Posted by on Saturday 20 October 2012

A1c apprehension and feeling a little deflated

I have an appointment on Monday to have bloods taken for my annual review a week or so later. As is often the case the mere hint of an A1c on the horizon has been enough to play havoc with my blood glucose levels over the past few weeks. Coming down with a cold hasn't helped either.

This time last year I was at a bit of a turning point. I had tried as hard as I could to improve my levels on MDI, and still felt there was improvement to be made. That review was undertaken at the hospital, and having discussed the ongoing challenges I was trying to tackle, the Registrar agreed that an insulin pump was a good option. I recognise that I am extremely fortunate to attend such a pro-pump clinic and after a few more appointments and a bit more prep, I was pumping before Christmas.

Regular readers (your gritty determination astounds me) will know that my journey towards an insulin pump was not entirely straightforward. I spent a great many years resisting the idea each time it was mentioned. Approaching a year into my pump experience I have just done a d-geek 'compare and contrast' exercise that convinces me more than ever of my position on the OCD spectrum - partly because it annoys me so much to have a key period of MDI results missing due to an *ahem* administrative error (I deleted them from one place before checking the place where I thought I'd copied them). I put together seven months worth of BG results side by side, matching 'tricky' periods like Christmas and holidays. I then examined them for a range of markers - BG average, SD, FBG in range, numbers of highs, numbers of lows and so on.

Without going into the minutiae (I appreciate I have to at least make a gesture towards allowing you to retain your will to live) the truth is I'm a bit deflated by the results. Since moving to the pump they are, in some ways, better than on MDI - but not really by very much. And if I'm honest I was hoping for the same transformations to my results that I'd seen in other people. People whose MDI skills I hugely respect, whose lives are busy and full of nice varied (and occasionally eyebrow raising) meal choices. People whose A1c's fell by a significant margin after a short time on insulin pump.

The trouble is I should be perfectly happy. My meter averages suggest that my A1c will be somewhere in the high 6's. To be disappointed by that seems ridiculous, but my last MDI result was 6.3. It is true that I'm having slightly fewer 'waffy' moments these days (thanks Dave!) but I've also had more readings in the 20s than I can remember thanks to multiple set failures which at one stage seemed to be happening fortnightly.

I still believe the pump is working for me - and having changed to Silhouettes a few weeks back I've not had a failure since - but by now I was hoping to have this whole thing sorted and be cruising along with more stability and less goalpost chasing.

I'll let you know what the result is when the A1c jury comes back in.

UPDATE: #teamsmug


  1. I told you Sils would sort you out!

    Remember you started off with very good control on MDI. A bit like losing weight, the smaller the number you start with the harder it is to see it come down. I had an A1c of 8.3% on MDI so a number in the low 7s on the pump was quite a drop. You were never going to witness a drastic change in numbers 'cos your numbers were good already.

    Pumping is about more than BG control. How do you feel in yourself? Is your quality of life better? How does D affect you emotionally? Try not to think about treating diabetes in isolation - you're treating YOU. It's no use having fantastic control if you're miserable. There are many things I love about pumping (as you know!), but the greatest improvement for me has been psychologically. It's still a battle - I know it always will be - but I feel much better armed and as a result it drags me down a lot less.

    Also remember I would kill to have your A1c. It's all relative - we all have our own battles - and you're doing a sterling job fighting yours.

  2. Yup - what Emma said, it's about quality of life. My A1C is actually higher on the pump than when I was on MDI. So, by that measure, the pump is worse.

    But by a sensible measure, quality of life, it is much better. Yesterday, for example, I went on a short but sharp bike ride (which included the Hill of Death(TM)). By messing around with temp basals I did this easily without going too high or too low. On MDI I would have been hypoing like a whatsit and stopping every 300m to shove more Lucozade down my gob.

    I also think that whatever we use - pumps or MDI - diabetes still sucks and is difficult whatever we do. But hey!

  3. Great post!

    Unfortunately (for you! haha) I am one of those people who actually saw a significant drop in A1c within the first three months and again at the six month mark but I started on a pump with an A1c of 10% (old school)- personally I would be ecstatic with your projected results! :)

    Don't beat yourself up if it's not what you wanted, just pick yourself and try again!

    Good Luck! Keep us informed!