How I went from an A1C of 81 (9.6%) to 62 (7.8%)

From this...

I wish I could tell you guys a magic cure for this. It didn't happen overnight. In fact, this drop in A1C took just under two years. Part of it I can attribute to switching to an insulin pump but on it's own an insulin pump isn't a magic cure. I would like to highlight that before this happened I made a 10point drop on my own. The pump is great but you do have to be prepared to put the work in. 

Pre Pump

I've talked about this before here but I found my diabetes managed to be like one big giant jigsaw puzzle, you try one piece and if it doesn't work you try another. That is what I was doing to start with. The first step came from wanting to have an active role in my health care. I had gone through the last 5-6 years, floating through as a passive participant in my health. I had terrible habits but not so terrible that it was unmanageable. My blood sugar levels were dangerous in the long run because they were contributing to a high A1c but in the moment I was able to live. The only point in which I needed medical intervention was when I ran out of insulin one weekend and I thought I would be okay till my doctors appointment on Monday. I wasn't and this showed my lack of knowledge about how intrinsically important insulin is. I went into DKA at the end of 2010 and came out of it being prescribed lantus which evened out my blood sugar levels. In any event, I was still running higher BSLs than I should have been and  I was consistently tired, grumpy and struggling to get out of bed in the morning. I put this down to stress and a heavy work load. I also continued to blame myself for these high levels.

And then halfway through 2011 I got sick. I rarely get sick and this one just completely wore me down. It was a combination of being run down, having the flu and a chest infection. I started paying a bit more attention to my levels and found that they weren't making sense even when my sickness go better. I emailed the Diabetes Nurse Educator and the hospital and organised an appointment to see her. From there we started working on the jigsaw puzzle. We adjusted my nightly lantus dose, my insulin to carb ratio, my correction factor, my insulin sites (I was asked to stay away from the left side of my stomach), and it felt like everything else under the sun. I even wore a CGM for a week (loaned to me by my local hospital) I was trying so many different things and trying to keep a brave face of it. Blogging helped but it did get me down to not see a better result than a 71 (8.6%).  Eventually the idea of a pump was brought and I was slightly hesitant at first. And then I had to go through an approval process with Pharmac which was terrifying. I did all this research on pumps and it made me really really want one!

Post Pump and becoming an active participant in my health care!

I've talked a little bit about my experience with my Animas Vibe here but one of the positives of a pump was my acceptance of my freaking enormous dawn phenomena. I now know that I need 3 times as much insulin during the hours of 2am and 6am compared to what I use during the day. When I discovered that it lessened off some of the intense blame I had been carrying for the past few years. With a dawn phenomena like that I was never going to be able to manage on injections. And that brings us to August 2014 where my latest A1c is 62. I know that I have a way to go before I am in a safer range but after 8 years of sitting in the 8 and 9 % range. I think that a 7.8% (or 62) is a pretty good sign. There was something amazing at looking at it and realising it was my lowest number since I moved to Dunedin in 2006. 

I can attribute my better levels to my discovery of the Online Diabetic Community. Diabetes is so isolating that it is damn great to have someone to share it with. 

Diabetes Blog Week 2014 - Poetry Tuesday

This year, Diabetes Blog Week and TuDiabetes are teaming up to bring out the poet in you! Write a poem, rhyme, ballad, haiku, or any other form of poetry about diabetes. After you’ve posted it on your blog, share it on the No Sugar Added® Poetry page on TuDiabetes, and read what others have shared there as well!

Click for the Poetry Tuesday - Tuesday 5/13 Link List.

I've written a couple of poems in the past. I don't know if I could find them now as I suspect they were on a long gone computer. I do remember I saved them in a folder and then made the folder invisible, I felt pretty spy like doing that. 

I do recall reading back on them that they were pretty dark and depressive. They were written at a low point during my teenage years. When I saw this topic I immediately did not want to do it. I thought that I would choose one of the wild card topics. However, when I looked at the topic again this morning I thought, hmm maybe I can write a Haiku - so I googled it and found an explanation on Wiki How.

There's some context to my Haiku - the word relentless came to me and just fit with how I was feeling about my diabetes management. I've been on my Animas Vibe for 6 months now and feel like I'm walking a tightrope. In order to qualify for continued funding of my pump consumables I need to show a 10 point drop in my Hba1c, that's about 0.9% drop in the other units. 

So today, I received the news that my A1c has dropped 14 points from 76 to 62 or 9.1% to 7.8%. So happiness for me! Glad to see the work is paying off. So this Haiku shows that change, from earlier in the day when I the word relentless resonated me so much to when I felt like the changes I made were seeing results. 

So without further ado.... 

Relentless Diabetic Puzzle

Turned a corner

The Changed Wind appears to blow through

Pharmac and Insulin Pump Funding concerns

I'm worried about the funding for my insulin pump, or more specifically the pump consumables. As far as I am aware, an application for funding was sent off in July/August last year. The application listed the last three of my HBA1cs, the lowest of which was 73 in the new units, or 8.8%. I received 9 months of funding for pump consumables in August and started the pump in October.

In the middle of last month (March) I had an appointment with my CDE. My A1c was 64 - or 8% in the old units. It was actually the lowest it had been in my 8 years with my current District Health Board. I haven't always been so intensive with my management. It was interesting to look back on those results, there was a couple of results that were so cringe worthy that I didn't want to see but for the most part my control has stayed in the 70s for the past 8 years. I hadn't realised that so seeing that 64 was even more of a win. What's more, is that I knew I could do better than this. In February the average on my meter was about 12.5 mmol/l, I had a couple of unfortunate experiences where my site or tubing pulled out so I woke up in the 20s with ketones. I was also using teflon cannulas with my Animas Vibe pump and found that on the 2 or 3rd day I would sky rocket in my BSLs and it would take so much insulin to bring them back down. When I switched to metal cannulas, the results were amazing. The March Average on my meter was 8.5 mmol/l - which would equate to about a 53 HbA1c. So at that meeting, my CDE was a bit puzzled at what she could do to bring down the 64 lower, based on a few days worth of records that indicated I was running pretty good averages. I explained that I'd changed cannulas and was certain that the month of February would be artificially putting my Hba1c higher than it was. She was happy with this, I was happy and I left feeling positive and overwhelmingly happy at the pump. We organised I would get an A1c test done in yjr beginning of May and that my CDE would put through the application for continued funding in Mid May.

And now we come to the month of April. The average on my meter is 11.1 mmol/l - which would equate to an Hba1c of 70 or 8 %. To qualify for continued funding I need to show a 10 mmol/l drop to a 63 I was on track for this in March but now? I'm scared. I'm been trying to figure out the reasons for the increased Bsls - I had been extremely busy at work, I had a family bereavement, I thought I might be getting a bladder infection...many things which could contribute. Freaking stress. So I'm scared I'm not going to qualify for funding.

So my plan of attack is:
- Increased exercise
- Recording BSLs and sending them to my CDE
- Healthier eating

It looks easy when I put it like that. I think it's been working though, I tweaked my Insulin Sensitivity factor a couple of days ago and I am noticing lower morning BSLs. I feel a lot better writing this all out and there is another thing that could be helpful to me. I received funding in August last year but didn't actual start on an insulin pump until October, so in theory I haven't actually had 9 months of treatment on a pump. My CDE has said that will be enough to get an extension, so I imagine that's the next step.

It's nerve wracking thinking about all of this and it has been on my mind a lot. Writing it down has been cathartic for me. If there is any one else having trouble with continuing their pump funding I would love to hear from you.

S x