A1c Above 7

Hey all!

Just writing to vent as we all are. I have had diabetes for 11 years now. I’ve always maintained a good A1c never reaching above 7.0. After my three week honeymoon last June 2014 I had an initial A1c of 7.8, I was terrified! Over the last year I’ve worked REAL hard to get it back down to below 7.0 and just when I was sure I would get good results I recently got an A1c of 7.2. I realize it is an improvement but I used to get low 6s so I’m just bummed, that is all. It has been a huge time of transition with grad school, wife being pregnant, and some anxiety…thus I realize all these things can affect BG. Diabetes sucks!

A1c Hx

June 2014 7.8
September 2014- 7.6
March 2015 7.4
June 2015 - 7.2

I totally understand, and it indeed sucks. I’ve had it for 31 years, and had hideous A1C’s for the first few years, then finally got my act together and gradually worked it down into the high 6’s and low 7’s. It’s not like the 7’s are bad, by any means. It just means you probably have some high spikes in there that are hanging around for a few hours, or maybe you’re riding just a bit high a lot of the time. So the good news is it’s fine tuning at this point. Are you working with an endocrinologist? Are you on a pump? Do you also work with a certified diabetes educator? The latter is great because they usually have an hour to spend with you to crunch the numbers and make recommendations, then you can schedule follow up appointments a few weeks later to see what other tweaks you can make. Are you following a lower-carb diet? Try keeping your meals at less than 30g when you can, and avoid between-meal snacks other than nuts or green veggies. Also make sure to check your BG at least 6x per day, and I think this stuff will make the difference or at least help get you under 7.

I can feel for you because as you say you are really trying; and the stress of a new baby [congratulations to you and your wife!!!] and grad school could be a factor. But, as @angivan says you need to fine tune - fine-tune both your pump and your meals. Remember too that the HB A1c in itself, although very important, doesn’t tell the whole story.

I see you use a pump: when was the last time you validated your basal rates and your carb ratios? and, do you count carbs fairly accurately for the quantities of food you actually put on your plate? I know that eating restaurant food it is close to impossible to know the carbs in many foods. How often and when do you test your blood and do you graph your carb intake, BG values and exercise? The “standard deviation” [SD] of your tests is a very important number - it will, when used with A1c indicate consistency and control of T1D. For years I maintained an HB A1c between 5.9 and 6.1 but my SD was in the upper 70s and wasn’t optimal control - now on doctor’s orders I’m aiming for A1c no lower than 6.5 and I see my SD os below 50.

Numbers by themselves aren’t everything, enjoy life and the joy of a new baby and take care of yourself so you’ll be here to bounce your grandkids and maybe great-grandkids on your knee.

Hi all,

Thanks! What does validating my basal and bolus ratios mean? I am trying to monitor them and edit them when possible…I use the new medtronic pump with the Next Contour tester. I test 8 times a day at least and recently got a CGM. I plan on meeting with an educator and using te CGM possibly once a month for more data and to help fine tune. The lack of consistency in regards to routine due to grad school doesn’t help…@Dennis how do I figure out about SD, and/or learn about that? I’ve never considered that. I just utilize my BG and A1c to measure success…and how I feel of course.

The last question you ask (SD) is the simplest to answer - I read it from my CareLink charts. You have a Medtronic pump and the contour Next “Link” meter. Setup yourself as a user on Medtronic Carelink and periodically upload data from your pump and meter and generate “Reports” - there are 12 different charts and logs including CGM and Meter overlay. SD is calculated for you on many of the charts. Your Contour Next Link plugs into a computer USB port and acts as a dongle. Reports on each chart or table are for periods of your choosing ranging from a single day to 12 weeks. I have a table that closely matches MY average 12 week BG to my 3 month HB A1c [it just might be coincidence].

The chart I most frequently use for adjusting my basal rates and carb ratios is “Modal Day Hourly”, 14 days - this chart shows the range and average of BG for every hour in which you have a BG reading - and I make gradual changes [+/- 0.125 units] based on this and my log showing unusual eating, exercise, extended bike rides. etc.

Now your first question about validating basal and carb ratios. The carb ratios are set by “seat of pants” by eating measured meals and checking BG before eating, 2 hours after and 3 hours after - play with that over a period of days keeping in mind that a previous meal [containing fat] could still be affecting you. For me my carb ratios vary over the course of the day from 8.5:1 to 20:1.

When I got my first pump, after 47 years of injections, all the endocrinologist said was “play with it, figure it out but start off having the total daily insulin no more than 70% of your total [Lantus and Humalog] daily injections”. Whatever I did has worked well and I “tweak” several times a year - especially with change of season.

I do the basal by fasting for three different 18 hour periods - and never do more than one period - Overnight, Daytime and Evening. I have charts that offer full instruction; they came with my original pump book and were available on the Medtronic website. If you can’t find these charts I can send them to you. As an example, after supper I don’t eat or take any bolus insulin until lunchtime the following day - unless the BG test is “out of established parameters”, high or low. If out of range it is necessary to eat or bolus and the validation is stopped, a correction is made to either basal or carb ratio and procedure will be tried again on another day.

Yeah, this is very wordy, but I found it works; after the first time, it is less cumbersome. In theory, once your basal is “properly” set you could, if stranded, go days just on your basal. But, as you guessed, that theory doesn’t account for stress. Good luck!

I hear you! I’m in a similar boat…marriage/cohabitation and some other life transitions have changed my routine in a lot of ways as well, and it’s been a struggle fine-tuning everything to get to a more stable place. I can’t say my A1c was always below 7.0 before that, but frequently it was — and, if not, then just above. But it’s been an uphill battle for the past year or two and I feel like I have been trying…it’s so frustrating.

You A1C sounds like mine and I think mine is OK. Above 7 is not bad. I try my best, and the A1C gives me some feedback on how I’m doing, but I’m not going to worry about it too much.

I admit I’m a skeptic, but I think a lot of this lower and lower A1C is a ploy by the medical and pharmaceutical companies to increase profits. The original DCCT study which proved that tightish control has effects on long term complications determined that a A1c of below 8.5 produces significant benefit. My doctor says the data doesn’t bear out that lower and lower A1Cs produce better results and if it too low can actually cause harm. That along with lower A1Cs mean probably more lows and I have chosen to not sweat it and ride between 7.0 and 7.5 which I usually due except the last time when it was 6.5.

I also think long term complications are a result of BS but so are genetics. some people develop complications at a very early age while others do not. For the first 15 years of so I had it I have no idea what my control was like but since I was on 1 or 2 shots of NPH and had no blood tester (not invented yet) and I so far am in good shape in regards to complications. I’ve had it for 38 years and had my eye exam the other day with minor retinopathy only. That can’t all be due to exceptional control, especially since I’ve never had it.

Anyway, that’s what I think.