The real work is here.

hard work ahead signFor me, it actually wasn’t that hard to get my A1c down from 8% (after our return from our Asia trip) to what it is now: 7.2%. This was was accomplished by macro changes, some of them forced due to being back in the United States. For example, I went back on my pump after doing MDI for our three months abroad. I also stopped eating noodles and rice with every single meal (god I miss those days). These changes alone probably slashed my numbers by the .8%.

But trying to go a measly .3% from 7.2% to 6.9% so I can officially say that I’m under 7? Now that is what takes work. There are no more macro changes to make: I’m back to eating a normal, lower carb diet. I exercise most days of the week. I have my pump and my CGM on at all times. Those things are great, but fine tuning is all about the micro changes.

It’s remembering to bolus 20 minutes before a somewhat carby meal.

It’s remembering to cut your basals before your workout but to bolus after to prevent a post-workout spike.

It’s not getting a popcorn at the movies because although Tuesdays are great, they are not a special occasion and don’t really warrant a “treat.”

It’s taking the time and effort to correct a 168mg/dL with half a unit of insulin before bed.

Actually it’s ever bothering to bolus a half unit for anything, really.

It’s not shutting the Dexcom alarm off in the middle of the night but actually getting up, finger-stick confirming and correcting the problem.

It’s telling your friends at happy hour that no, you don’t want to split the chips and guac but could we get an order of the carb-less chicken skewers?

It’s a lot of freaking work is what it is. It’s the extra effort that can take you diabetes management from “pretty good” to “dang, that’s a low A1c!” And it is hard.

But  I know that it’s worth it. And after this crazy, blessed, action-packed whirlwind of a year, that effort and focus is just the TLC my body needs.

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Comments

I’m in almost the exact same position! I’ve made most of the big changes, like starting the pump a little over a year ago (yes, late bloomer) and really perfecting my basal rate, correcting in advance for the post-exercise and post pod-change highs… and now it is down to all of those things you so perfectly mentioned above. I had an in-office a1c of 6.8 but my upcoming blood draw will tell the whole truth…

And I suppose this means I am probably not having bread before dinner in a restaurant anytime soon either, right?

I think you have summed it up perfectly! I have been trying so hard to get my A1C below seven but it’s so much work. Honestly, I think the pre-bolus is the hardest part. I never remember and maybe if I did, I would be where I want to be.

Good luck!

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