5 changes toward a lower A1c

Tuesday, August 19, 2014

I wrote here that I recently dropped my A1c to 6.3.  I promised I'd reflect and try to figure out how that happened.  It took me a little bit longer than I had expected, but I have definitely made some consistent changes in how I live my life and manage my diabetes.  Here are my top-five changes:

1. Exercise Consistently:  I had always picked up the occasional yoga class, indulged in the occasional personal training session, and trained haphazardly for 5ks.  That probably had some sporadically helpful effects on my bloodsugar, but I've noticed that consistency really seals the deal with exercise and bloodsugar.

First, consistency allows you to adjust for the weird bloodsugar results.  One yoga class drops my bloodsugar, another raises it, figuring out how to best mitigate those changes is both luck and repeat experience.  I've learned, for example, that eating a semi-serious snack three-four hours before a run provides for the best running experience and it doesn't matter too much what it is, as long as it involves some protein.  For some reason, a baked potato twenty-thirty minutes before a run will work well without many complications.  If I'm desperate and haven't thought ahead, a Gatorade will spike me enough to make it through the workout, but spells disastrous highs on the flipside.  Glucose tabs, orange juice, and Elovate to raise bloodsugar before the workout and I can expect to stay low and stop the workout early even if I dump lots of extra sugar into my body.  Why are they so different than Gatorade?  I have no idea.  This is just how it goes.

Second, I swear there is something else going on inside my body when the exercise is consistent.  It seems like the exercise is to bloodsugar control as the ocean is to temperature.  When I'm consistently exercising my body seems to tolerate and moderate changes better.  When I skip a few days, things become erratic.

2. Do something that feels good:  I recently added a yin yoga class that just felt good.  I added it into my schedule just for myself and not to achieve any specific goal.  I'm not sure whether this yin class really does anything that is super helpful in terms of building muscle or stretching out the connective tissue, but it seems to make a difference in my vitality.

3. Use a CGM: You can't beat wearing a cgm consistently.  First, you learn a lot about how your body responds to different things and when.  This allows you to understand better what action is causing a particular bloodsugar response and to take that into account.  For example, I really did not realize what killers rice and sushi are.  I don't eat them anymore.  Before wearing a CGM, I didn't fully make the connection and understand exactly how much havoc those foods wreak.  Second, you can respond quickly when you're entering a high or low crisis.  Third, you don't have to take as many compensatory actions to prop your bloodsugar up before doing things like going to sleep or exercising.  The CGM is a fabulous tool and it's saved many lives.

The downside is the cost and the added stress of trying to make it all work out.  Unfortunately, I haven't had any sensors for awhile as I have run out during the past month, which has mostly been spent fighting with Medtronic and my two insurance companies over ~$4,000 in medical bills that I actually don't owe.  But, I did have a consistent supply of the sensors during few months leading up to the measurement of my A1c.  I placed a fourth phone call to Medtronic today regarding the order and the amount of time it was taking to process my insurance...so we'll see if they actually are able to get things expedited or if we will continue to wait in a bundle of red tape.

4. Lower carbs.: Technically, you can eat whatever you want as long as you take insulin to cover it.  But, the law of large numbers applies to diabetes management and insulin dosing.  The more carbs you're eating, the more you're considering bolusing and the more opportunity you have to mess up.  It isn't that  low carb diet is necessarily healthier for a type-one diabetic, it's that the human error in guessing how the carbs will affect your bloodsugar is greatly reduced when the carbs are reduced.  For this reason, I have primarily switched to a low carb diet and I think that is part of what has helped me achieve better control.

5. Reduce stress: No law school, little in the way of cancer treatment, no bar exam, no starting a new job, no moving to a new city...stress is the rocketship to the planet of unpredictable highs.  I think it's highly possible that getting more parts of my life working and under control made most of the difference.  It's amazing how intertwined our body is and how much everything affects your physical health.  I'm pretty convinced that almost anything you can do to reduce stress (except, obviously, things like giving up on fighting with insurance companies) is worth its weight in gold in terms of health benefits.

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