I've been told to increase HbA1c to improve hypo awareness

dancer

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One thing.. Why is a dosage of 20 units a say making things complicated? Heck, it doesn't matter what your dosage is providing you can get good levels.

I know what you mean by fluctuating levels.. My levels could swing for a number of reasons..
A) days of getting up early or late... (Due to hubbys shifts) I had two basal rates for this and switched over the night before his shift changed)
B) I have slow colonic transit and know that at times when my stomach struggles my levels would shoot up for days. Flaxseed remedied this
C) days off to days working.. Again needing a different profile due to being a gardener daytime workwise and still busy when off but slightly less.

Have you been offered a CGM or a freestyle libre at all?

When dancing do you literally dance for hours at a time? Or do you have any break etc?

I don't understand why your consultant has not consudered a cgm to enable you to do dancing without fear of hypo's etc.
My consultant is now going to ask for funding for a cgm but non-medics make that decision so I'm not banking on it. It would be wonderful though, so fingers crossed!

We don't dance constantly but have one or two dances then sit down for one or two.

My insulin sensitivity is getting the blame for adding to the problem. Small changes in dose can make a very big difference to my blood sugars.
 

donnellysdogs

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Do you eat and bolus within 2-3 hours of going dancing?
Only for the fact that I can remain perfect for 6 hours whilst gardening or gym work providing I don't eat or bolus before hand. Its the bolus qty that is harder to handle because it is efeectively quite a large dose compared to basal rates....

To me if you are bolusing etc before dancing then you have both basal and bolus that will need attention. If you could basal test at dancing inbetween dances it would allow you to really see how much basal to drop etc.

Do you have specific times that you dance so that you could set up a different profile for those days.. Ie if you dance at 6pm you would drop the basals as needed but use a different profile so you could just switch over in the morning? Are your bg's changing after dancing as well?

This doesn't to me actually seem like a huge problem to get over... But I have to say I would only have basal running through me for dancing and test constantly for a few times...
 

dancer

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I generally dance about an hour after lunch or 2 hours after dinner.
At lunch I reduce bolus by 30% and use a 70% basal for a couple of hours. In the evening I reduce bolus by 20% and again use 70% basal. Generally this works but I could go high or low during/after dancing for no apparent reason. I tend to eat the same type of thing every day so haven't been able to find a diet link to the success/failure of my routine.
 

donnellysdogs

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Thats what I'm saying though... You are guestimating both bolus and basal reductions..
So how do you know which one is wrong?

If you did a basal test and cut out your lunch, and then tested during and after the dancing up until teatime at least you could find out which is right or wrong.

You are jyst guestimating them both at the moment and either one could be wrong.

It is also the timing of when you start your basal reduction as well.

To me, I would do basal testing. Have breakfast anf then nothing until teatime unless its carbfree like the jelly n cream.. Test whilst dancing and every hour as well until teatime and 2 hourly if necessary during evening / night. I would set up a different profile to switch to in the morning of the days when you go dancing and swop back according to whether you need a reduction as well at night on those days.. You may have to switch back to the other profile on waking the next day if you experience different levels at night on dancing days.

On my pump in the end I had 3 different profiles. Nowadays back on mdi I still give less or more basal according to activities but currently you are just guestimating 2 doses of insulin. At least if you get your basal right for these days it gives you the basic to work on for your bolus if you want to eat pre dancing...
 
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dancer

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Thanks donnellysdogs, you've given me food for thought. However, my present hypo situation isn't due to dancing as it started as soon as we returned from holiday and we didn't start dancing for almost a week. Obviously it adds to my predicament but normally my "guesstimating" works well with only the odd hiccup.
 

iHs

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The thing with basal rate testing for periods when more exercise is being done, is that the new basal rates would need to cover the exact level of exercise that was being done at the time of testing, so this is why only a guestimate basal rate profile can only be used and just hope that the basal rate profile selected will keep you ok for the type of activity that you are doing.
Its never that easy to do exercise with perfectly controlled bg levels. Ive always eaten something carby before doing exercise and still do even with a pump. That way, I can choose when I am going to do exercise instead of using a pump to plan ahead and activate a new profile or do a TBR. If something happens and what I thought I was going to do doesnt take place, then Ive got a problem with bg levels and would need to do corrections, whereas eating food as long as I eat about 15mins beforehand, leaves me better controlled..
 
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dancer

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It's certainly true that we never do the same amount of dancing at the same time every week. There are so many variables, hubbie's back, my feet, gossipy dancers, music we don't like, frustration at not remembering new steps, etc, etc. I used to eat carbs beforehand but then I reached the age when my waist was expanding, so tried to cut out those carbs.

Hopefully my hypo awareness will improve within a couple of weeks but it looks like I'll have double figure results post breakfast if I keep doing what I've been advised.
 

donnellysdogs

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Double figures are unecessary to get hypo awareness back and makes us miserable too!!
I would be doing my own thing..
 

Emily95

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I was told to run between 10 and 15 for 8 months to make sure I have hypo awareness
And after 8 months start bringing it down, so 9-14.
 

yingtong

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I was asked to run my blood sugars at between 10 and 12 for 3 months by my Endo which I did but blood sugars over 8 make me fill very ill, but it made no difference to my hypo awareness and fortunately after nearly 12 months my DSN and Endo won funding for a CGM for me.That combined with my pump,I now have very few hypo's.
 
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noblehead

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I was asked to run my blood sugars at between 10 and 12 for 3 months by my Endo which I did but blood sugars over 8 make me fill very ill, but it made no difference to my hypo awareness and fortunately after nearly 12 months my DSN and Endo won funding for a CGM for me.That combined with my pump,I now have very few hypo's.


@yingtong hope you don't mind me asking, as you are having so few now has this made any difference to your hypo awareness symptoms?
 
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dancer

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Emily95 and yingtong, thank you for that. I've been given no indication of what I've to aim for. Emily's levels seem rather high to me. I hope I'm not told to aim for that, I'd never be out of the toilet!

Ringtone I don't think you've been on the pump that long but I'd be interested in your answer to noblehead's question too.
 

yingtong

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Hi noblehead,absolutely no difference at all,but if my blood sugars are to drop my CGM is on Smartgaurd and forecasts I am likely to hypo and switches off my insulin and alarms.i am using Medtronic 640g and Medtronic CGM.
 
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noblehead

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Thanks for the reply @yingtong:)

I was reading about the Smartguard a few weeks back, its a fantastic device and can see why this has drastically reduced the amount of hypo's you were experiencing.

Best wishes.
 

ann34+

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After an HbA1c of 46, with 16% of a fortnight's test results hypo and 34% below target but above hypo, I was told to reduce my basals (I'm on the pump). I haven't lost my hypo awareness but have been as low as 2.1 with no symptoms.

My DSN said I should reduce each of my daytime basals by what amounts to a total of 8.6% but as I'm insulin sensitive I decided to only reduce by 4.3%.

I've just had a result of 12.3, two hours after lunch (I've been told only to correct at meals). I don't mind raising my test results but don't want them to go sky high for a long period of time. Can anyone tell me how long I should have these raised sugars for? I have asked but don't yet have an answer. I presume it's at least 8 weeks but just want to know what others have experienced.

Hi, Dancer, you do not say how long you have been diagnosed Type one, , but i have noticed you are only a few years younger than me, are insulin sensitive like myself, use not much more insulin than i do, and are on the pump. Hypos can cause all sorts of problems, one of the commonest being sometimes not so stable on your feet, and even slipping or falling whilst hypo.
If you have had type one 35 years plus, women in our age group who are long term Type ones are much more likely to have a hip fracture than other women of a similar age, (the figure is 10x more the last time i discussed it, but that took in type one women overall i think, even those more recently diagnosed - i will have to check ), and also more likely not to recover so well as a non diabetic woman. Until a few years ago this serious complication of type one was not much known about , it is getting more coverage now especially as it is realised that lower BMD affects a lot of younger Type ones. Some doctors are doubtful whether good control is necessarily protective of breaks
In older women, especially those who have no other complications at all , the dangers of going a bit higher for a while and then raising your HbA1c in order to try to regain hypo symptoms are seen as few, and absolutely necessary if your DEXA scan results are poor. I disagree with some posts, as each type one has to look at their own individual circumstance - also it may be you cannot get all your symptoms back - i cant - sometimes they are there, sometimes not - but then R.D.Lawrence, the famous diabetologist, wrote a piece in a medical journal - i still have it - about how hypo symptoms were often lost in even quite poorly controlled very long term diabetes - it just may not be possible with the tools currently available. The bones are a complex part of the endocrine system and how things pan out may also be affected by your genes and other drugs you may have used long term, but your age and sex is probably why your consultant is so concerned. I had a hip fracture when in my 50's - it is far worse than anything you could imagine long term, and also increases your likelihood for early OA. Your doctors are helping you. I too always had good control but i was not on the pump even though i had asked many times, and was not aware of minor hypos. I did not qualify because i did not need assistance - at that time the dangers of even a minor slip for older type one women were not known. I would keep to your doctors advice short term at least, and ask for a DEXA scan asap, then go on from there and discuss it all again.Best wishes
 
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Spiker

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I was told to run between 10 and 15 for 8 months to make sure I have hypo awareness
And after 8 months start bringing it down, so 9-14.
That's unnecessary, unethical and crazy! Who told you to do that?!?!
 
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Spiker

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I was asked to run my blood sugars at between 10 and 12 for 3 months by my Endo which I did but blood sugars over 8 make me fill very ill, but it made no difference to my hypo awareness
Shocking.
 
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yingtong

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Hi Spiker,I agree,but was prepared to do almost anything to get my Hypo awareness back.I had very good control prior this happening,the only good thing to come out of this is that I have a Pump and CGM.I really don't know.how I managed to keep such good control without a CGM.I personally think that CGM's should be part of kit issued to all Type 1's and I believe this will save many millions of pounds in cost to the NHS for treatment to Type 1 complications we all know to well about
 
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LucySW

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I was told to run between 10 and 15 for 8 months to make sure I have hypo awareness
And after 8 months start bringing it down, so 9-14.
That is horrendous. Perhaps there were other factors in the situation you haven't mentioned, but those levels are far too high. I would never agree to that.

I hope you're much lower than that now.
 
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dancer

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Hi, Dancer, you do not say how long you have been diagnosed Type one, , but i have noticed you are only a few years younger than me, are insulin sensitive like myself, use not much more insulin than i do, and are on the pump. If you have had type one 35 years plus, women in our age group who are long term Type ones are much more likely to have a hip fracture than other women of a similar age, (the figure is 10x more the last time i discussed it, but that took in type one women overall i think, even those more recently diagnosed - i will have to check ) until a few years ago this serious complication of type one was not much known about , it is getting more coverage now. Some doctors are doubtful whether good control is necessarily protective, and in older women, especially those who have no other complications at all , the dangers of going a bit higher for a while and then raising your HbA1c are seen as few, and absolutely necessary if your DEXA scan results are poor. I disagree with some posts, as each type one has to look at their own individual circumstance - also it may be you cannot get all your symptoms back - i cant - sometimes they are there, sometimes not - but then R.D.Lawrence, the famous diabetologist, wrote a piece in a medical journal - i still have it - about how hypo symptoms were often lost in even quite poorly controlled very long term diabetes - it just may not be possible with the tools currently available. The bones are a complex part of the endocrine system and how things pan out may also be affected by your genes and other drugs you may have used long term, but your age and sex is probably why your consultant is so concerned. I had a hip fracture when in my 50's - it is far worse than anything you could imagine long term, and also increases your likelihood for early OA. Your doctors are helping you. I too always had good control but i was not on the pump even though i had asked many times, and was not aware of minor hypos. I did not qualify because i did not need assistance - at that time the dangers of even a minor slip for older type one women were not known. I would keep to your doctors advice short term at least, and ask for a DEXA scan asap, then go on from there and discuss it all again.Best wishes[/QU

Two years ago I was told I had osteoporosis of the left hip (no treatment besides vitamin D3). I'm due another DEXA scan this month. My consultant also specialises in osteoporosis but did not mention the risk of broken bones when he saw me last week. I've had Type 1 for 37 years with no complications (touch wood!)

I just don't like being told I must raise my blood sugars but not being told by how much or for how long.
 
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