Working on my A1C
Anyone with diabetes (or anyone who is involved in the life of someone with diabetes) knows it’s all about numbers. It’s about targets & ratios & calculations. It’s about carb counts and blood sugar logs and the greatest number of all? The Hemoglobin A1C. Now, i must say all those other numbers are important so that you can achieve a goal A1C – you must be diligent about correcting & maintaining blood sugars in the optimal range. You must accurately count all carbs & bolus appropriately. There’s really a lot of “must”s & “should”s but when it comes down to it, I put FAR too much stock into what that particular number is every 3 months. My feelings on my A1C have waxed and waned over the years. Sometimes I’m able to smile and be proud. Other times I view it as a reminder that diabetes is a daily struggle and I use it as motivation to do better.
When I was hospitalized for DKA back in June, my A1C was an 8.4. Not optimal, but not my worst (that would be in the 9s). I was only 7.4 at diagnosis and got down to a 5.8 within the first three months (I credit the divorce diet, a honeymoon period and an amazing amount of dedication to my new routine for that – where can I find those things now?! Well except the divorce diet – fuck that noise!). And now I’ve begun making that number super important again. Because Ryan & are talking about babies. Not immediately mind you, but it’s not a decision to be entered into lightly. We have our age to think about (we’re both RAPIDLY approaching our mid 30s), the fact that we’re getting married next summer (I would like to do the get married/have a baby thing in the traditional order. Not because I judge people who don’t, but because it’s what we want for US.) and then of course, there’s diabetes. Getting my body ready to have a baby isn’t an overnight decision.
I discussed it with my endocrinologist for the first time about 4 months ago. So that would be ultimately two years before we’re ready to start trying. We discussed A1C goals (she wants under 7, I want under 6.5) and then I’ll be sent to the High Risk OB to discuss conception planning. SO naturally, I have begun paying much closer attention to my numbers on a daily basis. Below are some things I have done, am doing or will be doing to attain the best A1C possible – while still maintaining a “normal” lifestyle (aka, I’m not going to drastically change meal plans or exercise plans to something that it not able to be maintained long term. Consider it the difference between Weight Watchers (a lifestyle change) and a yo-yo diet (a quick way to achieve a goal but not easy to maintain for a long period of time)). Maybe these tips can help you. Maybe you can suggest things I’m not doing or should be. Tell me what’s worked for you in your struggle to achieve YOUR perfect A1C.
Carb counting – in an effort to be more realistic about both serving sizes and how to bolus correctly for my food, I am measuring it. Every meal I eat has my carbs carefully measured out – yes, with a measuring cup – and I’m finding it’s making a pretty big difference.
Pre-Bolusing – I have never gotten into the habit of taking insulin BEFORE I eat. Yes, it makes sense to have the insulin working before the carbs hit my system but I always had a problem with that. You see, my eyes are MUCH larger than my stomach. Therefore, when I sit down with a plate, bolus for everything on it, then only eat half – I’m fucked. I worked with my endo and now I bolus for 50% of what’s on my plate 5-15 minutes before I eat. Then when I’m done I bolus for anything additional not covered by the prebolus. I’m finding this is helping me not ride the glucoaster so much (and also has relieved a lot of nausea issues resulting from high BGs and blood sugar spikes and dips). Overall, another win.
Fingersticks – I just upgraded to the Dexcom G4 sensor and I LOVE it (review coming soon!). But even with this 24-7 glimpse of my blood sugars, I am still averaging anywhere from 6-10 fingersticks a day (I refuse to call it testing – I can’t pass or fail a fingerstick). For some reason, these numbers make me feel more accountable. And the biggest difference I’ve found for them is…keeping my kit in the bathroom overnight. I’ve discovered that I am more likely to test during the night if my glucometer is in the bathroom. I have no light in my bedroom during the night and I’m not going to turn one on & wake Ryan up to do so. Instead, I’m usually up AT LEAST once in the night so it’s nice to get that reading – especially if it’s high I can get it moving lower while I sleep instead of waking up in a fog and chasing it all morning (or all DAY sometimes!). And it makes sense since if my sugar is high I’m going to wake up to use the bathroom more anyway. I have done more middle of the night fingersticks in the last 2 months than I have in my 6 years with diabetes combined. It’s amazing – and I can tell it’s helping!
High/Low Tolerance – I’ve been having some issues with lows for a few weeks and just did some basal changes with the help of my endo. Once I even out again (why does changing your basal rate by just 0.10 unit make things freak the fuck out for a whole week?!) I’m planning on changing the alarms on my sensor and my BG targets on my pump. Right now my sensor is set to alarm “high” at 200 and “low” at 80 while my BG target on my pump is 80-130. In the next few weeks, I plan on changing my high alarm to alert at 180 and my low alarm still at 80 (I LOVE sitting in the 80s and wouldn’t want my sensor to alarm all day because of it). I’ll set my pump targets to 80-100. Really tightening up my thresholds will allow me to get tighter “control” over my blood sugars and therefore reflect in my A1C.
So that’s where I’m at. Do you think my plan will work? I’m waiting to hear back on my next appointment date but I’m anxious to see a new A1C result. According to reports I’ve run using my pump and sensor data, I’m under 7. Let’s see if I can keep that up – or even make it better before my next check in! xo