I choose to share my A1c because it has been helpful to me to see what other diabetics are achieving or struggling to achieve. It has also been extremely helpful to read about the specific tools or strategies people utilize to improve their BG control (see links at very bottom). Telling me you have an A1c under 7% is great, but unless you can explain how you did it, I still feel stuck.
So, in the spirit of full disclosure and with the hope that readers are always looking for different suggestions on how to manage diabetes, below is a list of very specific actions I took that finally resulted in me getting an A1c that started with a 6.
1. Wear a CGM 24/7 - My thresholds are set to 140 and 70, but they didn't start that way. I started with my high threshold at 200 and have slowly lowered it as I became more comfortable. This changes the way you view high blood sugar. In the past, I was satisfied if my number was 170, heck, I was glad if it was just under 250. I didn’t consider that “high”. Now that I’ve had it set to 140 for a while I am more aggressive with correcting highs. I am no longer satisfied with BGs in the high 100s, I actually recognize those numbers as “high” now and take action.
2. Pre-bolus before eating - <90, eat right away. 90-120, wait 10 minutes, >120, wait 15-20 minutes. If you’ve never pre-bolused, I’d start with 5 minutes (set a timer). If you aren’t noticing that it reduces post-meal spikes, back it up to 10 minutes. Keep experimenting until you find what works for you.
3. Rarely eating more than 20 carbs per meal/snack - Some folks can eat 50, 60, even 80 carbs in one meal, pre-bolus and never see spikes. I am not that person. I don’t know if it’s because I’m extremely insulin resistant (I:C ratio is 1:5 all day long), but I’ve gotten over it. I am 100% convinced that for me, living a lower carb lifestyle has made the biggest impact on my improved A1c. It also resulted in me losing 10 pounds in a year (and maintaining it). This was not a goal, just a nice unexpected side effect.
4. Eating food that is less likely to cause fast blood sugar spikes - KM60.
5. Walking if I notice my BG starting to rise too much after a meal - I’ve found that even with pre-bolusing for lunch, it’s not uncommon for me to rise to about 160-170. If I start walking while my number is at that level I will always drop back down to the low 100s within the hour. If I don’t walk, I will sit at 160ish for hours until giving myself another tiny correction bolus. Not only does walking help my BG, but it adds some moderate exercise into my day, which I was not doing before.
6. Regularly reviewing my DexCom and meter data - I now track my 7, 14, 30, 60 and 90 day BG averages every 2 weeks. This helps me see the progress I’m making and also identify if something is going on.
7. Being completely honest with my doctor - I’ve had my fair share of emotional breakdowns in my endos office. However, this lets her know where my head is at and also helps her make suggestions or tweaks to my pump settings. If I am not honest with her about why I was 315 three Saturdays in a row, she might suggest a change that isn’t going to actually solve the underlying problem. Be honest and ask for help when you need it.
8. Believing I could have better diabetes control - If you average all the A1cs I have record of taking over the last 18 years, my average is 7.9%. It’s easy to think, “why on God’s green Earth do I think I can have a sub-7 A1c if for the last 18 years I’ve always been in the 7s or 8s.” Here’s the thing, humans are amazing because of our ability to change. Just because something has been one way in the past does not mean it has to be that way for the rest of your life. You know what else has changed in the last 18 years? Insulin, blood sugar meters, insulin pumps, CGMs, carb counting, better tasting, low-carb food options, my personal understanding of my own body and its needs, insulin to carb ratios, the list goes on and on. With better understanding and acceptance comes better control. When you are ready, you can make it happen.
9. Not over-correcting low BG - Sometimes I long for the days of a midnight low where I would stumble to the kitchen and eat a giant bowl of Cracklin' Oat Bran. However, a person usually doesn’t need 400 carbs to rebound from a 68 and I’d rather not have a raging headache the next day while I fight a blood sugar of 300+. I’ve become a believer in good ‘ol glucose tabs. I carry them everywhere: purse, car, desk, bedside. I start with tabs if I’m low and if I’m really low (<50) I follow-up with a few saltines w/peanut butter. Then I set a timer for 15 minutes and FORCE myself to wait. Believe me, there have been plenty of times where I started saying my goodbyes, convinced I would be dead before 15 minutes passed, but I’m here.
10. Finding and participating in the DOC - I don’t mean you have to write your own blog. Just the act of reading the blogs, gathering information and having the emotional support has done wonders for me. I’ve learned countless tips, seen dozens of other diabetics achieve great control and felt empowered by this to make changes in my own life.
I don't know how long my trip in the 6s will last, but I am grateful for the time I've spent here so far and I'm going to continue to work like hell to stay longer.
Below are links to other bloggers who have written about this topic.
Alanna - Is it even worth it?
Allison - Why it's hard to hold an A1c below 7 and what she's doing to try and achieve it.
Ginger - 5 things that helped her reduce her A1c.