A few years back, my son was diagnosed with type 1 diabetes. During that time I've learned a lot about type 1 diabetes blood sugar monitoring and adjustment. I thought I would share a few tips that might help either you if you have type 1 or for your children if you are parents of children with type 1.
A couple of notes here before I begin. Remember, I'm not a doctor. These suggestions are just my experience with my son's type 1 and he uses an insulin pump with the fast acting insulin Humalog. If you are on injections using long lasting and fast acting insulin or a type 2 diabetic, these suggestions may not necessarily apply to you.
OK. Let's cover my tips.
1. Figure out how long your fast acting insulin stays in your system
The first thing my son and I noticed was that his Humalog peaked at about an hour and a half. By peaked, I mean that he was most likely to go low at an hour and half after a bolus. We estimated just based on experience that a dose of his fast acting insulin lasted about two hours. While not an exact science, we just assume he has no insulin on board from a bolus or corrective dose after two hours.
2. Set your pump's basal, bolus and corrective dose time intervals to how long your fast acting insulin lasts
After our discovery of how long a dose of insulin lasts in his system, we decided to set the time intervals in his pump to every two hours which is how long we figured hist fast acting insulin lasted for all types of doses. Doing this allowed us to more closely figure out when a dose was taken affected his blood sugar.
For example, if his blood sugar was normal at 8:30 pm and at 10:30 pm he was low. Then we know it's most likely his basal insulin was too high and it might need adjusting. If we adjust his dose in this situation, we would adjust it for the prior two hour time slot from the reading. Since the blood sugar reading was taken at 10:30 pm, we would consider changing the two hour time slot prior to the reading which was 8:00 to 10:00 pm.
We also set his insulin on board (IOB) setting on his pump to 2 hours as well.
3. Check every two hours (or however long your insulin remains on board)
Because his insulin on board is approximately a two hour window of time, I have him check roughly every two hours whenever possible.
By doing this, this allows you to keep on top of all your highs and lows, treating them more frequently as well as considering making small adjustments in your doses.
Treating highs as they occur rather than waiting hours with a high blood sugar is crucial to getting a lower A1C.
4. Treat highs as seriously as you do lows
A lot of times it's easy to get scared of lows and feel good when blood sugars are higher than they should be just because you know you won't go low. What tends to happen is you relax and don't treat the high's as they occur and this will inflate your A1C.
Always treat highs as seriously as you do lows.
5. Treat highs and lows based on your current IOB
While you want to treat highs and lows seriously, make sure you consider how much insulin you have on board when treating them. There's no sense over treating a low by loading up on carbs if you are near the end of the IOB period where it will spike your blood sugar higher than needed. Eat more carbs prior to a peak and less after.
When in doubt if my son feels really low, I tend to be a little more aggressive in treating serious lows.
On the high blood sugars, factor in your insulin on board when taking corrective doses. Your pump should help keep track of that.
Just keep in mind serious highs may also require more insulin and a check for ketones.
6. Don't be afraid to adjust your own doses
I think it's pretty common for people with type 1 diabetes to expect the doctor to monitor and change their doses. In real life though, the doctors don't have time to worry about it and doses often don't get adjusted until a check up requires a visit to the doctor.
If you want to have a better A1C, you have to get comfortable adjusting your own doses.
7. Adjust your basal, boluses and corrective doses in small increments based on the blood sugar readings
We adjust doses in the smallest increments when we make changes. Rather than make big changes, if we notice something out of wack, we look to the prior two hour time period and make a small adjustment in the dose.
It's a challenge to know whether you need to change a basal, bolus or corrective dose. I always focus on basal's the most because they are the easiest to figure out because you have no boluses in your system.
The main thing I want to stress is just start thinking about what your blood sugar number means each time you see it and ask yourself why the number is what it is. If it's high or low, you'll want to consider making an adjustment in the prior interval.
8. Don't make changes when equipment has malfunctioned or you feel you didn't estimate carbs right
Insets leak, pumps run out of insulin and sometimes we are flat out wrong on our carb estimate or when those carbs affect our blood sugar.
When those things happen, you don't want to adjust your doses since you would be changing them based on inaccurate data.
Conclusion
Unfortunately, a lower A1C happens is only possible if you are monitoring and checking your blood sugar frequently and making adjustments based on your blood sugar numbers when they occur.
These tips have worked for us and I hope they work for you. Let me know in the comments if you have tips you can share for type 1 diabetics.
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