# HbA1C struggles



## Lawra (Aug 20, 2020)

Morning everyone,

So, I don't normally do this sort of thing so I'm new to this but I really need help!
I'm coming up to 27 next month and my husband and I are really wanting to start trying for our first baby. I am already under the specialist diabetes nurse that deals with Pregnancy and diabetes etc. (I'm type1) I am aware that HbA1C need to be down at 48 to conceive for a healthy pregnancy etc - but mine are up at 64. I have asked what I can do to bring this down and what I get told is the normal 'healthy eating,  exercise and healthy lifestyle' but the trouble is, I do all this but still not doing much to bring it down, and its soooo FRUSTRATING!! I eat healthy, I'm active with work and work 10/11 hour days, I only weigh 9st2lbs so it cant be my weight - the only thing I can think of that I'm not doing is physically exercising like at the gym or something but after working long hours, I don't feel like it (I work in a residential home which is always fast paced) I'm always out with the dog as he is highly energetic. I'm doing everything I should be so I don't know what else I can be doing to help. My nurse has just increased my background insulin again to see if this helps but is there any advice you guys can give me?


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## Kaylz (Aug 20, 2020)

Hi and welcome to the forum 

Are your bolus ratios correct? Are you pre bolusing? 
xx


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## Flower (Aug 20, 2020)

Hello @Lawra and welcome, glad you've joined us

Have you been seen at a preconception hospital diabetes clinic so they can advise you specifically. Have you been prescribed or been on a trial of the Libre so that you can see your 24 hr blood glucose picture and find out where things are heading out of range?


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## PhoebeC (Aug 21, 2020)

Yes the Libre might help, let’s you see clearly what is going on.
I thought my diet was fine but then I really started to look at it again and I surprised myself actually! Worth nothing a week or so down perhaps and having another look at it.


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## Lawra (Aug 24, 2020)

Hi, sorry for the long response I didn’t know that I had any reply  
- @Kaylz sorry I didn’t know what bolus meant, it’s not a word that’s ever been used in the 4 years I’ve been diabetic so I had to google it lol bus yes I do bolus and I think they are right at the moment  x
- @Flower yes I am already under a specific nurse at the hospital, I’ve been on the libre sensor for almost 2 years now.
- @PhoebeC yes I have the sensor already, I have been keeping a food diary to see if I can see anything but I just can’t. I have a salad almost everyday for lunch (I feel like I’ll look like a salad in a minute!) then teatime I have a little bit more carbs but nothing that bad to make my levels the way they are  my nurse has even said that I’m doing everything that I should be, just have to work out the insulin ‍♀️


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## Kaylz (Aug 24, 2020)

Do you pre bolus though? Like inject in advance of eating? Have you basal tested and checked your ratios are still the same? xx


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## Inka (Aug 24, 2020)

Hi @Lawra 

The bottom line is that to get your HbA1C down, you need to keep your blood sugar in a tight range as much of the time as possible. Eating salad and exercising won’t help much if your insulin/carb ratio is off or your basal is wrong. You have to actively keep your numbers in range. Aiming for the pregnancy range is a good way to do it. Stopping post-meal spikes helps a lot. @Kaylz is right about the need to pre-bolus. You need to find the ‘sweet spot’ of how far in advance of each meal you need to inject so the insulin can get working and keep your spike down. 

It’s hard work and you need to do it constantly. You have the Libre so that should make it easier, but personally I’d fingerprick too as you’re looking for a pretty tight range and accuracy is very important.

The JDRF do a good Pregnancy Toolkit that contains pre-conception advice too.

Presumably you’re carb counting?


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## Lawra (Aug 24, 2020)

Kaylz said:


> Do you pre bolus though? Like inject in advance of eating? Have you basal tested and checked your ratios are still the same? xx


I do inject before mealtimes yes, I have tried injecting after meal before a while ago to see if it would help, buit wasnt much difference x


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## Lawra (Aug 24, 2020)

Inka said:


> Hi @Lawra
> 
> The bottom line is that to get your HbA1C down, you need to keep your blood sugar in a tight range as much of the time as possible. Eating salad and exercising won’t help much if your insulin/carb ratio is off or your basal is wrong. You have to actively keep your numbers in range. Aiming for the pregnancy range is a good way to do it. Stopping post-meal spikes helps a lot. @Kaylz is right about the need to pre-bolus. You need to find the ‘sweet spot’ of how far in advance of each meal you need to inject so the insulin can get working and keep your spike down.
> 
> ...


I try so hard to keep within that blue line. I do inject before a meal at least about 10-15 minutes before actually eating, I fingerprick at mealtimes so I can get that more accurate reading to be able to carb count properly.


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## Kaylz (Aug 24, 2020)

Lawra said:


> I try so hard to keep within that blue line. I do inject before a meal at least about 10-15 minutes before actually eating, I fingerprick at mealtimes so I can get that more accurate reading to be able to carb count properly.


Injecting afterwards wont stop spikes happening, to stop spikes you need to bolus in advance but it's so individual to person, what you are eating, time of day and where you are injecting and even then it doesnt always go to plan lol, for instance for me breakfast is left thigh and I need to inject 20 minutes before eating to avoid spiking, dinner is right thigh and I need to inject 10 minutes before and tea is stomach and i need to eat instantly to avoid dropping low, have you played about with your timings?  There are some that need to inject up to an hour before breakfast to avoid a spike so it really is so individual xx


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## Inka (Aug 24, 2020)

Lawra said:


> I try so hard to keep within that blue line. I do inject before a meal at least about 10-15 minutes before actually eating, I fingerprick at mealtimes so I can get that more accurate reading to be able to carb count properly.



Yes, it is hard work, but it’s good practice for pregnancy. Don’t despair - you can do this. I did (I have 3 children) and there’s nothing special about me  

If you do go above range after a meal (two hours after), do you correct? Do you correct when you see highs at other times?

It’s an active process - you need to physically nudge your blood sugar into line. Every time you see an unexpected high, correct it (carefully obviously). Check your basal amount is correct by doing a basal test. Then check your insulin to carb ratio for each meal. Then look at spikes after meals and consider moving your pre-meal bolus earlier for some meals if appropriate.

It’s good you’re injecting 10-15 mins before eating, but keep in mind some meals (by ‘meals’ I mean Breakfast, Lunch, etc) might need a bolus earlier than that. For example, with Humalog I need to bolus 30 mins in advance of breakfast (but less in advance for other meals).

Is there any particular time(s) of day you’re having problems?


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## rebrascora (Aug 24, 2020)

Your Libre should show you the problem areas where you are going too high. Is it after meals or through the night or every afternoon etc
What are your "Time in target" percentage like?
I find the Average Glucose function quite helpful as it splits the day into 4 blocks and for me my average is consistently a bit high through the night early hours @7.5 (I prefer it that way for safety)  but I am currently averaging 5.8 during the morning and similarly in the afternoon. 
My levels almost always drop slightly overnight to the point at which I get out of bed and then they start to rise (foot on the floor syndrome) so I could potentially go to bed on a slightly lower reading than I currently do (I tend to go to bed between 7 and 9) and take a half unit less basal (long acting) insulin (I take split dose Levemir) on a night to keep my average glucose lower during that sleeping period. These little tweaks are what gets your control tighter.

It may be that your basal insulin does not suit you and another brand of insulin might work better. As @Inka says the timing of insulin before a meal can be quite critical and breakfast time is particularly tricky for me as I have to wait almost an hour before I eat in the morning.... I now wait until my Libre shows a downward trend before I eat. I only need 20mins for lunch (if I have any) and dinner. I seem to be slow to utilise insulin but fast to digest carbs. 
Most people would hypo long before this and my consultant was pretty shocked that I needed that long particularly at breakfast but I know that I am not the only one as there are one or two other members of the forum who also have to wait this long before eating. It is highly individual. If you are getting spikes after your meals, the timing of this is what you need to experiment with.... but extend the time slowly and carefully each day in 5 min increment to find the sweet spot for you and best done on days off work when you have more time. 

The "Daily Patterns" function on your Libre can also be useful for spotting trends.


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