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Been told not to worry about my lowering my a1c?

indyjholtzmann

indyjholtzmann

Well-Known Member
Messages
54
Type of diabetes
Type 1
Treatment type
Pump
I went to see my nurse and diabetes specialist on Wednesday and it was the first time I've seen my specialist since my hba1c dropped from 67 to 63. Bearing in my mind that my a1c was 80 in August 2016, my specialist said to just keep doing what I'm doing and not worry too much about lowering my a1c anymore at the moment because of the major drop I've had.

I suppose I was a little put off purely because I've been doing so well, I'm heading in the right direction and I want to keep going. She did say that any further drops this quickly can be bad for me (I don't know how much truth is in that?) but I reckon it may also be due to the fact I've now been referred to an insulin pump specialist and am about to start my quest to get an insulin pump on the NHS.

I dunno, I think after all my years of doing terribly and now after finally getting it right I just want to keep it up but I also don't want to worry about it too much if there's no need to. I also don't actually know what my a1c should be and forgot to ask actually...
 
The target for type 1s is to have a hba1c under 48.

Fast drops in hba1c can cause problems with false hypos, increasing symptoms of neuropathy and retinopathy etc.
 
You're close to ideal, and will probably drop more without any/many changes. When you get to an A1C of 45 you'll get low sometimes. For sure. That's why they tell you to slow down the closer you get to goal.
 
I would carry on as you have been doing
many would say my HbA1c has been too low in the past ( 37-41 )
the last 2 years it has been between 46-48 on a pump -- my consultant seem to love me being at this level :)
 
Thank you everyone! I'll keep going as I am then and probably wait until a decision with an insulin pump. I'm assuming I'll see changes if I do get a pump anyway ^^
 
When you get a reasonable A1C, hypos and peak BG can do more damage than the average BG.

The risk of people aiming lower is that they get many more hypos, rather than getting fewer high BG peaks. As CGM are still uncommon medics don’t know what is going on as they just have AC1 to look at and some people with low AC1 get bad health due to their large swings in BG.

Your diabetes specialist said they are happy with what you are going, so be happy and keep doing it, as @TheBigNewt say your AC1 will lickly improve without you aiming lower.
 
Thinking about this more, what about each week just looking back at your records, choose the highest and lowest BG values the Libre have recorded and thinking about what you can learn from them. (Without trying to reduce the average.)
 
My endo suggests that type 1's should be under 53 as a target. It seems like you have been making progress, so just keep doing what you are doing! Also, bear in mind that a lot of doctors dislike low HbA1c's as they may be indicators of very low blood sugars, or frequent hypos. However, this isn't always the case - my current HbA1c is 29 and I hardly ever get below 4. This is partly due to a cgm (perhaps you could ask about getting one after you get your pump?). As long as you aren't getting very low blood sugars then it's perfectly safe to have a "low" HbA1c.
 
Well am very happy for you but I would wish I was in your boots as I cant be any miserable with my sugar levels and the Idea of a pump can be just a dream for some of us hence I would start praying as my body can only cope for certain times therefore happy new year
 
phdiabetic said:
My endo suggests that type 1's should be under 53 as a target. It seems like you have been making progress, so just keep doing what you are doing! Also, bear in mind that a lot of doctors dislike low HbA1c's as they may be indicators of very low blood sugars, or frequent hypos. However, this isn't always the case - my current HbA1c is 29 and I hardly ever get below 4. This is partly due to a cgm (perhaps you could ask about getting one after you get your pump?). As long as you aren't getting very low blood sugars then it's perfectly safe to have a "low" HbA1c.
Click to expand...

Hypos are my biggest problem at the moment when I'm at work. My carbs-to-insulin ratio is fine on my days off and I hardly get hypos but when I'm at work and moving around a lot (I'm a retail worker on the shop floor so I do a lot of walking), I do tend to hypo a lot...

There's a difference between CGMs and Flash Glucose Monitoring, right? I've got my Libre which I know is a Flash machine (and it is working so incredibly well for me at the moment that I can't imagine going without one anymore!). Can you get a CGM on the NHS or is it self-funding like the Libre? Though I swear I've heard people around here talk about something that can be placed on a Libre sensor that turns it into a CGM...

Though I don't think I'll worry about a CGM yet. I've just started using my Libre and need to try and get that insulin pump first :happy:
 
indyjholtzmann said:
Hypos are my biggest problem at the moment when I'm at work. My carbs-to-insulin ratio is fine on my days off and I hardly get hypos but when I'm at work and moving around a lot (I'm a retail worker on the shop floor so I do a lot of walking), I do tend to hypo a lot...

There's a difference between CGMs and Flash Glucose Monitoring, right? I've got my Libre which I know is a Flash machine (and it is working so incredibly well for me at the moment that I can't imagine going without one anymore!). Can you get a CGM on the NHS or is it self-funding like the Libre? Though I swear I've heard people around here talk about something that can be placed on a Libre sensor that turns it into a CGM...

Though I don't think I'll worry about a CGM yet. I've just started using my Libre and need to try and get that insulin pump first :happy:
Click to expand...


Yeah the difference between FGM and CGM is that the FGM (Libre), can only provide information (Current BG level, trend line and past BG levels) when you scan it. CGM on the otherhand is able to constantly send BG information and trend information to a receiver. This allows the receiver to have alarms if the BG is high or low. This is essential for some people with hypo unawareness.
The issue with a standard CGM (Dexcom or Medtronic) is the expense and because of this it really difficult to get funding. Some clinics keep a CGM system that patients can use short term (like a week) to get a feel for BG levels and tune basals and IC ratios but not all clinics do this. Or you can get 'long term' funding but this is a very extensive process and requires an application to the local CCG. This is only really an option if you have severe hypo unawareness and is very hard to get.

The libre on the otherhand can be converted into a CGM. There's two options, one uses the sony smartwatch 3 over the sensor this reads the libre via nfc and then bluetooths the result to an android phone (this is what I have which I DON'T recomend). The other is to purchase Blucon from Ambrosia systems (this works the same way as the sony watch option but is should be a lot easier to setup), ScottC has a thread on here using this method. Both methods uses an app called xdrip+. You would have to download the apk from github and install on your android phone.

xdrip+ lets you set High and Low alarms and send your BG results to a smartwatch (either Android Wear or a Pebble).

Setting this up with the libre has helped me so much and I would recomend going through the trouble of setting it up (but using the Blucon). Using this allowed me to get my HBA1c from 65 to 42 in 3 months by watching my BG levels and reacting to them (I should say here that I am using a pump which makes this easier to do).

Attatched is the view on xdrip of BGs today and my pebble watchScreenshot_20171226-223852.jpg 20171226_224135.jpg
 
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indyjholtzmann said:
Hypos are my biggest problem at the moment when I'm at work. My carbs-to-insulin ratio is fine on my days off and I hardly get hypos but when I'm at work and moving around a lot (I'm a retail worker on the shop floor so I do a lot of walking), I do tend to hypo a lot...

There's a difference between CGMs and Flash Glucose Monitoring, right? I've got my Libre which I know is a Flash machine (and it is working so incredibly well for me at the moment that I can't imagine going without one anymore!). Can you get a CGM on the NHS or is it self-funding like the Libre? Though I swear I've heard people around here talk about something that can be placed on a Libre sensor that turns it into a CGM...

Though I don't think I'll worry about a CGM yet. I've just started using my Libre and need to try and get that insulin pump first :happy:
Click to expand...

CGMs will give you alerts, flash just shows you the number when you scan. I think somebody has made some sort of phone app or something for the libre so that it functions like a CGM, but I can't remember exactly what it is. And I'm not sure about NHS funding - I'm not from the UK.

You may have less hypos on the pump since you can adjust your basal while you are at work. Using the 'temp basal' function, you can reduce (or increase) the amount of basal you receive for a set time period.
 
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