Seven Things For An Under 7% A1c

a1c_7_pin-r3922b6efb4e94a2ba81b3a8a090e88ff_x7j12_8byvr_512Last week, I made the declaration that I would achieve my first A1c under 7% at my next endocrinologist appointment, which will be my first appointment after living with diabetes for 20 years (#20 diaversary is January 27 if anyone wants to buy me a card).

But what exactly am I going to do that will make this appointment different from all the others?

1. Wear My Dexcom CGM

Ladies and gentleman, boys and girls. After tragically losing my transmitter in July, my warranty had finally expired and Dexcom has once again filed a claim with my insurance to get me a brand-new spanking transmitter to go along with the receiver and sensors that have thus far been collecting dust (okay, that’s not true… they are very clean!). I only had a few weeks to try out the Dexcom earlier in the spring so I didn’t get to really put it to good use and see whether or not it would help me achieve a lower A1c. Now that I have my CGM again, I’ll be able to monitor it closely for trends and make better judgement calls on how to adjust my doses, as well as douse any high blood sugar flames before they turn into raging forest fires killing everything in sight.

2. Eat carbs only when there is a carb count.

I often get in trouble because I like to eat out. When you eat out, the food that you’re likely to get isn’t very healthy. Even if you’re being a total goodie-two-shoes and ignoring the bread basket (you suck), you likely still fall victim to pasta or Indian or pizza that you think you know the carb count for, but in reality you are so, so wrong. It’s not even worth arguing with me because you know I’m right. That’s because I do it too. So my new rule is that if I’m eating out, I can only eat things for which I know the carb count for (that is, it has a label or nutrition guide of some sort). If there is no way to know how many carbs I’m eating, then I eat as low-carb as I can. At home, it’ll be easier because I have measuring cups and can portion things out appropriately.

3. Exercise only in the morning.

Two things from this. First, after weeks and weeks of trying, I’ve given up running at night. I thought it worked well in the summer when it was so freaking hot and humid out but lately I have been having nothing but trouble with low blood sugars (followed by high blood sugars) from running after dinner. I just can’t do it. In addition, I’ve found that my blood sugars are much better throughout the day when I get started with a run or a strength training session in the morning. I have a workout routine planned out and I think it’s really going to help a lot with getting my sensitivity up.

4. Regularly review my blood sugars.

You can’t fix the problem if you have no idea where the problem is happening. My plan is to start reviewing my blood sugars once a week, probably on Thursdays, because that’s a day of the week that I don’t have work or school. I can take my time and download or write down my blood sugars and take a look at what has been happening that week. I have a pretty bad short-term memory and I often think that I’m doing much better than I actually am until I take a look at the numbers and realize “I’ve been high how many times?!” And then I crawl under the covers and cry.

5. Talk to my “pit crew” more often.

I totally stole this term from Charlie Kimball, but I think it’s great. More often than not, I don’t really talk about my struggles with diabetes except at my doctor’s appointment, where my endo (who is awesome!) gives me some great pointers and then says “Check in with us and let us know how it goes.” And then I promptly don’t do what she tells me and don’t check in. That is until I get completely frustrated and helpless and then send a desperate email to Gary Scheiner asking him a question to which I already know the answer and then he tells me the answer that I already know. Then I huff and puff and get all indignant and then I ponder about whether it’s too late to move back home and have my mom do all my diabetes management.

(Word to the youngin’s out there: You have no idea what you have until it kicks you out of the house.)

6. Overcome “Carb Denial.”

One thing that I have never been able to overcome is my fear of calculating the correct number of carbs. That probably doesn’t make any sense, so I’ll try to explain. (But keep in mind it still might not make sense). I love to eat, and I especially love to eat carbs, but I don’t love to admit how much I’m eating. When you have diabetes, and you wear an insulin pump or are doing anything related to carb-counting, you have to know exactly how much you’re eating. You have to dial in the correct number of carbs so that you can get the right amount of insulin. But if you don’t really want to admit that you just ate 70 grams worth of tortilla chips while watching The Vampire Diaries, this can make managing diabetes kind of, well, impossible. I have always had this denial (my dad called it “silent protesting”) about what I was actually doing. As if not bolusing for all the carbs in the pancake breakfast at the diner was somehow going to make it disappear from my digestive track. As ridiculous as it sounds, one of my goals is to just start carb counting correctly. To actually admit what I’m eating and bolus for it appropriately and not try to weasle out of a pizza dinner with a nice round 100 grams when it is clearly so not 100 grams.

I mean, I live in New York for crying out loud. I’m pretty sure a single slice of a thin crust pizza is at least 112 grams.

7. Don’t give up.

I have given up various plans and schemes over the years when the going got tough and I got going. My inability to stick to a plan and do what I know I need to do is the biggest — if not only — reason why I haven’t really reached my goals. I know diabetes is hard and I know that no one can be perfect, but sometimes I feel like I’ve let that be an excuse. That what I’m doing is good enough and that at least I’m not as bad as I could be. That diabetes is hard and confusing and I shouldn’t try to understand it. That if I just keep plugging along everything will work out.

To be honest, trying to do better is exhausting. Just like losing weight, you are changing many habits and ways of thinking about what’s okay and what you’re comfortable with and what you naturally respond to. Just like there are some people who are naturally thin, I think there are some people who just naturally have better blood sugars. So this doesn’t necessarily apply to you. But if you are someone who struggles with doing the right thing, who would much rather be permissive and have the thing that’s tasty or do what’s easy, then I know what you’re going through. These changes aren’t easy and they aren’t fun. So many times I just wonder why I have to deny myself when there are other people who can have it. Or I wonder why it isn’t easier for me to give up the things that are bad for me.

But I’m not going to give up. Even if it takes me a hundred more A1c tests to get to an A1c under 6% (I’ll be approximately 68 years old), that’s what I’m going to do. I’m going to keep trying to get better at managing my diabetes. I’m going to keep working at living a longer and healthier life. For me and for my family.

The Truth In Numbers

I was diagnosed almost twenty years and in all that time I have never had an A1C under 7%.

And this fact fuels shame and embarrassment like you wouldn’t believe.

In these past twenty years, I have had more than 7,000 days and more than 175,000 hours worth of diabetes experience. I have interviewed world-renowned physicians like Francine Kaufman, Steve Edelman, and Bruce Buckingham. I have attended two ADA Scientific Sessions, three AADE annual meetings, and three Friends for Life conferences and countless scientific updates from ADA and JDRF. I have visited the laboratories Ed Damiano, Denise Faustman and the Diabetes Research Institute. I have researched articles for Diabetic Living, Diabetes Health, JDRF, and of course, Diabetes Mine. And I personally worked with the AADE Diabetes Educator of the Year, Gary Scheiner, on and off for the past 10 years and I faithfully see my endo every 3 to 4 months, who answers all my questions and treats me like I understand diabetes because I do.

107_0807fWhen it comes to diabetes, I know my shit.

And yet here I am, sitting at a 7.7%, wondering how it is that in twenty goddamn years I haven’t achieved this goal once.

The more I thought about it, the more I realized that this mirrors exactly my experience in losing weight. It’s not that I don’t know how someone loses weight, it’s that I don’t ever do all that it takes to actually do it.

Knowing what to do and doing it are two wholly separate things.

Because doing the things you know you are supposed to do is hard.

Here’s my repetition: I go to the endo or I get on the scale and I realize that my A1c/weight is too high. I have to do something about it. So I count carbs/eat healthier/exercise more/check my BG more often/look for trends diligently (ever notice how similar the things for weight loss and A1c loss are?). Then I go back to the endo or get on the scale and I see that my A1c/weight has dropped. Yay! What I’m doing is working! Woohoo! So then I stop paying attention as much. I figured what I was doing is what I’m “naturally” going to keep doing. And slowly but surely I get a little lazier.

“One more won’t hurt.”

“Oh, my BGs are mostly good, this high BG is a fluke.”

“Actually, I think I’m going low a lot these days.”

“I definitely ate really healthy today.”

“It’s a special occasion.”

Or simply: “I want this.”

And so then the next time I go to the endo or get on the scale, I find out my A1c/weight has gone up. I have to do something about it! And the cycle repeats itself. Over and over again.

I think that for me, I keep thinking that once I start moving in the right direction, I can go on autopilot. But that doesn’t work. Habits are incredibly hard to break and it takes way more than 21 days or however long they claim it takes to form a new habit. When it comes to my weight and blood sugar, it takes a heck of a lot longer than that. I have to pay attention more diligently. I know this probably sounds like a lot of “duh” information, but for me this doesn’t come easy.

My twentieth diaversary is January 27, and shortly after that, I will have another endo appointment (sometime in February or March). My last endo appointment, yesterday, had me at an A1c of 7.7%. My goal is for my first A1c of my third decade with diabetes to be under 7%. That is a big drop, but last winter I dropped 1.1% (from 8.3% to 7.2%). I think I can do it. But I have to be diligent about it. I can’t get lazy and just think that whatever I’m doing is just going to keep happening without me thinking about it. And like weight loss, it’s going to involve hard work, sacrifices and planning.

I’ll be talking more about my strategies in some upcoming posts.

 

Have you ever made a significant reduction in your A1c between appointments? What were your strategies?