Tag Archives: glucose control

What’s The Best A1c?

Covered in coffee and crayons but, here's the Proof
Covered in coffee and crayons but, here’s the Proof

 

I loved how on DSMA the other night, everyone agreed that the best A1c level varied from person to person.  It’s true.  There are so many variables in our lives that differ from others. 

Some people don’t feel when their low.  Some do.  Should they run their numbers the same?  What about a one year old versus a 25 year old?  Some of us are able to test more frequently than others, some have a CGMS and some don’t, some have complications and some don’t, and then there are personal preferences and comfort levels.

My goal for a low A1c seemed odd last night because of how low it is.  I aim to be between 4.5 and 5.  I truly understand why someone wouldn’t feel comfortable running numbers that low.  My goal is what it is because I always feel my lows (starting at 65), I stay at home with the kids all day (so it’s relatively easier for me to test and eat), and because I’ve heard that a non-diabetic usually has an A1c that starts with 4%.  Oh and because I don’t feel well if I run a little higher.  And if I don’t feel well, I’ll get depressed, and if I get depressed, every aspect of my life and my family’s suffers.

I’ve heard other data on what a normal A1c is and so the discrepancy is something I wonder about from time to time.  Is it better to have an A1c of 4.8 than 5.5?  I don’t know.  But, since most of the data I’ve read puts most A1c’s at a 4.-something, then that’s what I go for-providing it’s safe for me.  I’m grateful that I feel my lows.  I’m grateful that I don’t have a hectic lifestyle at the moment (even If I sometimes yearn for more excitement).  And I hope every day that having a low A1c will give me chances closer to that of someone without diabetes. 

Someone once emailed me saying my A1c was “rude to disclose” because it “made people feel bad about themselves”.  First of all, I’m sorry this person felt bad.  Secondly, we have a choice whether we let someone else’s results make us feel bad or not.  Thirdly, I’m well acquainted with my own past A1c’s of 8, 9, 10, and 11% and I have disclosed that, too.  We’re all on a journey to better and maintain health.  If I get a complication and you don’t, I should be happy for you and forgiving (not critical) of myself. 

Someone has also said I must be lying (so above is the picture of my latest lab results).  Luckily the majority of people in the DOC believe one another’s posted results, and that’s nice.

Anyway, the whole truth is, my feet are feeling funny lately…and it may not be diabetes related, but it may be and I’m scared to death.  I’ve limped a lot for the past 7 months and can only work out for about half a month and then I’m sidelined again.  So until I can see a doctor (appointment is in April), I’m going to aim low, try to avoid lows, keep standard deviation low, and <sigh> hope for the best.

The Science Behind Type 1 Diabetes and Weight Gain

 

It’s understandable that any community would prefer to say, “To each his own” when it comes to personal choices like eating preferences.  So I frequently hear diabetics say that they can eat whatever they want and advocate for other diabetics being able to do the same-as long as each person is successfully able to manage their blood sugars.

And this makes sense to me.  It’s true that every person’s diabetes varies from the next. 

Something that also makes sense to me is what Dr. Bernstein calls “The Law of Small Numbers”.

It’s something I figured out before hearing about Dr. Bernstein.  Since a certain percentage of insulin going in us isn’t being absorbed each time, there is a varying error margin.  The more insulin we need to give, the higher the error margin. 

For example when I lost weight, my blood sugars improved, in part because my insulin resistance was lower and I then needed less insulin than before.  When I changed my eating to lower carb intake, I again noticed better blood sugars because I took less insulin and therefore saw a lower margin of error every time insulin was given.  This lower margin of error is nothing short of miraculous on blood sugars.

If I eat a bowl of pasta, I’m personally, going to give about 7 units of insulin.  A certain percentage of this insulin will inevitably not be absorbed efficiently.  This means that after eating, I will most likely have to correct blood sugar with insulin or some sugar. 

If I eat a steak, I give about 1/2 a unit of insulin.  Again, a certain percentage of this insulin will not be absorbed efficiently.  An “X” percentage of 1/2 a unit of insulin is surely to be less than the same “X” percentage of 7 units right?  This means that with the steak, my chances for having a low or high after eating are minimized AND it means that if I do get a low or a high, the low won’t be very low and the high won’t be very high.  So I’m more likely to stay within a better range. 

This is why I don’t feel that a pump necessarily equals better blood sugar control.  If someone is eating all the carbs they want and just correcting with boluses and sugar as needed, then the likelihood for a higher A1c goes up-because of “the law of small numbers”.   

My lowest A1c test result was over 2 years ago and was a 4.6.  My doctor automatically assumed I was having too many lows and should let my “blood sugars run higher”.  “Really? Higher than yours get to be?”, I thought.   I had to explain to him that I had fewer lows during the time reflected in that A1c test than I had during the time my A1c was a 6.8.  I just had more consistent numbers.

The months prior to that 4.6, I was experimenting with low carb eating to see how my A1c would turn out.  Not only did I lose weight, but the greatest thing was how my blood sugars stayed even keel.  The swinging blood sugars stopped, as did my swinging moods.  Of course, there are still plenty of things that affect blood sugars but, for me, eating low carb made post meal 40’s turn into 70’s and 250’s turn into 150’s. 

It’s so much easier to get a 150 down to 100 than it is to get a 250 down to a 100.  Plus, correcting for a 250 means again that because you’re giving more insulin than if you were 150, there is a higher margin of error and a high risk that in a few hours you’ll need more insulin or more sugar. 

This brings me to my next point.  For type 1 diabetics eating a lot of carbs, weight management becomes difficult.  Most of the thin type 1 diabetics I’ve known of are either adults eating low carb diets or children who are still growing. 

How many type 1 diabetic children don’t start struggling with some weight gain once they turn 18 or 21?  Of course there are exceptions to every rule but, for the most part, I’d say that a way to minimize weight gain in type 1 diabetic adults would be to eat fewer carbohydrates.  The yo-yo on blood sugars that a higher margin of error exacerbates translates to more insulin and more sugar correcting.  This directly translates into weight gain. 

I know it’s not what you want to hear.  After all, we diabetics can eat anything we like and just cover with insulin!  Sure…but, I don’t know about you, I like to be thin.  It means less insulin resistance and better glucose numbers and an easier time exercising.  It also means there is less stress on the body in general.  Such as our feet.  What about knees?  10 pounds of weight loss equals 40 pounds of pressure off of your knees.  So the benefits continue on and on.

I’m making a case here because I wish someone had made a case to me when I was in High School.  I was on the Varsity Soccer Team and so I exercised at least 2-3 hours a day.  I was heavier than all the other girls on the team even though I ate less.  Not fair!  I could have been spared a lot of heartache and frustration. 

Back to today.  Currently, major financial restraints have me eating more carbs than I’d like to (more brown rice, less meat) and my daughter being allergic to eggs means I can no longer rely on an egg’s cheap, low carb, and perfect nutrition.  It’s probably why I’m not losing weight right now.  I eat 40% more carbs than I did 2 years ago.

But before all this, here is what used to work great for me:

Breakfast:  One or two eggs

Lunch:  Chicken salad or tuna

Dinner:  chicken/beef/fish and a side of veggies

Snacks:  Beef jerky, raw veggies, nuts, dark chocolate

Several times a week:  small servings of lentils or beans, fruit, green vegetable juice, Ezekiel Sprouted Grain bread.  (I try to make these my low correcting foods if I’m not too low)

Drinks:  Water, herbal teas, coffee (diet soda would work only it tends to make me really hungry)

I admit it isn’t easy or very cheap to eat this way (especially not cheap if buying all this in the organic section).  You get used to it though and dropping pounds and feeling healthier makes it more than worthwhile.  I’ll say it again.  It’s not easy.  You may feel something is missing from your diet.  Yet, if you are having trouble losing weight or if you are trying for a lower A1c, this is the best way I know of to do both.

I share this info because it proved invaluable to me and my health.  You take it or leave it or take a little of it, whatever you like. 

Salud!

Oral Medication Resource for Type 2 Diabetics

 

A big reality for type 2 diabetics is oral medicine.  This is something you’ll never ever see me write about because I don’t have a clue about oral meds. 

I did want to share with you however, a resource guide about oral medications for type 2 diabetics that Registered Dietitian, Emilia Klapp has put together. 

It’s always good to be safe when taking any medication and her guide includes such information you don’t want to ignore if you take any oral meds.  And I don’t mind stearing you to her site as it includes helpful daily info regarding important topics like hypertension and cholesterol and of course diabetes management.

So check out the Oral Medication Resource and The Diabetes Club when you get a chance!

Have a nice weekend!

Diabetes Juggling Act and Scary Creatures

 

I’m often most frustrated at my diabetes when I’m forced to multi-task between it and several other things.  I am a proponent of single-tasking in order to really give things the proper attention they deserve and in order to provide a greater focus to a task.  However, sometimes life makes you juggle a few more balls than you’d like. 

This week my son has been dealing with strep throat and because he has a twin sister and a diabetic mother, the week has been kind of nutty.  It has been a never ending stream of separating the babies so the other doesn’t get strep and disinfecting everything from the ground up about 3 feet (which is a lot of disinfecting!), trying to remember when pain medicine and antibiotic was given, cooking food for each meal only to find son won’t eat it, and last but not least, trying to keep on top of blood sugars even in the midst of feeling under the weather.

Yesterday I carried both my kids for 30 minutes (50 pounds in total) because they were crying pretty dramatically and finally when I thought my arms would burn off I decided to let them cry on the floor as I tested my sugar.  It was 32.  I’m sensitive to my children’s crying so much so that I separate logic and emotions and sometimes skip a diabetes related task just trying to comfort them.  That 32 snapped me out of that!

Still, I felt immensely frustrated because the diabetes was in the way of my mothering and I didn’t want it to be.  And what if something had happened to me?  I was alone!  Well, later that day Alex came home early to help and my mother came back over (she came by that morning as well).  Three adults and two babies and it was still plenty hectic.  At least I could test at this point without a baby trying to grab my meter and run with it.

Something else has been bothering me this week…I’ve spotted a bug twice in two days that I’ve never seen before (and I’ve lived here well over two decades!)  At first I think, “A spider? no…a giant stink bug? no…an evil praying mantis?”  My husband, whom I affectionately refer to as “animal planet” felt he knew what this was and captured the 1.5 inch long creature in a jar and after a little research we discovered the bug to be a blood sucking, disease carrying, “assassin bug”.  Supposedly these bugs are bed bugs if they get in your house and like to come out every couple days and fill up on animal or human blood for about 15-20 minutes.  I’m confused because why have I seen two in two days?  Husband and wife?  And why in Virginia?  They’re also called “kissing” bugs.  Did they hear Virginia is for lovers?  Apparently they are commonly found in Mexico, Central America, and South America.  In the US they’re found in Florida and Arizona more than anywhere else (which makes sense) but, why have they come way up here?  Doesn’t matter…what matters is this thing is a vampire and looks like this:

Wheelbug, a type of "assassin" or "kissing" bug
Wheelbug, a type of “assassin” or “kissing” bug
Top View
Top View

 

Sleep well tonight…. :)

When you hit bottom there is no where to go but up

 

Something I’ve been thinking about lately has been fueled by reading what fellow diabetes writers/bloggers have been saying.  So many of us feel like we’re living life on the edge and in fact, I would say that living with type 1 diabetes IS the epitome of living life on the edge.  It would be more fun to do by choice like these brave/foolish people but instead we are literally forced to make life/death decisions all day long.  And yes, we could say that we all make those decisions-like when we drive (shall I stop at this red light or continue?) but, the truth is that we’re walking on a tight rope for a living.  It’s a breeding ground for those moments movies like to dramatize the most.  Those moments when we are at our limit.  I think this is when we are our weakest and our strongest.

Sometimes we are spiraling down…down…until something happens and finally stops the spiraling.  Why?  Because we’ve hit rock bottom.  I refer to rock bottom as a way of saying someone has hit a wall, emotionally or mentally.  For example, denial often ends when one finally gets forced to snap out of it and although they’ve now reached a low point, it’s also a turning point and the beginning of healthy and necessary change. 

When our diabetes management routine isn’t working for us we will often go days, weeks, or months plagued by it.  We’ll complain that our numbers are not where we want them to be and we’ll do our best to chase our high and low blood sugars, but we’re not necessarily focused on troubleshooting.  We’re too busy living.  Besides, we’re getting by alright.  But eventually we hit a wall and are finally so intensely frustrated or upset that we break down and have the chance to look at our problem from a new perspective and with a sense of despair and urgency.  This sounds awful but it’s really not.

The idea to write what you read on this website came to me about six years ago after I spent 48 hours being closed up in my room.  I had finally had enough of my high blood sugars and my general state of health and felt so frustrated I cried for oh I don’t know, maybe 4 hours straight.  Funny thing happened afterwards…all my frustration was gone (due to exhaustion) and a sense of calm came over me and I thought to myself “When you hit bottom there is no where to go but up”.  I laid on the floor of my messy room-messy because I threw everything all over the place in a fit of emotional fury and that is when I came up with the idea for a book I would one day want to write.  Thus, the idea for The Girl’s Guide to Diabetes was born. 

There have been many of what I call “healthy breakdowns” and they have all led to some substantial improvement in my life.  I think it’s natural for humans although it’s probably a more frequent occurrence for us diabetics than for the rest of the population.  The key, I think is to realize that when you feel your lowest you are standing on the edge of something big.  You are facing an opportunity to face your mistakes logically (instead of emotionally), to forgive yourself, and to choose a different plan of action. 

Many great things in this world have been accomplished by those who have been pushed to their limits and forced to make important decisions.  So as diabetics, maybe we should think of ourselves as people with huge potential…

Diabetes and Kidney Stones, is there a link?

The above probably hurts less than a kidney stone/  Photo by Evgeni Dinev
The above probably hurts less than a kidney stone/ Photo by Evgeni Dinev

 

As a type 1 diabetic I’ve gone through surgery, had twins, been married, travelled, played sports, lost friends, lost family, been up, been down, etc. etc.  Just when you thought I had done a lot, today I’m going to tell you that by my 24th birthday I had already passed 5 kidney stones.  (But, none since!)

One was 9mm large and couldn’t even pass without medical intervention.  For this “kidney boulder”, as my urologist called it, I needed to have a lithotripsy.  This is essentially a non-invasive procedure where an ultrasound machine is used to send out a bunch of high energy shockwaves aimed precisely at the kidney stone, basically pulverizing it so it can be passed out of the body.  This procedure was called a success and I suppose it was… in the end. 

Just a few hours after the procedure I went right back into the ER with pain greater than what I felt during labor with my twins (although that was pretty mind-numbing, too).  The pain was enough to bump me up in front of some guy in the ER waiting room who was throwing up a lot of blood.  The pain was enough to be maxed out on morphine (I said, “Give me more!” and they said, “We have given you the legal limit, sorry honey!”).  The pain was enough to cause my mind to go a bit loopy because I didn’t think one could stay awake or alive through that kind of pain.  After a few hours of screaming and throwing up all of the bile in my liver it seemed I finally passed all of the stone fragments that were all scraping my insides all at once in a shower of agony.  I was sent home with a lot of morphine pills which kept me feeling quite over the moon for the next month.  They say one forgets intense pain but I don’t forget this experience.  This was 100 times more painful than the other kidney stones I passed.

SO…this is one reason I try to keep my A1c so low with very level blood sugars.  There have been reports stating a correlation between kidney stones and diabetes.  If diabetes is not well managed the body may become very acidic and one can become more likely to form uric acid kidney stones.  And if there is no correlation well…I’ll still be better off with tight glucose control.

Funny how I just found out that recent studies have shown a link between diabetes, high blood pressure, and that shockwave procedure I had done.  Apparently since having that lithotripsy, my risk for high blood pressure is about 1.5 times greater than before having had that procedure.  If I wasn’t a diabetic my chances for diabetes would be about 4 times greater.  That is huge!  Since I’ve got the diabetes part out of the way I’ve contacted my urologist to find out if he has heard this information-especially regarding high blood pressure.  I must say however, I never had high blood pressure until a few months after this procedure.  Since then I’ve maintained the tendency to have borderline high blood pressure.  Hmm…interesting to say the least.  (Info/article on this located here)

In case anyone out there has personal reasons to be interested in this information, I’ll let you know what my urologist says when he is able to call me back.

In the meantime here may be two more great reasons to remember to put blood sugar management first and foremost.  Trust me, you don’t want a kidney stone, and it sounds like you definitely want to avoid a lithotripsy.

My Top 5 Diabetes Blunders

 

Because I’m human, have something so ongoing as diabetes to take care of, and well, because I’m ME, naturally there will be plenty of mistakes.  The key is to learn from them.

Here are my Top 5 Diabetes Blunders-so far!  (In no particular order)

5.  You may have already read this story.  You can read it here.  I once gave 20 units of Humalog in place of Lantus.  I had been up very late the night before and was sleepy the next morning when I gave the injection.  I realized I used the wrong bottle of insulin just after injecting all of the insulin in.  I took matters into my own hands and had my husband, who was my boyfriend at the time, rush me to the ER where I proceeded to inform them I’d need intravenous glucose immediately.  They thought I was suicidal, I thought they were kinda ignorant.  Fun times.

4.  When I was 13 I rebelled against all things diabetes.  I tried to manage my sugars about half of the time while the other half was spent pushing the boundaries.  Somehow I managed to survive a year with an A1c of 11.6.  I spent Christmas that year especially miserable because I had a gum grafting surgery in my mouth which was to stop my sliding gums from sliding all the way off of my teeth.  My blood sugars have never been so high since feeling the fear of losing my teeth.

3.  Not managing my blood sugars well during my wedding.  Honestly, it was a huge disappointment for me to dance my first dance with my husband and focus on foot pain because my blood sugar was really high and I was in uncomfortable and sky high heels.  My honeymoon was spent in pain as a result-not cool.  If one could only go back :(  Check out this guest post I did for LemonadeLife.com about Diabetes Wedding Day tips.

2.  One of the best nights I ever had with my husband was when we were dating.  We were at a party, had tequila, and danced the night away.  You know that saying, “One tequila, two tequila, three tequila, floor!”?  Part of what makes the story so memorable is the way I hit the floor a few times while dancing and how nice Alex was about it.  For this diabetic, being drunk (something I have done a few times in my life) was a way to escape diabetes-if not for a moment.  Truth is, it does not work.  After being super happy that night I finally tested my sugar and found I was over 400.  I vowed to never let it happen again.  Alex vowed to never drink again because he was so upset at how high my blood sugar was.

1.  I drank too much again despite that previous vow.  This time, I didn’t feel my low until I went to test and came up 30 on the meter.  I panicked as stupid drunk people can do when a grim reality sets in.  I don’t remember much except scaring Alex to death, throwing up in the parking lot of a gas station, and screaming about my blood sugar.  I try to promote and advocate for fabulous diabetic women taking care of themselves.  This sort of story is one I remember from time to time and feel ashamed of.  Sure it can be sort of funny, but, what if the worst had happened?  How fabulous would I be then eh?  I shudder to think.  I have now gone years without this sort of thing happening again and intend on keeping the vow this time for good.

Believe it or not, the most alarming thing is I have hundreds of stories similar to the ones above…I just can’t think of them right now.

So If any of this relates to you-know you’re not alone.  Also, know that sometimes you’ll be lucky and other times you may not be.  If you are a diabetic, you can live a pretty “normal” life.  But, managing blood sugars should be the top goal-and not taking wicked chances.

 So, what are your diabetes blunders?

10 Ways to Multitask While You Exercise

 

How often do we get to the end of the day and think, “Uh oh, I either watch Glee or workout”?  Chances are you’ll watch your show.  I totally understand, but the only way for exercise to be super rewarding is to be consistent with it.  I wrote a post for Emilia Klapp over at The Diabetes Club(-where you can get tons of great info if you are diabetic). 

The post I wrote is located there and gives us 10 ways we can substitute our busy lives for a workout.  It’s a win-win situation when we get our stuff done and our workout accomplished at the same time!

Click on the link to check out 10 Ways to Multitask While You Exercise and how you can have a fun workout while watching TV :)

My Diabetes Yearly Eye Exam

 

Last night I couldn’t sleep.  First, my son woke my husband and I up at 2am.  Then his crying woke up his sister and so my husband and I were up an hour, each with a baby in arms.  After a while we didn’t know how to calm them down so they each got their morning bottle a couple hours early.  It worked although I had to stay on the couch with my little girl because she was glued to me.  Funny mama’s girl. 

Anyway, by 3:30 am when I got back into bed I found myself thinking about my eyes.  I’ve never had a problem with them (aside from worsening vision every year since age 14).  Diabetes-wise I’ve been fine.  I have noticed my eye pressure reading and glaucoma test results creeping up each year though they’ve always been in normal range.

Last year with my twin pregnancy my eyes were perfectly fine until I got really big at around the 7th month mark.  What my doctor noticed was a few leaky blood vessels in each eye.  She said they were small and probably due to the twin pregnancy (double the blood to pump in the body strains the eye!)  She did want to stress that I must not miss the next year’s routine eye exam, however.  And of course she told me to try hard to keep blood sugars steady so those blood vessels would have a better chance at disappearing.

Today I had that exam and we found that my glaucoma and eye pressure exams were better than they’ve been in years (odd but, awesome news).  Then she said it, “Your eyes are fine.”  I said, “What about the blood vessels?  Did they shrink?”  “They did, in fact their gone!  What have you done lately?”

“I don’t know…”

“Well, keep up the good work and remember your best defense is managing your blood sugars well and getting in here once a year!”

<<SIGH>>

I can’t tell you how relieved I am.  Now that it’s been a couple of hours and looking at the computer screen is no longer like glaring at the sun I’ve tried to take note of what I’ve done differently in the past year.

One thing is I feel like my blood pressure has been good this past year.  It’s never been really high but, I have always stressed at work to the point of having panic attacks or heart palpitations and being home with two babies has meant feeling much more calm and relaxed.  (Even though I often seem like a wild, clucking, mother hen).

Another thing is that I’ve been more active.  Instead of working out more I’ve been more steadily active.  Before my babies I worked about a decade and the job always involved sitting at a desk in front of a computer.  Then I’d get home and do a work out (or not).  Now, taking care of two toddlers means constant lifting and squatting.  My shoulders are kind of like an NBA player’s and my thighs are pretty wide with muscle.  All this lifting has created super abs (which are covered with loose skin so don’t ask me to prove it).  Point is, It has probably been beneficial to do more constant and steady moving throughout the day.  Lifting weights seems to help whether this is a child or a dumbell.  (Although I don’t think lifting weights is recommended if there are some problems with the eyes-not good to strain them!)

Last but not least I’ve also really cut out processed foods.  I’ve cut my salt intake considerably and my caffeine intake is very small compared to what it used to be. 

These small and subtle changes just might have done more than I ever expected them to.   

Wishing you great eye health today…:)

The CGMS. Do you have better diabetes management with one?

Photo courtesy of Michelle Meiklejohn
Photo courtesy of Michelle Meiklejohn

 

I don’t have a CGMS.  I tried to get one during my twin pregnancy last year because the doubled amount of pregnancy hormones really challenged my blood sugars and of course I wanted great blood sugars while pregnant.  My doctors didn’t support my wanting one though (maybe because my A1c at the time of conception was a 4.6%?).  Three doctors all told me to relax on my diabetes management.  I told them to relax. 

Anyway, I mostly wanted one to catch late night lows and highs that I couldn’t catch during the day when I was awake.  Since I didn’t get one I just tested every hour during the day and this worked well.  I tested every 2 hours during the night and this also worked well (I had to make a trip to the bathroom every 2 hours anyway). 

My question to everyone is, does the CGMS help your blood sugar average?  Does it help you maintain your blood sugars on a more even keel?  Has it helped you lower your A1c?

Before I fight for a CGMS again, I want to know you all really like your CGMS.  I already know how to get a great A1c without a pump and without a CGMS but, maybe there is something you know that I don’t?  (Or maybe I’m doing this the hard way?)

I’m sure there is something you know that I don’t.  This is why I’m asking-no, begging you to share your thoughts on this matter.  I know there are others out there wondering the same thing.  After all, if it is “proven” that the pump and CGMS help lower an A1c than part of me can’t help but want to know what real people say (as opposed to studies).   

One of my main questions is, does having a CGMS help you avoid more swinging glucose numbers?  For example does it help you not have such high highs or low lows?  This, to me, seems like a great help.  Luckily, I feel lows and highs early but, let’s face it, sometimes we’re distracted with life and maybe a beep here or there would save the day?

So what do I stand to gain with a CGMS?  I guess that is what I really want to know :)

Anxiously awaiting your responses!

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