A1c results are in...

[Eddy]

I've cut back on testing frequency, from about 15x/day to about 9x/day.

Mid-February was rough, with a week of 200 mg/dL excursions; Lantus and I just weren't getting along so well.

My most-recent 30 day moving average is about 100 -- which is 5 to 10 points higher than I'd like. (In all fairness, my January 30-day was in the mid- to high-80s IIRC.)

I thought my A1c would come back in the 5.5% to 5.7% range; higher would have been upsetting... particularly after my bad control earlier this week.

Nope. 5.2% :biggrin: This is a definite morale boost, and comes at a time when I don't mind getting one. I'm not going to play fast and loose, but I can relax a bit more about my numbers.

Now, then... I'm enjoying the greater consistency (fewer hypos!) that Levemir is giving me... so I shall have to see how the next few months pan out.

[art]

Relax!!!
Those are great numbers.
My A1C is usually around 6.0 and I almost never test below 100 and I've got the "Dawn" thing going on.
Live your life and don't let "our thing" control your life.

Art

[shiftzor]

Thats a very good A1c, i can only dream of that. 15x a day is an awful lot :D but worth it if you can get an A1c that low. Don't let the D rule your life too much. ;)

[davef]

Congratulations on a great A1c result!

[Eddy]

15x a day is an awful lot :D


Down to 8-9 now. I hope to get to consistent 6x.


Don't let the D rule your life too much. ;)


There is truth to this. I'm 26 days shy of my one-year DXiversary. This year has been one of extensive learning, research, and testing. I just have to know what I can do, what it takes to do so, and what I can expect.

That said, it'll be nice to redirect some energy into bigger, more-important challenges. :)

(Although I'm still strongly interested in diluting, and opposed to pumping, for those who have followed my other threads. ;))

[princesslinda]

Good job Eddy! You should be proud! Seems you've done very well in your first year of dealing with "the D."
:thumbsup:

[notme]

Great job Eddy. Do you have a lot of lows? I have often wondered how a type one can get such a great A1C without lows. I worked very hard and could only get my A1C down to about 6.3. I can't imagine a 5.2%.

Congratulations on a job well done.

[Eddy]

Do you have a lot of lows?


For a while, I'd hit 60 or so on a daily basis. This annoyed me... but not as much as hitting 120.

The reason I started mixing R and N (June and July 2007, respectively) into my rapid was because straight Humalog was just too brutal. I'd inevitably crash into the 40s, even the 30s, an hour after injecting. It was tearing me up, so I began dabbling with slower-acting mixes.

Although it's probably premature to say _too_ much about Levemir versus Lantus (transition completed only a couple weeks ago), here are my observations so far of Levemir:


fewer lows
lows not as low
no more 30-50 mg/dL drop every evening after basal
better waking/fasting consistency
highs don't feel as bad
more energy.


Recent readings, going back in time (all times in GMT):

04/03 1605 = 86
04/03 1241 = 80
04/03 0735 = 79
04/03 0459 = 120
04/03 0149 = 90
04/03 0003 = 84
04/03 2012 = 67
04/02 1801 = 111
04/02 1644 = 177 (stressed)
04/02 1252 = 139 (stressed)
04/02 0352 = 88
04/02 0206 = 118
04/01 2244 = 198 (very angry)
04/01 1833 = 136 (no excuse that i can recall)
04/01 1226 = 95
04/01 0345 = 68
04/01 0052 = 203 (toward the end of a very bad Monday that included coffee and anger)

My 7-day moving average is 115... which I believe is the highest I've had since about the first month post-DX.


I have often wondered how a type one can get such a great A1C without lows. I worked very hard and could only get my A1C down to about 6.3. I can't imagine a 5.2%.


I don't know. I inquired about a c-peptide test, to see if maybe I should establish a baseline for residual beta cell function. The doctor questioned the need. (I'll have to get back and debate.)

My basal seems to be 31U, regardless of whether I'm 70 kg or 84 kg.


Congratulations on a job well done.


Thanks. :)

The reason I initially joined here was to see what others "typically" (if such a word dare be used) applies. I have no idea how much of a daily high/low spread I "should" expect. I don't know how often people go hypo.

[notme]

I wish I had your ability to keep such a great log. I am not as organized as many on this site. I have started in the past few days, trying to keep better records and will get an A1C done the second week in May. Eeeesh.

I go hypo at least four times a week.

[Pote05]

Great Job, Hope I can get there next time....

[Eddy]

A quick note about lows:

Part of their siren song is that they're more quickly corrected than highs.

Re what might be coming into play for A1c values:

After a 200 Monday (I do not do well with sleep deprivation and coffee), I shot a 3U aspart correction. Normally, aspart finishes in 1:15 to 1:30. However, as BlueSky has often indicated, something about hyperglycemia affects insulin activity; 1:20 after my correction, I was only down to 180.

When I'm high, I tend to stay high or go higher.

When I'm low, I tend to stay low or go lower.

I find it easier to keep control than to regain it.

I do my darnedest to have good overnight numbers. Not only does it make a huge difference in sleep quality, but there's 1/3 of the A1c value right there. I'm fortunate not to have DP or other temporal basal variations.

I test obsessively with frequently-eaten foods, trying to determine the correct rapid/R/N mix for each.

I try to be more observant of food allergies. As much as I enjoy mushrooms, excursions to 200 mg/dL just aren't worth it.

Except for rare occasions, I've quit the caffeine. It's too hard on my system, causing my BG to rise by as much as 50 mg/dL per hour.

For several years, my hands turned leather steering wheels black. I now am keen to shower soon after getting much above 140, because my sweat is gross... even corrosive.

[Eddy]

I wish I had your ability to keep such a great log. I am not as organized as many on this site. I have started in the past few days, trying to keep better records and will get an A1C done the second week in May. Eeeesh.


Great log? Sorry to have mislead you. I just flipped through most-recent meter numbers. That's the first time I've done so. It doesn't interface with the computer... I generally fly by the seat of my pants, remembering "recent enough to be of concern" food and boluses.

I tried to start keeping detailed logs, but it was too time-consuming. What you might do instead is to experiment with individual foods, seeing how your body reacts to specific items. I think of foods in terms of "a little more rapid next time", "not so much R", "better start eating ten minutes later", et cetera.

I'm now quite familiar with favorites: bananas, dates, Kashi cookies, pancakes, potato-based soups, raisins, rice (brown and wild), spaghetti.

Of course, I believe part of my high Monday afternoon readings were due to seriously-underestimated potato consumption at lunch... so "falling out of the habit" of certain foods carries a price.


I go hypo at least four times a week.


I was daily, with a sub-50 or two each week. Fortunately, my lows now are about 10 mg/dL higher since changing basals.

IIRC: The first six weeks of the year, I only had one >200 reading, and four sub-40s. Not long after, things got uglier...

[Dimes]

Nice job Eddy, that is a sweet (as in good;)) number, and very consistent numbers overall since diagnosis.

[Scrabblechick]

Good going on the A1C! Glad to hear the good results.

[Kim_in_TN]

Congratulations! A 5.2 is fabulous!!! Keep up the good work! :)

[Jan B]

Eddy,

My goodness -- EXCELLENTO!!! You can lighten up a little if you feel you should . . . just not too much! Great work.

[SGT Shoutmore]

Eddie, good on ya!

[BlueSky]

Congratulations on that fantastic result. Whatever you are doing seems to be working really well :o
... I find it easier to keep control than to regain it. ...
This really is the crux of the control issue. The irony is that it is easier to stay in a narrow target range than it is to stay in a big one. :)

[Eddy]

Congratulations on that fantastic result.


Thanks. Thanks, everyone.


Whatever you are doing seems to be working really well :o


Heh. That's what the doctor said.

Quick anecdote about switching to Levemir: The doctor's office had never heard of it. After looking it up, and listening to my case for it, he wrote the prescription.

"It says 'use as directed'. My directions to you are: Do it safely." Heh. :)


This really is the crux of the control issue. The irony is that it is easier to stay in a narrow target range than it is to stay in a big one. :)


You know, I'd never really thought of it that way... but it _is_ easier to stay in a narrow range than a wide one. Interesting angle.

This observation leads me to believe that glycemic control must have some sort of positive feedback mechanism... which really doesn't make sense to me:

Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?

Of course, perhaps those mechanisms posed some sort of survival advantage in "normal" people. *shrug*

Any ideas?

[BlueSky]

.... Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?....
In the absence of a fully functional counter regulatory system, the body needs to be fed the right amount of glucose. Not too much (high BG) and not too little (low BG). If you don't provide enough glucose, insulin sensitivity increases as cells compete for the limited supply. This drives BG down. If you supply too much glucose, BG goes up and cells block the entry of this surplus glucose by shutting down insulin receptors. The increased insulin resistance drives blood glucose even higher.

So the secret of good control is to ensure that your cells have access to the right amount of glucose at all time. That is my take on it, anyway ;)

[shiftzor]

...
You know, I'd never really thought of it that way... but it _is_ easier to stay in a narrow range than a wide one. Interesting angle.

This observation leads me to believe that glycemic control must have some sort of positive feedback mechanism... which really doesn't make sense to me:

Why would the body tend to drop BG when it's already low? Or to raise it when it's already high?

Of course, perhaps those mechanisms posed some sort of survival advantage in "normal" people. *shrug*

Any ideas?

I would guess that it’s more to do with covering the carbs, i.e more carbs you eat the more insulin and the more mistakes you can make. The body doesn’t have much control over it other than a liver dump. The only other thing could be that the body is use to dealing with these bg ranges and somehow regulates carb intake better, I really don’t know. As to why the body works the way it does unlike those lizards (can’t remember their name) which use insulin that stops working below a certain bg level ;), I have no idea.

BlueSky has a better answer :D

[Eddy]

If you don't provide enough glucose, insulin sensitivity increases as cells compete for the limited supply. This drives BG down. If you supply too much glucose, BG goes up and cells block the entry of this surplus glucose by shutting down insulin receptors. The increased insulin resistance drives blood glucose even higher.


Ahhhh.... it makes perfect sense. My flaw was thinking from a macro BG perspective, instead of an "each individual cell getting [only] what it needs" standpoint.

D'oh.

Thanks. :)

[Gary_W]

Eddy - Well done on your fantastic numbers. You do it in a very weird way compared to most folks and your body obviously loves you for it :)

Do go careful with those super-low numbers; having regular sub-50 hypos may well mean that you won't feel 'em in time to help yourself. I certainly go lower than I used to before the old brain warns me about it, but (provided I'm not excersising) I still get ample warning.

You're right about the 'sleep is a 1/3rd of your A1c number'. I'm sure mine is going to suffer a bit in the short term as going to bed high to avoid Lantus drop has become a way of life for me at the moment. Roll on pump-day...

BlueSky - nice description of the insulin sensitivity thing. I know with correction shots, they work according to the book provided I'm below 10 (180 US). If I go North of there, the rule book gets torn up and thrown out of the window :(

Gary

[Eddy]

Do go careful with those super-low numbers; having regular sub-50 hypos may well mean that you won't feel 'em in time to help yourself.


*nod*

Plus I'm unsure of the ipso facto wisdom of regular sub-50 excursions. I correct below 70-80, and _really_ prefer to stay above 60. I'm definitely glad I switched basals.

Frequency definitely affects sensitivity. The first time I went below 50 (46), I was sweating like crazy and thought I'd pass out. How long ago that seems...

[owlyn]

That's a great result. I am very envious. I just got my latest A1C back, and I was excited to have it come in at 7.0, the lowest I've ever had (was 7.9 back in August). The doctor keeps telling me that it is rare for a T1 to come in under 7.0, so I should be pleased, but I keep seeing T1s here with results <6, so I am still bummed :( though not as much as in August.

BTW, I suspected it would be lower than in August, as I have had a significant increase in hypos.

[xMenace]

I'm 26 days shy of my one-year DXiversary.

LADA?

I suspect a honeymoon is helping with your control. A 5.2% A1C is just sick! :puke:

[Eddy]

LADA?


In retrospect, I'd had the three polys for... uhhh... quite a while. Like, on the order of five+ years. I'd not been to a doctor in forever, so I'm unsure just when the onset was.


I suspect a honeymoon is helping with your control. A 5.2% A1C is just sick! :puke:


I honestly don't know. I { proposed to my doctor } + { asked for a price on } a c-peptide test... have others found said test useful in evaluating residual beta cell function? About how much does that "typically" run?

My basal seems to be 31U/day, regardless of whether I'm 76kg or 84kg. For the heavier mass, that's 0.37U/kg daily, which I guess could well indicate residual beta cell function. The hospital originally started me at 0.50U/kg daily basal, but I soon ended up feeding the Lantus too much. (Basal needs may have been higher, as my elevated WBC at DX indicated I was fighting something.)

Carb coverage ratio is 1U:15g.

What's particularly unusual -- and I don't mind in the least -- is how quickly I respond to the insulins. Rapid response helps keep postprandials down, which I believe has a notable effect.

I'm also fortunate to have a smooth basal. Honeymoon? Just lucky? I don't know. Now that I'm using Levemir, my overnight very consistent, too... so I try to dial in a low-90s at bedtime to awaken with 85 or so. Having several hours around 90 probably helps, too.

How did I arrive at those start/stop numbers? Empirically, based on what makes me most energetic and feel the best. I do not feel good after sleeping above 100 mg/dL.

Anyone who's had the c-peptide test care to chime in? Perhaps I should fork the thread...