Tag Archives: a1c

Three Things… or more.

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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.

Aiming

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The past week, being school-free, has been awesome. I was able to spend more (relaxed) time with my baby and plan his very first birthday party without stressing over what test was coming up on Wednesday or Friday or what paper was due by Sunday. (Which, BTW, I got 120 out of 120 points on my English final!!! Bringing my total grade to an 88. I’m awaiting my last essay to be graded to know my final class grade.EEK!)

But during this time, I have been so grateful for the time to re-center my brain on diabetes a bit more, and learn how to juggle it with everything else. Since Kip is becoming somewhat independent now, I can easily just put him in his high-chair with some cheerios while I test, prebolus, and get our food ready. Things just don’t seem as “rushed”  and time consuming, so I have been learning how to work better diabetes control back into my life.

I’ve also taken this time to re-evaluate a lot of things diabetically speaking. What my personal needs are, what works for me, and what I need to do to get myself in order. Taking out all prior opinions of things that seem to be complaints due to frustration or praises due to giddiness and looking strictly at what works for me. No fuss, no frills. Just looking objectively – all pros and cons of every single thing – at how every aspect of my diabetes management works and what I need to do to make things work for me so I can obtain the best control possible.

I’m not happy with how I’ve been managing things over the past year. I’ve sucked at it. Now, I have a goal. My last A1c was 7.9% (Avg  = 204mg/dl) . For me personally, that’s just down right unacceptable (Remember: YDMV!!). My goal for my next A1c is 6.5 (Avg = 151mg/dl). Still not where I want to be, but it’s the higher end of the spectrum. My optimal range is 6.0 to 6.5. I have always felt my best when I stayed in between those numbers. And just to be clear – that 0.5 difference is a big deal to me. That means my average would need to stay between 136 mg/dl and 151 mg/dl. Still think it’s not that great of a difference? Remember, that’s an average of your glucose level for the past 3 months. Considering I typically go high (right now) twice a day and low once a day, that’s a big feat.

I’m working hard on this balancing act that is my life now. This past week, my average has been good. But then again, next week, I could do the same exact thing and get a totally different outcome. But that’s life with diabetes. You roll with the punches.

Right now, I’m just in a mood to punch back.

Disclaimer: I also know that a lot of people have problems with other people posting about what their A1c’s are and goals and whatnot. As with anything diabetes related that I blog about, my goals that I speak about are strictly for me. In no way, shape, or form am I trying to imply that you should have the same thing. Diabetes varies per person. A range that may be unacceptable to me may be perfectly okay for you depending on a lot of different circumstances. Always, always, always know and apply the following: Your Diabetes May Vary!!!  (YDMV)

Tests and Answers

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Yesterday’s endo appointment went well… I guess. There wasn’t much that was discussed or changed becuase, though my numbers on my graph were everywhere, my main concentration seemed to be floating “in the zone”, which is great. We are waiting on my A1c result to come back from the lab, as well as the TSH (thyroid stimulating hormone) result. When they drew the blood, I got my own sample and used my last A1c Self-check test to see what it said for comparison purposes.

Usually I would get upset, but seeing as how I’m working on bringing it down from the last result of 9.0, I’ll take it gladly. And I’m proud of it. Why? Because I’ve been able to do it without a ton of lows. For me, that’s a huge step. HUGE.

We started talking about a few other things though. I’m not back to “normal” after having Kip. He’ll be a year old next month, and I’ve only had 2 periods. My emotions and anxiety are worse than when I was first pregnant with him, and seem to be getting worse over time. He ordered two more tests – progesterone and FSH (follicle-stimulating hormone) to see if we can diagnose something there. If those come back normal, I’m assuming we can attribute it to stress and still recovering from having him.

I just want to know what’s going on. If it’s stress, okay, that’s fine, I’ll find out what I can do to fix it. If it’s medically, I want to know what steps I need to take there. I just want an answer to this mystery. I want to go back to feeling like me again.

 

*****UPDATE*****

Labwork came back. A1c is7.9, so that’s still okay. I’m on the right track.

Other stuff looks good too, so we can just attribute everything to my body still readjusting as well as stress factors. Yay.

Just A Number? – DEIA 2

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I received my call about my A1c this week. 7.5. I knew it had gone up, and actually guessed it to be 7.5. I know that is a decent number, but I still feel like I have failed. It went up a whole point.

The only problem is I have had less lows. I’m not ready to go back through constant lows just to have a better A1c. It seems that I would be more “at risk” with constant lows than not having a lot of them but having a higher A1c. It sickens me that our diabetes control is based on this one number. Like a credit score or something. It puts into our mind whether we have won or failed, when in reality we could be doing just the opposite.

Either way, I gotta get better control of myself.
For me.
For Erik.
For BabyK.
I can do this… I will do this.
Because its not an option…. Its a necessity.

Considering?

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Okay, so remember yesterday I talked about being on all these loops?? Well, I was thrown for another one this morning.

Last night, my OB called to tell me that all my blood work and my 24hr urine collection results came back great, and that he was actually shocked given my history with diabetes and renal disease (I had kidney problems about 10 years ago which from my understanding, had reversed itself with tight bg control), and that the protein levels were no worse than someone who was a healthy, non-diabetic pregnant lady…. all to which I was elated. So, the ruling for the swelling and random star-flashes is that it can be normal in pregnancy and I need to deal with it. (And no, he didn’t say it like that, but that’s the gist of it.) Then, this morning, I get a call from his nurse. She wanted to be sure he had called me back last night. She went back over the results, but said it in a slightly different way. She said that the results came back good considering my diabetes and renal history.

Considering??

What is THAT supposed to mean???

So, I go from feeling wonderful about this pregnancy.. that somehow I had done something good and that my body really was able to handle pregnancy just like any other woman and that it didn’t affect me that bad and I may actually be around a long time for this kid,  to feeling an instant rush of panic. “OMG, so I’m just in the good range for a diabetic? I’m not in the good range for a normal, healthy person? So that means I actually do have raised levels? I’m probably at risk for having to go back on pills for my kidneys once again not because of lack of control but because I decided to have a baby in the midst of having a body-wrecking disease????”

Then she tells me my A1c… 6.9. The highest since becoming pregnant. I swear, if anyone had walked into where I work at the time, they would have seen a 9 month pregnant woman doing everything she could not to lose what little bit of hope and happiness she had. Everything seemed to pile on me at once, and I felt like I had been a failure somehow. Had I gone through this pregnancy trying to do everything possible to keep this baby protected from what my disease could do to him just to have it all slip away in the last month?

I know a lot of this has to do with the hormones and just the general uncomfortableness and wanting this baby out of me. The pregnancy is coming to an end and I’m going through the transition of loving being pregnant to, well…. NOT loving it, dealing with the worry of how things are going to go and how I’m going to protect him on the outside, and the realization that I’ve only got less than two weeks until this transition occurs. The overwhelming knowledge that very, very soon, there will be a baby – my baby – in my arms.

After having my little down-fit, I called the OB office back and requested that the results be sent to my endo’s office. I know they usually do, but I wanted to be sure he got them because I trust his judgment of my diabetes care over my OB. I wanted to be sure he had them so I could discuss them with him when I go for my appointment Monday.

I am also going tomorrow morning for my 37 week (well, almost 38 week) OB appointment. I’m going to see if they’ll go ahead and schedule the induction date then so we can have a definitive date to mark on the calendar of BabyK’s arrival… that is unless he decides it’s time to come before then and I magically go into labor between now and the date set. That way Erik can know when to take off from work and I can schedule a few days off before to make sure I have everything ready for the hospital stay and be sure the house and BabyK’s room is 100% (or as close to it) ready for him to come home with us. I’ve said since the middle of the pregnancy that I felt sure he was going to be a July baby… and we still have 11 days left for that to happen. But with the way my primary OB sounded last night, the induction is still going to be set for the week after I turn 39 weeks (I’ll be 39 weeks on Saturday, July 30th). I’ll be sure to update tomorrow as to what the on-call OB says.

Just Doesn’t Make Sense.

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This was going to be my Wordless Wednesday post, but I simply can’t contain this into a picture.

I am both elated and dumbfounded at the same time this morning. See, yesterday, I called my OB’s office to see if they had gotten my A1c result back yet from the lab. I had to leave a message, but I got the call this morning as I was getting ready. The very, very nice nurse on the other end told me that everything looked good, and that my A1c and TSH were within normal range. Then she told me the result….

5.6.

“Wait a minute… did I hear that right???? Did you just say 5.6???? Are you sure you have my chart??”

N: “Yes, DOB is 8/28/XXXX, right?”

Me: “Yes, it is! But….

N: “It’s still a little above normal range for pregnancy, but it’s good.” (I guess she thought I was upset??)

Me: “But I just don’t get it… last month it was 6.2…. is that possible????”

N: “I guess so… just keep up with your diet and doing whatever you’re doing!” (As if diet was all that mattered…..pshhh! What-eva! Hahaa. Anyway….)

 

awardIt still hasn’t sunk in. It’s like getting an award you don’t deserve… or don’t think you deserve. I mean, with A1c, we rely on what that number is SO much to show how “good” or “bad” we’ve been… when in fact, that number doesn’t do that at all. It’s just an average of blood sugar over the past 3 months with most of that number reflecting the past month. It doesn’t show whether you are all over the place or tightly controlled. So while I’m on top of the world that I have an A1c the LOWEST I currently have record of, I’m still somewhat feeling undeserving. Why? Because even though I work my butt off every day to get good numbers, I still see the spikes and peaks all through my Dexcom upload charts and the logbooks that I send Dr. C every week. Spikes and peaks well into the 200 range that I am not proud of. Spikes that make me worry that I really am baking BabyK in there with boiling high bgs. It just doesn’t make sense to me.

But then again, what in Diabetes EVER makes sense, right?

(Oh, and the post yesterday…. didn’t mention DIABETES at all! Yep, I’m going to try to write posts on some Tuesdays that do not include the topic of Diabetes at all. Why? Because as we all say, there’s more to me than Diabetes. And yes, this is a huge copy of No-D-Day started by George that we have once a year, but for me, I feel the need to write about who I am… not just as a diabetic… but a person. I won’t do the topic every Tuesday, heck – maybe not every month, but when I do write them, I will tag the post as a TuesMe post… or something like that…. If you have any suggestions for what to call it, feel free to tweet me or leave a comment.)

(And the Wordless Wednesday post last week? That was my pump… after a shower. I couldn’t disconnect because I had done a combo-bolus for breakfast before getting in the shower, and had to use one of my old, very stretched-out headbands to clip it to and wear as a necklace. For this reason, I am SO glad that pump is water-proof!)

Just a Swimmin’

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One thing that I looked forward to when I found out that I was pregnant was not just the cute 5-7 month basketball-shaped belly, but finding out what it actually feels like to have a little person inside of you swimming around. There were times as early as my 14th week that I felt little things like random pokes here or there, but nothing at all like this week.

Although I can’t see or feel it from the outside yet, it is so weird to be sitting at my desk and around 10-11am, if things are quiet, this little one starts moving around. If it’s not just a few pokes here and there, it feels like something soft just rolling by from one side to the next. I’ll put my hand to my bump where I felt it and I won’t feel anything for a few minutes after that. So, most of the time now if I feel it, I just sit still and let him or her move and swim as they please. And I’ll feel it off and on throughout the day, and rarely at night when I get home. I guess because I’m moving so much more than just sitting at my desk and (from what I’ve read) my moving is rocking the baby to back to sleep.

And to that, I say this:

FEELING THAT IS SOOOOO FREAKIN AWESOME!!!!!!!!!!!

Ok. Just had to get that out there.

Now, for the diabetes side of things, I think I’m starting to rock between the scary lows and the irritating highs. Seriously. My CGM looked like a picture of the Rocky Mountains one day earlier this week. Some days I’m more sensitive to insulin, others I’m more sensitive to carbs. It’s kinda like the teeter-totter is starting to sway with all the other hormonal changes still going on. Of course, it could be that or the fact that I’m able to eat most anything now (except bacon.. that’s still out of the question.. I tried.) and my carb amount is starting to go from a goal to reach for meals to a restriction for meals.

In example: Lunch today. I ate a beef burrito from the local Mexican restaurant down the street. #1, in the first trimester that wouldn’t have even been something I would be able to consider without getting queasy. #2, If I did try to eat it, I would not have desired much of it and probably would have had to split it between a few meals, and would have had to eat something else to meet my 30-40 gram carb goal for lunch. Now?? I walked out of the office and craved one. So, I walked down there, ordered one, and devoured it along with half a basket of those sinfully just-gotta-eat ‘em chips they bring you to munch on before your food is served. Of course, now I am full beyond capacity and literally sick from eating the whole darn thing, and will be having to watch my bg’s like a hawk this afternoon because I’m pretty sure what I prebolused will not be adequate. I’m holding steady at 65 right now, but I’m sure once all this starts digesting, I’ll be trending upward, and not nicely.

My A1c did come back and I got a call yesterday. It’s at 6.3… down from 6.7 in mid-December and 6.6 the first part of January. I did honestly expect it to be lower since both At-home A1c tests showed me in the 5’s AND the average per my dexcom and meter was showing in the 100-110 range for the past several weeks. But of course, I keep forgetting that it does take time and it’s not going to suddenly be what you want/think it should be. The good thing is it’s trending back down to where I was pre-pregnancy. Now, if I can just keep it that way.

Smile

An Almost White Christmas

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hollyberryI hope everyone had a nice vacation/holiday/Christmas! I enjoyed being able to stay at home with Erik with nothing much to do other than sleeping (which has become my favorite past time!). We did our yearly Christmas rounds and watched most of the 24 hour “A Christmas Story” special that comes on every year starting Christmas Eve night. He and his family have a tradition of watching this movie. I don’t like watching it personally – it’s a cool movie and all, but not for 24 hours – but I figure it’s one of those things you just let them have their joy.

snowYesterday was a beautiful day though. You know how I keep talking about wishing and wanting snow? Well, we got it! And the day after Christmas at that! It was so exciting for us to see. (All across America I can hear a collective sigh among you guys.) And, it snowed for the rest of the day. AND it was still on the ground this morning when I left home to boot! We usually, if we get any snow and IF it sticks, will have it for a few hours one day and it’s gone. Now, granted, the sun is back out today and most of it will probably melt by lunch, but it was the most awesomest Christmas present ever to have yesterday. We got some pictures and played a little while, though I had to take it easy because I almost busted my tail taking pictures.

I got up this morning and weighed myself just knowing that since I had used a couple of my nausea pills that I might have gained at least a pound over the Christmas holiday with all the eating that is a must during this time. Nope – I’ve lost another three pounds. But looking back, I’m still eating less than I used to because of the glorious (can you just see my eyes rolling with that one?) morning 24×7 sickness. It has photo[1]gotten better, but it’s still there. I’m learning what foods are okay and what to leave the room when being cooked. I have started picking up those little bottles of Special K protein shakes and drinking half of one with my meal (which mostly consists of either crackers, grits, or rice) to try and get some kind of protein in me that I can stomach since most are off-limits for the next few weeks (well, hopefully only that long!). I do think that switching vitamins helped though. The sickness is still there, just not nearly what it used to be. If I had known that, I would have asked for those “horsepills” a lot earlier!!!

Otherwise, diabetes has been behaving for the most part. I will have to change a few basals in the early morning hours as I am waking up low around 3:30am, but otherwise things seem to be doing very well right now. We’ll know more when the next A1c comes back. Speaking of A1c’s, remember I was waiting on my other one to come back? Well, for those of you who don’t follow me on twitter, it came back at 6.7. I was very upset with myself because the one time I decide to take a little break, I end up pregnant and it’s higher than it needs to be. The OB wants to re-do the test at my next visit to be sure it’s coming back down, and my endo assured me that though it did jump, it’s okay, and to keep faxing in blood sugars once a week. (I’ve said it once and I’ll say it again. I love my endo!)