Need Advice on Lowering Hba1c

[kitsunerin]

Hey everyone! I am needing surgery and after a discussion with the surgeon, he said he needs my hba1c to be under 70 and preferably under 50 in order to go ahead. My most recent one was 78 and I need to lower it! I'm type 1 by the way!

My blood glucose always run high no matter what I seem to do. I think I am scared of hypos so much I try to avoid them as much as possible. I am due to go on the DAFNE course next month because of my problems with recording BG and also taking insulin.

I have avoidance personality disorder and am having therapy for that, trying to get myself used to the idea of checking sugars more and taking pills on time.

What can I start doing today to lower my hba1c? I know my op will be postponed because of my high score, but hopefully I can get it down.

I'm at a loss and I would really love some advice, even if it seems obvious ;; Thank you!

 

[Deleted Account]

Can you give us some information about your diabetes treatment?
Do you follow a basal/bolus regime?
How do you decide how much insulin to take?
Do you carb count?

Sorry for all the questions. Don't worry if you don't know or don't do it... the DAFNE course should help and we can give you some pointers.

 

[SallyEzra]

Sorry to hear you are having a bit of a worrying time. It is great that you have a DAFNE course starting next month because I am sure that will really help. I learnt all that stuff 30yrs ago when I was diagnosed, but attended another course a couple of years ago and it was so good to refresh my understanding & bring it all back front of mind.
I guess just making sure that covering the basics of making sure that the insulin is going in when it should & testing your blood sugar before taking insulin, so you know if you need to adjust it upwards/downwards, plus controlling your carb intake will help ensure that you are in the driving seat to control your Hba1c.

Why are you so fearful of hypos?. Have you had a particularly bad time with them in the past?. I only ask because I currently also have a fairly significant issue with my latest Hba1c, but for me it is because it is far too low, in fact the consultant giving me the feedback explained that he had never seen a Hba1c that low.......it was 15, so living with & managing hypos had become my world in recent months & whilst not the best quality of life, hypos can be managed. I am pregnant & have a very very odd reaction to pregnancy - it lowers my blood sugar significantly. Fortunately however this is my 2nd pregnancy so I expected it and am not like a rabbit in headlights this time around!.

 

[kitsunerin]

Hey guys! Firstly I am on 32 units of lantus a day and I am doing 10:1 carb ratio with humalog, but I think it may change throughout the day.

As for fear of hypos, I ended up in hospital a few times because of it, as well as for ketoacidosis where I was in a coma for three days in another country. So I have had very negative experiences and I guess because I have some mental health problems, the fear is still there.

I try to do low carb but because I am disabled my house mate cooks for me a lot and although I've told him multiple times, he still makes high carb meals or gets takeaway. I know I need to be more firm with him though.

I'm really looking forward to DAFNE! When I was diagnosed in 2003 I didn't get taught much as it was in a small Welsh hospital that didn't even have a dedicated diabetes unit. I was taught to take insulin for sugars, not carbs which I am certain led to me becoming very ill.

I only actually found out that I am supposed to count carbs two years ago, which is ridiculous. I am trying to still come to terms with my diabetes even now. I struggle a lot and I've been avoiding diabetes resources for well over a decade.

 

[EllieM]

IN theory you can have high carb, but you do need to be able to take the right amount of insulin for it by carb counting. Do you have a correction dose as well (eg I take 1 unit of humalog for every 2 mmol/L that I want to reduce my blood sugar). Most people on lantus and humalog take about the same number of units of both, so I'm suspecting your 10:1 carb ratio may be wrong (unless you're taking 300 carbs a day).

I suspect your HbA1C will come down drastically once you've done the DAFNE course but there are other things you can do to help with hypos. Can you ask for a cgm (continuous glucose monitor)? You could set this to warn you if your blood sugar went too low.

 

[SallyEzra]

It sounds to me like you are on a really positive new wave of learning in diabetes care, which I am sure is going to serve you well. EllieM above, has given some really helpful advice on insulin & carb counting. And your knowledge around carb counting will only get better via the DAFNE course. On the last course I attended, I really appreciated being given some guidelines for estimating carb content by looking at the plate and when you haven't been able to pre-weigh everything. And I am guessing, for you, when someone else has been cooking, that this is the sort of thing that may really help. So if it is not covered off on your course, make sure you ask the question.

I do very much understand the fear of hypos. I had some rather extreme hypo situations in my adult life when I was transferred onto Lantus from my previous basal insulin. After a few months I was fortunately temporarily then shifted onto Tresiba, which was more reliable for me, until I could be put onto a pump with Novorapid, which is an insulin I know how I react to as I have taken it for the majority of my adult life. At the time, I had to invest in a private diabetic consultant who tracked my response to Lantus, which for some reason, in my body had an absorption rate that didn't at all coincide with what the drug company advised it should be. So relieved that this is now all resolved, because, like you say, those extreme hypo memories can persist!.

Are you taking regular blood sugar tests at the moment, pre-DAFNE, so you can get an idea if your blood sugar is sitting closer to the zone you need it to be in for your surgery to go ahead?. If you are & your blood sugar was higher than it should be, the conversion rate that EllieM gives you above is usually the starting point to correct it with your Humalog insulin - so one extra unit of Humalog for every 2mmol you want to reduce your blood sugar by.

Best of luck with it all.

 

[ringi]

You have done the hard bit, admitting you have a problem, and starting to take action.

Ask your diabetic consultant about getting a CGM with alarms, so that an alarm goes off before you get low enough for a hypo. The NHS does not like spending money on them as they are expensive, but with your avoidance personality disorder and fear of hypos I think it can be justified. (Remind him/her that a giving you a CGM will cost them less than a few days in a hospital!)

Once you have done your DAFNE course, if possible, pay for a FreeStyle Libre for a few weeks so you can better understand your BG.