Tag Archive for: hba1c

, , ,

“Why are you so harsh on yourself?” 😳

I got a DM on Instagram recently, where the (probably) well-meaning person asked something along the lines with “why are you so harsh on yourself when it comes to diabetes?” 😳

It was implied that I pay too much attention to things like blood sugars, nutrition and HbA1c, when “all you have to do is count carbs and cover for them with insulin.”

Well. I don’t agree. 🤷🏻‍♀️ To me, that is a way too simplistic way of looking at managing something as individual as diabetes can be. Check out the rest of my answer in this short clip:

https://youtu.be/vMiX2ykf170
Type 1 Thursday – Hanna Boëthius

👉🏼 What tools have you found that work the best for you in your diabetes management? 👈🏼

Disclaimer

The only purpose of this video and website is to educate and to inform. It is no substitute for professional care by a doctor or other qualified medical professional. This video and website is provided on the understanding that it does not constitute medical or other professional advice or services. Instead, we encourage you to discuss your options with a health care provider who specializes in treating Type 1 Diabetes.

/0 Comments/by
, ,

High or low blood sugars?

How often do I have high/low blood sugars that need treatment? 🤔 A question from the audience!

Learn how I attempt to avoid the high and low blood glucose readings (that are, more or less, a part of life as a Type 1 Diabetic).

Type 1 Thursday with Hanna Boëthius

What about you? How often do you have highs or lows that require treatment? Let me know in a comment!

Transcription

If you prefer to read the information in the video above, please find a written version right here:

High or Low Blood Sugars?

This week, I have another question from the audience. And it’s a personal one-ish. Well, I don’t want to get your hopes up, it’s not that bad. Actually a normal question, but it is more personal natured one. So I’m looking forward to answering it. Because this person writes:

How often do you have a real low or high blood sugar that you need to correct? Is it rare, or is it part of everyday life?

I thought this question was very, very interesting. And I guess I’m not that open, perhaps, with my blood sugar levels online, because I frankly don’t think it’s very interesting to share them. If you want me to, I could share more of my day to day values. (If you do, please leave me a comment so that I know because I cannot read your thoughts out there! 😃)

High and low blood sugars are of course part of living with Type 1 Diabetes and no one can deny that. The frequency of them, however, can greatly and amazingly be influenced by different lifestyle factors, for example. For me, for example, a low carb lifestyle has really helped to eliminate most highs and lows. I no longer get those extreme highs followed by extreme lows, because I simply follow the law of small numbers so I don’t have that much insulin in my body. And also not that much insulin required, that I get those quick drops. Furthermore, I don’t eat that much sugar and carbs so that I get the high highs. You can do a lot with lifestyle factors!

It’s also a question of definition. For me is low is below 3.2-3.5 mmol/l, which is about 65 mg/dl, and my highs are already around 6.5 mmol/l or 117 mg/dl. It’s really a question of definition. Do you mean those super-highs of 400 mg/dl and then down to 20 (22 mmol/l to 1.3)? Or, do you mean this sort of gradual, just on the verge kind of sugar surfing highs and lows? It differs from person to person.

Basal Testing

The number 1 thing that I would advise people in this situation is to check your basal settings. Whether you have your long acting insulin or an insulin pump with a basal setting, make sure that those dosages are correct. That can save you a lot of trouble! This is something that I do on myself, as well, I make sure that my basal settings are correct (or as correct as they can be because life happens and things go up the wall sometimes) If you want me to do a video about how to basal test properly, then also let me know in a comment!

If your basal dose is correctly set, you also need less corrections to get the results you need. If you’re too low or borderline too low, for example, and your basal isn’t too high so your blood sugar won’t keep going down much further. With the right settings for you, you only need very little carbs to get you back up into a healthy safe range. Same with highs, if you are borderline high, you don’t need that much insulin to get yourself into a nice, safe healthy range again, because your basal insulin is correctly set.

My Trick

I correct before there is a high or a low. Of course when I can, things like sleep, illness, travel, stress and things like this too much work (guilty as charged!) can of course make this a little bit trickier and hinder me from keeping that level of control. But whenever I can, I do react before it the low blood sugar or the high one is a fact.

Managing this before they’re a fact, I cannot say enough that a CGM, a continuous glucose monitoring system, really is worth its weight (well, really is worth its value) in gold, because they’re quite expensive. They’re small, but expensive things. Anyway, they are worth absolute gold so that you can react before there’s a high or there’s a low blood sugar.

CGM’s are of course not exact. I don’t know of any CGM system that is absolutely exact. Especially when my goal range is so small, it is very, very annoying that it is more most often 1-3 mmol/l (18-60 mg/dl) off. It’s not really exact, but it is invaluable to see the trends! Where is your blood sugar trending? If your blood sugar is steady and starts to trend downwards, then you can already treat so that you need a lot less and the the hypo doesn’t become a fact. Or, if you see that you’re trending upwards, you can play with either temporary basal if you are in a pump, or wait it out and see what happens ,or correct with insulin. For the trends, and the CGM is fantastic and I could not recommend any more!

Timing

Reacting in time actually also helps the Standard Deviation of your blood sugar, as well as your Time In Range, which is what reacting in time will help. This will also help your HbA1c. That little trifecta is a fantastic measurement of health for diabetes. And that also is helped by reacting in time so that you don’t go high and don’t go low, but you can react before it is a thing.

Doing it this way, reacting before a high becomes a high or low becomes a low, makes them very rare. It actually makes them more rare than then it would be, if I, for example, added a ton of sugar, or the recommended amount of carbs for example. This is true for me, and I’m not going to talk about anyone else. But for me if I added that, I would have many more highs and I would have many more lows, because I would have to fight the carbs as well as my body with the stress, work, illnesses, and all of the other 45 things that always influence our blood sugar.

This is my Dexcom G6 24 hour curve from 20th February, and I’ve marked where I used my method and reacted before a high was a high and a low was a low:

I want to hear from you:

Do you have highs and lows often and that you need to react to? Or are they rather rare for you? Let me know in a comment. I’d be happy to chat with you there.

Ps! Join me live next time, Thursday’s at 6pm CET on my Facebook or Instagram for another episode of Type 1 Thursday!

/1 Comment/by

All about my latest HbA1c…

“Your A1c is 4.8%”, she said with disbelief in her voice.

“No way”, I replied, laughing, “it must be an error!”

“It’s time for your yearly blood work anyway, let’s throw in an HbA1c, too. The labs margin of error is a lot less”, she mentioned.

Excellent suggestion!

Well, the lab results came back at 4.7% (29 mmol/mol)! My lowest ever reading, by far. And that without significant lows – Dexcom shows 6% lows for the past 90 days (a few of them are pressure lows too.)

I remember just a few years ago when I could easily have added a 1 in front of that result and it would’ve been my reality. I remember the pain, frustration and hopelessness I felt. I am reminded of my war wounds from having battled T1D for 34 years.

And I finally feel a sense of freedom. Freedom of having found things that work for me and my diabetes management. Freedom in the feeling that normal, healthy and healing blood sugars ARE possible, even after living this long with this disease.

This by no means means that I never have problems. That I never have days when it’s all shit. Or never have moments I want to give up. But there are less of them now.

If I can do it, so can you! 🙌🏼 Share your achievements with gratitude – they are worth it to be acknowledged!

Thank you for your support and for following me on my diabetes journey. 🙏🏼 You are the best.

HbA1c
My latest HbA1c result, including lab print screen

Ps, do you want to know my HbA1c lowering formula? Watch my Type 1 Thursday episode about it here!

/2 Comments/by

Type 1 Thursday – My HbA1c Formula

Lowering your HbA1c as a Type 1 Diabetic is HARD!

How did I turn my double digit HbA1c nightmare into a healthy 5.0% habit? Find out all about my 12 step formula in this week’s Type 1 Thursday!

My HbA1c Formula

What is your goal A1c? Or healthy goal in general? Let me know in a comment below!

Transcription

If you prefer to read about my HbA1c Formula, here you go:

Getting your HbA1c down as a Type 1 Diabetic is hard! It’s really, really hard and requires a lot of work and effort. So how did I turn my HbA1c from a double digit nightmare to a 5.0% healthy habit?

In this week’s Type 1 Thursday, with me Hanna Boëthius, one of the cofounders of The Low Carb Universe, as well as a Type 1 Diabetic since 34 years. I don’t know if you know, but I reached something magnificent. I have had a long, long standing dream of reaching a HbA1c of 5.0% (31 mmol/mol) in the “other scale”. This week, I finally got confirmed that this was the case and I couldn’t be happier! But what you may not know about me, yet, at least is that not that many years ago, I was a total diabetic mess. I failed to take care of myself. I had terrible blood sugars and very little knowledge of how to actually manage diabetes. So my A1c not too long ago was in the double digits, which is not good for anyone who knows anything about blood sugar. At the same time, I was so hopeless because I was clearly not given a the proper tools of taking care of my diabetes.

I actually shared my full story a couple of weeks ago, but so that no one else has to go through all the trials and tribulations that I did, I have formulated my getting a better HbA1c formula!

It’s what I have done to bring my HbA1c from double digits to a healthy, happy 5.0 habit. I’ve actually been under 5.5% for more than three years now, something I’m very happy about! That means that it’s stable, that means that I have found out a few things that work for me. That doesn’t necessarily means that they work for every single Type 1 out there, but they work for me. And maybe just maybe you or someone you know will be able to draw a little bit of inspiration from what I’ve done, so that you can get healthier and to your health or A1c goal as well.

This is a 12 point plan, so buckle up and get ready, we have a lot to go through!

Number one is definitely eat low carb. I know, it’s a very heated topic in all of this. But if you have problems with blood sugar, there is really nothing else that will work as well as to lower your intake of dietary carbohydrates. This also means my favorite topic in the world, which is the law of small numbers. Instead of with a lot of carbs, you add a lot of sugar, and then you have to chase it with a lot of insulin and then the margin of error is just equally as big. Instead, you can eat a little sugar, you add a little insulin and the margin of error is smaller. This is the number one reason why low carb for diabetics is such a great idea, because it leaves out so much of the guessing work. I also incorporated intermittent fasting into my routine a good couple of years ago. This means that I skip breakfast every day, just because I’m just not hungry, and I don’t see the point of stressing my body with trying to, to digest more. Intermittent fasting that has helped me a lot, and maybe it’ll help someone out there too.

You have to find out if you are intolerant towards any sort of foods. A very common intolerance is dairy, for example, which is a big thing within low carb. If you have any issues or allergies, then maybe it’s not going to help you reach those blood sugar goals that you are so dearly after. Make sure that you find out other things, for example eggs, night shades… People have intolerances towards many foods, but you might not find out.

What is your personal carb threshold? I know this is also very widely discussed within the diabetic community. I personally eat maybe 20 grams of carbs a day, most days not even. For example, the great Dr. Richard Bernstein says that you should eat 30 grams a day with six grams of carbs for breakfast, 12 for lunch, and 12 for dinner. It’s all up to you finding out what kind of level that you should be at for the best results. This is definitely not carbs from cookies, and pasta, rice, potatoes, all this stuff. This is green leafy vegetables, vegetables that have grown above ground, as these vegetables don’t impact your blood sugar as much.

Treating the few hypoglycemia as that you still will experience, but not as many, with precision so that you don’t go up and down and down and up and up and down as we were used to on the high carb lifestyle that I was on before, but treat lows with precision. Use the exact number of grams of glucose that you need to get into back into a healthy, safe level of blood sugars. If you overshoot too often, then your average blood glucose is going to go up. If you want to bring your A1c down, then make sure that you stay in range as much as possible.

Second point is medication, whatever kind of medication you’re on. Yes, insulin, but I don’t want to discount any other sort of medications you may be on, they may have an impact on your blood sugar, please check this with your doctor. When it comes to insulin, there are two really important things that you have to do: number one, basal rate or your basal dose of insulin, the long acting insulin that should keep you stable throughout the day and night. Please test that this is correctly dosed. If it’s not, then it’s going to cause you to either slowly but surely go up in blood sugar or go down and blood sugar if you’re take too much basal. You can test this by fasting and checking your blood sugar every hour of that fasting window, you can either divide it up or do 24 hours in one go. The second part is of course, bolus insulin, the mealtime insulin. Make sure you know your ratios, and that they are properly calculated, or found out through trial and error, as they are in my case. The common ratio calculations that exists with high carb eating, don’t quite apply to all diabetics eating low carbs. So for very many of us it has to become a trial and error. With a law of small numbers, the error margin is not that big. So you’re not going to be in for a wild ride. It takes some time to figure it out.

Also pre bolus for your meals, even if they don’t contain that many carbs, just so that the insulin has a bit of time to start working before the food comes and does the same. What really helps when you’re trying to find out your medication and ratios and pre bolusing for meals, and everything else, is of course to have a continuous glucose monitor. This is either Dexcom, for example, or Freestyle Libre, or any of the other ones that are out there, whatever one fits you the best. I know they’re very expensive, and they’re very hotly debated as well. But they are a huge, huge help when it comes to really lowering your A1c, because when you see a trend you can start acting before the catastrophe is a fact, hyper or hypo.

The next point, is blood sugar levels. As a perfect diabetic, or whatever that means, you should try to aim for an average of 4.6 mmol/l or 83 mg/dl. This is what people who are healthy and have a functioning pancreas’ are on average. If you are at a much higher average right now, don’t try to get down to 4.6 or 83 in one go, do it step by step. All of the modern blood sugar meters have an average measurement of blood sugar. Depending on how often you prick your finger, it might may be representative of what it actually looks like. As soon as you see where that average is, just try to aim for values slightly below that. You will slowly but surely take it down to normal healthy levels and therefore achieve a normal healthy A1c. You HbA1c, in short, it’s the average blood sugar for the past sort of six to eight to 12 weeks.

How you correct blood sugar also matters! Don’t be aggressive about it, whether you have to correct a hypo or a hyper. That causes the large margin of error. Be careful about it, and have a little bit of patience. I’m the worst person to talk about this, as I have zero patience! Be sure that you have a little bit of patience when you do treat, as things can turn quite suddenly. Find out if you are affected by the dawn phenomenon, for example, which is when the liver kicks in and starts shooting out sugar so that you wake up in the morning. Or if you have something that is called boots on the ground syndrome, which is when you are have woken up and you put your feet on the ground and the stress of your day gets your liver going and your blood sugar consequently goes up. Those can also be fine tuned with basal insulin, which needs to be handled by a doctor.

Then number next is stress. Stress is a really a blood sugar killer! It really aggravates your whole system, and it causes your blood sugars to go up. Make sure that you can prevent and avoid as much stress as you can in your every day life. How can you reduce it? Well, you have to find what works for you. Could it be yoga? Could it be meditation? Could it be a long walk in the nature? Could it be a hobby, could it be having a pet? Stress is really something that we have to work all of us, but especially people with glucose problems need to work hard at trying to eliminate it.

Next point, movement. I don’t like the word exercise, so I’m going to use movement. Our bodies are made to be moving and our bodies feel good if they get to move often and in different ways. Find out what makes you happy. What is fun for you, what way of moving is so fantastic that you just forget about time? It could be dancing, it could be the ones that I mentioned before, yoga, walking. It could be weight training, it could be dancing on the beach (which we do happen to do in Mallorca! If for nothing else, join us to find out how much fun that is in November.)

Movement has a very individual reaction on blood sugar. In the long run it definitely smooths things out. But when you’re doing exercise, or you’re moving vigorously, chances are that your blood sugar is going to go up. You need to find out what strategy works best for you. There is a rule of thumb – strength training makes your blood sugar up and cardio makes your blood sugar go down. But that’s not true for everyone, that’s just a rule of thumb! You have to find out what works for you and what happens to your body in different movement situations.

Next point is planning. Make sure that you are prepared for basically anything when it comes to diabetes. If you’re traveling, carry a glucagon kit, always have glucose tabs with you, no matter where you go. And even if you’re only doing a quick run, make sure that you are prepared for anything that can happen.

No matter how great of control you have of diabetes, things still do happen. Please be prepared for all eventualities at all times. For example, also bring enough test strips for your blood sugar meter, make sure that your insulin pump or your vials have enough insulin in them for the day or the time you’re going to be away. It is all about planning. It really is about treating and treating blood sugar – if you fail to plan, you really plan to fail. Don’t get caught in that trap. That can save you a lot of “interesting” moments with diabetes.

Next point is mindset. What is your goal? Set a clear, actionable, timely goal. Also make a plan of how you’re going to get there. Without motivation and a proper mindset, you aren’t going to reach your goals.

Next one, acceptance. Accept that diabetes is what it is, life still happens with it. And you can only do the best you can, and you can only do the best that works for you. You can’t do much more than that. And please don’t hate diabetes! The more you make it your enemy, the more it’s going to lash right back at you and you’re not going to be able to work with it, which is what you have to do. You have to be kind to yourself, you have to show yourself some love, even when things go wrong. That way you’re going to get to a better relationship with your diabetes, which is also a huge point.

Find your support network, whether that is that our coaches, CDE’s and nurses, doctors, spouses, personal trainers, and other happy people around you, like your friends, family, pets – all of these people that that create the network around you. Make sure they are supportive. This is who you turn to when you have a bad day, or when you want to celebrate a fantastic achievement. You don’t have to sit there by yourself, you can turn to other people and let them help you both in good times and in bad. When it comes to the medical side of your support network, please make sure that you have a Medical Dream Team. This is a key to getting the care that you know that you need, and to try to find out what works best for you. This is where you can really get support for your lifestyle choices, and also help you with your diabetes management.

Hydration, you have to hydrate! Make sure that you hydrate properly, because this helps the body to keep all that, perhaps, unnecessary sugar at bay. The body really does well when it is well hydrated. I personally try to aim for about two liters of clean water a day. It doesn’t have to be that for you.

Finding a routine that works for you . A daily routine, as in you get up sort of the same time in the morning, you go to bed sort of the same time at night, and everything in between. Of course you should be spontaneous and have fun, too! But the main parts that could have a little bit of a structure will help you manage your blood sugars better. Perhaps this could include when you take your basal injection, if you’re on pens or syringes, or when you change your pump site. Also work into your routine when you take your supplements, when and how much you hydrate, when you eat, what you eat, when you move… Building it into a routine is great, because blood sugars, as far as I’m concerned, aren’t too happy about uneven routines, they tend to do better when there is a routine, so that you know what you’re doing.

My final point are supplements. Some potentially blood sugar lowering supplements may be of use. The ones that I take, for example, are omega 3, vitamin D (helps autoimmunity) magnesium (high blood sugars do require a lot of magnesium), also zinc for the immune system. Chromium also can help keeping your blood sugar levels a little bit more stable, as it helps with insulin sensitivity way down in the cells. Also, I’ve heard a lot of good things, but I haven’t tried it myself yet, about alpha linoic acid, ALA.

These are my 12 steps of what I did, and my HbA1c formula to lower mine from a double digit nightmare to a healthy and happy 5.0% (which actually in fact, if I get to brag for a second, is better than even some healthy people have!). I’m very very proud of myself, especially after 34 years of living with this disease and it not having been very easy at for very long periods of time.

What is your A1c goal (or if you are not focusing on A1c – what is your health goal)?

Let me know in a comment and I’ll be happy to chat with you there.

/0 Comments/by

Diabetes Expert

Diabetes Expert – that’s a bold statement!

Being an expert, you have to be perfect, don’t you?

You need to be able to juggle anything that is thrown at you, know every single little detail about your topic and preferably have 67 Masters, PhD’s and other qualifications to be one.

Right?!

I used to think so. I really did. “Experts” in my life used to be my doctor and endocrinologist, for example. And these people know a lot, they definitely do. But they usually have zero training in nutrition, for example.

And they may not know or understand everything about YOU and YOUR individual case. You’re always going to be your own best doctor, because you know YOUR body, your situation and your case the best.

So, who am I to call myself a Diabetes Expert? 

It’s true, I don’t know everything about you, your life and your case. Yet. But I am willing to listen, learn and help you on your road to become a healthier you.

It’s really my passion in life, to get to help you through what I’ve already been though. To share all the tools, tricks and food that I’ve found has helped me and many others.

But what happened to GrainBrain? I’m sure you’re curious!

GrainBrain has been a fantastic stepping stone on my journey of becoming healthier, happier and more experienced. And it has served me very well when I was only about eating healthier (i.e. grain free).

Now that I’m fully focusing on helping people with diabetes to become healthier, lower their A1c’s and feel more confident, I feel that the name GrainBrain has run it’s course in my business.

I don’t want to hide behind a brand anymore, I want to show even more of myself, my journey and how I can help you on yours. Become even more authentic, if you want.

Which is why I’ve decided to change the name of my business, refurbish the website and get a fresh breeze in here! So please help me welcome Hanna Diabetes Expert!

In light of this, I looked up how a few people define what an expert is. And their answers made me smile.

Warning – there’s some self-assessment coming up! 🙂

“What qualifies anyone to be an expert? I view an expert as someone who has considerable intellectual knowledge and real world experience in a particular field, area of study, process, or activity. They possess knowledge and experience in greater measure than a majority of others in their field. And they can express their expertise in order to help others understand and implement any appropriate ideas and actions based on that information. (…) Today, I would venture to say experience builds expertise faster and stronger than education. For education not applied is merely knowledge locked in the brain and not tested in the real world.”

Well, if 30 years of trials, errors, successes and blood, sweat and tears aren’t experience enough, I’m not sure what is?

I thought this was a really interesting point of view. Another article I found, listed 5 quite similar characteristics of being an expert as states above:

“Knowledge: Clearly being an expert requires an immense working knowledge of your subject. Part of this is memorized information, and part of it is knowing where to find information you haven’t memorized.”

This is one of my favorite parts of doing what I do – I learn new things every day. Whether it’s about myself, a client, or diabetes in general, I make sure there’s an ongoing addition to my knowledge.

“Experience: In addition to knowledge, an expert needs to have significant experience working with that knowledge. S/he needs to be able to apply it in creative ways, to be able to solve problems that have no pre-existing solutions they can look up — and to identify problems that nobody else has noticed yet.”

Having a coaching background that has taught me a trick or two throughout the years is certainly beneficial. Experience and knowledge go hand in hand. And, the whole reason you work with someone, be it a coach, mentor or expert of some sort, is to get another perspective on your situation. It’s so easy to get stuck in your own bubble and lose view of the Big Picture. Working with someone on the “outside” of that bubble can really help you regain your aerial view.

“Communication Ability: Expertise without the ability to communicate it is practically pointless. Being the only person in the world who can solve a problem, time after time after time, doesn’t make you an expert, it makes you a slave to the problem. It might make you a living, but it’s not going to give you much time to develop your expertise — meaning sooner or later, someone with knowledge and communication ability is going to figure out your secret (or worse, a better approach), teach it to the world, and leave you to the dustbin of history (with all the UNIX greybeards who are the only ones who can maintain the giant mainframes that nobody uses anymore).”

Yes, communication is definitely key. In any relationship. But there’s also a huge difference between talking to someone and talking at someone. The latter is usually a waste of everyone’s time. And you can only communicate your solution to someone who is ready to hear it.

“Connectedness: Expertise is, ultimately, social; experts are embedded in a web of other experts who exchange new ideas and approaches to problems, and they are embedded in a wider social web that connects them to people who need their expertise.“

I aim to help as many people with diabetes as possible. To get new input and not get stuck in old ways, I make sure to stay connected to different other experts within fields of interest to my clients.

“Curiosity: Experts are curious about their fields and recognize the limitations of their own understanding of it. They are constantly seeking new answers, new approaches, and new ways of extending their field.”

One fatal mistake would be to get stuck in my thoughts, my ways and in what has worked for other clients. Every client is a new, exciting opportunity to help someone with a problem (or many).

I want you to know something though…

Being and calling myself a Diabetes Expert definitely doesn’t mean that I have perfect values all the time, endless amounts of energy, smooth cgm curves and my A1c keeps effortlessly where it should be. I have catastrophical days, too. Because there is no such thing as a perfect diabetic.

Diabetes is a lot of hard work. Sometimes grueling hard work. But it’s also about perspective and wanting to find a solution. Finding YOUR solution, how you can cope with it and how you can turn it into the very best you can.


What are you an expert in? How do you share this with the world?

/2 Comments/by

HbA1c, just a number?

Do you ever find yourself paying a little too much attention to a specific number?

Your weight? Your distance covered? Milestones reached? Friends on Facebook?

Or, perhaps, your HbA1c, the “lighthouse” of how you’re doing as a diabetic?

It’s easy to put a lot of weight on a number (pun intended!), because it’s something measurable, something you can follow and have a direct understanding of whether it improves or gets worse.

What’s difficult to understand is that these numbers, none of the ones I mentioned above, matter much.

Your weight technically doesn’t matter much, as long as you feel fit and healthy with it. Neither does the amount of kilometers you ran last week, unless you were in a race… Counting milestones only creates an inner stress and pressure to reach your goals faster, harder, more productively. And, friends on Facebook – are they r e a l l y friends…?

I know. This is crazy cakes.

We’ve been told, time and time again, to set measurable goals, and it’s really hard to find ways to measure improvement without those numbers.

So also when it comes to diabetes care and the HbA1c value.

I’ve been conditioned for 30 years to regard my HbA1c as the shining light of how well I’m doing, so the habit isn’t easy to break. Even when I know I’ve done pretty darn well lately.

I had my a-few-times-a-year appointment with my endocrinologist earlier this week.

Driving there (only takes about 7 minutes, but still), I was super-nervous and kept sending little wishes out for a lower-than-last-time HbA1c reading (which was 6,4%).

I got there, peed in a cup, had some blood taken, weighed in and measured my blood pressure. For someone who has a severe case of “White Coat Syndrome”, which is when you get nervous just seeing, being near or even thinking of a doctors office, the last part always seems a little stupid. And it was this time too, because it was through the roof.

I got into my endo’s office and we chatted a bit about life in general, before we got into the whole diabetes thing.

Once again, I was complimented by her on how well I’m doing. This is still a weird feeling to me, after having basically been a disappointment and being scolded for the other 28 years I’ve met with endocrinologists.

She told me that there probably isn’t much more I can optimize about my care without having a lot more hypos. “Watch me” I thought to myself, as I still think I can, and I will keep trying to optimize and improve until the day I die.

Anyway, to the value that every diabetic has been conditioned to regard as a sign of life or death: my HbA1c was 6,2% this time, or 44 mmol/mol.

This is the lowest I can ever remember having during my 30-year career in and with diabetes. I asked my parents, too, and they can’t remember anything lower either.

The fact that I’ve put so much emphasis on it and then receiving exactly the result I was hoping for made me ecstatic. Happy, euphoric and close to tears of pride. In my opinion, with all right. (And I have yet to celebrate this properly!)

After we had discussed some other topics, and I had received all the supplies I needed from their office (making it feel like Christmas every time I go there!), I got into my car and drove off, full of joy!

I got home, told my husband about the result, he gave ma a huge congratulatory hug, and I was so darn pleased with myself. I posted a rarely-seen-selfie  and got on with my day.

Later in the evening it hit me though. I was sad. Despite my excellent HbA1c result. Despite the praise and the congratulations. I felt saddened.

It took me a good few minutes to figure it out, a little EFT tapping and some meditation came in very handy at that point.

I was sad, because that result didn’t mean anything, really.

Fine, it means that I’m reasonably well controlled in my diabetes. It means that I’ve come a long way from where I started a few years ago after a long diabetes burn out, giving me double figure HbA1c’s. And it gives me a little hope for the future.

But it also means that I’m not really awarded in anyway for it (unless I buy myself something pretty, or have a glass of champagne to celebrate). It doesn’t give me a break from diabetes, not even for a minute. It doesn’t stop the poking, prodding and always having to be on alert. It doesn’t mean I can live carefree and forget about everything.

It just means that I’m alright and that my doctor is proud of me. And that I’m technically “pre-diabetic” according to my HbA1c. 

Don’t get me wrong.

I love the fact hat I’ve found my own way and am finally in the position where I feel like I have even the faintest of clues about this whole diabetes thing.

I love the feeling of not being scolded by my dream health care team. And I love that I can say that I’ve reached a new record in my life.

But I don’t think it’s the best idea to put as much of a value as I do on this one value. Especially as there are so many other factors that determine how well I’m doing and/or how healthy I am.

 

What about you – do you also put too much emphasis on one single number? Perhaps it’s your weight? How far you’ve run this week? Or maybe you’re like me and put (too) much focus on your HbA1c?

/2 Comments/by

Doctor’s Praise

Have you ever had a doctor’s appointment during which you get praise from said doctor?

This was a completely foreign concept for me until recently, despite having lived with Type 1 Diabetes for 29 years.

But as I’ve managed to gain better insight into the illness that co-habits my body, and therefore slightly better control, there have been more and more positive encouragement coming form my health team.

Just a couple of years ago, I would always be scared of going to the doctors, any doctor I have (and I have a few).

Scared of the results, scared of what they might find this time.

Scared of being told off, scared of being disappointed in myself.

Scared of being hurt and a failure. Scared of the amount of work that lay ahead of me.

Because that’s what it had been like all my life.

Every doctors appointment until recently, had been one of disappointment, hurt, even tears, and after, not-being-bothered – because why bother if I always get the same sh*t shoved at me by the doctors?

Let’s not turn this into too much of a sobby victim story though.

About a year ago, when I had finished the education for my pump with my lovely diabetes educator, she told me I was one of her best patients.

After having grown up with the notion that doctors (and nurses) are equal to the evil spawn of something ugly, I was stunned for a second.

And then filled with love. Love, gratitude, and appreciation.

Not necessarily for diabetes, but rather for the advancements I had made by that point.

It was probably my first (and to this day, only) time I’ve performed a little one-man boogie in a doctor’s office.

It’s incredibly what a little doctor’s praise can do!

It spurs you on, keeps you going and at least it helps me when the going gets extra tough (which it inevitably does, considering it’s diabetes we’re talking about.)

And then today (aka the-second-time-my-jaw-dropped-through-the floor-at-my-doctor’s-office), at my check up, my doctor goes to me: “you’re one of my best patients. You seem much more relaxed about diabetes now than when I first met you.”

Wait? Did I hear that correctly?

My immediate reaction was to ask if she could put it in writing. She answered that she would if I really wanted her to.

To the point: yes. That might very well be true that I am, as I don’t know a single of her other patients. And I’m super grateful that I’ve managed to get to where I am today.

But I don’t think she has any idea of just how much work I’ve put into gaining this clarity I now have of diabetes. Which doesn’t, by any means, I’m anywhere near full understanding of it. It just means that I’ve made some progress in the recent years.

A few examples:

I’ve had to say no to things I really wanted to do because my blood sugar wasn’t cooperating.

There have been some late nights…

,,,,and early mornings…

…including wake ups in the middle of the night.

A copious and endless amount of (painful) finger pricks, injections, pump site insertions and CGM sensor insertions.

Carrying medical equipment around, big handbags have been of benefit. My shoulders and neck muscles do not agree.

Snacks, snacks and more snacks.

A huge part has been the mental work I’ve done. Truly coming to terms with diabetes is not an easy task, and is usually completely overlooked by the medical community. I’ve meditated for hours, and now I notice a difference in my blood sugars when I don’t do it! Stress is closely linked to blood sugars, so it’s really important to find ways to release stress. A newer tool I’ve been using is EFT tapping to try to get past the bigger concerns regarding diabetes.

Eating well and according to diabetes, which, for me, means very low carb.

Having to play my own pancreas. On the outside. With zero communication from the other organs that play a part, like the liver, for example.

Drinking lots of water. I’d be so rich if I had a penny for every liter of water I’ve drank!

Exercising and trying to figure out how it works. Sometimes exercise makes my blood sugar high, sometimes low, sometimes the same and sometimes the effect doesn’t come until 12 hours later (depending on how strenuous the exercise was). What on earth do I do with my basal settings?!

Speaking of which, figuring out everyday things like flights, how to eat on the road, restaurants, walking too much (and at irregular times!), drinking alcohol, combining an outfit to fit medical devices as well as how to solve the caffeine question, have all been part of the journey so far.

And that’s just to say what it has taken so far. It definitely doesn’t mean that it will always stay the same. Diabetes is a very dynamic and constantly ever-changing partner to have by your side.

But, this is where it really pays off to have a carefully selected and well-researched health team.

Because even if they don’t know exactly what you’re going through, they’re willing to understand and make arrangements for you.

 

Oh, yeah, my A1C? 6.4% today.

/0 Comments/by