There are lots of choices when it comes to diabetes care. Choosing a treatment plan. What kind of insulin should I take? Should I pump or use MDI? Oral medications or insulin (for type 2′s)? Symlin or Metformin? But for me, the choice I’ve been having to make lately is a quintessential question every person with diabetes must face: Lower your A1c aggressively and deal with the lows that come with it, or remain in the high 7′s and 8′s with blood sugars consistently between 150 and 250, but avoid lows?
I think that this is why I ran in the 8′s in my childhood. It was easier on my parents and on me to run a little high than to risk hypoglycemia.
Lately I’ve been aggressively trying to get my A1C below 7. My last A1c was 7.5. That is excellent, the lowest I’ve ever been! It was after three months on both the pump and using a continuous glucose monitoring system. But I’ve been having quite a few troubles with lows. I have dropped below 50 a few times, and this is a rare occasion for me. To top it off, running lower means that I don’t feel the lows til I get into the 50′s! It’s craziness. I am really glad that I have my Dexcom 7 Plus to help me catch the lows before I wind up on the floor. To this day I still haven’t been in the hospital due to lows, been disoriented due to lows, or had any real bad experiences with lows. I know the day is coming though. I’m doing everything I can to avoid it.
Several factors have been playing into this. Of course, being more aggressive with meal boluses and experimenting with combo bolus (Combo bolus is what Animas calls it when you take part of your insulin now, and part later, using a setting on the pump) effect my blood sugars. I started taking Symlin again, a synthetic form of a hormone that aids in the digestive process. It helps insulin work faster and better with carbs and helps avoid spikes after meals. I was using Symlin semi-effectively when I was taking multiple daily injections, but when I started the pump I decided to see if I really needed it or not. My conclusion, after analyzing pump and Dexcom post-meal data, was that I needed to try it again, because I was spiking over 200 after almost every meal. Unfortunately, it means recalculating insulin to carb ratios when you start taking it. And I am stubborn. It takes two or three lows before I know I’m not over bolusing and am ready to change the ratio.
Another thing that i need to figure out is my basal rates. I know my basals are off due to messed up night numbers from my Dexcom. But I have this nagging cold, and I want it to be gone before I basal test, just so that I don’t increase the rate too much (infections often make me run higher).
And then there is the exercise. Exercise, for me, generally effects me for at least a couple days afterward so long as I work out at least 30 minutes. And, hopefully, if I keep up my exercise routine, weight loss will result. And that will result in lower basal rates and more low blood sugars.
The overall goal is not to reduce insulin necessarily, but to gain better control. I felt good when I went to the doctor’s office in January and was happy with my A1c results. But I have been feeling more out of control lately, so the goal is to control the things that I can control (exercise, how many carbs I eat at once, taking medicine prescribed to me in order to avoid after meal spikes), and hopefully this will result in overall better control. If that means lower insulin dosage, that’s great. But if not, if my insulin rates stay the same or increase, and my A1c still goes down, then that is perfectly fine too.