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Re: [IPk] Variable insulin resistance etc



Hi Melissa,

That's right.  When I'm in good control (meter averaging 8, my A1s are
low sevens).  

When I'm ok (meter averages 9) then a1cs are in mid to high sevens. 

When I'm bad (meter averages 10) then I'm in low 8s.

Good and bad are 'on the pump' - I never saw a single digit meter
average beyond one or two days when I was on injections (average over a
week or 14 days).  

That's the trouble with pumps: they raise your expectations of what's
possible, so when your control slips to what, pre-pump would have been a
fantastic result, you are disappointed rather than exatatic!

Cheers,

Pat




In message <email @ redacted>, Melissa P. Ford
<email @ redacted> writes
>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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-- 
Pat Reynolds
email @ redacted
   "It might look a bit messy now, 
                    but just you come back in 500 years time" 
   (T. Pratchett)
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