Today, my endo let me know the results of my A1c. I’ve been freaking out about it because I have been trying so hard to get it back under 7. Not for anyone in particular and not for any “goal” reason, but because when I had my numbers under 7 before and during the pregnancy, I felt better.
I have been working so hard the past 6 months to get it down from the 9.0 result I had in March. The complete relearning of my diabetes had taken a toll on me, along with having to overcome fears of lows happening while taking care of Kip. My March A1c was 9.0. There was no lie or denying it.. I knew it would be in that range. Then, June came and I hoped it would be in the low 7’s, but it came back at 7.9. I wanted to just stop trying. What was the point? But I knew I needed to keep going. Making little changes here and there to somehow get back the tight control and tight control (yes, I said that twice.. tight control meaning control over my actions and tight control meaning less highs and lows and more in-range glucose numbers).
This A1c? 6.7. I’m not going to lie. I had hoped for low 6-ish, like, 6.2-ish. BUT I’ll gladly take it because it’s under my higher-range mark.
When I published it to Facebook, my friend Leighann asked me, “If you could share 3 things that made that drastic improvement, what would they be?” So I thought.. Hmmm.. That would be a great topic for a post! Most of you probably already know these, but here’s what’s worked for me.
#1: CHECK, CHECK, CHECK! It goes without saying that anyone wanting tight control needs to check their glucose levels as much as possible. For me, what works is making sure to check pre-meal and 2 hours after every bolus I ever take – meal or not. I have learned to take advantage of the BG reminder in my pump (whichever one I’m wearing.. Animas, Medtronic and OmniPod have this function) and learned to MAKE myself take heed to the reminder. Instead of just dismissing it, I act on it. Granted, I trust my CGMs, but they aren’t always right.. and when trying to stay in tight or control, I rely on my meter first.
#2. Upload and review! Every two weeks, I upload my CGM and pump/meter data and review it. And I don’t mean just look at it and guess where to make improvements. I sit down for a good 30 minutes to an hour and become my own endo. I look at the numbers and try to remove my anger, frustration or anything else I may want to feel at the time. You have to let go of and look past however your readings my look and don’t think you have failed if you have 14 highs and 20 lows. You have to just look at it as a “problem area” and try to think of the best way to fix. I mark up, circle, and draw all over my CGM charts to try to pin-point areas. Know how your insulin affects your body and make decisions based on that. Of course, run anything you might be wanting to change by your endo first. ( I don’t most of the time, but I’m never making huge changes anyway.)
#3 Watch you food! As a diabetic, I hate for someone to tell me I can’t have something… because I know I can bolus for it and be okay. But what is that saying? One thing that has to happen with your insulin is balance. If you’re taking more insulin to cover food, then you’re more than likely going to have to take more as basal insulin. Staying within a certain calorie or carb limit per day helps you to not throw that balance off. For me, staying at 55/45% bolus/basal ratio works. Some have a 60/40, others a 50/50. Try this experiment: look at what your ratio is now. If you’re really off, like 70/30-ish or even just no where near 50/50, try to get your bolus amount that day to meet your basal amount for that day. So, if you take 20 units for basal insulin per day, make sure that your total bolus amount for the day doesn’t go above or (really) below 20 units, and see how your blood sugar reacts the next day. Trying to make sure your carbs balance with your insulin more than just one meal or snack but as an entire day helps. Also, though we don’t want to say that you can’t eat a food… try to listen to what your body is telling you. If a particular food doesn’t agree with your bg, really think about severely limiting it or eliminating it all together. By saying that you don’t want to consume a certain food, that doesn’t mean that all diabetics can’t have it at all, just that we all handle foods differently. I don’t want to eat things with wheat in them because I’m gluten-sensitive and it makes my bg skyrocket (among other things), but little Suzie can eat a sandwich and breeze through her afternoon with barely a bump on her CGM graph.
And for added bonuses:
#4. Make sure (if you’re a pumper) that you are using supplies that fit you. If you start to see a rise in your glucose levels and you’ve already done the switch-out time (of everything – new bottle of insulin, new cartridge and new set) and time again with no improvement, make a change. Call your pump company and see if they can send out a sample of different sets. Call your endo and see if you can get a sample of a different type of insulin. Don’t be afraid to make changes.
#5: Don’t stress yourself! Make little changes that will fit themselves into your life. Diabetes will be with you for a while. Make sure you’re taking steps at a pace that won’t burn you out fast. Take things slow and build on them.
#6. CGM users, Don’t be afraid to set tighter limits! I keep my high alarm set at 140. It can be a pain in the butt some days to have it go off after every meal, etc, but it alerts me fast so I can be aware and take care of what’s going on before I get above my 180 limit in my head.