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Practice makes near perfect at bedtime

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The Question
Fri Oct 12 18:32:49 EDT 2012

Can't seem to quite please my diabetic nurse practitioner. My A1c has gone from 9.3 to 7.3 in 2 months. Been on Levemir and rapid insulin for 8 year
Asked By: bilmarsh  
Category: Insulin

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I am female, 70, diabetic 2 for 25 years, been on long term insulin and rapid insulin for 8 years, now in the past 2 months victozoa 1.2. My carb ratio is 6 to 1, breakfast 24 carbs, lunch 30-45 carbs, dinner 45 to 60. The nurse practitioner seems still not satisfied, my A1c has gone from 9.3 to 7.3 in 2 months. Still don't like my bedtime blood sugar readings. They have ranged from a low of 123 to a high of once 225. I eat no snacks, just the 3 meals. I mail in my numbers every week. Today was grandparents day, had my usual Slimfast for breakfast, then drove 50 miles to the grandparents program, had a snack of 1 donut hole and 1/2 cup cider, sugar went to 223 instead of the usual 120. Any suggestions?
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Expert Answers (1)
2012-10-18 13:55:04.0

As a nurse, CDE, I would be thrilled to see a patient's A1C go from 9.3 to 7.3 in 2 months. You have GREATLY decreased your risk of long term complications. So, congratulations! The American Diabetes Association currently recommends an A1C under 7% and the American Academy of Endocrinologists recommend it to be 6.5%. However, all A1C goals should be individualized and depend on things like risk of low blood sugar and age. You did not mention any problems with low blood sugar, so I would probably advise you to work with your NP regarding "tweaking" your insulin dose a little. If your only high readings are at bedtime, your supper time insulin or insulin ratio or your supper time carb intake may need to be adjusted a bit. I would also recommend checking blood sugars two hours after all meals to see if your ratios need to be changed.

Please see a dietitian specializing in diabetes. It is generally recommended to eat a consistent amount of carb spread throughout the day. Your current suppertime carbs are over twice in amount than your morning carbs. I also wonder if a dietian would add a bedtime snack to your meal plan.

My third concern is your low breakfast carb intake before a 50 mile drive. Always check your blood sugar before driving to make sure that it is high enough to prevent a low while driving. Work with your NP to find out what your "predriving" blood sugar target should be. Keep snacks and treatments for low blood sugar stocked in your car.

As for your sugar spike after eating a donut hole and cider...Both contain simple carbohydrates that tend to spike blood sugar levels, especially if not eaten with other foods. Remember that 1/2 cup of cider can be used to treat low blood sugar precisely because it can rapidly bring up blood sugar. Again, speak to your NP and a dietitian. You may need to limit portion sizes of simple carbs OR provide insulin coverage with rapid acting insulin if you choose to eat them. Good luck!

Answered By: Donna Yuscavage
Accreditations: RN, BSN, CDE
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Community Answers (1)
2012-11-16 10:05:49.0

Congrats on getting your A1C down to 7.3. I think however you need to talk more with your diabetic counselor about food combination and how they effect your blood sugars. Your Slim Fast shake contained between 20 and 40 carbs and with the protein in it it should not have caused a blood sugar spike. But, it did increase your blood sugar! Then, you added a high glycemic starch with the donut hole and a high glycemic sugary fruit juice. Mixing a starch and a sugary drink causes a food combination which accelerates the blood sugars entering your blood. This is one of the most helpful things I have found along with eating more fruits and veggies instead of processed grains, processed meats, and processed meals, never never combine a meal high in starchy foods with a fruit or sweet drink,wait at least 1 hour between the starch and the sugars will help.
Answered By: dkashefska

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*** All information contained on dLife.com is intended for informational and educational purposes only. Our Expert Q&A is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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