Type1 struggling. HBA1c

Hi,I've been diabetic for approx 30 years, and and believed I knew everything there was to know. whilst I understood the concept of carb counting, and BG testing, I think individual BG tests did not give me sufficient information for me to personally justify doing it often enough. As a result my control was terrible. I bought a couple of books... Think like a pancreas and sugar surfing, self funded a CGM, and start on a pump next week. I highly recommend reading think like a pancreas a starting point. it all depends what you have tried so far amd what motivates you, but I found the books eye opening and I learnt so much from them!

@Mrshaylett I don't start on the pump until next week. It is something I had always straight out discounted because I didn't fancy having a needle in me 24/7 (I genuinely had no idea that you can get plastic cannulas). I knew I needed to start blood testing (I'd go months without doing even 1) and by chance I noticed a poster for the Libre CGM. My diabetic clinic were hopeless, but something clicked for me.
I investigated the CGM technology and fed up of waiting for the Libre, purchased a Dexcom (seriously, THE best decision of my life). I think because I was financially committed at this point, I read those two books, plus a couple of others, and everything clicked into place. The first paragraph in one book explained that whether you are newly diagnosed, or a veteran, you are likely to learn new things from the book and suddenly the lights came on. Things I had suspected for a long time suddenly made sense, things I had no idea about, I learnt, and some things, were simply confirmed.
I knew nothing about carb Factors or correction ratios, and assumed that if my doctor told me to take 12 units for lunch, that's what I did. I didn't know anything about insulin sensitivity, and most worryingly, I didn't even know what basal and bolus was, despite having been on MDI for 25yrs+.
The books explained everything from the ground up, and allowed me to understand what my BG was doing, and why, and how to control it with micro-doses and carbs. Coupled with teaching me what to expect of the CGM, and therefore appreciating how much better control I could get with a pump. Sorry, it is a long winded response to what could have been "I've not started the pump yet", but felt context might help a little.

Hi mrshaylett, my situation is quite similar to yours. Had diabetes for the past 16 years.

had my pump experience in the past and it was great. i did not continue because its too expensive. after graduating from university middle of this year im gonna start saving money to purchase my own pump.

paulliljeros, all the best to your pump experience! do let us know if pump is going well for you.

@Mrshaylett, the needle leaves behind a cannula which administers the insulin when using a pump, the cannula insertion is automatic on some pumps and the whole procedure is straight forward enough

My advice would be to get your basal dose right if on MDI, without getting the basal right you will always be chasing your tail, the book Think like a Pancreas covers all this and much more.

Hi @Mrshaylett I have had a pump for 2 years and I've found it life changing I can't imagine being without it now but @noblehead is right you need to look at your basal first as if it's not correct now it still wouldn't be on the pump so you would have the same problems, pumps are amazing but take effort from you to make them work

@Mrshaylett can I suggest two things in addition to @noblehead basal testing. Firstly up your BG testing to do all the meals pre and 2 hours after so you can see what is really happening with the BGs (or even better try a Freestyle Libre for a few weeks), secondly if you are not already low carbing then cutback for a while and just take those swings out of the equation whilst you sort the underlying control. Hopefully it will become clearer to say why if you do need a pump and if you know what is going on then to be better able to use the pump.

I'd also recommend the book "Using Insulin". It's the equivalent of "Pumping Insulin" for non-pumpers.

steve_p6 said:

@Mrshaylett can I suggest two things in addition to @noblehead basal testing. Firstly up your BG testing to do all the meals pre and 2 hours after so you can see what is really happening with the BGs (or even better try a Freestyle Libre for a few weeks), secondly if you are not already low carbing then cutback for a while and just take those swings out of the equation whilst you sort the underlying control. Hopefully it will become clearer to say why if you do need a pump and if you know what is going on then to be better able to use the pump.

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I understand that CGM is prohibitively expensive for many, and by no means a necessity, but if you can afford it, it will make this process much, much easier. As @steve_p6 has said, even if you invest in a libre for just 4 weeks (approx. £160) or use it intermittently, or invest longer term with a libre or Dexcom, the information you will glean from the graphs is invaluable. I have been astounded and still am. Again, the books cover this in some detail, so perhaps read those first, but I would recommend you consider it if you can.
Either way, as others have suggested, I would concentrate on getting your basal right first, and then assessing you correction and carb factors. Good luck, and let us know how you get on.

I have been reading these posts with great interest as I too have problems with my bg levels even though I have been a T1 diabetic for nearly 16 years. I will definitely be finding these books to read...Thankyou all and I will be following Mrshaylett to see how you go on ☺. Thanks again all.

Similar story, T1 for 20 years, and with hindsight, my control had been poor; Hba1c always averaged mid to high 8's. I was always told it needs to be below 8, but struggled. Late last year, I had a new DSN and Dietician at my hospital ; they took a good interest to help me and we've been working hard. Still struggling so have now changed background insulin from Levemir to Tresiba. Because I was doing so many finger tests, I ended up buying the Libre scanner test meter ; so glad I did, the report graphs give so much info about how the Insulinx are working, I am able to make my own decisions and choices. I am still struggling to get constant levels and am very much peaks and troughs, but I'm starting to understand it more! Still very frustrating though and am unsure if I'll ever have good control, but am trying. There seems quite a few negative threads about the Libre, but so far I'm really impressed (started January). We just have to keep working at it. Good luck.