Just got my lowest A1c to date. Here's my history along with what I was trying... Keep in mind, prior do the LC diet, I was taking 15 units of humulin L every day, and had been taking insulin for over 25 years. I'm a type1 that still produces some insulin.

12/2001 = 7.4 (high carb diet with 15 units of insulin)
12/2002 = 4.7 (Atkins induction type diet, under 20 carbs a day no meds [yes, this is a great number and without meds, but come on folks....])
4/2003 = 5.5 (35-40 carbs a day)
10/2003 = 5.8 (35-40 carbs a day)
12/2003 = 4.5 (35-40 carbs a day, plus 1000 mg of Glugophage XR; 500 in the morning, 500 before bedtime)

Note: Glucophage is not something a Dr will usually not prescribe for a type 1, but I was able to talk my Dr into giving it a shot after I had noticed some decent results from some that I "borrowed" from a friend. In fact, he didn't want me to do anything different since my A1c was under 7, but we all know what that kind of thinking will get you.....

Way to go!!!
I hope I can make a post like this someday

I get my blood work done this coming Feb I just hope its lower than it was in OCT before I started LCing

Those are awesome results! I'm hoping my next A1C will be below 5 (last one was 5.3).
I also think it's great that your doctor is willing to work with you and let you try things that are unconventional. Metformin is sometimes used with type 1 diabetics, though...to help decrease their insulin requirements.



Sadly that is still the recommendation for diabetics...under 7 is acceptable. I'd like to see that recommendation lowered so that the expectation for diabetics is to achieve normal A1c's instead of "good enough for a diabetic" A1c's. It probably won't happen for a long time, though, since there are a lot of diabetics following the traditional ADA diet that are struggling to even get their A1c's under 7 and it's because of that doctors feel that getting it under 7 is doing great.

Well, Type 1, that is good news indeed, those are very fine A1c readings. Just out of curiousity, what carbs did you add, going from the less than 20 to the 35-40? Speaking personally, I cant see any carbs worth taking medication for, but we all pays our money and takes our choice, right? anyhow, very happy for your, would think with Ac1 like that, you will NEVER have to worry about diabetic complications. Great work. Bill

I am curious Lisa as to what strategy you would use for a T1 who makes no insulin of their own(which is most T1s), to achieve a 'normal' 4.5% HbA1c..?? An HbA1c of 5% = an average bg of 80 (4.4).
Perhaps I misunderstood and you mean T2.
Eve

Eve...since I'm not a doctor, suggesting a strategy for achieving those number is really beyond me, but after researching as much as I have I'm convinced that it's very important for all diabetics (T1 and T2) to achieve as close to normal numbers as possible to reduce the chances of long-term complications.
Here's what Dr. Bernstein has to say about it: (taken from pp. 112-114 of his most recent book)

"The ADA recommendations for "tight control" of blood sugar from its Web site is as follows:
'Ideally, this means levels between 70 and 120 mg/dl before meals and less than 180 mg/dl after meals, with a glycated hmoglobin [HgbA1c] level less than 7 percent.'

The recommendations go on to state that tight control (what I advocate) "isn't for everyone" which I believe is nonsense. But the ADA's tight control as defined above isn't very tight at all. I would call it "out of control."

and:

"When it comes to type 1 diabetics, where virtually all of the needed insulin is going to be injected, I increase the target to 90 mg/dl even though we know that the mortality rate-even in the general diabetic population-is slightly greater for those with fasting on pre-prandial blood sugars of 90 mg/dl than it is for those with blood sugars of 85. I use 90 as a target for myself because of the greater risk for hypoglycemia with a target of 85."

He states that an A1c of 5 corresponds to an average blood sugar of 100 with a 40 point jump for each 1 point increase of A1C, so the ADA recommendation of below 7 corresponds to an average blood sugar of 180. Dr. Bernstein's target of 90 for a T1 is still below 5 on the A1c scale and way below the ADA recommendation of 7 or less.

Unfortunately, in the real world, if you inject insulin, your bGs are either on the way down, or the way up, and maintaining an avereage bG level of 90-100 which = Hba1C of 5% is an impossiblity...you would have to be hypo-ing ALL the time or living on one glucose tablet every half hour and nothing else....Eve

Evee....I'm not going to sit here and say that it's not difficult and a lot of work for a T1 to maintain a fairly steady BG, but if Dr. Bernstein as a T1 can achieve it and expects his T1 patients to as well, I can't agree that it's an impossibility to do so; it's not always a piece of cake (no pun intended) for a T2 to keep a steady blood sugar, either. Difficult? Absolutely. Requires a doctor who will work with you and find the right types and amounts of insulin as well as the correct injection schedule to match what you eat? Absolutely. Requires changes in what and when you eat as well as rethinking and changing what you've probably been doing for a long time? Again...most likely yes. The ADA states that "tight control" isn't for everyone and on that point I have to disagree with Dr. Bernstein. Not because it's impossible, but because many people find that achieving that is more trouble than they believe it is worth.
You're right...as a T2, I can't completely relate to what a T1 goes through on a day to day basis and because of that I can only rely on what people like Dr. Bernstein have to say about it: http://www.diabetes-book.com/book/chapter7.shtml
http://www.diabetesincontrol.com/drbernstein/ask.shtml
Ultimately, we all have to decide for ourselves how achievable the goals that Dr. Bernstein sets are for us as indiviuals and to what lengths we are willing to go to achieve them. I can't set blood sugar targets for you, knowing very little about your diet and lifestyle any more than you could set them for me. I do still firmly believe that the closer we can come to achieving the targets that Dr. B sets (T1 and T2), the better off we will be in the long run.

The only point I am trying to make Lisa is that T1 with no insulin of their own CANNOT physiologically maintain a bG in the 4.0s and you have to be able to do that that get an HbA1c of 5%.......no more grief from me on this subject...

Hi Eve:
I totally agree that this is not always possible for non-diabetics to acheve H1Cas low as 4.0. and i've checked non-diabetic BG after meals and they spike sometimes higher than I do. also, i doubt that all Dr.Bernstein patients achieved a strict BG of 80-85 24 seven.
as for type 1, it's must be the toughest task ever, considering that not only food but also illnesses, stress, activities, anythign and everything makes our BG fluctuate daily. this is may be ADA doesn;t want to stress diabetics even more suggesting this tight control. personally, i get stressed when i see my BG at the number i don';t like, and some other ppl are stressed too, which makes it even worst. the more i read into diabetes, the more i think that it's much complex than anyone can imagine. and it's simply put, human biochemistry is still remains a white spot on the doctor's road map.
Thanks,
Dina

Dina...that's not what he says. Those targets are for fasting blood glucose and 2 hour post prandial blood glucose, not 24/7. What he does say is that we should shoot for no more than a 30 point rise (I'll allow as much as 40) following any meal and then get it back into the target range within 2 hours of eating. Everyone (diabetic and non-diabetic alike) will have a rise in blood sugar after eating, but most people should be back within a normal range within 2 hours of eating. It's not the occasional spike that will raise your A1c, it's constantly spiking high and then going back down or keeping an elevated blood sugar for too long after eating that will raise your A1c. For me, a blood sugar over 120 at any point is unacceptable, but that's just me.
Dr. Bernstein has a lot to say in his book about estimating your real food requirements and keeping what you eat on a day to day basis (ie the amounts of protein, carbs, etc...) stable so that you aren't constantly having to adjust your medication requirements. He also goes into pretty great depth about how to find out how much 1 gram of carb will raise your blood sugar and base your medication requirements on that. Of course, there are always situations out of your control such as sickness, stress, excercise, etc...that will also influence your blood sugars as well as even how much insulin you inject at one site at one time (Dr. B. states no more than 6 units at one site at one time or your body will neutralize a lot of the insulin you inject and you wind up with higher blood sugars than you should for the amount of insulin that you injected) and he addresses those situations in his book as well.
At this point, the only time I have trouble achieving those targets is when I eat something I shouldn't (ie cheat) or too much of something that I can have or when I'm sick. Yes, I know I'm a T2 but since I'm not using any medication, my blood sugars can quickly get out of control if I'm not paying careful attention to what I'm doing, too.

Sorry.... I'm back ...

Lisa, for T1 using the proper amount of insulin/food/exercise to be back within 2 hrs pp is certainly attainable, but no-one has yet explained to me how I can KEEP it there for another 3 hours. bGs MUST continue to go down (still insulin working), or they MUST start to go up again (insulin all used up)...it cannot stay static, balancing itself nicely as a lot of T2s may manage. There just isn't a mechanism left to do the balancing/tweaking act..!!

Do we eat again and inject again at 2-hourly intervals..?? I am not being facetious...an answer to this problem would certainly be of benefit to me and my control.

Lisa:
I'm type II too, and pay very close attention to what i eat, test more often then i need and it looks like the concept of carbs spiking BG after meal is not always applicalbe, at least for me. like this morning, i ate for BF: 1/2 cup egg beaters, 2 tiny slices of smoked salmon and 1/2 lc tortilla. not much carb, right. less than 3 active carbs, and 1 h after my BG was highest i've seen - 132, eekkk. this is the highest i've seen after a meal, and high protein meal always spikes my BG higher, than a meal containing moderate protein and some carbs. i usually check 30-45 minutes after a meal to see if i spike too high. even after a meal containing 20-30 g of carbs it doesn't spike higher than 115-117 in 30-45 minutes. i've noticed many times, than too little cabrs and my pp will be higher. i'm not on any meds at all, and my fasting is far away from 80-90 range, hovering at 110-120 range for most of the days. and i'm now on 70-80 g active carbs daily as i 30-40 g is too low and my liver puts out too much sugar to compensate and raises my BG. as for pp is mostly in 80-100 range depending on time of the day and exercise regime. i think it's pretty decent control but not as good as Dr.B suggests. i think that type 2 diabetics are all different, for you, lower carbs means better BG, for me, not exactly the same.
i've consulted many endo doctors and they all refuse to Rx any meds to lower my DP, motivating that potential side effects may outweight benefits of having FBG of 80-90 range. i've also checked other diabetic site by Dr.Mirkin, where the emphasis is placed on H1C number rather than FBG. I'll have to refresh my memory on Dr.B's book.
thanks
dina

Eve...I take it you're not using any type of basal (long acting) insulin in your current regime?

Dina...when you got that 132 what was your fasting before breakfast and how many grams of fiber were in the tortilla? It was also a fairly low fat breakfast, so the carbs you ate would hit your system faster.

Lisa:
my FBG was 110. this LC tortilla has a total of 11 g carbs and 8 grams fiber per whole thing, making 3 g of active carbs per serving, and i ate half of it. this will make about 1.5 g of carbs +about 1 g in egg beaters. very low carb breakfast, and still BG spiked very high. on the contrary, i can have FBG sometimes much higher, around TOM, like 135. then i'd have BF with 2-3 bran-a-crisp crackers, some PB and greek lc yougurt. and my 1h BG will be around 90-100. it's a mistery for me but too low carbs and high protein/fat food makes mt BG worse. it's hard to find a source of protein, which doesn't contain naturally fat. besides may be egg whites.
Thanks,
dina


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Dietary Fiber 8g 32%