[viranth]

Originally Posted by Scratch

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

Why would you do that? Rice cake is very high GI ...

[Lloyd]

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?

My only 40's were when I had a A1c in the 7's and was on glypizide.

I've been in the 50's twice in 15 months on a pump, with an A1c of 4.9 for the last 8 months.

The doctor has no clue.

-Lloyd

[Evermont]

Originally Posted by pegasus

...his immediate response was, "they must have a lot of 30s-40s BGs."...Thoughts?

My most recent A1c was 5.7. I've never been under 86 and never over 220 in almost a year of testing 5-7 times per day. I don't understand your guy at all.

[Scratch]

Originally Posted by viranth

Why would you do that? Rice cake is very high GI ...

I was just joking.

The rice cake itself is 11g of carbs, I was 73 mg/dl and had about 1u of bolus insulin remaining. Works for me.

But according to that one endo, I momentarily saw a high spike of blood sugar.

Last time I saw a blood sugar up over 300 mg/dl was the time I forgot to bolus for lunch a few months ago. And I had probably eaten up around 90g of carbs.

[Real4]

Originally Posted by Kendall

Anyway, my question is...what are your secrets to getting your A1cs so low? I know that there are no magic bullets or miracle systems. It will always be hard work, but what are the practical things you do to stay in such tight control? I'm sure some of you do things I would never think of on my own. So please share the wealth with the rest of us.

One think that works. test often, correct often. I correct with as little as 1/2 a unit of insulin.

[xMenace]

Originally Posted by Evermont

My most recent A1c was 5.7. I've never been under 86 and never over 220 in almost a year of testing 5-7 times per day. I don't understand your guy at all.

You're not injecting insulin either. Non-IDDs have more of an intensity problem, not a timing one. It's much tougher for us to synch the insulin troughs with the sugar humps.

[Gary_W]

Originally Posted by Ailsa

What a great question Kendall



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.

Hello Ailsa,

I try to be <7.5 at the two hour point and if I'm eating at home and therefore able to weigh out the portions then I achieve this pretty consistantly. This works for MOST foods, and means that I'll be down at a 5.5 by hour 3 and then stay somewhere between 4 and 5.5 until I eat again.

If I am higher at the 2 hour point, I'll put the number into my pump and go with its suggestion UNLESS I know that the meal I ate was correctly counted but evil in terms of GI. If that's the case, the high is deserved and will come down by itself. I'll just leave it and test at hour 3.

If I am down at a 5 or so at the 2 hour point, I'll think carefully about what I ate. If it was all low GI / high fat etc then again I'll leave well alone. If I feel that I'm down there because I messed up the carb counting then I may eat or drink a little something (small amount of juice, some apple etc) to stave off the inevitable hypo at hour 3...

It seems to work well. Apidra helps; it is about 65-70% gone after 2 hours so it's excellent at dealing with that post-meal spike. The other thing that has helped with spikes is the super bolus on the pump. I super bolus every single morning. For those not in the know, you 'steal' some of your basal and give it up front at the same time as a food bolus. My morning basal varies a touch, but between 7.30 and 10.30 am I have a grand total of 1.65u of basal insulin trickling in. If I get up and eat 40g of carbs, I need 4u of insulin. I actually inject 4 + 1.65 = 5.65u of insulin, then I set a temporary basal rate of 0 for 3 hours. In this way, my post-breakfast spike will be minimised and I won't go hypo later on. Museli, cereals and toast are all do-able with a 2 hour BG of 7-8, which is pretty good as far as I'm concerned. Especially as I have a gradual drift down to a 5 and it stays there. Lunch time for me is anywhere between 11.30 and 3pm, so it needs to

And Pegasus - that is a typical outdated comment. Yes, you can lower your A1c with persistant hypos. But to suggest that this is always the case is just not true. It is the spike duration that does you in, and IMO if you can get the spike to be reasonable at hour 2 without going hypo at hour 3 or 4 then your job is well done. This is achievable by dietary choice, correct insulin use and many other ways of which regular hypos is the least desirable I have around 1 mild hypo per week these days. At some points with MDI I was up to 3 per day. I still had a great A1c but that was the bad way of doing it. Not intentional I hasten to add....

Gary

[Gary_W]

Originally Posted by Real4

One think that works. test often, correct often. I correct with as little as 1/2 a unit of insulin.

You've got to love the pump. I did a correction shot of 0.05u of insulin earlier because the pump suggested it.

Did it make a blind bit of difference? No. But it felt cool in a weird kind of way. Yes, I do need to get out more.

Gary

[birdyland]

I'm T2, but on insulin....

I test test test and test again... and I LOG everything via spreadsheet.

Good luck TTC, I sent you a PM ;-}

[Kendall]

Apparently I started a little bonfire of activity on this one. I seem to understand the importance of getting the basal correct first. I think I have that pretty well set. A few more minor tweaks maybe but I'm so sick of fasting I'm taking a break for a day or two. From what I've heard, I think carb ratios are next along with correction factors.

I think the post meal spike is where I keep getting stuck. I have a very difficult time keeping my post meal BGs from going over 150. Sometimes I skyrocket up to the mid 200s and stay there. I pre-bolus by about 15-20 min, more if I start out high. I don't seem to be going low at 3-4 hours usually. Does that mean my carb ratio is off? I seem to need a correction almost every meal.

Do I just change my I:C ratio and see what happens? Or is there a more scientific way of testing it? Thank you all for your input.

[pegasus]

Originally Posted by Kendall

Apparently I started a little bonfire of activity on this one.

Me too!

I clearly have a bunch to learn about this. In a minidefense of my doc (you should hear him go on about the corrupt drug industry, and how bad so much science is because of control by industry, etc.--sentiments I think would get support here ). I think his comment was meant a bit hyperbolicly--not that people w/low A1cs are constantly getting 30s and 40s, but that all Ds have even nanoseconds worth of extreme highs when food hits our systems because we simply don't have the same ongoing and automatic physical functions as non-Ds, and so there must be similarly momentary lows to balance.

But as I say, I have a lot to learn.

[shiftzor]

Guys just remember it’s easier to stay in a small bg range than it is to stay in a wide range. Concentrate on lowering your Standard Deviation which will help your A1c. Typically you should be under 10mmol/L or 180mg/dl after a meal but I would aim for the same bg as you started with ideally. The key to all of this is to not stop learning and to keep testing. We should make a sticky with all of this useful information so many people ask.

Diabetes Monitor - standard deviation buzz

[cheryl]

I have learned a few things along the way, and am still learning i am nowhere near five a1c, but keeping only basal testing is effective if it's your same set routine daily....

I have a very very off schedule, I get stressed, I went from loosing massive amount of weight to finally not....

One thing, never test basals if your are around your monthly HORMONES do throw it off a bit....Test a week after you get your monthly this gives us girls less time to get it so.....

I was all gung ho to retest here after I got a root canal that was making my sugars wacky, Had to wait for the monthly then my job did something awful to me, took me off the schedule, I am working different hours different time frames don't know WHAT to do, was high from stress last week, got resolved at work, but working 12-8 one day, 9-5 the next, cannot basal test on these days. I decided for now to do it on days off, and if I am willing when it's over night....

I tell you, I had everything set back in from DEC-March, poop hit the fan and I have not been level since....I don't know when it will all settle, but now, since this last stressful event and actually seeing a 308 because of it, never do I ever hit that high, unless set faliure...that I am done, I am not stressing, so now, I am dropping again...

STAY AWAY FROM STRESS, that is the key to finding your true rate....and do the testing on your normal avg routine days, never on a different day...

Cheryl

[LancetChick]

Originally Posted by shiftzor

Guys just remember it’s easier to stay in a small bg range than it is to stay in a wide range. Concentrate on lowering your Standard Deviation which will help your A1c. Typically you should be under 10mmol/L or 180mg/dl after a meal but I would aim for the same bg as you started with ideally. The key to all of this is to not stop learning and to keep testing. We should make a sticky with all of this useful information so many people ask.

Diabetes Monitor - standard deviation buzz

That's exactly it. As I said earlier, my only goal in testing every hour and logging the results was to narrow my standard deviation, and having my A1c drop over an entire percentage point was merely icing on the cake. Narrowing the deviation is healthier, too..... developing 3 complications with A1c's in the low 6's seems rather unusual, but it wasn't my average blood sugar that caused the complications, it was the fluctuations. Wide fluctuations = Damage, no matter what your A1c is.

[Lizzie G]

Originally Posted by Evermont

Forgive my T2-ishness... but wouldn't some exercise and focus on nutrient dense low GI carbs (even if low carbing) also be helpful for a T1?

yes its enormously helpful, but not majorly in reduing your A1C directly...for that you need to get correct basal, CHO ratios, and time your shots depending on what you are eating. doing a lot of exercise also causes the CHO ratio to vary a lot more so you have to be extra aware at all times!

low GI has pros and cons to be honest. i find that rapid acting insulins are only ideal for certain things and anything that sticks around a long time involves splitting shots quite a bit, if i take novorapid with wholewheat pasta for example, and dont split, i tend to go a bit low an hour after food and then keep rising for along long time (maybe 4 to 6 hours) so of course if its the evening it is difficult to go to bed not knowing whether or not you will end up in the right place, and as someone else mentioned nighttime is the crucial time to maintain a steadt 5 to 6 as the backbone of good control! having said that low GI stuff is excellent a couple of hours before exercise with minute amounts of insulin and reduces the need for glucose tabs during your workout. i also adore lentils beans pulses etc and prefer the tastes to white rice and flour and so on.

anyhow, i must go and do some work (groan)....good luck in your A1C quest. my last was 6.6, i hadnt been putting too much effort in, my goal for next time is below 6. we will see. i think it can be done without having to be too limited or obsessive...maybe!!!