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Re: [IPk] Frequency of HbAic - long rabbit

Dear Heather,

HRT is most likely having quite an effect on your bgs. We hear about 
hormonal changes in puberty, pregnancy, and menopause, but birth control or 
HRT constitute hormonal changes too. As do the years between puberty, any 
pregnancies, and menopause. Estrogen and the other 'female hormones' don't 
work on an all-or-nothing switch. Puberty takes years and perimenopause 
precedes menopause. Hormone levels are unstable not only a couple of weeks 
per month. On a year-by-year basis the general output/trend increases or 
decreases. I had to read a pop-psychology book about biology in male-female 
relationships (one of the Barbara and Allan Pease ones) to see a graph 
indicating female hormone activity throughout life. How many women with 
diabetes have been accused of noncompliance when it's their ovaries &etc. 
contributing to insulin resistance? (Gr!)

The stress you've been under sounds really heavy. Do you have many 
adrenaline rushes? Last year I got a lot of e-mail from a guy who was 
messing me about. Once I tested my bg before I looked at my e-mail and then 
again 20 minutes later, after reading a note from the loser. My bg had gone 
up by 3.9 mmol/L. Another time I went up by 5 mmol/L in 30 mins because he 
e-mailed me. My HbA1c went down after he left the country. I wasn't 
necessary to his professional success any longer, so he stopped e-mailing 
me...thank goodness. My health has been better without him.

Now, a big YEA for 7.4 being your best ever! That is cause for celebration 
and encouragement. You now know how at least to keep it there--barring 
hormonal changes and adrenaline rushes (but those do warrant changing basals 
and correction boluses)--if not to push it down further, over the next few 
months. Whoever advised you about the 1-year interval for HbA1c may not 
understand how dynamic HbA1c is, and how short-term. You could have another 
7.4 in another 365 days, but for 300 of them you could have run at 9, things 
suddenly changing in the run-up to your appointment.

I know lower HbA1cs only *reduce* the risks of complications, they do not 
mean never having any. I want to feel like I did everything in my power to 
delay the onset and reduce the severity of complications when they come. My 
goal is to have the lowest HbA1c possible without a lot of hypos. I am 
aiming for 6.0 right now. I may have done myself some damage that isn't yet 
showing by running HbA1cs closer to 8 for several years while I wasn't as 
careful as I'm being now. Still, type 1s treated according to the DCCT since 
diagnosis are likely to have a much different experience from anyone 
diagnosed much before it. If you've had type 1 for 25-30 years by now, 
you've seen a lot of changes. My life with diabetes has always included 
accurate fingerstick bg meters. MDI was never radical. A pump was available 
to me after 3 years of injections, not decades. I've had lots of advantages 
thus far.

IDDM 10 years; MiniMed pumper 7 years

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