[viranth]

My last A1C was 5.3%, I'm very pleased with that result.

I don't really know how I got it, I just tested, tweaked my doses and everything worked great.

The basal is very important though, like everyone else says. When I was sick, with fever, for the first time since I got DX'ed, I really saw that the basal is almost everything.

My first night time low (short time ago) was my own mistakes that got me.

I guess the trick is to learn from your mistakes, eat healthy right food, keep a log of what you eat and test test test!

[art]

Beats me. I sort of cruise between 6.0 and 6.5.
If I go lower I feel like ****.
Have the baby. It's worth it.

AFS

[Eddy]

Originally Posted by Gary_W

What you say is absolutely true, but I'd add a little T1 footnote... Excercise can really severely affect the way that insulin works in a person. If you understand its effects then fine. If not, it can really cause peaks and troughs in the glucose levels that can rather spoil your day. It is, of course, vital to long term outcomes (says he sitting on his rear end yet again) so it is worth learning how to do it...

Ohhhh yeah. Just a little walking can make a huge difference. And I've tried some jumping around "one-person moshing", which I found also drops me with quickness.

Originally Posted by Gary_W

As for low GI stuff, yes I agree in principal BUT if you ONLY eat low GI then you can get the unfortunate situation that the insulin beats the food.

Pumpers can use a different bolus shape. MDIers can split boluses or use slower-acting insulins.

[Evermont]

Thanks Eddy and Gary for confirming my hypothesis. I'm starting to get just how tricky managing insulin is - hats off to all of you who manage to figure it out!

So now I understand that extra precautions are needed for a T1 who wants to do the right thing and exercise and eat well, but they should do it for the same reasons that everybody else should do it - plus helping with long term control of BG.

So it's strategic but with tactical implications.

[viranth]

Start lifting weights and interval training on bicycle and running.

On my diet and exercise I've dropped 13-14 cm (5-6 inches) around my waist, I'm stronger than ever and the sixpack is almost there.

My glucose control is very good as long as I work out, when I can't work out, for example when sick, then glucose control is much harder.

So, work out, there is absolutely no reason why you shouldn't. It'll only take you an hour or two (if you're into it), and what are you missing out on? Watching TV or playing games or being online? It's not like you haven't done it before, and you know it's going to be there when you get back.

[Gary_W]

Originally Posted by Evermont

Thanks Eddy and Gary for confirming my hypothesis. I'm starting to get just how tricky managing insulin is - hats off to all of you who manage to figure it out!

So now I understand that extra precautions are needed for a T1 who wants to do the right thing and exercise and eat well, but they should do it for the same reasons that everybody else should do it - plus helping with long term control of BG.

So it's strategic but with tactical implications.

That's about the size of it. The bell curve of insulin needs to match the bell curve of the food. If it does, you avoid spiking post meal and avoid hypo later on. Get it wrong in either direction and one or other happens. Eddy alters the shape of his insulin bell curve by mad chemistry and mixing various types of insulin. I just use Apidra and slow it down using the pump's extended bolus facility for the higher fat foods. But I'm still at the early stage of the pump learning curve and it's not as reliable as regular carbs without the extended bolus. Extending really does help me with mild excercise after eating, though, which was often a quick trip to hypo city on MDI

[LancetChick]

For me, the biggest things are testing and logging everything that affects my BG. When my A1c's were in the 6's my blood sugars were really all over the place, and my only goal was to reduce the variation and strive for stability. I started testing roughly every hour, and documenting it all, and my A1c's just "happened" to plummet..... I'm now hanging pretty steady at 4.8%.

As others have said, getting the basal rate exactly right is a key element. Also, understanding how long foods take to digest, and matching with an appropriate bolus duration is important, as well as understanding the nature of various foods and how they respond to insulin. For example, in me, a 150g carb hot fudge sundae will take 4 hours to digest, whereas a plate of baked French Fries with 1/3 bottle ketchup and the same # of carbs will take 6-7 hours to digest. Protein begins converting to glucose in me from 1 1/2 - 2 hours after eating, and this lasts up to 6 hours. I do not count carbs, unless the exact info is right there on the box, nor do I weigh anything..... I just test every hour, sometimes more often, sometimes less, and if my BG is starting to rise or fall, I nip it in the bud immediately. I find that higher carb meals match insulin action more exactly than lower carb meals, and if I dose correctly I don't ever get BG higher than the 90's.

If there is no food digesting, I'll correct a BG of 95 so that my meter averages stay in the 80's (pumps are great for that). Mind you, I do make mistakes, and get surprised by hormonal insulin resistance, which will give me high blood sugar, but I figure if I correct it quickly, then I'm a little like a non-diabetic who will have elevated BG after a carby meal, but not otherwise. Different reasons for the highs, but overall, similar results.

Having written all this out, it sounds as if diabetes is a full-time job for me, but it really isn't. Testing frequently is certainly inconvenient, but only takes a minute per test, and I eyeball foods to come up with an insulin dose rather than calculating carb content, protein content and bolus duration, which I consider too time-consuming for me. It generally takes a second to come up with an insulin dose, and if I've made a mistake (which I do), then it won't have become too apparent when I test an hour later, and I can correct before anything too out of hand occurs.

I'm still learning, and next endo visit I'm going to ask for metformin, since I find insulin management much easier the more sensitive I am to insulin, and the less my liver acts up.

[Ailsa]

What a great question Kendall

Originally Posted by Gary_W

Learn how to inject for different foods. If something that you love gives you grief at the 2 hour mark, try pre-injecting / over inject and then snack at the 2 hour point. But be safe

Gary I would be interested to know what sort of bg you are aiming for at 2 hrs?
I use novorapid which does not fit my digestive profile very well.
I find I am hitting 9-10 (160-180?) at 2 hours. but down to 4-6 (70-100) after 3 hours. if I Have more insulin I am hypo after 2 1/2 hours & have to clock watch to avoid it.
Apidra is not available where I live.

Would be interested in your thoughts on this thanks.

[pegasus]

I recently asked my endo about below-6 A1cs, and his immediate response was, "they must have a lot of 30s-40s BGs." I asked what he meant, and he said, regardless of how well controlled one is, the instant a diabetic takes in food, there's an immediate--however temporary--spike, could be 500-1000 BG. Could come down within seconds, but it's there each time nonetheless. So one would need 30s-40s to average out to a <6; which, he says, the brain/body can adjust to, but isn't necessarily ideal. So, he says, the generally recommended diabetic A1c would be ~6.5, to avoid those extreme lows.

Thoughts?

[Scratch]

Originally Posted by pegasus

I recently asked my endo about below-6 A1cs, and his immediate response was, "they must have a lot of 30s-40s BGs." I asked what he meant, and he said, regardless of how well controlled one is, the instant a diabetic takes in food, there's an immediate--however temporary--spike, could be 500-1000 BG. Could come down within seconds, but it's there each time nonetheless. So one would need 30s-40s to average out to a <6; which, he says, the brain/body can adjust to, but isn't necessarily ideal. So, he says, the generally recommended diabetic A1c would be ~6.5, to avoid those extreme lows.

Thoughts?

Get a new endo? He doesn't seem to have that all good a grasp of mathematics and digestion rates which I would find very troubling for someone of his specialty.

He's right that we would all do well to avoid extreme lows but either he is misinformed some, or he's misinforming you some, and that's troubling, IMO.

[xMenace]

Originally Posted by pegasus

Thoughts?

Your endo is full of ****!

[Lloyd]

I limit my carbs to 80 g per day
I test 6-8 times
I use an insulin pump

[LancetChick]

Originally Posted by pegasus

I recently asked my endo about below-6 A1cs, and his immediate response was, "they must have a lot of 30s-40s BGs." I asked what he meant, and he said, regardless of how well controlled one is, the instant a diabetic takes in food, there's an immediate--however temporary--spike, could be 500-1000 BG. Could come down within seconds, but it's there each time nonetheless. So one would need 30s-40s to average out to a <6; which, he says, the brain/body can adjust to, but isn't necessarily ideal. So, he says, the generally recommended diabetic A1c would be ~6.5, to avoid those extreme lows.

Thoughts?

TOTAL BS! That's the kind of thinking that prevailed when I was first diagnosed over 20 years ago. It's funny being a type 1 diabetic, because we are in a position where, at least the more veteran of us, know more than the doctors about insulin management, and we are able to see how these doctors treat this disease. I have seen and heard ignorance beyond belief spewing from the mouths of "professionals"..... to the point where the advice they give is downright dangerous. I use my docs for prescriptions and lab tests and THAT'S IT.

[xMenace]

Originally Posted by LancetChick

TOTAL BS! That's the kind of thinking that prevailed when I was first diagnosed over 20 years ago. It's funny being a type 1 diabetic, because we are in a position where, at least the more veteran of us, know more than the doctors about insulin management, and we are able to see how these doctors treat this disease. I have seen and heard ignorance beyond belief spewing from the mouths of "professionals"..... to the point where the advice they give is downright dangerous. I use my docs for prescriptions and lab tests and THAT'S IT.

.

[Scratch]

I just ate a rice cake and my blood sugar spiked up over 500 mg/dl!