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Re: [IPk] Variable insulin resistance etc



Mmm Ken,

I think Pat meant that her meter average is 9 mmol/L, which is not in the 
least equivalent to an A1c of 9. (Pat - please correct me if I'm wrong 
there!!!)

It's more like her A1c should be around 7.5-7.7 if her meter average is 9, 
at least according to this chart (see below) that I found on Medscape. [NB 
These numbers may have been revised since the DCCT was published and HbA1c 
test standardization became a prioritiy, but I don't think they'll be far 
off.]

One could say that an A1c above 6.5 is in general not so great, but if >7 
but <8  is the best that one can achieve without too much hypoglycemia and 
hypo unawareness, it may be okay as long as one has good genes.


Melissa
Type 1 11+ years; MiniMed pumper 7.5 years; Animas pumper 1 year


HbA1c Value Average Glucose
7% ~150 mg/dL (8.3 mmol/L)
8% ~180 mg/dL (10.0 mmol/L)
9% ~210 mg/dL (11.7 mmol/L)
10% ~245 mg/dL (13.6 mmol/L)
11% ~280 mg/dL (15.6 mmol/L)
12% ~310 mg/dL (17.2 mmol/L)
13% ~345 mg/dL (19.2 mmol/L)
14%  ~380 mg/dL (21.1 mmol/L)
*Nathan DM, et al. N Engl J Med. 1984;310:341-346.


----Original Message Follows----
From: email @ redacted
Reply-To: email @ redacted
To: email @ redacted
Subject: Re: [IPk] Variable insulin resistance etc
Date: Sat, 15 Jan 2005 19:47:22 EST

In a message dated 01/15/2005 19:12:06 GMT Standard Time,
email @ redacted writes:

Plus, as  I've described, I think I have very different basal and bolus
needs when  I'm 5 or 8 or 11 or 16 ... and if I drift up from 7.5 to 8, I
don't stay at  8 (although the basal would have been fine, had I stayed
at 7.5, but  instead I flip up to 12.

Here are a few of my thoughts Pat. First and foremost, I would try to bring
down your bgs to get your HbA1c lower. From what you have indicated it is
  (9?), it is far too high. If need be take more tests and any result above 
7
give
yourself a correction bolus. Would you consider running your bgs in the
  normal non-diabetic range (4-7)? I wouldn't be too hung up on always 
correcting
basal  rates because as you know, there are so many variables (insulin
  absorption, hormones, stress, insulin sensitivity, etc.) that can affect 
the
basal
rate  from day to day that it is bound to change. Instead, I would suggest
  testing more and using correction boluses. The other thing to remember 
about
bgs
particularly for type 1s, is that any test result is only what your bg is  
at
  that particular moment. If you were to test again in 30 minutes you might 
find
that it is either on its way up or down, perhaps due to your last insulin
  bolus or food eaten rather than a sudden change in insulin sensitivity. 
Just a
thought. . .
Ken
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