[Kendall]

I have been a member here for about a week and I'm reading tons of posts and my husband is starting to think I'm getting sucked into some new cult. Okay, not quite, but I've read most of the threads on at least the front page of Type 1, Pumping Insulin, Monitoring, and Carbs/Calories. I have learned a lot and been reminded of a bunch of stuff I had forgotten that I ever knew. I see that several posters consistently have A1cs near or bellow 6. A few are even consistently close to 5.

The reason I even found this forum is because my husband and I are talking about planning our first pregnancy and I also got my recent A1c back and it was 7.3 (one of my highest ever). I knew it wasn't going to be great, but I'm considering it a starting point for improvement. For several years after dx I stayed in the low to mid 6 range, so I know I can do it. Even in the last week I have seen a huge improvement (avg BG down from 156 to 140) just by paying more attention and pre-bolusing for meals.

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.

[dbc]

Restricted/low carb eating plan does it for me, & you'll find many people here saying the same. My last A1c was 6.1

Other things are knowing your I:C ratio, tweaking your basal rate just right, and noting the phases of the moon(!!) - that just to say it isn't all science, seems to me there' s an art to it as well!

There are folks here with good control who eat a more "normal" diet, I don't know how they do it! Seems to me there's no linear correlation between my I:C ratio for a lo-carb meal and I:C for a high carb meal, but that may just be me

[matingara]

i agree with the above.

i would also recommend you buy the book by Dr. Richard Bernstein and follow that. just search on Amazon and you should find it easily.



-- Joel.

[Gary_W]

Hello Kendal,

It is possible to get an A1c below 6 without low carbing. I manage to do so (5.8 these days and eat 200-250g of carbs on average). This is less than the ADA standard amount, but still enough to make Bernstein blush... It includes breads, rice, pasta, cous cous, fruit, the occasional cake etc. Nothing is off limits. All ethnic diets greedily eaten...

My secrets (such as they are) are as follows:

Ensure you basal test and get this set up correctly. Nothing else makes sense if your basal is off. It also allows you to go to bed at a low (but safe) number and have the confidence that you'll wake up Having your BG between 5 and 6 (90-108) through the night will really help bring the HBA1c down. Too much basal plus the inevitable snack before bed does not help your A1c quest.

Work out your I:C ratios and also your correction factors. Be aware that these may change throughout the day. Be willing to adjust them when your body changes, which it will...

Learn your insulin profile; you need to know how quickly it kicks in, when it peaks, how long it lasts. Only then will you be able to safely pre-inject and correct.

Carb count effectively. Buy some good books, good scales and (at home) weigh everything. I have the Salter nutrition scales and they are great.

Test before each meal and then test 2 hours afterwards. Correct as needed using your ratios and your understanding of what insulin you have on board.

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

Treat hypos with 15g of fast acting carbs (glucose tabs preferably). Wait 15 mins and test again. Treating with chocolate, cookies etc will not be effective and gives you rebound highs.

Consider pumping if you can get access to it. It adds better overal control and wellbeing IMO. My HBA1c is unchanged from MDI to pumping at 5.8, but I manage it now with far fewer hypos than MDI + many other benefits. My Animas allows 1/20th unit increments for bolus so you can really match the food effectively.


Hope this helps, good luck with the pregnancy.

Gary

[xMenace]

What Gary said.

If your basals are off at all, you'll never get your meal ratios set properly. Once you get your basal rates and meal profiles set, it really is clear sailing.

Every test should mean something to you. For years I never bothered testing much because they didn't tell me anything. Now every one does because I understand my behavior so much better. When I have an off test I can pinpoint the probable cause(s) very quickly and act properly. No or little guessing.

"Think Like a Pancreas" and "Pumping Insulin" should be in your library.

[Eddy]

Basal testing (I'm a bit off right now), meal profiling, insulin profiling...

...and a bit of luck. I'm fortunate enough that insulin works quickly in me. I can correct quickly (even faster if I shoot in the bicep), and prevent large mealtime spikes without prebolusing. That's why I use my insulin cocktails: I often want slower action, without several smaller, fast-and-peaky injections.

[shabbie]

my last 2 A1c's have been 5.7 and 5.6.

my 'secret' is pretty much what gary and xmenace said. i eat a normal diet giving me around apx 180g-200g carbs daily and maintain a normal weight/BMI.

mostly i like to eat low GI foods like beans and veggies etc. but i also have a weakness for daily chocolate. i try and avoid dairy based foods as this just messes with my profile too much!

understanding how everything works for you is the real key

good luck with TTC

[Olidus]

This site is not like a cult more like a support system.
And for me - my secret is this site.
I am on here and learn something new about the D almost every day.
TEST, TEST and more TESTs.
Never guess - and make sure you know where your body is at, and how you react to the food you put in your system.

As Gary mentioned Carb counting helps alot.

[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?

[davef]

Another T2 sneaking in behind Keith, I've gotten down to 6.2%, for me it's been two things, 1.Being on this forum 2. Testing and striving to make sure what I eat keeps me on target (Less 110 FBG and less than 140 after 2 hours after first bite)

Not sure if that helps,

[Olidus]

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?

So true - The exercise and focus on nutrient shoudl apply to everyone be it Diabetes or not.

I was always told the better shap you are in the less resistance your body builds up to insuline.

[matingara]

yeah. i know tis was asked as a "Type 1" question. and i as a "Type 2" (i think) answered with my opinion.

But on this difference, Bernstein is very clear. small inputs are best. the effects of carbs cannot be exactly predicted all the time.

so, Bernstein basically believes that low carb means that less insulin is needed for both T1 and T2.

this avoids mad swings in BGLs.

it makes a lot of sense if you read the book. i am not an expert.



-- Joel.

[Kendall]

Well, I think I am on the right track then. I have been doing tons of basal testing this week. My doc helped me tweak a few things already. Once I get that set, I was planning on checking my I:C ratios and correction factors. I am on the pump already so I think I might need to have different I:C ratios at different times of day. Dinner always seems to need more.

I have been testing a ton and the pre-bolusing for meals seems to make a HUGE difference in my 90 min - 2 hour post readings.

Thanks Gary for the reminder about 15g glucose and then retesting when low. That is something I used to do religiously but have slacked off on and it does mean I've had a lot more rebound highs.

Because of this forum I have also been looking into low GI foods and how they can help. I need to do a little more research on this. I also need to get "Think Like a Pancreas" and "Pumping Insulin". I keep hearing good things about them.

All of these tips along with support from all of you and some dilligence on my part and my A1c should be headed down under 6 soon. Thanks all!

[MJM]

No one thing will get you right. It's the whole package that will make it work correctly. The package would, in my opinion, start off with having correct basal rates. Carbohydrate Ratio is also important. Exercise is also important. The correct food is also important. In other words the whole package.

[Gary_W]

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?

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...

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. You are then left with an evil hypo at the 90 min post prandial mark, a belly full of food and the prospect of having to eat something to treat the hypo that won't work quickly due to already being full. Been there, bought that T-shirt and it really isn't much fun. Same goes for low carb food. In me, I can cope with 'regular' food (by which I mean a bit of carbs from all GI groups but more brown than white, a bit of protein and a bit of fat). It's the high fat, high protein stuff with minimal carbs mixed in that gives me the most grief in terms of getting my levels right at 2 and 4 hours post meal. For some people's metabolism, low carbing may well be for the best as far as their BG goes but it's not a blanket rule whatever Bernstein says.

Both of the above are really covered by my point about knowing your insulin profile. Once you understand how your rapid insulin works in your own body with certain life factors / foods then life gets a fair bit simpler. It is a real shame that doctors often talk in terms of amounts as opposed to telling patients how it absorbs over a period of time. An obvious point once understood but it drives you nuts until you 'get' it.

And I wouldn't say you were T2-ish. Tee Tootal? As opposed to me who is clearly an insulinholic

Gary