SIX POINT ONE EXCLAMATION POINT
I have worked really hard for this! Here are some of the things I have done/have realized while I have been working so hard to lower my A1C even more:
1. Getting Type 1 as a child, with little to no transition care from pediatric endocrinology to adult endocrinology sort of screwed me over for awhile. And this is why:
- As a child, when I was taught carb counting, I was taught that a carb is a carb is a carb and that if I make sure to count all the carbs in something, I can eat whatever I want. This is not true! I get why they tell this to people, though. It makes the shock of getting diabetes not so bad. Also with kids, a lot of endos don't set as strict glucose targets for safety reasons. As an adult, I've learned on my own that some carbs are crazy on my blood sugars, no matter where on the glycemic index they fall. The best advice I ever got with regards to what I can and cannot eat is "Eat to your meter." For example, foods that are exactly the same on the glycemic index can have completely different results in my body. I wish a doctor had told me that a carb is NOT a carb is NOT a carb and that I can't eat whatever I want.
- As a child, my blood glucose goal range was a lot less stringent. I have these psychological barriers to having a blood sugar under 100 because my pediatric endo always told us "don't go to bed without a snack if you're under 100". Therefore, my brain just automatically thinks that 100 is the cut off point. Ugh. It has taken me a lot of will power to get over this one! A CGM has helped a LOT with that!
2. Stable blood sugar = low carb + high protein+strict eating schedule. Unfortunately, all those crazy low-carbers I used to make fun of had something right. Lower carb diets and higher protein diets DO make for more stable, in-range readings. Also, even though analog insulin is faster these days, it still isn't fast enough, so in order to optimize my insulin usage, eating every 2-2.5 hours keeps things nice and stable. I definitely don't do this all the time, because I absolutely HATE eating on a strict schedule. I'm a big proponent of Intuitive Eating,even though I'm not always the greatest at it--as in I can down a bag of Peanut M&Ms faster than Usain Bolt can run the 100m dash. My husband, or any old roommate can attest to this. And (Peanut M&Ms aside) eating when I'm not hungry is not something I like to do. Also, eating when I'm not hungry brings back traumatic memories of having to eat in random places at specific times as a kid, and crying through my snack because I had to eat at that time because that's what my kiddie diabetic-exchange meal plan called for. Oh the days of NPH! Grrr! (Seriously, I'm surprised more Type 1's don't have eating disorders. Is there a study about this somewhere? I know that the phenomenon exists, but does anyone know if it's at a greater proportion than the rest of the general population? I'm curious.) So, yeah. I'm still trying to find balance with that. But a regular schedule does help immensely, even though it's not practical or even necessarily healthy.
3. Salter Kitchen Scales=my new best friend. This right here is why diabetes is obnoxious and why I hate dietitians. You really do have to weigh and measure every stupid thing you eat in order to get the correct carb count (or memorize what the carb count is, or take a WAG)! I avoid casseroles to begin with (my husband thinks they're gross and doesn't even like the word casserole), but when it comes to carb counting, CASSEROLES ARE THE DEVIL. Especially casseroles made by someone other than me.
4. Getting comfortable being "low" and the 15-15 rule. Like I said above, I've had to adjust my psyche to deal with anything under 100 before bed time. But, I've taken things even further, and just gotten comfortable with letting my blood sugar hang out in the 70s without treating. And I've tried to treat with glucose tabs a lot more than with regular food. And about the 15-15 Rule. This is the rule that ALL the doctors tell you to use for how to treat a low. "Eat 15 grams of CHO, and test again in 15 minutes. If you haven't started to come back up, eat 15 more grams and repeat." What's the point of having a carb ratio then?! Sheesh. When I follow the 15-15 rule, I have rebound highs. I wait at least 20 minutes to test now. If I do end up eating more, I'll do it 1 glucose tab or so at a time (4 grams/CHO). It's better to eat what your carb ratio tells you you need to eat, IMHO.
And that's enough. This post is getting long, but I just wanted to get some of these things down in writing, so I remember what I need to do to get to the place where I'm currently at. And something important: This is what I need to do for my particular brand of diabetes. Your diabetes may vary. Some people don't need to do this to get nice results, some people need to do other things. That's the thing about diabetes, there is no ONE prescribed method of treatment that will work for every diabetic. It's all trial and error.