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HBA1c on pump

Discussion in 'Insulin Pump Forum' started by searley, Aug 29, 2021.

  1. searley

    searley Type 1 · Moderator
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    So, im just a couple of weeks away from being on the pump for 12 months, and im not going to lie its not been easy, but a few days ago i had a hba1c done which came back at 47 to which i was happy as previously my lowest has been in the 60's

    now i look at my bg reading over the last few months and see area's i could improve, and im thinking i should set myself a new hba1c target of say 39/40..

    id like to know what other pump users are getting and what they aim for... should i be happy with 47? am i being unreasonable to want to push a little further?
     
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  2. Antje77

    Antje77 LADA · Moderator
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    Depends.
    You should definitely be very happy with your 47, amazing improvement!

    It's not unreasonable to want to try for a lower hba1c, but only if doing so doesn't negatively affect your quality of life. Working harder on your diabetes than is good for your mental health isn't a good thing and can easily lead to diabetes burn out.

    However, as long as you feel happy working on improving your time in range (or lowering the top end of your range a little), yes, by all means do!
     
  3. Juicyj

    Juicyj Type 1 · Expert
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    That's a massive improvement - personally I never set a target as I think that it takes so much effort daily to stay on the tightrope that getting my HbA1c result could lead me to either feel elated or depressed having made all the effort, I also don't feel the HbA1c is a true reflection of my control as i aim for stability with my levels as much as possible so I just work on time in range, and I aim for 70% each week. I remember getting 43 once on the pump and then having to deal with the NHS feedback saying they weren't happy with it as it 'obviously' meant i'd been experiencing alot of hypos to of achieved that. Personally I think it's finding what works best for you and what your comfortable with.
     
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  4. In Response

    In Response Type 1 · Well-Known Member

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    Great improvement @searley
    I do not have a HbA1C target because the justification for my pump was to minimise the swings. So my HbA1C has not changed much but my time in range has greatly improved.
    I have been lucky to have a HbA1C in the low 50s or high 40s for the last 10 years whilst I have been pumping for about 5 years.
    The pumping years have definitely had far less hypos and exercise has been much easier.
     
  5. searley

    searley Type 1 · Moderator
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    ok

    I've used time in range targets of 4 to 9.5 and average 80% in range

    I was just thinking if I could improve the 20% out of range. and instead of sitting 7+ most nights get that a little lower

    I still consider myself new to the pump even though I've had it for a year.. but since having it I've not seen anyone in relation to my diabetes so I don't even really know what the expectations are for me to continue on the pump


    so maybe it's just more sensible to try and maintain what I have...
     
  6. Antje77

    Antje77 LADA · Moderator
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    If you're not having nighttime hypo's, this sounds like a managable plan. :)
     
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  7. himtoo

    himtoo Type 1 · Well-Known Member
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    such a difficult question to answer because we are all different and live different lives ........my A1c has been between 5.7% and 6.3% for quite a few years now but i also am retired and don't have work stress ...........i don't set a target ... i just try to look at myself on a day by day basis and do the best that i can
     
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  8. EllieM

    EllieM Type 1 · Moderator
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    Not a pump user but I do have a dexcom. My only hesitation would be that you don't want that lower hba1c to come at the expense of having more hypos, since it's scarily easy to lose hypo awareness if you have too many. I like @Juicyj 's policy of just doing the best you can day by day, but if you want to go the target route then go for it. (Personally I would love to get below 48, though I know my clinic will whinge about hypo awareness if I do. ) Congrats on an awesome result.
     
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  9. Chas C

    Chas C Type 1 · Well-Known Member

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    Mine is currently 45, at my last review I was advised to take care and watch hypo's (even though I was not having issues). They told me that a level of 45 was expected for non diabetics and my GP mentioned that too. So over last 18 months with t:slim and Dexcom I've dropped from 47 to 45 with no real extra effort (personally I think the night time setting has taken care of this for me). My target levels are 4.1 to 8.1 with a target BG set at 6.1 on pump. You have done really well but I'd think that aiming for 39/40 might be a bridge too far ?.
     
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  10. searley

    searley Type 1 · Moderator
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    GP also said to me I was risking hypos.. but I have dexcom and it actually alerts me at 4.5... so I know I'm not having hypos... in fact nights are my worst time where I average about 7 over night
     
  11. Chas C

    Chas C Type 1 · Well-Known Member

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    We are all different as mentioned by @himtoo, we can offer advice but all based on our own personal experience which might not fit your lifestyle. I don't recall the pump your on but the night time mode on the t:slim is just perfect for me.
     
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  12. Chas C

    Chas C Type 1 · Well-Known Member

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    Just saw on FB your on t:slim too.
     
  13. searley

    searley Type 1 · Moderator
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    yes tslim I use night mode but my body seems to battle it... I will creep up the basal slightly... but from what most are saying 47 seems quite good so I will work on maintaining that... improve the few spikes I do have.... and be happy that this last 12 months has been the best controlled I've been for many years

    my only real problem was I've been on the pump for a year and not seen anyone since started... so never really discussed long term goals and expectations
     
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  14. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    I'd be very chuffed with getting into a range at which complications are far less likely. I'd still probably be trying to get it even better but it depends on why it is out of range e.g. poor bolus timing, miscalculation on carb ratios? stress or illness?
    Hopefully you can make more use of the insulin delivery features like extended boluses or a tweak of the basal if you can spot a pattern?
    My pump and cgm system works brilliantly when it works well but by day 3/4 seems to get tubing fatigue and throw my time in range figures out of kilter.
     
  15. searley

    searley Type 1 · Moderator
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    pre a d extended is somewhere is need to apply a little more effort
     
  16. Chas C

    Chas C Type 1 · Well-Known Member

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    So this is something I'm always doing, pre delivery and extended. Takes a bit of thought to get right and adjustment too. I started with a 20min advance dose of 30% with remaining 70% spread over 75mins. Did this for a year or so then started to adapt to suit food type, exercise (pre-post meal), pre meal BG's (although was doing that in first years - if low then no upfront but adjust instant dose vs delayed), illness. It works really well for me.

    One other thing I have found is that if you do a straight correction insulin dose the pump suspends CIQ for about an hour, however if you use a Carb dose to apply the correction insulin then CIQ carries on working, although you do need to take this into account when looking at history and total carbs. Also you can apply carb doses (either for correction or food) during an extended bolus (but only as instant - not extended) then the original extended carries on as it was set.
     
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  17. searley

    searley Type 1 · Moderator
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    my issue with pre bolus if i go anywhere before 8 minutes before meal.. sometime shorter im hypo by the time ive eaten so very often leave the bolus until right before i eat....... sometimes i prebolus but split it so 30% 10 mins before. 70% over 36minutes this often works out

    ive found the same with corrections so i either take more insulin... or lie and say ive had food

    think i will continue playing, and improving where i can.. and be happy with an hba1c below 50 :)

    but its nice to know what others do
     
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  18. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Thanks. I will find that button and use it (pre bolus that is). Seem to be having major tubing fatigue with my t slim soft 90mm tubing and quite a lot of delivery issues but sticking with it for the lovely steady sugars I get (Dexcom) when it all works!
     
  19. Chas C

    Chas C Type 1 · Well-Known Member

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    I do the same if I think I'm going to go low, even sometimes if bit too low, eat first then bolus with extended sometimes with no pre-bolus too. Really depends on what I'm eating, where my pre-meal BG's are heading etc.
     
  20. Chas C

    Chas C Type 1 · Well-Known Member

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    @NicoleC1971 its on the bolus screen, when you get to the screen headed Deliver XX.XX n Bolus ?, select the extended button, then you can set how much you want immediately and how long you want the rest to be delivered over. Follow all the screens and don't forget the last one to confirm delivery otherwise you'll get a beep 5-10 mins later saying bolus not delivered.
     
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