My hba1c is bad

Nicola M

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677
Type of diabetes
Type 1
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Pump
My hba1c currently calculated based on the info my tomato app collects is at 10.9% (I know it’s bad) I feel it’s fairly accurate as I regularly calibrate with finger pricks. I’m just struggling to get my sugars down they are often fairly high and take a long time to come down and I end up feeling lousy all day because of it. Basal testing especially the moments when I start to go high (usually overnight) is hard because I work 40 hours a week and I don’t particularly want to be testing every hour on a work day which only leaves the weekend and as everyone who works all week probably relates to you value your weekend sleep a lot. I’m at my wits end and feel very hopeless right now.
 

Fish_PhD

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I have always had high HbA1c readings, but was recently offered a diabetes awareness course by our local diabetes support team, aimed specifically at type 1 sufferers. It was over four weeks, with one day a week attendance, and it opened my eyes considerably, as a iot of the information I had been given over the years was either wrong or more aimed a type 2 diabetics.

As well as diet, exercise, stress and other factors, they taught a small group of us how to calculate our basal dose correctly, and then how to calculate the bolus units to carbohydrate intake. These values are different for everybody with diabetes, and it turned out that the reason I was going high was due to injecting too much basal insulin (which was completely counter-intuitive to me).

Basically, ensure that you eat at least 4 hours before going to sleep (and drink only water). Prior to sleeping, measure your blood sugar and note the result. Then test again immediately on waking and see if your blood sugar is at the same level, give or take a bit, as the previous night. Testing over a week, this allowed us to judge whether our basal amounts were right: if the morning values were lower, then we were injecting too much; higher values indicated not enough of a basal dose. By adjusting in one or two unit increments over the next week, we were all pretty much consistent.

For the duration of the course, we also had to keep food diaries, noting total carbohydrate intakes (from the nutritional values printed on packaged foods and from reference publications), along with times of eating and bolus injection times and amounts. We were then able to work out what our individual carb to units values were, with guidance from the diabetes nurses and dieticians. These can vary depending on food GI values, stress, exercise, etc, but this should then give you a better idea of what to inject and when.

There was a lot more information on the course, and the guidance we all received on our own individual diabetes was amazing. If your LHA can offer you a similar course, then I would advise anyone with type 1 to take advantage of it.

For me, the end result is that my HbA1c has dropped 13% in the past 5 months, and continues to do so. Whilst still too high, I am feeling a lot better and more in control of the condition.

If anyone has any questions, I'd be happy to provide my attempt at answers (I'm not a trained healthcare provider), or try to point you in the right direction of someone who can.
 

Juicyj

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Hi @Nicola M Sorry to hear this :(

I know what you mean about basal testing, it's a pain when you're busy and just trying to get by.

Here's another thought process, could you keep a diary, so track your carbs eaten, insulin taken, blood glucose readings ? Another way to catch the monkey is by looking for patterns so by just following a similar diet for a few days and carrying on as normal but then reviewing it in 3-4 days seeing if you can identify trends, i'd suggest keeping carbs and fat down a bit whilst doing so.

As you can see already running higher is leaving you feeling lousy as you're not converting your glucose efficiently, also can you speak to your DSN and get hold of a CGM to help you monitor it, mine has a spare one she keeps for these events, it's really useful if you're struggling to test and keep track of things x
 
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Fish_PhD

Newbie
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I should also add that I converted to the FreeStyle Libre blood glucose sensor a year ago (I know that some LHAs are beginning to offer this on the NHS). Whilst not for everyone (and very expensive for individual private purchase), it gives readings for the last 8 hours through a small, permanently attached sensor attached to your arm. This is a real benefit for understanding what your blood sugars are doing overnight without having to wake for a fingerprick test every hour or so.
 
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novorapidboi26

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are you on a split dose of basal.......?

and I assume there is no Libre to help you....?.

instead of going every hour you could do only one test at the beginning and at the end of the chosen time slot you are testing, which would give you a rough idea of what might be going on....
 

Diakat

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Hugs @Nicola M good suggestions above about “rough” basal testing. My contribution is, how far before eating do you inject? Giving the insulin time to get going in your system can also help.
 

Nicola M

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677
Type of diabetes
Type 1
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Pump
I usually inject 10 mins before meals I was always told by my DSN to do that, thank you all for the other suggestions I’ll be giving them a go and seeing if I can get my sugars down! I definitely want to get them down as feeling lousy everyday isn’t the best feeling in the world.
 
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Diakat

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I usually inject 10 mins before meals I was always told by my DSN to do that, thank you all for the other suggestions I’ll be giving them a go and seeing if I can get my sugars down! I definitely want to get them down as feeling lousy everyday isn’t the best feeling in the world.
You might want to experiment with moving that back to 20 or 30 minutes.
 
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slip

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Do you have any hypos at all? Do you change your basal settings on your pump at all? if you're going high over night then change your basal rates covering that period then at least hopefully you'll be starting the day on a good number and work from there. I'll +1 @Juicyj comment about logging/noting everything and reviewing after a few days.
 
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porl69

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Hi @Nicola M I do think you need to be doing a basal test to get your base insulin sorted. I know its a PITA BUT it needs to be done. Get that sorted then you can start looking at timings on your boluses before food etc
 
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