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Re: [IP] A1c

In a message dated 9/29/2002 6:14:43 PM Mountain Daylight Time, 
email @ redacted writes:

> I just got my first A1c after going on the pump.
> I am very down.........prior to pumping my A1c was 11(I KNOW AWFUL !!!) and 
> just last week(3 months after starting on pump)  I am only down to 10.5 !!! 
> I was expecting something alot lower.
> My sugars have been running so much better since I have been on the pump, I 
> am rarely over 300(used to be between 300-500 OFTEN) and most of the times 
> when I check it I am under 200, closer to 150.
> I don't know what to do now, any suggestions or thoughts?

Don't give up!!!  As you said, you ARE doing much better -- so keep at it and 
things are bound to improve even more!  Do you have a diabetes team (CDE/Pump 
Trainer/Endo) who will work with you on this???  It helps to have 
knowledgeable support and guidance -- but if you don't, that doesn't mean you 
won't be successful.  

The one thing that struck me was that you reported being  in the 150 to 200 
range a lot -- which though a lot better than what you ran before seems to me 
to be a fairly high target range for an adult pumper (unless you're doing it 
on purpose to deal for a while to deal with a problem with hypoglycemic 
unawareness).  Having a lower target range would certainly do a lot towards 
whittling down those A1cs.  Now getting your BGs safely into a lower target 
range is likely to require a combination of things such as adjusting your 
basal rates and perhaps your carb ratio(s) -- as well as testing out your 
correction factor (i.e. how much insulin it takes to get a certain reduction 
in your BG level).

As an example (and you'll need to figure out what makes sense for you), my 12 
year old daughter has a target range of 70 to 120 and unless she's recently 
exercised, we correct her to a target of 100.  We've got her basal rates and 
carb ratios in pretty good shape (though they need adjustment periodically, 
especially since she's dealing with all those hormones!).  Her correction 
factor is .1 unit for every 5 BG points reduction desired.  So, for example, 
if she checks before lunch and finds that her BG level is 160, she does a 
"corrective" bolus of 1.2 units plus whatever bolus she needs to cover the 
carbs she's eating.  (Maybe you're already doing this).  She also tests 
fairly frequently:  before each meal and 1 1/2-2 hours after, bedtime, and 
once during the night plus before (and sometimes during) exercise and, of 
course, if she feels low.  

Having the target range that she has (70-120) , periodically testing  basals 
and carb ratios to make sure that there still proprely set, using corrective 
boluses, and frequent testing have all helped her get her a1cs down into 
sixes and keep them there since pumping (and with far fewer lows than she had 
when she was on shots)  . . . I know you can do it too!  You've got three 
months experience with pump operations and now you've got the opportunity to 
start fine tuning things so that you can achieve your own goals for what you 
want your a1cs to be . . .

If you need more detailed help, there are lots of experts here on the IP 
list, a lot of great information on the IP web site, and of course, there is 
always the pumper's bible "Pumping Insulin" by John Walsh.  It takes work, 
but your pump gives you a great tool to work with -- GO FOR IT!

Pumpmama to Katie
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