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Running out of ways to attempt to reduce my HbA1c - please help

himtoo said:
Hi there @tiredoftrying2017
just read through the rest of the topic and your replies--

some really great advice on advance bolus. extra testing is great advice too.

it is amazing all the things we can pick up from the forum -- you should not feel bad for not knowing something -- our medical teams are not really great at helping to educate us properly -- most of it is picked up by reading or trial and error.

being on a pump gives you the best chance of getting the reduction you're looking for.

your consultant just sounds downright nasty upsetting you like that -- nobody knows how hard we work at this every single day !!!

edited to add -- I normally test between 10-12 times per day and I am not even contemplating getting pregnant ( haha -- it would be a miracle ) :D
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Haha!! That would be a miracle!
You are right re: the consultant. I don't know any other diabetics so this is really helpful and I guess we become our own experts through trial and error. Forums are where to learn best practice and tips a non diabetic consultant would never understand!
 
Thank you @azure - yes definitely got some strategies to try out so have got some motivation back.

I think you all deserve a degree in diabetes management or a cut in consultants salary
 
Hi @tiredoftrying2017

I'm also trying to get pregnant. I agree with everything that's come before. I just wanted to say good luck. I also have a job that makes it hard to test. I have a libre and it's on 24/7 thanks to my work healthcare paying for it. Don't suppose you have anything like that where you work? It really is a massive help to head off unexpected rises or heading off a hypo before it happens.
 
SugarCyborg said:
Hi @tiredoftrying2017

I'm also trying to get pregnant. I agree with everything that's come before. I just wanted to say good luck. I also have a job that makes it hard to test. I have a libre and it's on 24/7 thanks to my work healthcare paying for it. Don't suppose you have anything like that where you work? It really is a massive help to head off unexpected rises or heading off a hypo before it happens.
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Thank you, that's really kind. Good luck to you too. Hmmm that's a really good point. I do pay for some kind of health plan but I'd never really thought about it. Will check it out
 
Hi @tiredoftrying2017 - I'd definitely recommend the FreeStyle Libre, as others have suggested - you'll certainly get a much better idea of what's going on, even if you only use it for a couples of weeks.

A couple of things spring to mind about your HbA1c - firstly, you say you're eating about 150g carbs per day - but was this also the case in September, when your HbA1c was 54? I ask because many people observe that low carb diets can cause high sugars, including myself - see my post here:

https://www.diabetes.co.uk/forum/threads/low-carb-but-high-sugars-advice-please.123659/

Secondly, what are your sugars on waking? If you're doing everything right during the day, and your HbA1c is still higher than expected, it's possible you're going high during the night; if so, this could have a marked effect on your average sugar levels, given your sugars could be high for 8 hours or so in every 24 - however, the Libre will quickly establish what's going on here!
 
Hi @Odin004

Thank you. I've never heard of low carb not being good for you so thanks. I've always been a believer in a balanced diet so will always have some carbs, I think I need to get the variance in my bolus timings right.
My mornings aren't too bad - last few days 7.8, 7.7, 6.1, 3.8(oops!)

Last year, I honestly can't put my finger on it. I wasn't trying as hard. Maybe I just need to relax!!
 
tiredoftrying2017 said:
Hi @Odin004

Thank you. I've never heard of low carb not being good for you so thanks. I've always been a believer in a balanced diet so will always have some carbs, I think I need to get the variance in my bolus timings right.
My mornings aren't too bad - last few days 7.8, 7.7, 6.1, 3.8(oops!)

Last year, I honestly can't put my finger on it. I wasn't trying as hard. Maybe I just need to relax!!
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No problem - a balanced diet is key, and it sounds like you have no problems there - getting the bolus timings right - and relaxing - will definitely help too. I'm sure you'll achieve your goals - I wonder if you could also switch to a more supportive consultant. Diabetes can be more of a stress than even we realise sometimes - the very least you can expect is someone who will fight your corner - not someone who makes you feel like a failure.
 
looks like u've gotten more than enough advice already, and i'm no expert ofc but i don't see why there would be any problem getting a baby? u seem to be pretty healthy..

..don't worry too much and just enjoy the getting pregnant practice ;)
 
j@mez said:
i don't see why there would be any problem getting a baby? u seem to be pretty healthy..
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Ladies with diabetes are advised to have hba1c under 48 before trying to conceive as high blood sugar can cause miscarriage and foetal abnormality, there are very tight blood sugar targets during pregnancy for the same reason. So experience getting blood sugars controlled, evidenced by hba1c in target, is going to be very useful in preparation for pregnancy.
 
Thanks @j@mez and @catapillar

That's what had been frustrating me so much, to the onlooker I'm a healthy person but I'd be going against medical advice.

Friends have said 'just try it, unhealthy people get pregnant and have healthy babies all the time' - Annoyingly this is true but I would never forgive myself if I knew I could have tried harder and there were complications. Also annoyingly everyone I know seems to be pregnant with the question "When are you having kids?" I politely smile and say not yet.. my real answer "You have no idea, I wish I was"


That said, because it is so unknown and stressful to get right I'm going to take one step at a time, make tweaks throughout September and lots of recording with the aim of having tighter control in Oct/Nov/Dec ready for my next HbA1c in Dec.

If back at square one will need to work even harder! (But will be pretty upset!)
 
catapillar said:
Ladies with diabetes are advised to have hba1c under 48 before trying to conceive as high blood sugar can cause miscarriage and foetal abnormality, there are very tight blood sugar targets during pregnancy for the same reason. So experience getting blood sugars controlled, evidenced by hba1c in target, is going to be very useful in preparation for pregnancy.
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OK, i'm not too familiar with what 48 or 69 means in terms of mmol so excuse my ignorance.. just looked it up and 69 is like 8.5 mmol on avg i guess.. bit too high but not that bad.. like other peeps mentioned, pre-bolusing & a CGM to monitor things might help to see where u peak and get the overall hba1c down

..i've personally never done any pre-bolusing either bc i'm always a lil worried taht i mess up with my food and then have 2 eat like 32 units worth of candy 2 make up for it ;)
 
tiredoftrying2017 said:
Thanks @j@mez and @catapillar

That's what had been frustrating me so much, to the onlooker I'm a healthy person but I'd be going against medical advice.

Friends have said 'just try it, unhealthy people get pregnant and have healthy babies all the time' - Annoyingly this is true but I would never forgive myself if I knew I could have tried harder and there were complications. Also annoyingly everyone I know seems to be pregnant with the question "When are you having kids?" I politely smile and say not yet.. my real answer "You have no idea, I wish I was"


That said, because it is so unknown and stressful to get right I'm going to take one step at a time, make tweaks throughout September and lots of recording with the aim of having tighter control in Oct/Nov/Dec ready for my next HbA1c in Dec.

If back at square one will need to work even harder! (But will be pretty upset!)
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never mind me, i'm an idiot ;)

good luck and all that jazz

♥
 
j@mez said:
OK, i'm not too familiar with what 48 or 69 means in terms of mmol so excuse my ignorance.. just looked it up and 69 is like 8.5 mmol on avg i guess
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No it's not. An IFCC hba1c of 69mmol/mol is the same as a DCCT hba1c of 8.5%, which equates to an average blood sugar of 10.9 mmol/l over the previous 3 months. So on average, blood sugars are sitting in double figures.

A hba1c of 48, which is the NICE target for all type 1s and is the target that ladies with diabetes thinking of trying to conceive are advised to meet, equates to average blood sugar of 7.8 over the previous 3 months and is the same as a 6.5% hba1c.

In contrast to having blood sugar levels, on average, in double figures, a pregnant lady with diabetes is advised to have blood sugar under 5.3 on waking and under 7.8 1 hour after eating.

Complications in pregnancy arising from blood sugar levels over those targets can include increased risk of miscarriage, increased risk of birth defects, high birth weight babies (which carries with it risk of a traumatic birth causing damage to mum and baby), neonatal hypoglycaemia (which carries with it risk of severe brain damage and death).

Things that can help with meeting the hba1c target would include:-
  1. Getting hold of "pumping insulin" by John Walsh so that you have the info to make pump adjustments yourself, rather than relying on the DSN to do this for you;
  2. Basal testing and adjusting basal dosage to suit you as needed - https://mysugr.com/basal-rate-testing/
  3. Reassess whether your insulin to carb ratio actually works for you with post prandial testing to see what's happening, here's a course with a refresher on carb counting - https://www.bertieonline.org.uk
  4. Consider CGM or libre monitoring to help with really seeing what is happening with blood sugars, as discussed, if you're testing 4 times a days it seems you're missing the peaks. You want to find out when those double figure are happening, is it after meals of is it overnight. If increased testing or continuous monitoring doesn't show them then you may want to get tested for anaemia and request fructosamine testing as an alternative means of monitoring average blood sugar in people whose red blood cells don't play nicely with hba1c tests;
  5. Increased monitoring will probably make you want to experiment with pre bolusing, here's an article discussing the use of pre bolusing to avoid post prandial spikes - https://www.diabetesselfmanagement....blood-glucose-management/strike-the-spike-ii/
 
Please get a libre, so you can understand how your food affects you sugars! It will make you a lot more confident to change the timing and amount of insulin you take. If you cant't afford one, ask your friends to get you one for your birthday or so. Even better would be a funded cgm of course. I don't know much about health care systems outside the Netherlands, but I think it's a little bit easier to get one when you're trying to get pregnant. Good luck!
 
I'm still not sure if it's a fluke but since taking the advice of forum members/really focusing and testing more my daily average has been the best I've ever known. I know the libre may take a while to settle but it's currently 1-2 high than my BG which is fine for trends and I've either been in range or lower due to exercise which I'm working on managing.

I won't lie it's very exhausting!!
 
Excellent @tiredoftrying2017 :cool:

That's the key - watching your BS and leaping in it if a reaction (insulin or carbs or dose change) is needed. That way you'll get your HbA1C down. It's an active, constant thing, but you should see good results.
 
Fingers crossed!

That just happened... went to the gym. Scanned right after and the arrow was plummeting BG reading off my omnipod was 2.0

I also downloaded an app to record my food/glucose/activity and so far so good, minus the lows.

Food log isn't 100% accurate as couldn't always find the brands and haven't input my insulin
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