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Oh, 'eck - I am going to be in trouble.....

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silentsquirrel

Well-Known Member
Relationship to Diabetes
Type 2
On Monday I had my bloods done in preparation for meds review and diabetic review. The results have now appeared online, and my HbA1c is 34. Last year it was 36, and the previous few years between 39 and 42. I know this figure would be a cause for much rejoicing among those on diet control or on metformin only, but I have been on insulin for some years, as my signature below says. (It only took me about 7 years to get round to it!).

I am dreading the annual "You must be having too many hypos" lecture. My GP and the consultant (neurology/geriatrics) that I saw last year about my increasing tremor both say I have very good control, but the nurse in charge of T2s on insulin at the surgery says I have very tight control, and she says it in the most disapproving tone she can muster.

I really don't! I would hope my management is reasonably good most of the time, but control, no, and tight, no. I think my management over the past year or two has improved, mainly because of:
1. Changing from Lantus to Levemir, split unequal dose.

2. Prebolusing by 1 - 1.5 hours for breakfast.

and 3. Bolusing 6 - 8 units of NR on waking (without food) to deal with DP. I often don't want breakfast until late morning.

1) was at my request, not their suggestion and I fear they may be very disapproving of 2) and 3).

There are a few things I could try if I wanted to improve my management further, but I doubt if these would make so much difference,

I have very few hypos, almost never below mid 3s, and not long-lasting. Since the change from Lantus, almost no hypos at night. I can only remember one hypo in the past year where my brain was shouting EAT. EAT, EAT. But I don't think she believes me.

My averages on my meter are usually between 6.5 and low 7s, occasionally outside this range. Perhaps my red blood cells die off sooner than average?

A few months ago I saw 3 Time In Range diagrams, one almost perfect, one OK and one not so good - but the point was they were all from people with the same HbA1c. I meant to take a copy to show the Nurse, but was distracted, and have not been able to find them again. Do any of you using Libre or CGMs have any ideas where I might find them?
 
On Monday I had my bloods done in preparation for meds review and diabetic review. The results have now appeared online, and my HbA1c is 34. Last year it was 36, and the previous few years between 39 and 42. I know this figure would be a cause for much rejoicing among those on diet control or on metformin only, but I have been on insulin for some years, as my signature below says. (It only took me about 7 years to get round to it!).

I am dreading the annual "You must be having too many hypos" lecture. My GP and the consultant (neurology/geriatrics) that I saw last year about my increasing tremor both say I have very good control, but the nurse in charge of T2s on insulin at the surgery says I have very tight control, and she says it in the most disapproving tone she can muster.

I really don't! I would hope my management is reasonably good most of the time, but control, no, and tight, no. I think my management over the past year or two has improved, mainly because of:
1. Changing from Lantus to Levemir, split unequal dose.

2. Prebolusing by 1 - 1.5 hours for breakfast.

and 3. Bolusing 6 - 8 units of NR on waking (without food) to deal with DP. I often don't want breakfast until late morning.

1) was at my request, not their suggestion and I fear they may be very disapproving of 2) and 3).

There are a few things I could try if I wanted to improve my management further, but I doubt if these would make so much difference,

I have very few hypos, almost never below mid 3s, and not long-lasting. Since the change from Lantus, almost no hypos at night. I can only remember one hypo in the past year where my brain was shouting EAT. EAT, EAT. But I don't think she believes me.

My averages on my meter are usually between 6.5 and low 7s, occasionally outside this range. Perhaps my red blood cells die off sooner than average?

A few months ago I saw 3 Time In Range diagrams, one almost perfect, one OK and one not so good - but the point was they were all from people with the same HbA1c. I meant to take a copy to show the Nurse, but was distracted, and have not been able to find them again. Do any of you using Libre or CGMs have any ideas where I might find them?

I got this from Dr Googleby searching "time in range diabetes", then going to images. There are LOTs if diagrams/images of this sort of thing:

1627589815382.png


That image is downloadable from the DiaTribe website
 
I got this from Dr Googleby searching "time in range diabetes", then going to images. There are LOTs if diagrams/images of this sort of thing:

View attachment 18120


That image is downloadable from the DiaTribe website
Brilliant, @AndBreathe , many thanks! I had not looked at the Diatribe site before, only thought to search forums, not Google, doh. Looks as though I should find what I want there.
 
Brilliant, @AndBreathe , many thanks! I had not looked at the Diatribe site before, only thought to search forums, not Google, doh. Looks as though I should find what I want there.

No worries.

Sometimes I think it's easier to find stuff for other people than for ourselves - especially when we really, really want to find something!
 
Hi SlientSqurrel,



Stick to your guns. I've had similar feedback and have very similar average finger-prick results and HBA1c to you.

I take / share a graph of how many finger-prick results I'm having at 4 or lower, which isn't many, along with overall average finger-prick results.

A few years in and my GP and practice diabetes nurse now seem to accept that I'm in control and not risk-taking.

More often than not, the presumption seems to be that tight control without excessive hypos is unlikely :(
 
@silentsquirrel do you have a CGM or Libre? This would be able to prove your levels are in range.
Perhaps if you don't have one and your team are concerned you are having too many hypos you could turn it to your advantage: either you are not having hypos (most likely) or you have little hypo awareness. A CGM or Libre will enable you to check this.
At the same time, you will be able to learn a lot from the data it provides.

I don't know when you are taking your finger prick readings but if they average between 6.5 and 7.0, typically, I would expect to see a HbA1C higher than 35 because you will be missing the peaks (which you will see with a Libre or CGM). An average of 6.5 gives a HbA1C of 38 (https://www.accu-chek.co.uk/tools-and-resources/hba1c-calculator#). Obviously there are lots of approximations going on with this calculation. But if you want to show Time in Range, you need to be monitoring all the time; not just finger pricking.
 
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