[moon]

Today I met with my endocrinologist, a woman I've come to like.

My most recent A1c was 6.1 which is down from 7.1 a month ago. Thank you Dexcom! I'm keto and have been as conservative as possible with insulin and do not experience lows or highs really. Because of my CGM I'm able to spread out my bolus, responding to my body's reaction to protein and fat in a particular meal.

I told her I was disappointed not to be in the 5's but she said I could not be doing things more perfectly. I was waiting for the typical endo lecture about keeping A1c higher from fear of lows and while I got the lecture, she didn't latch onto lows since I don't have them. She started quoting studies, the last one out of Australia, showing best results are when diabetics are between 6-6.5 A1c and <6 there is an increase in cardio issues. I didn't register it all (she talks quickly and I was anxious to get on the road to the airport!) and was not taking notes, but will the next time. But - my main takeaway was that I'm content now to be in the high 5's to low 6's.

She said when she has a patient who is doing things so perfectly (my CGM lines are impressively flat she said) she often returns them to their primary care. I don't need her she said. Oh yes I do I argued! You need to make sure nobody takes my Dexcom away!

She said she'd be pleased to keep me as a patient. Whew!

Feeling good about where I am, that using insulin is no big deal, diet is pretty easy, not driven to veer off ... all of it, even being in the 6.1% club

 

[mbuster]

Sounds like you got a keeper, but she's trying to stay in bounds of medical community expectations of talking points.

I think there is evidence that excessive insulin in circulation does cause many cardiovascular problems. The tale of an A1c less than 6 being the cause is like saying its those few grams of saturated fat and ignoring the 200 grams of carbs a day in your meals. That's a problem they keep ignoring.

 

[moon]

Agree mbuster. Also, it says nothing about what the swings were. Repeated severe lows contributing to lower A1c are not healthy.

I did ask if she'd fire me if I was in the high 5's and she said no

My quandry has been - is it better taking more insulin to achieve lower A1cs or minimizing insulin and being content where I am.

 

[itissteve]

My quandry has been - is it better taking more insulin to achieve lower A1cs or minimizing insulin and being content where I am.

My $.02 is that there are so many other health, environmental, and lifestyle factors involved that you'll never know which course of action serves you better.

You have a CGM but not a pump, right? And who pays for the insulin?

 

[moon]

Right - CGM without pump. I pay for insulin though that's not a factor in mulling which is better: more insulin for a couple/few more points A1c or content around where I am.

For the moment am choosing the later but am open. It's rare for me to go >140, my spikes are more in the 130 range.

 

[itissteve]

I guess I'd wait for another A1c and see if it's worth changing your mind....

 

[mbuster]

I would think with your WOE and your BG control moon, your insulin would not be considered excessive.

I think for many Type 2s, myself included, early on in our diabetes, our bodies put out large amounts of insulin to keep the BG under control until resistance outlasted the beta cells ability to keep up. Some became insulin dependent, and continued to eat what they wanted and were instructed to just adjust the dose to cover.

I think most Type 1s are different in that they are more aware of the need to carefully watch what they eat and are less likely to be insulin resistant. But I know that there are also some who just dose to the high carbs that they eat.

I believe those insulin dependent Type 1s and 2s, who regularly eat large amounts of carbs, and the higher insulin resistant Type 2s will be much more likely to encounter damage from excessive insulin circulating in their blood than someone using a lower carb diet that doesn't require much of an insulin demand.

JMO

 

[moon]

Yeah, it wouldn't take a lot more bolus to drop my A1c a bit, just a bit more maintenance for my protein/fat curve. My basal is dialed for the moment: wherever I am just after bedtime is where I stay, usually now a perfect flat line.

You're probably right that a few more bolus units wouldn't be a big deal as a trade-off.

 

[VeeJay]

Just saw this thread. WOW, moon, you've really got things in line. Good for you, girl.

And that endo is certainly a keeper.

 

[alamogirl]

Congrats on your new A1C. I go for lab work next month. I hope I can maintain my membership in the 5% club .