Hb1ac

Well done on improving your HbA1C by so much! That's amazing

For me, I find that I have to keep a pretty strict eye on my sugars else my HbA1C will creep up. What I found reduced mine was focussing on spikes after meals. I corrected initially, but then looked at things like doing my bolus earlier to help control the spike for that meal in future.

I also looked out for sneaky highs during the night or early morning, and I adjusted my basals for those.

I don't know if that helps, but I find it's just constant monitoring that does it. If I relax that too much, my level rises.

Good luck

Fayefaye1429 said:

hi wondered if anyone might give me some tips.

History: the in the past around 2006 my hb1ac was 12.8 then I got on a pump and got to 7.4 which was amazing! However since then even with good diet, check my blood sugars up to 12 plus a day and correct basal to it or situation I still can't get it down.

Why do I want it down? I need to for my eyes according to my last eye test I have danger of one eye having major issues. My eyes are my vital item so I am determined to get them better. Also to be honest sport control is a nightmare and I have tried all suggestions from hospital and forum. I just can't get it to stay at about 7. I can now control it for illness and period days which was a nightmare so yay!! Basically anyone has any tips as my Hbc this week was 7.4

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Have you asked your diabetes team about a loan of a CGM for a period?

There are several pump users who have commented on the difference the Libre has made to their control, because of the virtually constant monitoring of their sugar levels. Some have reported on unexpected rises (and sometimes dips) in the sugars many hours after eating certain foods. From memory, rice and pasta showed "interesting" patterns. Based on that information, they have been able to adjust how they set their pumps to operate around those meals/foods.

As a curious T2, I am obviously have an interest in all things diabetes, but I wouldn't for a moment suggest I have any real knowledge or deep understanding of split bolusing or the other techniques I hear discussed.

The Libre isn't a cheap option, but it's cheaper than traditional CGM systems as far as I understand. I'm guessing some of the decision making around that would be based on your budget, which only you would really understand.

I wish you well with it all.

Fayefaye1429 said:

Thank you for your comments. I have a very close eye on it, sometimes I wonder if too much? I am starting with a new diabetic team this month so my plan is that Donnelly dogs has kindly helped with is to try and prove my need for a c g m permanently but I am aware I am limited. I am hoping to get otherwise I am so lost. I did get offer one for a week however it's was a non responsive one and it sounds odd but comes from a company that I had a very bad experience with to the point it caused a massive problem to my health so I won't touch their products. I hear the libre is good but not much different price wise dex com

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If you do a forum search, numerous people have done longer term 2/3yr if I recall correctly, on "traditional" CGM versus Libre. The major, major difference that hit me, when I read those thread (I'm an avid reader), was that the Libre startup costs are a fraction of those for Dexcom or the like. Libre is about £130/140 for a reader/meter and two sensors, so that's the first month covered, then the sensors equate, including delivery, c£100 a month. The Dexcom reader alone runs into four figured, as I understand it, so you can see how the differences are stark in the early days.

From memory @tim2000s had done a lot of thinking, researching and documenting about this. He may be a better guide towards appropriate reading than me. As a T2, my objectives and needs are quite different to T1s.

Thanks, in anticipation, Tim.

Thanks @AndBreathe .

Hi @Fayefaye1429 - CGM is a little tricky on the NHS, as really the only way to prove that you need one and can get it funded is if you have no hypo awareness. It is not considered a necessity by any hospital, full time, otherwise.

This is principally because the studies that NICE uses to assess therapies and technologies have not shown long term benefits to users of CGM that are clinically significant when compared to finger prick testing. You will therefore need an extremely compelling case that includes hypo unawareness to get it through your CCG.

What you haven't said in your earlier comments (and I'm afraid I can't recall all your posts on the forum, so I don't know the answer to this) is how you are managing what you eat. Many of us (me included) have found that signficantly reducing our carb content has had a significant impact on Hba1C as well. I do a lot of exercise and sport and eat typically less than 70g of carbs a day. It has made managing the variation of my blood glucose levels much easier, and alongside the libre has meant control is a lot better.

If you have questions in terms of costs, then take a look here: http://www.diabetes.co.uk/forum/threads/cgm-fgm-price-comparison.75106/

It gives a reasonable explanation of what is possible. It may also be worth seeing whether you can get your pump switched to one which is CGM compatible, such as an Animas Vibe or Medtronic 640G. Certainly the cost of CGM is lower with the Vibe.

There is also discusison of NICE guidelines for CGM in this topic: http://www.diabetes.co.uk/forum/thr...elines-its-quite-revealing.79529/#post-887895 and a couple of contributors have mentioned getting it themselves, including @yingtong who may be able to assist you with your case. Bear in mind that they have lost hypo awareness though, and this is a critical part of the case.

Fayefaye1429 said:

Libra vs dex I emailed both asking for the prices the difference was only a 100 or so I found but I will definitely look into it all. I feel I need a monitor which I know the dex does that could help me through sport. i wonder if I apply and ask the nhs to buy the monitor only and I self fund the rest whether it could be possible? I am just out of ideas now

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Faye, I'm not quite sure what you are asking about, from Dexcom and Abbott, but the first year cost of a Libre is around £1290, while, even if you get two weeks out of a sensor on the Dexcom, it costs about £3,000 for the first year.

What do you mean when you say that you "need a monitor which you know the Dex does"?

That is a terrific reduction in Hba1c @Fayefaye1429........well done

Have you looked at Runsweet for suggestions on how to adjust your insulin when exercising, its a really good website and was set-up for people like yourself who have type 1 diabetes and enjoy sport:

http://www.runsweet.com/

To get your Hba1c down further do look at your basal rates and make sure they are right, like @azure make sure your night-time basal rate is correct as this represents a good third of our day and if you get this right it will go a long way to improve matters for you, once you get that sorted you can then look at doing basal checks throughout the day and work from there...... in other words start from the basics as you would on MDI.

Just one other thing, if you've recently been told you have retinopathy you need to be careful when lowering your Hba1c further, any changes should be done slowly and you should discuss this with your diabetes care team and Ophthalmologist, it's said that sudden tightening of bg control with retinopathy can make matters worse so do be careful.

Hi Fayefaye as tim2000s has said I have a CGM which is funded,to get this it took 12 months of battles with the backing of my Endo and DSN.I was able to prove cost effectiveness as I have no hypo awareness whatever,though I had very good B/G control and I had tried every way to get my hypo awareness back.I would still give up my Pump and CGM if I could get my hypo awareness back.I have been type 1 for over 52 years.

@Fayefaye1429, there's a good explanation about sudden lowering of Hba1c and retinopathy progression in the following, but as you will see although they do give a precautionary warning it does say the long-term benefits of a good Hba1c are huge when it comes to eye health:

http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm