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RE: [IP] good A1Cs without frequent lows possible?



 I set my target for 90 mg/dl in the day, 100 mg/dl at night. My A1c runs about
5.7% normally, or
 around 6.1% when on high doses of prednisone. I could achieve lower if I didn't
insist on being at
 100 mg/dl or higher when driving, and have to drive at various points
throughout the day.

 I get maybe 4 readings below 70 per year. Maybe 1-2 readings below 80 per
month. I have never been
below 60, and I intend to keep it that way!

 I have a unique mix of challenges and advantages. I take steroids daily to stay
alive. I'm not sure
 if that's advantage or disadvantage -- at least I know when I take them, and
know my adrenal gland
 isn't putting out cortisol at random times. My glucose levels drop under high
stress. But it does
 make for a dynamic situation, and greatly impaired counter-regulatory response
to lows, so I'm quite
careful to avoid them. I suspect glucagon would not always be reliable for me.

 The last I checked my c-peptide, I did produce some insulin. That gives me an
advantage in heading
 off lows, since whatever's left of my body's basal insulin production will shut
down, effectively
 reducing my basal. So I'm not sure I can legitimately claim credit for my good
results!

 I eat a high-calorie, mixed diet, definitely not low carb. That's distinctly a
disadvantage.

What I find important to avoid hypos is:

 1) Frequent testing. I test about 14x a day, and I'm sure a continuous monitor
would be a distinct
improvement.
 2) Correctly-set basals. Mine are constantly changing, but the closer they are,
the better my
control.
3) Proper carbs ratio & correction ratio
4) Good carb-estimating skills, or eating foods with known carb quantities.

 I have also developped techniques for correcting for inaccurate basals through
observation, and
 estimating corrections for past and future missing basals. This is a necessity
for me with changing
 steroid dosages, but not something I'd care to explain how to do & have someone
playing around with
it.

 I think that people who cannot achieve low A1c's either have a problem with one
or more of the above
 four items, or have an inherent element of unpredictability, such as
gastropareisis, that has to be
 allowed for. I don't think everyone can achieve the same results, but I do
think that careful
 attention to the four basics above, plus appropriate responses to whatever
additional personal
factors you have, can help you reach your own personal optimum.

 Some of you tolerate lows lower than I'd accept, and I would (as many have)
take a somewhat higher
 A1c to avoid them, if there were no other way. But I have tested 24+ times a
day under some
 circumstances (high steroids) -- so I'll go to some extremes to keep the highs
down while avoiding
lows.

 One thing I do to keep the A1c low is to use the Superbolus technique both with
high-carb meals and
 with corrections, to minimize the amount of time I spend at high levels. If you
minimize the time
 spent high, you reduce the amount you need to be low to balance it and still
achieve a good A1c.

 I don't, however, measure my success by my A1c, but rather by how close I keep
my blood sugar to my
targets.

-----Original Message-----
 From: email @ redacted
[mailto:email @ redacted] On Behalf Of
Jim Skelton
Sent: Monday, May 08, 2006 12:06

 I got the MM 715 pump a couple of months ago, and to avoid the readings below
70 I had every couple
 of days, sinmetimes down in the, I set the target at 130. When the bolus and
basal doses had been
 tweaked a little and there was some stability, I lowered the target to 120. One
improvement has been
 using a lower bolus than the equivalent Lantus I used to inject, and more
Humalog in the mealtime
 boluses than I used to inject at mealtimes The old injection schedule took too
long to bring down
post-meal readings, and required emergency snacks to head off hypoglycemia.

 So now I wonder how low others set the target? Can you target at 100, or does
that push the hypos
too low ?

 For those with excellent A1C, what target do you set, and how many lows<70 do
you get in a week?
.
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