No change to HbA1c

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novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

vic demain said:
I've been having problems with my HbA1c. did the course about 18 months ago and ever since have suffered a huge amount of hypos. Was told the HbA1c should steadily drop, but that has not been the case, still around 8.2. I have dropped my BI dramatically. Trouble is, I will test between meals and am often around 13 but by next meal test I am low. Have tried really hard but getting fed up with all the hypos and the high HbA1c



Sounds like a pain in the bum....going low for the next meal means either too much QA or BI, so if we assume the BI is correct its your QA. Avoiding the spikes between meals can be achieved by injecting well before you eat, you can start of with 10 mins, then go up to 20 if needed, even 30 like me, even more possible, and it can vary depending on the timw of day...........

have your team mentioned that option.......

vic demain DAFNE Graduate
Hillingdon Hospital NHS Trust
87 posts

That hasn't been mentioned and my concern would be taking QA which works immediately, a period before eating, when already going low at that point, would potentially be dangerous. First though is to get rid of the hypos, then try and sort things out. Not so much a pain in the bum, just feel cr*p a lot of the time.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

I agree getting the lows away comes first, so drop your insulin/carb ratio till your on target next meal, test in between to see how high you go, if its too high for your liking the you can think about dose times.........they say it works immediately, but i dont think thats accurate, after about 30 minutes its ready to go, but mainly its meeting up with the digestion....

MelissaF DAFNE Graduate
South West Essex PCT
56 posts

Hi Vic,

Interesting to hear that you're having similar problems with your HbA1c.

I would suggest to maybe cut down on your testing between meals for a few days and to just test as DAFNE dictates before each meal and see where you are then. My HCP said that it's really hard to apply the DAFNE rules when you're testing throughout the day as the DAFNE rules tell you not to. This may have changed since I had the conversation with her though so please feel free to correct me.

Maybe see how your results look from there and then look at BI levels and meal ratios to see what needs correcting by the rulebook.

The other thing that I'm bad at doing is testing too often and then giving myself too many corrective doses. This means that my sugars constantly yo-yo from too high to too low and never really stabilise. Might this be happening to you? This is also something I associate with feeling rubbish pretty much all of the time as you describe.

When you test between meals and you get a high reading, do you then correct with a QA dose? If so, this might be causing the low before your next meal. It might be worth just observing and seeing whether it would have dropped normally without your intervention.

I'm not sure if this means that we should expect highs betwen meals or not as I guess we wouldn't normally be aware of them with DAFNE testing. Can any HCPs advise? If we shouldn't be seeing that and it's a problem then maybe a pump would be an option as that constantly monitors and corrects doesn't it?

The other thing that JWo suggested to me is trying to be really good about not snacking between meals for a while. This isn't to say that you can never snack between meals obviously, it's just that this obviously makes your readings a bit less clear and it's easier to see what's going on if you restrict carbs to mealtimes for a few days just for the sake of clarity.

With me, if my levels are constantly dropping throughout the day, this usually means too much BI so maybe keep looking at that as well.

I also agree with what Novorapidboi says about when you take your QA. Although we are told that it doesn't make a difference when we take it, I'm convinced that it does. I quite often take it after a meal when I can be sure of the number of CPs I've eaten. However, I know that my control is much better when I take it before a meal. I guess you just need to experiment to see how it affects you. I also agree that you don't want to be doing that if your levels are low to begin with though so definitely try and solve that one first.

Let me know what you think.

Melissa xx

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

Melissa,

I agree with purely testing before meal and not snacking, that is the DAFNE way and why were all here after all. Only when your doses are correct can/should you then investigate your in between meal spikes, that were the dose times come in, all foods digest at different rates and I suppose at differently at certain times of day. So trying to match that digestion with your QA 10, 20, 20 minutes before the meal can help in my experience....... Very Happy

Chchch
Mid Yorkshire Hospitals
17 posts

Hi Melissa

How are you getting on with getting your A1c down for pre-conception purposes? I'm amazed that the hospital will only test your a1c once every 3 months, as soon as I told my hospital I was thinking about having a baby I was offered tests and appointments every month, as well as appointments at the special pre-conception clinic which is arranged between the diabetes centre and the ante-natal clinic (all of which i grabbed with both hands!). I would suggest that you speak with them about your plans and hopefully they will offer you some excellent support too. After years and years of attempting to achieve "perfect" control, the hospital has agreed that I am not getting the results I deserve based on how much effort I put in, so have offered me the pump. It is actually NICE guidance that women who are wishing to become pregnant should be offered the pump if it's needed. Started on it 2 weeks ago - early days as yet, but my main concern of being hooked up to something 24 hours a day has proved to be totally unfounded. I actually enjoy having it attached, which I know sounds weird, but it's so incredibly convenient, and apart from the odd prob with knowing where to put it if I'm wearing a dress, it's been totally fine. If you get offered it, please don't turn it down purely because of your fear of being attached 24/7 - it could make life so much easier for you, as I hope it will for me.

Cheers.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

the HbA1c is only effective over a 3 month period, the life of a red blood cell, but if your team offer more than this due to pregnancy it can only be a good thing..........its only a test though......

Chchch
Mid Yorkshire Hospitals
17 posts

The idea is that as soon as you start making changes and bringing your overall levels down, this will be reflected in your a1c within a few weeks. You are absolutely right about it being only a test though - I still find that too much emphasis is placed on A1Cs (especially by consultants) and that even a decent a1c can mask widely differing blood glucose results on a daily basis.

MelissaF DAFNE Graduate
South West Essex PCT
56 posts

Hi Chchch,

Thanks for your post. I've been trying really hard and my day to day results are a lot better but I haven't had my HbA1c tested for months so I can only hope that it's reflected in that (although it didn't seem to be last time). My hospital are adamant that they won't test more than every 3 months but I have an appointment coming up in the next couple of months so I'm sure that I will be allowed a test then. After the disappointment of my last test, I'm concentrating more on my daily results and just trying to get them as good as I can. I don't want to start worrying if my HbA1c isn't as good as I want it to be as a I don't really have the luxury of delaying conception for too much longer because of my age.

I haven't really been offered any specialist pre-conception advice unfortunately although one of the diabetes midwives did offer her services as a contact if I needed her. I think that this was more an act of kindness than a professional strategy though. It's a shame really as I think that it's really important and would probably help a lot of people.

How are things going on the pump? Are you really finding it OK? I still really hate the idea although anything that improves your health should really be an appealing thing I think.

Are you using it for pre-conception purposes too? Do you think that it's helping and how long would you be planning on using it for? Would this be your first baby?

It's interesting that you say that your hospital say that you don't seem to be getting the results that you deserve with the amount of work that you put in. This is kind of how I feel about my situation as well. I wonder if it's just something to do with our bodies and how the diabetes affects us in particular or whether the knowledge that's imparted from the DAFNE course can sometimes work against you. I'm ofter guilty of over-correcting for instance which then leads to yo-yoing between highs and lows instead of more stable results. What do you find?

Melissa xx