How come BG goes up in the morning??!------REDUX

[rzrbks]

As per requested at the Diabetes Fair this weekend, I cornered 2 CDEs, diabetes nurse and Dr. about Dawn Phenomenon.

General concensus was that the only true way to effecaciously deal with Dawn Phenomenon is go on The Pump.

NPH is less stable than Lantus, (their group opinion) but while on a 12 or 24 hour basal injection there really wasn't much that could be done to deal with Dawn Phenomenon.

((So, evee, the info I posted about changing basal Really Does apply to Pumpers))

CDE wanted eevee to come to the clinic I go to and be put on monitoring device for three days to check and see exactly what was going on----I pointed out that it would be difficult for eevee to come all the way to Topeka, Kansas, USA from New Zealand and CDE agreed that it MIGHT present difficulties. LOL


:topic:

Was gently prodded by all four that it was time for me to go onto Pump----I smiled and told them "No, Thank You." and pointed out that worst A1c, so far, was 5.7

My CDE laughed and told the others about how she's been trying to get me on a pump since her first day of working with me. Then she said, and I quote:

"What can you do with the Perfect Diabetes Patient?"

Geez, it felt really nice being something besides a "Perfect *^%$#$%#* " as some people have refered to me.

[eevee]

I'd love to go on the machine, but you are right re the travel bit...nobody offered to organise payment for the trip...???
I'd watch out for your CDE..maybe she has an ulterior motive....

Cheers......Eve

[mg_2204]

... there is something I don't understand Rz and pardon my ignorance...

I was under the impression the pump was for patients who --for a number of reasons-- couldn't cope anymore with injections and had either too many highs or lows. If your worst A1C was 5.7, in my mind, you don't need the pump. So why would your CDE want to put you on the pump if you don't need it??! Or perhaps I haven't got my facts right. Who can be on the pump?

Very envious of your worst A1C by the way :) :) :)

Marie
:)

[eevee]

Most people do go on the pump to get better control, Marie, but not just in the circumstances you describe. It can be a matter of convenience, and, once understood/'mastered', it can bring peace of mind not achieveable with MDI. As well, a new injection/infusion site every few days means many less needle holes.
It is becoming a more common practice to put children on them with the view to lessening their long-term complications.
If your worst A1C was 5.7, in my mind, you don't need the pump
Do you mean that one shouldn't strive to have an even better HbA1c..?

.........Eve

[SunniD]

I know to those of us who are 'perfect' like Rzrbks <smile>with A1C's of 5.7 and not experiencing many lows a pump may not be warranted but many others with that A1C would be experiencing many lows that would warrant a pump. That is a reason to go on the pump to eliminate the lows as they are life threatening.
I learned this from talking to the MiniMed rep. They can pretty well find reasons no matter what your control is like to warrant
a pump if you desire to have one.

SunniD

[Shalyndria]

Originally posted by mg_2204
[BI was under the impression the pump was for patients who --for a number of reasons-- couldn't cope anymore with injections and had either too many highs or lows. If your worst A1C was 5.7, in my mind, you don't need the pump. So why would your CDE want to put you on the pump if you don't need it??! Or perhaps I haven't got my facts right. Who can be on the pump?[/B]
Heck I just wanted one! :D Had great A1c's on MDI's for 12 years (only one above 8% in all that time, and that when I was a rebelling teenager, with the exception of initial Dx of course) but the flexibility of lifestyle appealed to me. Didn't have too many highs, had the extremely rare low. It's the insurance companies, in my view, that impose criteria on the pump. My physician had to say I had Dawn Phenomenon (I showed slight signs of it) in a letter to my insurance co. that was inaptly named "medical necessity". He knew I wanted it, and I was gonna get it no matter what. Like any Diabetic doesn't have a medical necessity.

I do know that the pump companies generally recommend it for anyone taking more than 4 shots a day.

Shy

[mg_2204]

Hello Eve!

I think I'm still a bit confused about all those numbers... For me, anything below 6 is wonderful, a level a non diabetic has no problem maintaining for example. By the way, is there such a thing as a too low A1C? To tell you the truth, I'd be worried if I was told my A1C was under 5. I tend to associate anything below 5 with hypos... and that's enough to freak me out. Perhaps a misconception? I think I'll never stop learning about diabetes... and I must admit that sometimes I feel overwhelmed by all I need to learn still.

SunniD, Shy : That's right! A pump means less shots. For that reason alone, it's enough to go on the pump. Didn't realise this. Come to think of it, I've never seen a pump!

You must all forgive my obvious lack of knowledge in that matter. I just hope I haven't offended anyone.

Marie
:)

[eevee]

I'd be worried if I was told my A1C was under 5.
You'd have every reason to be worried too Marie. If you HbA1c was below 5%, it would mean your daily average would be about 74(4.2). IMHO that means lots of tests below 4.0/72 and that would be really scarey.

Cheers......Eve

[mike9876]

Non diabetics have a normal a1c range between 4 and 6.

[rzrbks]

mg_2204
Hello Eve!

I think I'm still a bit confused about all those numbers...

Marie,

To maintain A1Cs below 6, many people, me included, have to hit quite a few lows, below 80/4.5

--reasearch is showing that diabetics who continually go below 80/4.5 can, That's, CAN or MIGHT be causing Brain Damage

one of the things that does appeal to me about pumping, is that--generally speaking--one has better, more stable control with many fewer lows while Pumping

as stated many times before, however, the idea of being hooked-up 24/7/365 doesn't appeal to me, coupled with the fact that 95% of the time, injecting with 31 gauge 1/4 in needle doesn't hurt

Lastly, it's psychological---I can, to a certain extent, forget I have diabetes while I'm using MDI--just set the stuff where it will be out of sight. If I were on a pump, I couldn't fool myself EVER.

I believe, my shrink agrees, being able to "Put Away", for short periods of time, the fact that I'm diabetic helps me deal with all the rest of the time when it must be in the forefront of Life.

It's the game I must play to keep my sanity.

[KLD]

For me, anything below 6 is wonderful, a level a non diabetic has no problem maintaining for example.
In my opinion, you're right about this, Marie. Of course, it depends on how you attain the A1C result. If it is the result of a stable, non-diabetic's bg range, then a 5.0 is an excellent A1C. The trouble with using an A1C result as a guide to how we're doing with our control is that a "good" A1C, such as a 5.0, can also be the result of an average of lows and highs. An A1C of 5.0 has to be considered together with our daily bg readings before we can know whether it's good or bad in our particular case.

The information sheet that comes with my One Touch Ultra strips shows that a normal fasting bg range for a non-diabetic person is 3.9 - 5.8 (70 - 105) so I don't believe that 4.5 is dangerous. That's not to say that it's not a good result - it's excellent - and I'm sure that for a person whose results fluctuate a lot, it's a good idea not to go below that in order to allow a safety net. My only point is that I don't believe 3.9 or 4.0 is dangerous provided that that is the lowest you go.

Karen