and also to write more things down.
Thanks everyone for the suggestions so far! Keep 'em coming.