Lowering my A1c is my diabetes priority at the moment. I'm ready to bump down from the 7.3% that I've been stuck at for the last six months. I'm looking to get back under 7% and head towards 6.5% to achieve another "lowest A1c of all time." But today it hit me that lowering my A1c is really taking a toll on me.
Not only is it increasing my diabetes stress to do everything right (or at least the majority), but it's also creating a domino effect with quite a few other aspects of my life. Things that are "tolerable" but when combined make me wonder if it's worth it. I feel like I'm always in a state of "weighing the consequences:" do I try harder to lower my A1c or do I tolerate the 7.3% and avoid the ill effects?
One thing that I'm hesitant to do at any time (but especially when I'm seeking a lower A1c) is to lower my insulin by much. When I started having all the lows last week, I refused to lower my insulin by more than a unit at a time (per dose of Lantus). I've lowered it by two units now and I'm waiting to see how I respond. But that initial moment that I know I need to do something is the toughest...because if I do too much then I end up high and my hopes for a lower A1c get slimmer and slimmer.
And since I refuse to lower my insulin by much, I have lows...sometimes severe, multiple times a day. Like last week. I ended up having so many lows and having to eat so much and cut workouts short that I've gained a pound back from the six pounds I've lost. Instead of weighing my options to think that the lows are not only dangerous but will make me gain weight, I kept my focus on lowering the A1c and avoiding the high swing that comes with lowering my insulin too much. Now I'm kicking myself for it.
The other thing I've done recently is cut down one of the prescriptions that I'm on to see if I can get better control that way. I take the hormone cortisol every morning and was on a higher dose. My doctor and I decided that lowering it would be a better idea because it didn't seem to be giving me as many positive effects as we wanted...we were concerned that the negatives were going to start kicking in. And a few weeks ago, I decided that I wanted to go completely off of it because I've had such trouble with my morning blood sugars (and I feel like the cortisol is responsible).
But now that I've cut it back and I'm slowly tapering off of it, I'm experiencing the negativity that comes with the lower dose. I'm tired in the afternoons to the point that my eyes sting. I wake up wanting to sleep another few hours, only to realize that sleeping isn't really going to matter. I'm just fatigued. I don't know if that will wear off once I get to the end and "adjust" or if I can increase my thyroid to accommodate, but it's disappointing that I might have to be fatigued in order to get those blood sugars under control.
Overall, it's a tough point to consider if the lower A1c is really worth all this extra effort/chaos. I know that I want a lower A1c because I want to have the option to get pregnant in the next few years. I want a lower A1c because sixteen plus years of diabetes takes a toll on my body. I want a lower A1c because it feels better than struggling the way that I do now with a 7.3. But I don't want to be tired, I don't want to run low, I don't want to gain weight.
So which way do I go? Keep trudging till I get the A1c better and stabilized? Or do I head back to the safety of knowing I'm stable, but not under 7%?
I haven't read all of your blogs to know how you are trying to lower your A1C. Eating smaller portions? Exercising more? Both?
Have you thought about a pump? For me, the ability to really fine tune my insulin delivery using only one type of insulin made a HUGE difference.
I can't attest to any A1C results since I live on a sailboat and in places where questions about A1C get responses like, "do you mean A-B-C?", but for me, I try and focus on frequent testing and trying to get my post-prandial and overnight numbers right. That way I figure a good A1C will follow.
Fair Winds,
Mike
(aka YOGA O)
Life on a sailboat! That must be both exhilarating and tough with diabetes. I do anything and everything to get my A1c down. I tried the pump for almost 2 years, it raised my A1c so I switched back to MDI's. Haven't had an A1c done since I made the switch, so I'm hoping it worked out for me this time!
Life on a sailboat is mostly excellent until I have to deal with trying to get prescriptions refilled for 9 months at a time! It is almost comical.
I have been thinking more about your efforts to lower your A1C and I might point out that it is just a test that gives an approximation of your level of control. I haven't done much research on this, but I recently saw something that said A1Cs may not have much meaning beyond 2 weeks.
So I guess I would focus on continuing the "right" activities; exercise, eating "good meals" and watching the portion sizes, test, test, test w/your glucometer, etc. Make small tweaks, not huge changes.
Hi Lindsey,
I am a data person and I realize that we do not alway catalogue data in a manner that we can utilize as we go forward. Meaning;
1. Does our insulin needs change via seasonal temperature changes. Some need less in the winter and more in the summer, some need more in the winter and less in the summer, and some have no effect.
2. Relative to a prior blog.... Today, www.diabetesmine.com has a post called "Doing July 4th Right" from a piece by John Crowley. It is a great suggestion and does also work for those gathering of friends and food.
3. Exercise. See Health, New York Times, Tuesday, June 30, 2006 pages D5, by Tara parker-Pope, "A 3,000-Mile Triumph, Spurred On by Diabetes. Contained in the article is..."As the body adjusts in the later days of the race, the cyclists must generally increase their insulin injections."
Stay the course. Your writings show that you care and that is great. Life is a balance and you have a focus. As Always, and have a great day.
D2
You're so right that we don't always retain the data in the right way. I've never once looked at seasonal adjustments, but if I needed to I could go back and look. It's so hard to keep all the variables straight with diabetes (temperature, activity, stress, sickness, medications, food, insulin, hormones, and so on) in a tiny logbook. I'd be logging for days if I tried to keep track of it...so sometimes it's just tracking the most important bits for us and guessing with the rest! Thanks for the resources :)
i would love to know how to get my A1c down. i am a type 1 diabetic of 30 yrs. now and am on an insulin pump but still cannot get it figured out well enough to "control" my bg's. i cannot get my A1c out of the "9" range. what do i do? i'm so frustrated!! also when my bg's r in the "normal" ranges and i exercise my bg will drop fast and hard then i eat so much that i end up over correcting, then taking more insulin to come back down etc. the cycle continues-the spikes and drops etc. it's like chasing your tail trying to get back on course,is it safe to exercise when my bg is 200 or above? and why do i feel fine when my bg is in the 200's?
Hi beckydoodle~ I'm so sorry to hear about your frustrations with the pump/diabetes in general! I know EXACTLY how you feel! Are you working with an endo or diabetes team? The only thing that got me through the adjustment to the pump was having my friend Tracy (a pump user) help me through the basal tests, look at my numbers with me, and all that. Do you have someone that could do that for you? I'm always willing to give you my tidbits if you'd like my email. It's better to exercise when you are under 250, ideally under 200. When I'm above 250, I take a unit of fast acting and wait at least 30 minutes for it to get to work. The pump should make exercise much easier but it takes some trial and error. If you feel normal in the 200's, that's not a terrible thing. Everyone is different. As long as you are testing often and correcting, you don't need to worry that you don't feel the highs. Lows on the other hand are a different story. (Sometimes running high can also cause your body to adjust to being in the 200 so you don't feel high when you are and you may feel low when you are 150 since your baseline is off.)