Top tips for lowering HbA1c please

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SB2015

SB2015

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Relationship to Diabetes
Type 1
I read of people on here with amazing HbA1c values.
I wondered what would be your three top tips for achieveping these values.
I know everyone is different but I would be interested.

I keep going back to Pumping Insulin and Think like a pancreas, and they remind me of good strategies. Now I just need to apply them consistently.

This week I focused on timing of injections, and have tested when I wake and delivered the insulin for breakfast then. The delay that I reckon I need, according to my BG and CHO, before eating breakfast just determines when I manage to get out of bed!
 
Well, my tips would be:

1. Timing of injections/bolus - working this out has made a big difference for me, particularly in smoothing my levels so I get fewer lows and fewer highs. When I was first diagnosed I was getting good HbA1c's, but getting some quite large swings in levels, so although the HbA1c number is similar now, I know it is due to better overall control 🙂

2. I am fortunate to be in a position where I decide what I am going to eat most of the time, so make all my own meals. This has made them pretty predictable, helping with insulin dose-setting.

3. Regular exercise makes me more insulin-sensitive, and therefore doses are smaller and more accurate - I find that the larger the dose, the more tendency for error there is, whether that means ending up higher or lower than expected 🙂

My previous 2 HbA1c's have been 34 (5.3%) and 31 (5.0%) 🙂
 
1. Like Northerner, my number 1 tip would be, timing of Bolus. I reduced my HbA1c from 7.2 to 6.5 just by addressing this and reducing post meal spikes.
2. Eating a reduced carb diet. I don't go ultra low, but again, it's ironing out those spikes
3. Working on my Lantus to provide the 'best fit' for my basal. I suppose the pumping equivalent would be, making sure I set my rates correctly for my needs at any one time of day.
 
Top tip for an amazing HBA1C: Don't be diabetic.
Realistic tip: Don't beat yourself up about it. Try all the different strategies, but always remember, diabetes does not control you, you control it. And if fulfilling every strategy means you are constantly miserable because you cant do anything, its controlling you. If something works, and you can fit it in to your life with a little bit of tweaking, use it. If it requires you to massively overhaul your life to the extent that you can't live it anymore, dump it.
Some people, due to their particular flavour of diabetes and lifestyle (yes, Northie, I'm looking at you 😉) find it 'more straightforward' (note the quotes, its not, ever, easy) to get a good level of control on an average basis (which is what the HBA1C is measuring). (That's not counting the un-explained hypos that happen to us all at times.) Others have influences that actively prevent this (hormones in women, for example, a classic influence that really can screw up an average, and that you can do nothing but react to (until you pass menopause), in many cases).
And finally, some actual tips:
-Basal test. On an ongoing basis, to check things haven't changed.
-Bolus timing. As noted above by Northie and Robin.
-Reduced (not no or very low, just reduced) carbs.
-Routine. Having a set routine really helps to smooth things out for me. Which is why, when I go on holiday, things go a little haywire and I end up testing twice as much as usual. (But that's allowed. It doesn't happen all the time, so on occasion, its fine.)
 
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Thank you all for the really useful tips.

I have heard of them all but do not consistently use them and it is useful to know which ones are at the top of your strategies. Retirement means no two days are the same, which is why the pump is so good.

Timing comes up a lot and is something's I have only recently considered.
Hence the focus on that at present.

Like Annette whatever I do it is going to have to fit in with life, but I am happy to make adjustments where I can.
We were good at always taking a stroll after our evening meal throughout the summer, but not so good in the winter!!

With no specific structure to any week it is easy to forget things as other priorities take over.

Thanks again for the ideas. Top tips still welcome from others as well.
 
Apologies for laziness, but lifted these from a blog post a while back:

  1. Education. Get access to proper structured education regarding diabetes management. In the UK we have DAFNE which is highly thought of, but other options are available. Things that should be included (in my opinion) are:
    1. carbohydrate counting, working out how to check and change insulin:carb ratios for different times of the day
    2. SMBG technique - when to test and what to do with the results *including* basal testing to PROPERLY adjust basal on an ongoing basis
    3. correction factors - when and how to correct (with insulin or fast-acting carbs) to aim bring you back into range without jumping aboard the gluco-coaster
    4. exercise and alcohol
    5. dealing with illness
    If structured education courses are not available in your country/area you can do a lot worse than buying 'Think like a pancreas' (Scheiner), 'Type 1 Diabetes' (Hanas) or 'Pumping Insulin' (Walsh/Roberts) which cover much the same ground. Though the benefit of peer support in group sessions should not be underestimated
  2. Test more often AND RECORD THE RESULTS. Find some way of keeping notes daily as you go along. What you are eating, units and timing of doses (how long before... split doses...), exercise, mood, everything! Without a fairly detailed set of records I find it impossible to see what is going on. Personally I still love mySugr for this.
  3. Gadgets - seek out new tech that can help you manage your diabetes more easily. It might be a 0.5u pen; a smartphone tracking app, or copy of 'Carbs and Cals'; or it might be a BG meter with a bolus wizard so that you can have properly fine-tuned ratios without having to worry about keeping the maths easy. Additionally, ask your clinic about access to Insulin Pump therapy and CGM.
  4. Seek peer support - join a forum or two, join Twitter, read some blogs (thanks!) or even *crazy!* join a local group and meet face to face. Living with diabetes is tough, but it's even harder if you are battling on your own. For everyone there's a little corner of the internet that can provide support, encouragement and shared experiences.
http://www.everydayupsanddowns.co.uk/2015/01/65-a1c-target-reply-comment-that-got.html
 
  • Timing - at breakfast time it takes about an hour for novorapid to start working in me, in the evening 10-30 mins!
  • Reduced carbs
and a kitchen timer to remind me to do bolus and again to eat! (I spend a lot of time beeping and buzzing :D)
SB2015 said:
Retirement means no two days are the same, which is why the pump is so good.

whatever I do it is going to have to fit in with life, but I am happy to make adjustments where I can.
QUOTE]
That's one of the many joys of retirement!
Click to expand...
 
Robin said:
1. Like Northerner, my number 1 tip would be, timing of Bolus. I reduced my HbA1c from 7.2 to 6.5 just by addressing this and reducing post meal spikes.
2. Eating a reduced carb diet. I don't go ultra low, but again, it's ironing out those spikes
3. Working on my Lantus to provide the 'best fit' for my basal. I suppose the pumping equivalent would be, making sure I set my rates correctly for my needs at any one time of day.
Click to expand...
My way of doing things too. Bolus delay on pump works good for me. & as Northy says don't sit still, move around
 
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