Pre-pregnancy hba1c struggles

[CK12]

I've been struggling to get my hba1c down to target range for nearly 4 years. I moved to a pump just over a year ago, whilst it has made some difference, i still have a way to go and my mental health has really been affected by the toll this is all taking. Has anyone else been in a similar boat? Does anyone have any hba1c reducing tips? I make tweaks and once one area improves, another goes out of whack - typical diabetes really! Thanks in advance

 

[Deleted member 27171]

Hi @CK12 - welcome to the forum.
Sorry to read you are finding it hard to get your HbA1c down. I can confidently say, yes, other's have definitely been in your boat, you are not alone in feeling like you're in a constant uphill struggle. I'm sure someone with the first hand experience of that will be along with some support/advice for you.
Great that the pump has made some improvement, though perhaps not as vast as you had hoped. What pump do you use?
Do you have a Freestyle Libre to monitor your bgl or a CGM, or do you use finger prick testing?

 

[Inka]

@CK12 Do you test after meals? Catching meal spikes is a really good way to get your HbA1C down. Test, assess, and correct if necessary.

Also, set an alarm to get up and test during the night so you can see what’s happening there and make adjustments to reduce any highs.

To get a good pre-pregnancy HbA1C, you have to be quite aggressive in your control and test a lot.

Can you give some examples of times you’re having problems? Have you done a basal test? Have you checked your ratio for each meal?

 

[Thebearcametoo]

Have you asked your team about a Libre or CGM too? It may help identify where you’re getting Niger readings.

 

[PhoebeC]

@CK12 Do you test after meals? Catching meal spikes is a really good way to get your HbA1C down. Test, assess, and correct if necessary.

Also, set an alarm to get up and test during the night so you can see what’s happening there and make adjustments to reduce any highs.

To get a good pre-pregnancy HbA1C, you have to be quite aggressive in your control and test a lot.

Can you give some examples of times you’re having problems? Have you done a basal test? Have you checked your ratio for each meal?

Agree on the after meal spikes, it was only the Libre that actually showed me this, I would be fine after 2 hours of eating but what was happening in those 2 hours was too high.
So now I take my insulin well in advance of when I eat so it has plenty of time to kick into action.
Are you on the Libre? I would really recommend speaking to your team about it if not.

 

[CK12]

Thanks everyone. I use a Libre. My team have put me forward for funding for either Dexcom or a Medtronic specific CGM. Does anyone have experience of those?

I get up during the night to test often, I generally test very often. At the moment my main problem area is between dinner and bed and i've been playing about a lot with bolus and basal testing and i'm keeping everything crossed that the latest tweak is making a difference.

Do any of you find you that your sugars spike just before your period as well?

I really appreciate all of your quick responses.

 

[Thebearcametoo]

A spike before periods is common.

 

[PhoebeC]

Yes, mine go mental before my period, and during I get random hypos! First sign it’s on the way.
What are your levels like between your evening meal and bed?
what are you eating?

 

[Inka]

I find that a little activity after my evening meal helps. I do mean a little - even walking up and down stairs doing household chores helps. So, I try not to just sit there, tempting as it is after a busy day. I eat then get up and move rather than sit or watch TV. I have a set time after which I can chill. It sounds trivial but I notice the difference when I don’t do it.

I’d also add that basal needs can randomly change, and that my evening basal has been both lower than my average hourly rate and higher.

 

[SB2015]

I get up during the night to test often, I generally test very often. At the moment my main problem area is between dinner and bed and i've been playing about a lot with bolus and basal testing and i'm keeping everything crossed that the latest tweak is making a difference.

Welcome to the forum CK12.

Sorry to hear that you are having a tough time at present. I hope that some of the suggestions that you have been given prove helpful.

With regard to issues between evening meal and bed, I had the same and we did three things which helped a lot
- moved our meal so that there is a clear four hours after the meal before bed
- go for a walk or do something for at least 15 min after a meal.
As @Inka says this really help reduce the spikes.
- timing of the Bolus. I now always test 30 min before the meal is due to be ready, and based on that, and the arrows on my Libre I decide how soon to inject. If on target for me it is about 30 min before the meal, If I am high we delay the meal a bit to allow the correction to get going.

I hope that those may be of some help.

 

[CK12]

Welcome to the forum CK12.

Sorry to hear that you are having a tough time at present. I hope that some of the suggestions that you have been given prove helpful.

With regard to issues between evening meal and bed, I had the same and we did three things which helped a lot
- moved our meal so that there is a clear four hours after the meal before bed
- go for a walk or do something for at least 15 min after a meal.
As @Inka says this really help reduce the spikes.
- timing of the Bolus. I now always test 30 min before the meal is due to be ready, and based on that, and the arrows on my Libre I decide how soon to inject. If on target for me it is about 30 min before the meal, If I am high we delay the meal a bit to allow the correction to get going.

I hope that those may be of some help.

Thank you so much for this advice. What insulin are you on? I'm on fiasp so am trying to get it right in terms of how far in advance to dose since it is faster acting. We have started trying to eat earlier as well so the more we can do that the better picture we'll have. Thanks again

 

[CK12]

I find that a little activity after my evening meal helps. I do mean a little - even walking up and down stairs doing household chores helps. So, I try not to just sit there, tempting as it is after a busy day. I eat then get up and move rather than sit or watch TV. I have a set time after which I can chill. It sounds trivial but I notice the difference when I don’t do it.

I’d also add that basal needs can randomly change, and that my evening basal has been both lower than my average hourly rate and higher.

Thanks Inka

 

[CK12]

Yes, mine go mental before my period, and during I get random hypos! First sign it’s on the way.
What are your levels like between your evening meal and bed?
what are you eating?

I'm eating a range of foods, there doesn't seem to be a pattern. Have you found any foods in particular cause you to spike. Before bed can range from 10 ish up to the high teens at the moment.

 

[PhoebeC]

I'm eating a range of foods, there doesn't seem to be a pattern. Have you found any foods in particular cause you to spike. Before bed can range from 10 ish up to the high teens at the moment.

Apparently protein isn’t the easiest to digest in the evening.
I would start a food dairy if was you and work out which foods it is.
I find I infect my insulin better from my stomach and with my evening meal taken well before I eat.

 

[SB2015]

Thank you so much for this advice. What insulin are you on? I'm on fiasp so am trying to get it right in terms of how far in advance to dose since it is faster acting. We have started trying to eat earlier as well so the more we can do that the better picture we'll have. Thanks again

I use Novorapid, but the pre Bolus time will be different for each of us. I did switch to FIASP for months and had to shorten my timings as you suspect. It is definitely a trial and improvement process for each of us.

I went back to Novorapid when I found that I kept getting skanky cannula sites with FIASP and it hurt so much. I decided the benefits in timings were not enough for me.

 

[everydayupsanddowns]

How long have you been using Fiasp? I tried it for a few months and it started out OK, but quickly became very unreliable for me - which I’m. not sure I would have spotted without sensors.

 

[CK12]

How long have you been using Fiasp? I tried it for a few months and it started out OK, but quickly became very unreliable for me - which I’m. not sure I would have spotted without sensors.

Over 18 months and I don't think it is part of the problem, but I will raise it at my next chat with my nurse. Thanks

 

[Inka]

I'm eating a range of foods, there doesn't seem to be a pattern. Have you found any foods in particular cause you to spike. Before bed can range from 10 ish up to the high teens at the moment.

Is that all the time or just before your period? And do you correct when you see the spike eg at 2 hours? And does that have any effect?

I second the advice to give Fiasp a good scrutiny. A number of people have described it as ‘becoming like water’. Newer isn’t always better. If you’ve been struggling this long to get a good HbA1C, I’d say you need to really ‘get back to basics’ and build things up from the ground again. Assume nothing, and start afresh. That is, look at your insulin, look at your basal, look at your mealtime ratios, etc.

I’m positive you can get some improvement. You’re already making sensible changes like eating your evening meal earlier. I know it must be hugely frustrating and upsetting, but you can do this - honestly you can.

 

[CK12]

Is that all the time or just before your period? And do you correct when you see the spike eg at 2 hours? And does that have any effect?

I second the advice to give Fiasp a good scrutiny. A number of people have described it as ‘becoming like water’. Newer isn’t always better. If you’ve been struggling this long to get a good HbA1C, I’d say you need to really ‘get back to basics’ and build things up from the ground again. Assume nothing, and start afresh. That is, look at your insulin, look at your basal, look at your mealtime ratios, etc.

I’m positive you can get some improvement. You’re already making sensible changes like eating your evening meal earlier. I know it must be hugely frustrating and upsetting, but you can do this - honestly you can.

Thanks a lot Inka. Since going on the pump there has definitely been a lot of exploration and a lot of tweaks in terms of basal, bolus, correction etc. But more to do for sure. My mental health has suffered a lot, especially this year, so i'm really hoping for some light at the end of tunnel. I've been pretty stable for the last couple of months, so I feel like things are improving, more than they have for a while, but you know, diabetes likes to throw in some surprises. Appreciate everyone's support

 

[CK12]

Hi Everyone, thanks again for all of your support and suggestions. This week we've been given the go ahead to start trying to conceive. I can't quite believe it. Thanks again.