Reaching my A1C goals

I am trying to get my A1C lower. In April it was 7.5 which is where it was in January, and I want it below 7 (to follow the new guidelines of diabetes control). I have 5 weeks until my next A1C test (had to push it back for our trip to Colorado at the end of July) and I am trying to plan now how to manage the next 5 weeks to at least get my A1C closer to 7. I know I should have been doing this for the past 8 weeks since my last endo visit, but there were other things I had to focus on instead.

So, now that the test is looming nearer, and I am feeling more in control of my emotions, I am wondering what to do. I have had an A1C under 7 during the last 9 months of 2007, but I wouldn't say that I had good control during that time. In fact, in the time where it was under 7 I had some of the worst lows ever as an adult.

I know that its attainable, but for me its just figuring out how to keep my daily glucose numbers stable and in my "target range". For myself I am aiming for a premeal/fasting range of 85-130mg/dL, and a post meal range of 140-180mg/dL. At a blood sugar of 80 I find I tend to go low easily and fast. And anything over 190 tends to give me headaches or other negative symptoms of hyperglycemia (irritability, excessive thirst, sore muscles, so on...)

I think trying to keep stable blood sugars is a better criteria of reaching my goal for a couple of reasons. First, it will hopefully prevent me from having as many lows as I did back in 2007; secondly it will help keep my weight stable and ideally even assist with my weight loss goal. Lastly I am hoping that keeping my glucose in range will help my mood, because I feel that highs and lows have a tremendous effect on my mood. A high blood sugar makes my anger flare up a lot quicker than normal, and a low makes me overly sensitive and teary-eyed, not to mention exhausted after its treated. Does anyone else get that too, that highs and lows play with your mood?

So, for now, here's what I have on my plan:

• Wear the CGMS. Not once a while but as often as I can, every day if I can tolerate it.
• Eat more fresh veggies. I LOVE red, yellow, and green peppers so I should try to eat them more. Along with cucumbers. Yum!
• Add more fiber to my diet. I bought some English muffins today with the right amount of carbs I want (21g) and 5g of fiber. Perfect for breakfast, just add protein and I'm good to go.

There. I put it in writing, on my blog. Now I have to follow through!

Terrified

I have an endo appointment later today and just got done uploading my pump to the CareLink site. I like to use the reports that can be generated there, they do an awesome job of showing trends, especially with the sensor. So, after uploading my devices and reviewing my reports I was very disappointed to see that my average glucose is floating between 170 and 190 for the last 2 to 12 weeks. More than disappointed. Terrified. And pissed. With all the lows I have been having the past 3 months you'd think that I would at least have kept my average the same as it was before - 150ish. But no.

Later today is when I will have the blood drawn for the A1c and I will get the result during my appointment. I am trying not to tell myself it will be terrible, but I have a feeling it will be. According to this online calculator (that I got from Kerri's page, thanks!) my A1c will be between 7.6 and 8.2. Ughh. Not what I wanted. Not what I hoped for.

And I just don't get it. I don't get what I am doing wrong. I know there are things I can do better, but I didn't realize that in not doing those things better I would bump my A1c up so easily in the course of 3 months. Uggg. It makes me feel sick just thinking about it. Or maybe that's the creamer in my coffee kicking in and churning my stomach. I don't know.

A part of me feels like the increased average is due to my harder attempt at working out. Because when I work out I HAVE to raise my blood sugar to at least 180 so I don't drop low during the workout. Sometimes I have raised it too high and finished a workout with my glucose in the 190s. But that only happened a few times, usually I am right at 100 or less post workout. And....

And I just don't GET IT! How am I supposed to work out but keep my blood sugar from dropping? And don't say to suspend the pump because I learned quickly that this only leads to extreme highs 2 hours post work out. Reducing my basal rates before/during exercise does something similar only I don't spike quite as high.

(If you can't tell this is the pissed side coming out)

So, here I am stuck. Not sure how to do this diabetes and workout thing right. And probably with a worse off A1c because of it. Damn.

Can I have a new report card please?

I am tired today, not necessarily of diabetes but just in general. Over the last year after my A1c was more "normal" than it had been in over 9 years, I started noticing a new trend with symptoms of high glucose: I can't fall asleep if my sugar is too high or don't sleep nearly as well. Does anyone else have highs keeping them oddly awake or preventing a good sleep? Well, I am assuming that because I have better control over my glucose and a better A1c than I did for most of my adolescent and early twenties years that this is the only reason I am noticing this now (greeaaaat) .

For some odd reason it is very easy for me to let my sugars run too high or higher than ideal while I am asleep. I can't even remember the last time I actually woke up in the middle of the night just to test my glucose, and I only test it late if I happen to be awake which usually means I am out drinking with friends or I'm awake because it is high.

The latter explanation is why I am tired today. This week (or month) I have been slacking on tight glucose control before and during bed and now I am tired from letting my glucose sit around 200 for long enough to prevent a normal bed time last night. Since it was 1 am I decided to confirm the high and sure enough - 207. I was awake another hour when I finally just resisted the urge to fidget and forced my self to lie down in bed and breathe deeply. For fun I gave myself a quick bolus of 1 unit hoping it would help me fall asleep sooner.

Sigh. I don't know why I do that; I am good about testing when I wake up, before I eat, when I am out, before I drive but its as though once 9 or 10 PM rolls around my mind and body resist doing what I know I need to do and I slack.

One "good" thing came out of my high-insomnia last night: I uploaded my meters and pump to the MiniMed CareLink site for the first time since...oh far too long! And rediscovered just how fun it is to be able to run all those reports about trends or daily carb use, or pretty much anything you can think of it can generate, I mean its really cool! In all my excitement I sent an email to my doctor to let him know that I finally did it and asked if he wanted me to print certain reports for my appointment next week or what he preferred. He responded this morning with what to do and then the last line of his email was "Your A1c was 6.9 - FYI" ( I had gone in for the blood work last week for my appointment with my Endo next week).

I am pleased with this result but a little disheartened because it is up a small bit from last February and I bet its because of the night time highs and my unmotivated attempts to fix/control/prevent them.

I'll tell you what it is about this most recent A1c result - its a damn grade, and because I did better on the same "test" three months ago I feel as though I failed it this time. So silly, I know. But its true. I will admit I thought it was a little higher from noticing the increased restless nights since February but I also hoped that I was wrong.

I am glad to hear this today versus next Thursday and be bummed about it the entire day and the following day, which just won't do because its Taylor's rehearsal dinner and wedding next Thursday and Friday; I wouldn't want the damn grade ruin it for me, so there is a positive about that last sentence of his email.

So, one week until the actual Endo appointment where I am sure we will talk of the lack of bed time testing, the rehearsal dinner, and Taylor's wedding!! No matter how tired I am, I am not too tired for enthusiasm about that!!