high HbA1c

[Beenie1]

Hi guys, i am very new to this but i need a bit of advice.

I am the only one in my family with type 1 diabetes so i can't really talk to them about it as they don't really understand what is going on. Today i got my HbA1c level back and it is over 14, which was absolutley devastaing to me as i have been working so hard with a dietitian and increasing my monitoring dramatically. I have always exercised regularily, i'm not a regular hypoer and i'm not over weight so i do not understand why it is forever going up. I was diagnosed 3 years ago and never really got to grips with it in the begining and then the hospital lost sight of me and i was without care for 2 years. I have moved hospital now due to moving cities and over the last 6 months have been improving my ways majorly after been told i had the beginings of diabetic retinopathy - that scared the life out of me! i don't know what to do so if anyone has any good tipos for me or general advice i would much appreciaite it. i exercise several times a week and eat low GI - but i am stuck and feeling very very low about this so if anyone can help that would be great?

thanks,

Beenie

 

[RussG]

Hi Beenie,

I'm sorry you're having such trouble. Do you mean that your HbAlc was 14%, i.e. an average BG reading of 23mmol? Have I understood right? Obviously this is very high.

If that is the case, without seeing some of your readings, it's going to be hard to say anything specific but the obvious conclusion is that your insulin doses are insufficient for your diet and exercise. Can you share some of your numbers with us (i.e. fasting readings, pre and post meal readings, insulin doses and carb contents for your meals) and we can see what advice we can give?

What has your consultant said is the problem?

 

[Beenie1]

Unfortunatley it is 14%. i'm on a 1:10g carb in the morning and 1.5:10g carb in the afternoon of my novarapid. On average my morning sugars are between 6-9 and lunch i'm nearer 12 before and similar with dinner then usually about 8-9 at bed.

My after dinner measurements are a bit higher probably in the 20s most times but i check an hour after dinner and i have been reading on other threads that it is best to inject 20-30 minutes before you eat as opposed to when you eat as food is absorbed quicker than insulin so that might be one reason they are high after food as when i have tested previously with individual foods i am injecting the right amount for each item. Sometimes i dont get chance to sit with a meal during the day as i am a final year med student and end up running from clinic to clinic to surgery eating small bites of a sandwich or rice salad and so my sugars can get up to 28, but that is not very often.

I have only just moved to this new hospital and they forgot to send me my appointment in august so the next appointment available was this wednesday, 23rd Novemember. i am also going on a DAFNE course in 2 weeks so hopefully that will help but if i have had diabetes for 3 years i don't know how easy it will be to break, i'm sure, any bad habits?

Beenie

 

[Beenie1]

i would say that generally i eat a wheat cereal in the morn with skimmed milk and i weigh my food so depending on the weight i work out carb content and inject one unit to every 10g carb, lunch is generally a salad, lentil soup or brown bread sandwich and dinner is usually wild rice, basmati rice or noddles with fresh veg and chicken or fish. i snack on fruit or riveta or fruity cereal bars but use the packet as a guide to my injection. exercise wise i tend to do a mixture of hour work outs , hour to hour and half exercise classes and a 3-6 mile run per week so i exercise 5-6 days a week. i dont drink most nights and if i do its gin or dry white wine and if i have a sweet tooth i have a hot choc or dark choc as i hear its better for you?

my life summarized ha

Beenie

 

[noblehead]

Beenie,

Hopefully the DAFNE course you are attending in two weeks time will put you on the right track to improving your Hba1c.

Nigel

 

[Fallenstar]

Hi Beenie
What Basal insulin are you on and at what dose? Maybe this needs to go up?
They don't sound like too bad a level really before meals and morning not too bad...not bad enough to have a Hba1c of 14 , so you must be having a post meal spike a lot, or nighttime highs.

Do you test during the night to see what your profile is then? The best time to check are pre meal ,then two hours after food to see how that food has effected your BG, obviously before bed and if you can on occasion during the night to see what is going on in your sleep.
Test like this for a week/ ten days write the results down and see what pattern you get.

Take these results on DAFNE (which will be great for you) and they will give you plenty of help to work out your dose adjustments for food, and correction ratios for if you are running high if you are eating irregularly at work, correction doses are invaluable to get good control.

Try not to worry too much about falling out of the loop, it happens but it sounds like you are on the right track now, it will get easier and you will get on top of it soon with the help of your team, use them , that is what they are there for

Good luck and let us know how you go on with DAFNE

It sounds like your diet is good and exercise brill, just need to get your doses right by the looks of things

 

[Beenie1]

thanks guys you do not realise how much your input is helping me. i have tested my sugars a few times in the night and they are quite high, but i always thought nothing of them as my levels are ner normal in the morn but obvioulsy that is something i need to work on. I inject 10 units of levimir in the morning and another 10 at night before i go to bed, so maybe it would be worth looking at that? i will keep a close look at my levels and bring them to DAFNE, i don't know much about DAFNE so i am hoping it will be a great kick to help me on the right track i just hope that i haven't done too much damage now, it freaks me out to think that i might have and wont realise until years down the line! when there is nothing i can do!

thank you for helping me guys

Beenie x

 

[Snodger]

I would bet that with some support from dafne tutors you'll be back on track pretty quickly, because you sound like you have a really positive attitude and you are already doing lots right -it's almost certainly just a question of upping your ratios and your basal dose, which they'll help you with on dafne. You may need to bring your HbA1c down gradually, so go into it with the attitude that it's going to set you off in the right direction rather than as a magic bullet.
As for 3 years of 'bad habits' - from what you describe you are doing all the right things, no bad habits, it's just a question of getting the dosage right. So you should get a lot out of it and I really wish you lots of luck.

 

[AMBrennan]

My after dinner measurements are a bit higher probably in the 20s most times but i check an hour after dinner and i have been reading on other threads that it is best to inject 20-30 minutes before you eat

Sorry for putting this rather bluntly, but BG shouldn't be at 20 even if you test after one hour (guideline for pregnant women is < 7.8 mmol/l after one hour). I'd strongly suggest increasing your dinner Novorapid dose unless the tests two hours after a meal are low (<9 mmol/l).

Sometimes i dont get chance to sit with a meal during the day as i am a final year med student and end up running from clinic to clinic to surgery eating small bites of a sandwich or rice salad and so my sugars can get up to 28, but that is not very often.

Again, obviously eating without taking your insulin is not a very good idea. If you really cannot spare the time to inject, have you considered not having a snack? Based on your fasting BG reading (high-ish) I don't think that you'd be particularly at risk for having a hypo if you skipped lunch.

 

[phoenix]

Tou obviously are well motivated to change things and you are on the right course, improving youe diet and you are already exercising . The DAFNE course should help you with the remaining bit of the puzzle; understand how to use your insulin efficiently. I'd just like to emphasise Snodger's remark that you may to bring your HbA1c down gradually.
This isn't just to make adjustment easier or a psychological thing, it may be better for your eyes to take this downward adjustment slowly.

 

[david.bligh]

I was very much like this. I've had diabetes now for a similar amount of time, though the DAFNE course really helped. I think that can only do so much though.

Only after doing Weight Watchers did I really start to see just how much I was snacking. Stupid things like a quick biscuit, or drinking a mouthful of coke because there's nothing else in. It's easy to think that you over compensated earlier so it's ok, but it isn't.

That was my issue anyway, and my hba1c has come down loads. The real point to this is write down EVERYTHING as only then will you really see what's going on.

Quick thing before I press submit... Low GI food is great, but unless you know your ratios are 100% spot on, all your going to do is mess up your sugars not anticipating the long rise that they can cause.

Good luck. Let us know how your course goes