First HBA1C following Diagnosis

[ElkBond]

Today I had my first review following diagnosis in Feb 2016, I got a bit of a telling off with a HBA1C of 4.7% (28). I now have to bring it up to the 5s which is fair enough.

I have also been referred to the pump specialists as I carb count and have good control (if a bit low). I haven't had a spike past 8 for a while!

I am personally looking into an Omnipod (suppose it could match my other Dexcom pod!) but we will get to that later. Any pump users who want to recommend theirs to me fire away, it will no doubt take a fair while to sort all this out.

I tend to keep carbs low to save me jabbing as its not always convenient but I do have some medium amount of carbs in the week. Nothing ridiculous. However, I am going to try to have my favourite meal sometime soon, indian with a naan and rice!! I will take it slowly and want to nail it so my graph is as smooth as can be, I do like a challenge!

 

[Squire Fulwood]

I tend to keep carbs low to save me jabbing as its not always convenient but I do have some medium amount of carbs in the week. Nothing ridiculous. However, I am going to try to have my favourite meal sometime soon, indian with a naan and rice!! I will take it slowly and want to nail it so my graph is as smooth as can be, I do like a challenge!

I wish you well and hope it works out for you. As a T2 I only know about trying to keep levels down but your problem is to get the sums right. Enjoy the meal.

 

[Jaylee]

Today I had my first review following diagnosis in Feb 2016, I got a bit of a telling off with a HBA1C of 4.7% (28). I now have to bring it up to the 5s which is fair enough.

I have also been referred to the pump specialists as I carb count and have good control (if a bit low). I haven't had a spike past 8 for a while!

I am personally looking into an Omnipod (suppose it could match my other Dexcom pod!) but we will get to that later. Any pump users who want to recommend theirs to me fire away, it will no doubt take a fair while to sort all this out.

I tend to keep carbs low to save me jabbing as its not always convenient but I do have some medium amount of carbs in the week. Nothing ridiculous. However, I am going to try to have my favourite meal sometime soon, indian with a naan and rice!! I will take it slowly and want to nail it so my graph is as smooth as can be, I do like a challenge!

That to me looks near as **** it, "pre diabetic" range.. (Someone pull me up if I'm wrong about the PD figure.)
I personally wouldn't feel bad about that A1c.. If you manage by very LCing on your basal.?
Depends on the hypo frequency? & awairness? That would be the main concern for the docs...

 

[Squire Fulwood]

That to me looks near as **** it, "pre diabetic" range.. (Someone pull me up if I'm wrong about the PD figure.)
I personally wouldn't feel bad about that A1c.. If you manage by very LCing on your basal.?
Depends on the hypo frequency? & awairness? That would be the main concern for the docs...

I watched one of the professors talking on a video and I learned that T1's have an interest in keeping their Hba1c's from not going too low since a low Hba1c means more hypo risk. I did not appreciate that before I saw the video,

 

[Jaylee]

I watched one of the professors talking on a video and I learned that T1's have an interest in keeping their Hba1c's from not going too low since a low Hba1c means more hypo risk. I did not appreciate that before I saw the video,

To be fair.. If a T1 can maintain low & smooth without too many events with hypos. I don't see the issue. I've been told off for being in the early to mid 6.. (Ideally, the official figure is 7.5?!?) They'd soon say "I told you so" if one lost a leg...

I just go in. & sit through the formalities....

 

[noblehead]

I am personally looking into an Omnipod (suppose it could match my other Dexcom pod!) but we will get to that later. Any pump users who want to recommend theirs to me fire away, it will no doubt take a fair while to sort all this out.

Hi @ElkBond

I'm an Omnipod Pump user, it's my first pump so have nothing to compare it with but do have to say it's a great pump, very few issues to date and the support network seems very good.

I opted for the Omnipod as it was a tubeless pump, if you look on YouTube there's some good video's where users talk about their experience of using the pump (but keep in mind that some video's are a few years old and the size of the pods have since changed).

Best wishes and well done on your first HbA1c, I think aiming for the 5's over 4's is sensible advice.

 

[ElkBond]

Thanks @Jaylee, @noblehead and @Squire Fullwood!

I havent had too many hypo moments, I did reach a 2.4 last week which was the first 2 I have hit for ages. However I did not feel it half as strong as the last one. Surfing the low 4s to high 3s for quite a lot of the day must have lowered the feeling threshold. I noticed the feeling even though my Dexcom was telling my I was in high 3s at the time, which is why I checked. So I am still aware (thank god!). Staying in the 5s should get me back to how I was before. I will never forget the 2 I had after I had too many units to have some apple pie - shaking wasn't the word for it!

@noblehead the tubeless Omnipod is the main reason I am aiming for it, that and no pump clipped onto a belt. I still avoid jabbing if I can, needle phobia must be lingering more than I hope. I had one bad experience in public where I tried to jab before a meal, not in the loos for once. But and the needle stung before it got in all the way, I was red, sweating all over and could see people looking, no fun. So yes back to the loos I go if its essential when I am out. So having something inserted once rather than 5 times a day would definitely make me feel a bit more free.

 

[catapillar]

Can I ask if you have been having a lot of hypos? Where is your low alert set on your dexcom?

4.7% = an average blood sugar of 4.9. If you are spiking up to 8, you must also be dropping below 4 to balance that out, at least occasionally? Please correct me if I'm wrong (and or virtually throw something at me!)

HbA1c shouldn't be seen as the measure of perfection. Unfortunately, it's the only tool we are measured against, but it is a blunt tool. Don't strive for perfection on the HbA1c at the expense being hypo frequently & your hypo awareness - living without hypo awareness is a frightening pain in the ar*e! It's easy to ignore the risks of being hypo, because they are much less well researched than the risk of running high. But know that an increase in your HbA1c from 4 to 5 won't cause any significant increase in the risk of complications (according to DCCT).

 

[noblehead]

However I did not feel it half as strong as the last one. Surfing the low 4s to high 3s for quite a lot of the day must have lowered the feeling threshold.

Hence why consultants are concerned when HbA1c's are too low.

@noblehead the tubeless Omnipod is the main reason I am aiming for it, that and no pump clipped onto a belt. I still avoid jabbing if I can, needle phobia must be lingering more than I hope. I had one bad experience in public where I tried to jab before a meal, not in the loos for once. But and the needle stung before it got in all the way, I was red, sweating all over and could see people looking, no fun. So yes back to the loos I go if its essential when I am out. So having something inserted once rather than 5 times a day would definitely make me feel a bit more free.

Sound like your still quite anxious about injecting, being tensed up will make it all the more painful and unpleasant.

The pods have a automated cannula insertion which is quite painless and yes you only have to change it every 3 days unless you have a problem like a blocked cannula or a pod failure, you don't have to carry the PDM around with you all the time as the pod is pre-programmed with your basal rates, so if you occidentally left home without it you would still be receiving your basal insulin but wouldn't be able to bolus for meals.

Overall it's a good pump but I would encourage you to look at all options, each pump has their pro's & con's.

 

[ElkBond]

Can I ask if you have been having a lot of hypos? Where is your low alert set on your dexcom?

4.7% = an average blood sugar of 4.9. If you are spiking up to 8, you must also be dropping below 4 to balance that out, at least occasionally? Please correct me if I'm wrong (and or virtually throw something at me!)

HbA1c shouldn't be seen as the measure of perfection. Unfortunately, it's the only tool we are measured against, but it is a blunt tool. Don't strive for perfection on the HbA1c at the expense being hypo frequently & your hypo awareness - living without hypo awareness is a frightening pain in the ar*e! It's easy to ignore the risks of being hypo, because they are much less well researched than the risk of running high. But know that an increase in your HbA1c from 4 to 5 won't cause any significant increase in the risk of complications (according to DCCT).

I had the low alert set to 4.2 (it's higher now) and I very rarely spiked to 8 - that was the highest. Most days the biggest food spike is 6ish, then a slow trickle down to the 4s. I very rarely went lower than 3.8 (Dexcom helped) so in fact I've only had a few true hypos where I felt it, maybe two this month. If I was doing anything like running/ driving I would always get my levels in the 5s before I carried on. But when lazing about, I would be low 4s until the beep. It's early days, still getting the hang of it all. My mindset was 'the lower the better' and there's talk of people keeping it in the 4s here so I thought nothing of it.

But now it will be a slow trickle to the 5s! I have lowered my basal. It was one of those things, it was happy and stable ticking away in the 4s so I kind of got used to it. I still test before/ after every meal, and on wake/ sleep. I have kept it in the 5s since my review actually (5.2 currently, just checked as I am off to bed).

@noblehead yes needles are still a pain but never mind. I have/ will keep looking at other pumps, I have a long wait anyway

P.S Apologies for the bad grammar in last post, that one slipped my pre post check!

 

[catapillar]

Just remember that a normal (non diabetic) blood sugar CGM line will not be always in the 4s - they peak & trough too, just gently, like how it sounds you are doing. I'm glad you are not having too many hypos.

Have you had a cpeptide test? I just wonder if they will let you move to a pump while still honeymooning, do you think you are still producing some of your own insulin?

 

[ElkBond]

@catapillar I am definitely producing my own insulin, I went from 18 units to 10 in a week of so. One minute I was still a bit high followed by non stop lows for half a week, took the basal down myself. That was maybe 2-3 weeks after my diagnosis.

I thought that, but the consultant knows I am still on the honeymoon period and was happy to refer, we will see. If I have to wait, I will wait. I am good with the numbers so I know I could cope.

Funny you should mention that, my girlfriend has just trialled a week of my dying dexcom transmitter, some foods took her to 7.8. There was a fair few bumps up after a drink or fruit or something. It was good to see. At rest the Dexcom was adamant she was 4.8 (usually 5.0-5.2 when we occasionally checked).

 

[catapillar]

I think I would just be worried that an erratic pancreatic function would make a pump more difficult to manage. But it does sound like you are more than capable of overcoming a few difficulties.

I can understand why a pump would be desirable with needle phobia (cruel combination). Have you looked into iports to make injection less of a struggle - http://www.diabetes.co.uk/diabetic-products/iport-injection-port.html - I've not used myself, but they do look good.

 

[pinewood]

What needles do you use? It shouldn't sting when injecting NovoRapid. If you don't already use them, try the 4mm BD MicroFine Ultra.

@catapillar - my experience is that it seems to be somewhat easier for newly diagnosed patients to get pump referrals, even during honeymoon. I was "offered" a referral one month after diagnosis and at each of my follow-up appointments since, despite definitely still being in the honeymoon phase. I've turned it down as I'm okay with MDI for now and don't like the idea of the pump being attached to me, but it's good to know that the option is there.

 

[ElkBond]

@catapillar I would have thought the opposite to be honest, being able to adjust insulin as the pancreas changes sounds much more bearable than a fixed basal. I have seen an iport but my phobia (although initially very afraid) is not bad enough to warrant that I don't think. I get the needle in, just not so good at it in public.

@pinewood Yes I do use the 4mm, I have very little chub so they were recommended to me. I must just keep hitting a folicle or tense up like @noblehead mentioned.

 

[CarbsRok]

I am personally looking into an Omnipod (suppose it could match my other Dexcom pod!) but we will get to that later. Any pump users who want to recommend theirs to me fire away, it will no doubt take a fair while to sort all this out.

Why not go for the vibe you don't have to carry your Dexcom receiver around with you then as it's incorporated with the pump?

 

[ElkBond]

@CarbsRok I have the G5 so I only need my phone and the vibe only works with g4.


Sent from my iPhone using DCUK Forum mobile app

 

[catapillar]

They reckon Omnipod will have a dexcom integrated PDM by the end of the year.

Although, I think they were saying that this time last year...

I've got a saline filled Omnipod on at the minute (having a dummy run to see if I can commit to it for warranty period). So I can't say anything about the functionality. But insertion was easy & painless - you press a button on the PDM so have no responsibility for putting the cannula in, which I really like because puttin my dexcom sensor in turns my stomach. The pod is tiny & I have genuinely forgotten it was there until I'd finished the first two lines of this post!

 

[CarbsRok]

@CarbsRok I have the G5 so I only need my phone and the vibe only works with g4.


Sent from my iPhone using DCUK Forum mobile app

Ah ok, I have a smart phone and it's out smarted me lol I hate the ruddy thing.

 

[ElkBond]

@catapillar Oo dexcom integration would be awesome. Although, what exactly does it do, for example on the animas, does it respond to the readings? e.g. if you are low it will slow / stop basal for a bit?

How are you finding the trial, I haven't heard myself anything yet (its been less than a week, calm down!).

@CarbsRok God everything I need is on my phone (don't care for social media though). My lights, glucose readings, alarms.... etc - they are definitely smart nowadays.