[soso]

For me an approach that includes exercise (but not excessive or life interrupting) careful attention to my food choices and insulin use (i.e. lots of testing with new foods) and being prepared to tweak as I go (things never stay the same week in week out)

I get very few high spikes(that I know of..haha) and not many lows (the odd mid 3 and the very occasional mid 2)

I put this down somewhat to eating a lot of fibrous veggies and not much at all in the way of processed or packaged foods. I eat 70% chocolate every day though and once in a while have a carb fest and bolus for it with reasonable success..
IMO it just takes time to work out how your body works..BUT, I think reading the forums and threads like this just give so much info that you do start to absorb and learn and work it into your own situation and that leads to a lot of success.

[orpy]

I recently went from 7.2 to 6.0 and it's because of lantus and humalog...I do eat low carb but always did. I struggled for three years feeling like a failure because no matter what I did, exercise, low carb, oral meds, I could not get my A1C down; in fact it just kept creeping up. I tell newly diagnosed diabetics to not waste too much time; get insulin sooner than later if you are low-carbing and seeing no results.

Along with Bernstein's book, be sure to read Jenny Ruhl's book, recently published.

[metamarty]

I'm constantly around 5.0%, with latest around 4.8%

I don't do low carbing. I've found that good control can be achieved by using two primary rules:

- Don't count carbs. Count glycemic load instead.
- Match action profile of insulin to action of glucose.

I feed all ingredients I use into a program I wrote to come up with the correct insulin action required. Fat slows down glucose uptake, so I look at the total glycemic load divided by the total grams of fat to decide what type of insulin to use (actrapid/novorapid). The lower the value, the slower the glucose will work. I also use this to sometimes delay taking the insulin, or taking it a bit earlier or even to add a bit of olive oil to get the values matched. This ensures the profiles of insulin match the glucose uptake. After about 45 minutes, I measure the glucose level to see if it peaks correctly, or possibly lower or higher to take corrective action.

[Kendall]

metamarty - What kind of a program is it that you use? I am just getting into the idea of GI and glycemic load and don't know a ton yet. I know with the pump I have a lot of flexibility in how I dose the insulin but I haven't yet figured out how to maximize its potential.

[metamarty]

Originally Posted by Kendall

metamarty - What kind of a program is it that you use? I am just getting into the idea of GI and glycemic load and don't know a ton yet. I know with the pump I have a lot of flexibility in how I dose the insulin but I haven't yet figured out how to maximize its potential.

I wrote it myself. Basically it's a webbased food calculator. It contains a database of food with all relevant information including GI. It adds all values for a given meal to provide totals.

GI is sometimes hard to get, so I must guess it sometimes, but even then, glycemic load proves much more valuable than just carbohydrates. Given the total load, it then divides this load by my personal load per IE value, which is roughly your carb to IE ratio divided by 2.

Also, the glycemic load divided by the total fat seems to be a good indicator for the time it takes for glucose to be processed. A pump could use this information to spread the insulin dose over a period of time, instead of giving it all at once. The real values are very personal, but if you happen to notice that your insulin dose works too quickly, while later in the evening, your glucose levels rise, the glycemic load divided by fat was probably too low. Pizza is notorious for this effect.

[dbc]

Originally Posted by metamarty

I'm constantly around 5.0%, with latest around 4.8%

I don't do low carbing. I've found that good control can be achieved by using two primary rules:

- Don't count carbs. Count glycemic load instead.
- Match action profile of insulin to action of glucose.

I feed all ingredients I use into a program I wrote to come up with the correct insulin action required. Fat slows down glucose uptake, so I look at the total glycemic load divided by the total grams of fat to decide what type of insulin to use (actrapid/novorapid). The lower the value, the slower the glucose will work. I also use this to sometimes delay taking the insulin, or taking it a bit earlier or even to add a bit of olive oil to get the values matched. This ensures the profiles of insulin match the glucose uptake. After about 45 minutes, I measure the glucose level to see if it peaks correctly, or possibly lower or higher to take corrective action.

Metamarty - this sounds like the "missing link" I've been looking for. Going by my fasting BG & 2hr PP readings, my A1c should be around 5.5%, but it stubbornly stays at 6 - 6.2. I do lo/restricted carbing & high protein/fat. Seems I should concentrate on the 3,4,5 hour PP reading to understand the glycemic load vs fat effect.

One learns something every day! thanks!

[metamarty]

Originally Posted by dbc

Metamarty - this sounds like the "missing link" I've been looking for. Going by my fasting BG & 2hr PP readings, my A1c should be around 5.5%, but it stubbornly stays at 6 - 6.2. I do lo/restricted carbing & high protein/fat. Seems I should concentrate on the 3,4,5 hour PP reading to understand the glycemic load vs fat effect.

One learns something every day! thanks!

This will be very subjective, but overall, fat reduces glucose uptake speed. If you're doing high fat, you should check your values later in the evening. Chances are you've calculated the correct insulin amount for the first few hours, but glucose is still being absorbed once the insulin has stopped working. In the evening novorapid has this effect for me. Switching evening insulin to actrapid did the trick for me. It might be that you would do better by taking a bit more insulin of a slower acting type.

[Alene]

I'm going to have to go back and read these posts in detail again, but I noticed that a couple people said they use "corrections" after meals to keep their a1cs low. We all do this from time to time, but I've heard it's not good because you don't want to depend on the sliding scale all the time. Once you have your basal/bolus and carb counting figured out, you should be able to assume that your bs will level out after your meals. I especially don't want to have to use the sliding scale method because I can't afford that many test strips as my insurance is going to expire at the end of the summer. I would love to test 10x a day or whatever, but I think that we should all be able to test only 4 times a day. Should....

I also want to mention that I think good a1c results have a lot to do with LUCK. for a while I was leveling out pretty well, and I met another girl with diabetes that always had spikes and drops in her blood-sugar. She tested constantly, used the sliding scale, did everything to try to figure out her diabetes, but nothing worked. I couldn't figure out why she had problems, I figured it was that she was doing something wrong, but I think it was just that her body would basically do what it felt like doing.... be it due to stress or whatever, she just happened to have a really hard time taking care of herself and I just happened to do O.kay with minimum effort. Sometimes when you do what makes sense, it just doesn't work.

[Gary_W]

Originally Posted by Alene

I'm going to have to go back and read these posts in detail again, but I noticed that a couple people said they use "corrections" after meals to keep their a1cs low. We all do this from time to time, but I've heard it's not good because you don't want to depend on the sliding scale all the time. Once you have your basal/bolus and carb counting figured out, you should be able to assume that your bs will level out after your meals. I especially don't want to have to use the sliding scale method because I can't afford that many test strips as my insurance is going to expire at the end of the summer. I would love to test 10x a day or whatever, but I think that we should all be able to test only 4 times a day. Should....

I also want to mention that I think good a1c results have a lot to do with LUCK. for a while I was leveling out pretty well, and I met another girl with diabetes that always had spikes and drops in her blood-sugar. She tested constantly, used the sliding scale, did everything to try to figure out her diabetes, but nothing worked. I couldn't figure out why she had problems, I figured it was that she was doing something wrong, but I think it was just that her body would basically do what it felt like doing.... be it due to stress or whatever, she just happened to have a really hard time taking care of herself and I just happened to do O.kay with minimum effort. Sometimes when you do what makes sense, it just doesn't work.

It is more expensive on test stips, but testing at 2 hours after a meal is (IMO) essential to ensure good blood glucose control. Whilst in the majority of cases you can safely assume that you got the carb counting right and that your blood will come down to normal at the 4-5 hour mark, that 2 hour test will point out the occasions where you got it wrong so you can do something about it in a timely manner. They also help to point out any problem foods.

As to luck, I wouldn't hold with that. However, it is clear that some people have a much easier time managing diabetes than others. But this is a dynamic process.

This time last year, Lantus used to last almost 24 hours in my body and was a pretty close match to my actual needs. It just worked. By Christmas, it changed and my basal needs would go up and down like a thing posessed. They still do. I started pumping 3 months ago to cope with this nice change. My basal rate goes up and down many times each day and the pump now caters for that. Every 2-3 weeks, my body changes again and I have to adjust the rate at particular times of the day (I have just had to give an extra unit of insulin during the night as my DP seems to have worsened, but to make up for it I've been getting afternoon hypos so I've had to throttle back the afternoon basal...). Were I on MDI, I would indeed now be having a pretty miserable time of it. With pumping, it messes me around for a couple of days whilst I confirm that it is a new trend rather than a temporary blip but then it's sorted out.

Because of my particular body, 4 tests each day just wouldn't cut it. Yes, I'd get by but I don't want to 'get by'. I want to feel well. But if you can get away with 4 tests whilst feeling good and having decent numbers then good for you I'd ideally like to stab my fingers rather less but don't see me doing that any time soon.

Gary

[cheryl]

Originally Posted by Alene

I'm going to have to go back and read these posts in detail again, but I noticed that a couple people said they use "corrections" after meals to keep their a1cs low. We all do this from time to time, but I've heard it's not good because you don't want to depend on the sliding scale all the time. Once you have your basal/bolus and carb counting figured out, you should be able to assume that your bs will level out after your meals. I especially don't want to have to use the sliding scale method because I can't afford that many test strips as my insurance is going to expire at the end of the summer. I would love to test 10x a day or whatever, but I think that we should all be able to test only 4 times a day. Should....

I also want to mention that I think good a1c results have a lot to do with LUCK. for a while I was leveling out pretty well, and I met another girl with diabetes that always had spikes and drops in her blood-sugar. She tested constantly, used the sliding scale, did everything to try to figure out her diabetes, but nothing worked. I couldn't figure out why she had problems, I figured it was that she was doing something wrong, but I think it was just that her body would basically do what it felt like doing.... be it due to stress or whatever, she just happened to have a really hard time taking care of herself and I just happened to do O.kay with minimum effort. Sometimes when you do what makes sense, it just doesn't work.

I know how you feel on the test strips, but for me with my activity level at work which varies, Ok my point, I was only 80 2 hrs after breakfast on Friday versus, I was 150 two hours after breakfast on Sunday, I ate the same same bolus, same basal rates, same activity....I knew I needed something to snack on at 80.........

Also for me being on the pump, I can pinpoint when there is a clog or set might be absorbing what not.....I have skipped post meal test if I feel ok....but sometimes I just don't....I have to know where I am at...

But it is expensive....honestly though I can probably get away with it at work moreso....

Cheryl

[Gangrel]

The only time i'll correct at the 2 hour mark (if I even do a 2 hour test) is if I'm really high. Like, maybe 12+. In my mind, it just complicates things way too much.

If you correct for a 10 2 hours after you eat, then sit down 2 hours later for your next meal and you're an 8.0, what do you do? Do you ignore it, knowing you still have 2 hours of correction rapid in you? Will it stack up with the bolus you're about to do for what you're going to eat? Is 8.0 too low for that period now, because the correction dose might push you down even further?

I much prefer to take my checkpoints at intervals where I *know* what's happening (well, what should happen anyway). That means my body is free of rapid and I can make a clear headed decision on what to do next.

Am I ever going to have an A1c in the 5's? Most likely not. But I much prefer the relaxed nature of this approach rather then fretting about things, and for the past few years I've managed A1c's lower then 6.5, so that's good enough for me.

[xMenace]

Originally Posted by Alene

I also want to mention that I think good a1c results have a lot to do with LUCK. for a while I was leveling out pretty well, and I met another girl with diabetes that always had spikes and drops in her blood-sugar. She tested constantly, used the sliding scale, did everything to try to figure out her diabetes, but nothing worked. I couldn't figure out why she had problems, I figured it was that she was doing something wrong, but I think it was just that her body would basically do what it felt like doing.... be it due to stress or whatever, she just happened to have a really hard time taking care of herself and I just happened to do O.kay with minimum effort. Sometimes when you do what makes sense, it just doesn't work.

She's working hard but not necessarily working smart. Using your daily compliance tests is very difficult to identify problems. There are too many variables going on, and single tests cannot identify who did what.

To gain that level of control one has to do controlled testing where variables are eliminated or kept static. Basal testing is the classic example. Eliminate food and extra activity to identify how your basals behave. Once you've done this, and adjusted to ensure your basal dose(s) keep you flat, you've eliminated a big variable from your daily activities, and your tests should now be representing bolus action only. Now eliminate food and activity variations, and titrate until ratios are set. Voila!

Not complete, but 80% so. Enough to get an A1C close to 6. Pumping or MDI.

[xMenace]

Originally Posted by Gangrel

The only time i'll correct at the 2 hour mark (if I even do a 2 hour test) is if I'm really high. Like, maybe 12+. In my mind, it just complicates things way too much.

If you correct for a 10 2 hours after you eat, then sit down 2 hours later for your next meal and you're an 8.0, what do you do? Do you ignore it, knowing you still have 2 hours of correction rapid in you? Will it stack up with the bolus you're about to do for what you're going to eat? Is 8.0 too low for that period now, because the correction dose might push you down even further?

I much prefer to take my checkpoints at intervals where I *know* what's happening (well, what should happen anyway). That means my body is free of rapid and I can make a clear headed decision on what to do next.

One of the outcomes of my controlled testing was an expected pattern or profile. I now know at 2hrs pp for breakfast that 8.0 was ideal for me. Anything lower I'd drop my basal rates and anything higher I'd correct.

It works very well for me in the mornings. In the evenings before bed it's not so clear. For some reason my evening variability is much less consistent. And correcting before bed is risky for me where I tend to crash in the night.

I tend to be aggressive during the day and cautious at night. But as Aaron has implied, corrections can backfire. I can attest to that

[LancetChick]

Originally Posted by Alene

I'm going to have to go back and read these posts in detail again, but I noticed that a couple people said they use "corrections" after meals to keep their a1cs low. We all do this from time to time, but I've heard it's not good because you don't want to depend on the sliding scale all the time. Once you have your basal/bolus and carb counting figured out, you should be able to assume that your bs will level out after your meals. I especially don't want to have to use the sliding scale method because I can't afford that many test strips as my insurance is going to expire at the end of the summer. I would love to test 10x a day or whatever, but I think that we should all be able to test only 4 times a day. Should....

Yowza, what can I say in response to this kind of thinking? "Correcting" errant blood sugars is not the hallmark of the Sliding Scale Method; it's just good practice, promoting good health and helping to ward off complications. In addition, some of those "corrections" are, in fact, additional boluses to extend the insulin action after consuming a meal that takes longer to digest than the insulin takes to wear off. If you're happy with having your BG "end up" in normal range, with no concern about what it's doing before then, good for you. I am not so complacent, and that's why my A1c's are so low.

We should all be able to test ONLY 4x a day..... put your head back in the sand, this shouldn't interest you at all. I developed some nasty complications testing that infrequently, and it was only by testing MUCH more often that I was able to reverse them. If I were unable to afford to test so often, I'd get rid of my satellite dish, quit going to restaurants and movies, get a cheaper place to live and get a second job if I had to. Diabetic complications are no fun, and they have an annoying tendency to get worse.

Originally Posted by Alene

I also want to mention that I think good a1c results have a lot to do with LUCK.

Uh-huh. Testing 4x a day---> retinopathy with recurring blind spot, frozen shoulder, arthritis.
Testing 15x a day---> clear vision, no hemmorhages, no frozen shoulder and no arthritis...... TOTAL COINCIDENCE!