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HbA1c tips and advice?

  • Thread starter Thread starter Deleted member 99915
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Hi,

Just hoping I can get a bit of advice from anyone who has alot of experience managing type 1 or a spouse of someone who is type 1.

My girlfriend is type 1 and has been for several years. Shes been through the dafne course and all a while back and she always seems to manage her insulin levels quite well when we are together. But theres particular times during the day when she notices her sugars fluctuating more and as such giving her higher than average levels. Obviously because of this shes having trouble getting her HbA1c down. With two tests in 3 months coming back around 10. Obviously these are approaching high and have understandably upset her.

I was just wondering if anyone had any advice or tips they use to get an improvement on their HbA1c when they have higher levels than they would like.

Or day to day advice even. Obviously she knows quite alot about it all having been diagnosed a good few years back, and I know nothing lol. Im just hoping there is anyone on here with even more experience than her managing it who would have advice?

Also is there anything I could be doing to help her improve her daily levels and HbA1c by extension?

Thanks
 
Hi, what kind of diet is she on?
what kind of numbers does she have on waking,before a meal and 2 hrs after, is she on any other medications,
with more info we should be able to help you
 
Diet im not sure, just normal. no particular dietary adjustments as far as I can see compared to what I would be like. On waking she is usually around 6/7s with the odd higher towards 11. She would have her levels under control prior to meals around 7 again and 2hrs after around 9, obviously depending on what she has ate. Breakfast and lunch usually seem to be fine and that would be when shes at work, its more towards the evening, dinner time when she notices her levels getting away from her. There are times in the evenings when she would acidently have a nap which mabye you could tell me if its bad. She would tend to go to sleep quite late at night also normally between 1&2 if that would make a difference, though as far as I know she still keeps her sugars good til then. She isnt on any other medications I dont think, what kind of medications could have an affect? She sometimes takes supplements, like cranberry for example, could this be having an effect?

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I don't think the nap in itself is bad it's not going to raise her blood sugars, and won't lower them either particularly - I think the thing with napping is maybe to watch out that she isn't hypoing in that - but then if her sugar level starts to go high in the evening that could be unlikely, maybe she needs to look at her insulin injections and speak to the nurse at the hospital and explain that to them what's going on and talk about the evening rise and see what they think as they should have the full picture. If she goes to bed high and then drops down to 7 over night maybe she is spending a chunk of the night fairly high but that is all guess work and just ideas - I'd speak to the hospital and just explain the issues and see what they advise, and then hopefully she can get it down - testing lots (even some of the dreaded middle of the night testing) and making notes also helps (I know it is very easy to get bored of that quite quickly - but it will help give you a clearer picture, and help the hospital be able to advise you with a clearer picture too).
 
May well be that her basal insulin is running out and that is the cause of her higher bg readings later in the day. There's a book that I'd highly recommend called Think Like a Pancreas by Gary Scheiner, it's a fantastic read and has loads of advice and information to help your girlfriend get on top of her diabetes.
 
Hiya!

Sometimes when the levels drift up towards evening it's because the basal insulin is running out. If you only do one injection of basal a day, it might not be lasting the full 24 hours - Levemir is particularly prone to this although some people find the same with lantus too. I split my basal dose and take some in the morning and some in the evening to make it last the full day.

Also, the easiest way to reduce the HbA1c is to stop pushing your blood glucose up in the first place - that means reducing carbs. All carb turns to sugar and increases BG, so if you eat less of it, your BG doesn't rise as much. If your girlfriend eats lots of potato, rice, pasta, bread, cereal, she could reduce the portions of those right down - it makes a big difference. Unfortunately, DAFNE leads us to believe that we can cover carbs with insulin and eat what we like - it isn't as simple as that though and you make your life a whole lot easier by reducing those carb portions.

Smidge
 
Ditto what Smidge and Noblehead said. If she follows that advice, she will sort her levels out. By the way if her HbA1c was at 10%, but her daily readings are as she suggests then there is a mismatch somewhere. An HbA1c around 10% implies she's spending a lot of her day in the teens. Is she testing before and two hours after every meal?
 
Thanks very much for the advice so far everyone, its really appreciated!
Cheers for the reading advice too noblehead ill see if I can get her a copy and mabye have a read of it myself

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Hi samjb, thanks for the advice. She is testing before every meal im sure and im pretty sure she checks 2 hrs after when she can. While working during the week I know she finds it hard to check them after. I think in the evening is when she might be drifting into the teens and perhaps not checking them as shes not eating anything

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I agree that if she is on Levemir then splitting it can help as it only lasts 18 hrs max. Although I only take mine once a day I make up for it running out of steam by having more rapid insulin for the last meal of the day. I assume she does use both Basal and Bolus insulin and carb counts the number of Bolus units to inject?
 
She is definitely on levemir, so that could be a major part of the problem. Does anyone know if there are better alternatives to Levemir she could be on (I dont really know if they are interchangeable, im still kinda new to all the info)? Yes she uses both Basal and Bolus, and carb countd the units to take. I think she uses the carbs and cals iphone app as well as her book.

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When you say you take more rapid on the last meal would you not find that you would dip low? She uses, is it nova/novo rapid (cant remember the spelling)

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There is a new longer lasting insulin on the market (can't remember the name, but it lasts up to 72 hours) that some t1s have found really helpful and good…but again you'd have to go via the hospital to get all the advice on dosage and to be changed onto it.
 
degludec is the name - but splitting the dose might work too, again I would get advise on what to do and what doses as by injecting the levemir twice a day you will get a bit of overlap of the levemir so you might want to look at when you do the extra injection and all sorts like that - so have a chat with the Diabetes Nurses.
 
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