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Terrible blood glucose control - need advice

H

honeydew

Newbie
Messages
3
Type of diabetes
Type 1
Treatment type
Insulin
Hi everyone!

So I've been a type 1 diabetic for almost 14 yrs - I was diagnosed when I was a child. My hba1c has never been brilliant and at best was 7.6, but has frequently been around the 8/9 mark.

I had a real shock the other week when my hba1c was in the high 9s. I suppose I've never really made it a priority and just really let it slip!!! It's been on my mind a lot and I've decided that something really needs to change.

I'm really upset that I've let it get this bad, so I was wondering if anybody has any advice - particularly regarding:

1. DAFNE
It sounds like a really useful course. Have you done it? What did you get out of it? How much did it improve your control?

2. Different BG monitors
Have you tried many different monitors? Is there one you would particularly recommend over the others?

3. Insulin pumps
Something I'd definitely like to look into, but do insulin pumps really help to improve your control? Plus, I'm not keen on being attached to a pump all the time.

4. General
Have you ever been in a similar position and let your BG slip? How did you manage to find the motivation to improve it?

One of the problems is that I've moved around a lot (overseas) and seen a whole load of different doctors, which hasn't been all that helpful. I've been semi-carb counting for a while, but because I've moved around so much I've never had the chance to refine my insulin:carb ratio etc. so I'm working on that at the moment!

Thanks so much for any help!
 
First off it's quite typical for Hba1C to go up over time UNLESS you do something about it. So don't beat yourself up too much. All those ideas you list are good. I would say DAFNE is your starting point, it's the best thing and you can't get a pump without it anyway (at least in my area).

Monitors I would say not so much, though the ones with bolus calculators can be very helpful. But then there is the new FreeStyle Libre that we are all very excited about, an almost-CGM but much cheaper to buy and hopefully not too expensive to run.

But get yourself to DAFNE first. I would go so far as to say it is life-changing for a diabetic.

And while you are waiting, hang about on here and read the forums and you will pick up LOADS of useful tips.
 
this might help as a refresher a bit till your DAFNE course

There is an online course for background and an idea to it. Free to registerhttp://www.bdec-e-learning.com/

This set of workbooks are worth reading and practising working examples only of carbs and doses
Don't change dose without nurse approvalhttp://www.diabetesinscotland.org.uk/Publications/9224 Overview

Workbook 1http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb listhttp://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diaryhttp://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Basal testinghttp://www.diabetes-support.org.uk/info/?page_id=120

Sick day ruleshttp://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowcharthttp://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf
 
Last edited by a moderator:
Thanks so much! DAFNE does sound like a good starting point for improving blood glucose control, so I'll talk to my doctor about taking a DAFNE course.

@jack412, thanks for the links - they'll definitely be handy to refresh my knowledge of carb counting in particular.

I guess that there's room for improvement, but I'm prepared to put in the effort.
 
Hi a Honeydew and welcome to the forum

I'd imagine you did get a shock when your Hba1c shot up to 9, that is way to high and you do need to bring it down to avoid complications further down the road, I'll try and answer your questions individually:


1) Yes, it's a really useful course and I would encourage you to go on the course, you need to let your diabetes nurse and they will put your name down for the next available course. I've done the course myself, and much like Spiker found it really helpful in getting to grips with my diabetes management, it covers all the basics like getting your basal insulin right, your insulin-to-carb ratio's, carb counting and what to do when you are sick and unwell, as well as giving advice on how to adjust your insulin when physically active. I can't say the course alone helped get my diabetes under control but it certainly helped that's for sure.

2) Accu-chek do a boulus adviser meter and it's called the Aviva Expert, it's a really good meter and once you input all your data it works out your bolus doses for you going by your current bg levels, it also allows for things like illness, stress and exercise, all this information is put into the meter when you first get it and normally a DSN will help you input it and show you how to work the meter, I can highly recommend it.

3) Insulin pumps are fantastic, the more I read about them the more I'm convinced they are the way forward, they offer more flexibility and control than MDI and you rarely hear of anyone wanting to give them back once they start on one. There's been quite a lot of members on the forum who have recently changed to insulin pumps, hopefully they'll see your posts and respond.

4) I didn't have good control for a lot of years, the motivation for me was after I got diabetic retinopathy and I realised that this could just be the start of things, also I wanted to see my grandchildren arrive one day which is a great motivator in itself.

In general, just read up as much as possible on type 1 diabetes, the book Think Like a Pancreas is a must read for anyone wanting to get to grips with diabetes, you can purchase it on Amazon for around £12.

Any more questions just come back.
 
Some Gp's are changing their patients over on meters.. Ours are. I had a battle yesterday explaining to a diabetic nurse that I would not change as my pump was accuchek and would not fully work unless she continued with aviva strips..... People may not be able toget choices of meters soon...
 


Out of interest DD, what is the meter they are wanting to change to?
 



Hey HoneyDew! Welcome along!

Please don't beat yourself up about your control, a lot of people have done things like this in the past - me included. But realising it and wanting to start the positive changes is a great step in the right direction!

I have been on an insulin pump since the beginning of this year, I went back n forward unsure of if it would actually work for me, did I want this thing attached to me all the time? What about when I'm sleeping or on holiday? But I got one and the last 9 months have been an absolute dreammmmm! Obviously it takes a lot if work, you can't just put it on n it works by magic, attending the DAFNE course and doing a lot of testing is what makes it work along with eating correctly. I love mine and can't imagine going back to 5 injections per day. No way. Had my clinic appointment just the other day and my nurse told me my control is looking great, which has motivated me to try even harder than I already am.

I got a new bg monitor when I got my pump and they are linked together so that my readings get sent straight to the pump.

Do you think your a1c is high because you don't carb count and inject properly? Or is it just the carb counting you struggle with?

Are you not going to be travelling around as much now so that you can get into a bit more of a routine?

Hope I've helped a little feel free to ask any other questions!

Abbie xx
 
noblehead said:
Out of interest DD, what is the meter they are wanting to change to?
Click to expand...
I think it was a glucometer? I was so incensed that I didnt really listen. I have an appointment with Practice Manager regarding PPG matters next week so I will ask the responses that have been received from other Patients and will let you for certain..
 
Glucomen LX?
 
Could be, but I'll find out.. Are the strips for these cheaper? (Without a doubt!!)
 
donnellysdogs said:
Could be, but I'll find out.. Are the strips for these cheaper? (Without a doubt!!)
Click to expand...

Not sure about the bg test strips, but the ketone strips for the Glucomen LX Plus cost around £20 for a box of 10, I had trouble getting my gp to prescribe them and only got them when he left the practice.
 
Snap
 
Lol Snap again
 
iHs said:
Lol Snap again
Click to expand...

Did you get asked if you test?

Having to tell a dsn to look at my records and her not having a clue what a pump involved really cheesed me off.

She a new dsn, so I will have to educate her!!!!
 
Sorry, I've diverted the OP off track..
 
Hi HoneyDew,

Well you've managed the first step to getting yourself back under control by posting on here. I flit on and off this site as and when I need a good kick up the bum.
However I do have to remind myself sometimes that some people on here are far further along in their understanding and care (not necessarily in years more in dedication) well either that or they are superhuman.
Best thing I have done is attended a DAFNE (or the prettier name of DAISY which is what my hospital calls it) I can't recommend it enough, it gives the power back to you which I think is such a liberating thing. It's also excellent for refreshing yourself on basics that you were probably told once 14 years ago. Only thing is - if your place of care is like mine - there is quite a wait as they take small numbers of patients on board and it's a multi disciplinary course so get talking to the right people ASAP!
Secondly the pump is something I've known would help me but once again it's a time consuming thing therefore if you do go down that road make sure it's what you want. I'm literally on my way to see my DSN now to get my insulin fitted to my pump as I type and I've been asking for a pump for 2 years now.
I know the two things I have recommended are more long term solutions and diabetes doesn't wait for no man so I would suggest putting some time aside to concentrate on you. Us diabetics have an excuse for that sort of thing. Read back up on all of the basics, read some new research, create a little table for blood results, find some apps, buy a cool notebook to joy down your results and patterns and make an appointment to speak to your DSN about your concerns and struggles at the end of the day that's what they are their for.

Go for it!
X


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