Yesterday's endo and CDE appointments left me with plenty of new techniques that I'm ready to put into practice. Even though my A1c finally bumped from 7.3% (which I'd been stuck at with the pump for over 6 months) to a 7.1%, I know that I can do better. And despite the better A1c, I'm not seeing the types of patterns that I prefer to see. So here are all the tips that I'm setting into motion over the next weeks.

• First and foremost, my post-prandial numbers are the worst after breakfast. Often I see results like 220 or 260. I tried lowering my insulin to carb ratio just for breakfast, but never could find the right mix. My endo suggested adding protein to my breakfast (something I'm not so great at)...maybe a little yogurt or soy milk. I'm hoping that works, but if not I'm going to try Symlin. I've also bumped my breakfast bolus up to 30 minutes before the meal (currently I do it with the meal).

• I'm also working on getting my Lantus straightened out so my basal insulin isn't as scattered as it is right now. To figure this out, I'm only correcting bedtime blood sugars over 250. With my history of seizures and severe night lows, I have to get this straightened out first without pushing my body too far. It scares me to sleep with a high number (just like it does to go to bed too low), but I'm hoping I can figure the Lantus out soon enough and stop soaring to the 250's in the first place!

• Still on the same page, we've raised my morning Lantus injection by 2 units (which I'm going to carefully watch as I do feel this might be a little too much) as well as moving it up by a few hours. Instead of doing it at 11am or noon, I'm going to do it when I wake up (so about 8am or 9am depending on weekday or weekend). Although I don't always wake up at the same time, those extra hours should help with the post-breakfast highs and move the Lantus peak away from where I see a lot of lows (late afternoon).

• Next on my list of diabetes "to-do" is to get my exercise blood sugars under control. Right now, I'm hesitant to bolus before going into a workout since I'm tired of treating lows with more calories than I expend. But I'm also realizing that working out three times a week leaves me with about six hours of 200 level blood sugars. So anything about 250 (again), I'm bolusing with 1 unit of Humalog to help my body avoid those spikes from weight training.

• The past few months I've noticed the week or two before my period I'm experiencing higher averages than "normal." Although it's not a truly stable trend, it's still something I've been puzzling over in recent weeks. So if I feel the need, the suggestion is to lower my carb ratio that week or two to counteract the insulin resistance my body is so fond of. I'm not exactly positive I'm going to put this into practice (I might continue to watch the trend) since it means computing a much harder ratio in my head and raising my risk for lows if I'm wrong. But we'll see.

• The last big tip on my list is something I'm not so certain about, but I'm willing to give anything a shot to get this A1c down. My CDE recommended using the KwikPen to carry in my backpack and purse instead of my usual vial and syringe. She claims that all the jarring and temperature changes may affect how my Humalog is truly working (leaving me with the erratic numbers that I have now)...so the pen lowers those negatives. I'm doubtful this is truly a problem, but it's kind of nice to take a break from the traditional.

I'm excited to see if these changes truly help my averages. I'd give just about anything to see my blood sugars stabilize (I don't even care if they stabilize at 180, but at least they'd show a pattern!) since everything is all over the place right now. Basically, I want all these tips to ease the burden of managing my diabetes. A little added convenience and a little lower blood sugars (without severe lows) may just be the answer to bumping my A1c down again.