Tuesday, October 31, 2006


The last HbA1c I had before starting on the pump was 5.8 % (Nov. 14 2005). In April this year, when I started pumping, the aim of my diabetes nurse and I was to try to increase this just a little (to 6.0 %) to see if this would also eliminate some of the nasty lows that had experienced. While these nasty lows were not that numerous after the switch to Lantus 3 years ago, they would occasionally show their ugly face, usually leading to a trip to the ER or a visit from the paramedics in our home, so I sure would like to get rid of those.

As described in previous posts, the switch to the pump still has to prove its worth in relation to lows. Because of that I wasn't too surprised to see a slight decrease in my HbA1c at my endo appointment in the end of June, almost 3 month after pump start. At that time it was 5.7 %, which would be great if it wasn't because of all the lows it included.

Last week I mailed another sample for HbA1c-analysis. Sunday evening I went into my web health portal to see if the result was back yet. It was. I have an appointment with my diabetes nurse this Thursday, and I am looking forward to see her reaction to the result. 5.3 % it said, which is the lowest it has been since I moved to Odense in the beginning of 2001.
My HbA1c results the past 2 years

Before that I had results as low as 5.1 %, which at that time was more a concern to my doctors than to me, because I didn't had that many low, and certainly not as many requiring assistance in their treatments as I have had afterwards, even with higher A1c's.

I will have to admit that the perfectionist inside me most certainly aims for an A1c that is normal, i.e. in non-diabetic range (4.6-6.4 % as far as I remember from patophysiology classes). Not at any costs though. The current 5.3 % result, while in this range, stores too many low lows. I cannot remember ever having tested, or even being able to test, at 1.1 (20) or lower (my meter just reads LO for values of 1.1 and below) in all the years I was on MDI. I have already lost count on the number of times this has happened while on the pump, but it is at least a handful of times. Of course these lows are somehow outweighed by the highs that has also been present, especially after soccer games, but that just shows that the BG-curve has not leveled out as much as anticipated. Hopefully this will happen with time, but it is a bit difficult to be patient, when you were promised results, potentially within 3 months.

It may sound like I am all negative about the pump and the promises that comes with it. That is not the case. I certainly see advantages with this therapy as well. I am probably just, still, a bit frustrated by the fact that I cannot seem to get a hold of things with CSII, and that it regularly causes issues that are not only troublesome but also scaring at times. I hope that my next A1c will be as great as this one, only without the hypoglycemic backside of the result :-)


Scott K. Johnson said...


I can certainly see why things are frustrating to you on this change to the pump.

All of this talk about how things will be "so much better" on the pump, and yet it's not so much better for you.

I think you can appreciate both the pros and cons of pump therapy, and only you will be able to make the decision on what to do.

I don't know the details of your situation, but would there be any benefit to using the pump sometimes and shots other times? Is that even possible for you? Just a thought.

I have to admit, that does sound like a scary A1C for a type 1 diabetic.

Chrissie in Belgium said...

I totally understand your frustration with not attaining the goals "promised" by the pump. I believe the tighter control one has the more hypos will occur. you have to judge if in fact the pump DOES help you! Your control with MDI did seem exceptional! Each person is different. The pump has done wonders for me, but that doesn't mean it is the best solution for YOU! To keep the HbA1c low, but eliminate hypos, at least bad hypos, is the wish of all of us Ds. i achieve much better HbA1c values but I still have loads of hypos and they get lower and lower! You on the other hand had good HbA1c even with MDI. With the pump, although maintaining good HbA1c levels you have even more hypos so I do not know what to say!

Heidi said...

Scott, I have actually been playing a bit with the thought of using the pump at times and shots on other. I don't know whether it is practically feasible, though. At least it will probably require at lot of attention to temporary basals and potential hypoglycemia, when going back to the pump after shots - the first couple of days I was on the pump were characterized by recurrent lows, probably due to Lantus reserves still being in my system.

I don't know. In some ways I gotten quite use to the pump, and have learned to appreciate some of its features. I guess this is also why it bothers me so much not to feel like being able taking full advantage of this regime.

Hypos are part of being a T1, regardless the therapy. I would just like not see those very low sugars too often. I mean, I am okay with lows in the 2.2-3.3 (40-60) range. It is the ones below 2.2, and especially the ones below 1.5 (27) that scares and bothers me, not least when I happen to almost be able to act normally at these numbers, because that is being so close to the "edge" of unconsciousness that it scares the hell out of me just to think of the potential dangers it poses.

Anyway, it is nice to get rid of some of the frustrations about this disease and its management on this blog, and know that people in the DOC know exactly what it feels like. That is a therapy in itself :-)