HbA1c . This is a model of the haemoglobin molecule. From you tube video by Casey Steffen
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The blue blobs represent glucose. (the red represents the heme or iron) As you can see some have become bound to the haemoglobin. There are other glucose molecules outside the molecule as they would be in the blood. If the two come together then these molecules will bind to the haemoglobin. If there is a lot of glucose there then far more will get bound to the haemoglobin so at periods of high glucose concentration more glycation will take place. But it takes time (hours) for the reaction that causes glycation to become fully permanent . I infer from this that short periods of high levels may not be fully reflected since during this period the protein and glucose can separate. Once permanently bound the glucose remains there for the lifetime of the cell ie up to three months. It does not get removed during periods of low blood glucose levels.
Basically a high HbA1c reflects time at higher levels . Glycation still takes place at lower blood glucose concentrations but there will be less glucose around so less of it will happen http://www.diabetesinfo.org.nz/hba1c.html
Your high intensity exercise regime may indeed cause periods of highs with the anaerobic exercise and also lows during the cardio aerobic exercise. People with T1 have different responses to exercise than many people with T2 (because of injectable insulin which doesn't go away and also possibly because of an increased adrenaline response. )
Have a look at the sections on runsweet , diabetes and sport and starting sport (there are several pages that explain in detail in this section) As to how to deal with it, have a look at some of the sports that involve this mixture of aerobic and anaerobic exercise. http://www.runsweet.com/DiabetesAndSport.html
Hi @Maxy
i have read through your entire post and you have given a lot of information.
first (and most important in my humble opinion) is that you sound as if you are yo-yoing ( which you mention too ) with your lows and highs in a short period of time.
it will be intensive work but i think you should start keeping a daily food and insulin diary to look for patterns. ( have your care team already asked you to do this ? )
as to a pump if you are experiencing some hypos without recognising symptoms you may still qualify within NICE guidelines-- this is something else to talk to your care team about. Keeping the journal is important too as it shows your commitment to getting things right.
pumps are good, but only if you have had a good lengthy experience carb counting and trying out different doses and timings to try and get better control.......
the criteria to get a pump can be loosely interpreted I suppose but it is a postcode lottery to be honest.........
once you get the basic in carb counting and dose adjustment you will find gaining control much easier, especially if you exercise regularly, this helps a lot.........and a goo educational course should touch on adjusting insulin for exercise.....
Hi Maxy, it sounds as though you are finding it quite hard. One of the symptoms you are describing is issues with bolus ratios. I don't see you saying anywhere that you've done a basal test to determine that this is at the right level. It might be a place to start and would at least allow you to benchmark where you are. This is a useful link http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007
I do a lot of gym work, and have had to undertake this process to get my old basal under control and since changed to a new one. Once you have this to the right level, the bolusing becomes a lot easier. I too have different basals for gym and for non-gym days.
Always worth a try.
receiving a structured educational program is on the NICE criteria I believe, but as I say, it isn't followed strictly.........
I believe that you should definitely go on a course before the pump though otherwise you wont be using it to the best of its ability............
the pump generally delivers a much more efficient dose of insulin, this being down to not having to give yourself one big load of insulin by injection, then hoping for a nice, smooth, even absorption......you will use less insulin, which will result in much more reliable doses etc.....
this fact alone will make for a noticeably better control, easier control...........an understanding of your basal and bolus needs is essential though...
get the ball rolling though for the pump and get swatting up on the carb counting and dose adjustment.........
yes looking at your intitial bolus and subsequent corrections that 2.8 @ 8:34pm fits nicely near the end on the life of the 7 unit correctionHi himtoo,
I agree fully that I am yo yoing quite frequently. It has been better with accurate hypo treatment. I was taking a written diary- but I've been given a carb counting blood tester which has so far been quite helpful, has logs of net consumed carbs and injections with correct timing. I'll post an example below of what my written diary has looked like- any specific advice on how to write them would be appreciated! This was on a really bad day when nothing was going right:
yes looking at your intitial bolus and subsequent corrections that 2.8 @ 8:34pm fits nicely near the end on the life of the 7 unit correction
i don't find it odd at all -- it is consistent with an overcorrectionWould you say the bolus and corrections not working over that timeframe is odd?
That's unfortunately the million dollar question and hotly debated amongst diabetes researchers. (I've been following the debate for several years and really there is no answer. Some experiments with cells and short term measurements of biological markers suggest problems caused by spikes. There isn't really any long term evidence to confirm this; it actually points to averages or HbA1c being important (and stability in those is important too) The big caveat is that there are no long term trials using continuous monitoring )Does it mean that these higher levels don't cause as much damage to the body due to them being present for short amounts of time?
That's unfortunately the million dollar question and hotly debated amongst diabetes researchers. (I've been following the debate for several years and really there is no answer. Some experiments with cells and short term measurements of biological markers suggest problems caused by spikes. There isn't really any long term evidence to confirm this; it actually points to averages or HbA1c being important (and stability in those is important too) The big caveat is that there are no long term trials using continuous monitoring )
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