The A1C

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Craig: I'm Craig Stubing and this is Thicker Than Water. Living with type 1 diabetes all day, every day, it can be hard to take a step back and see the big picture. Things that seem small when they happen could be a pattern we don't recognize because we're only thinking about it in that moment. When we see our endocrinologist or diabetes educator, it gives us an opportunity to think about how we've been doing for the past three months instead of just thinking about the last three minutes.

When it was time for my Aunt Laura's first appointment since being diagnosed, we were both interested to see how endocrinologist thought she was handling this new life with type 1.

Laura: We were able to download the Dexcom and then they took the blood from my A1C.

Craig: How was that?

Laura: You want a drum roll?

Craig: Sure. [laughs]

Laura: It was 6.9.

Craig: What was it when you were diagnosed?

Laura: It was, I pulled that out because I figured you'd ask me, it was 9.4.

Craig: That's a big change, but I guess a little insulin will do that.

Laura: Yes.

Craig: How did she feel about your A1C, really happy?

Laura: She was thrilled. She said, I'm doing really, really good and I should just stay the course. I think she said I was insulin-sensitive, that meaning I guess I don't need a lot of insulin yet, she wasn't sure if it was still honeymoon. My main instructions were just to stay the course. If I start to see a trend of higher levels to contact her because then we'd re-look at it. She didn't want to change my night time and she didn't change anything for my day time for now. I asked about waiting the 15 minutes after I take my insulin to eat. She said I should be waiting 20.

Craig: Are you going to do that?

Laura: Well, I think I'm going to do it for a week and see. I just like to see if there's a major difference because maybe when I do go high, maybe I'm missing the mark on the insulin. I did ask if I go to a party or something, I said, Easter, it would be nice if I could have had 15 more grams of a carbohydrate. She said, "Well, if you want to do that once in a while, if you're at a party, you can take an extra unit."

She gave me permission to do that, but I told you that already. I'm probably not going to do it a lot. I said this to your uncle. I'm just a rule follower. That's just the way I am. You tell me this is what I got to do and then that's what I do. Like now I've got permission to take an extra unit periodically for a party or something like that. Now I'm still not sure I'm going to do it, but I got permission to do it.

Craig: Even with permission. I was going to ask what the first thing you were going eat extra was, but I guess that's not going to happen for a while.

Laura: It might happen at like my grandson's first birthday party. Maybe if there's cake, I'll have a piece of cake. Do you know what I mean? I might have a cookie before then, I don't know. I don't really want to shoot because I have to get the shots which aren't thrilling. It would have to be where I'm going to have it with my meal. Do you know what I mean? Not where I take the whole thing at once. When you have a pump it's a little easier to, you're not doing a shot, you have to--

Craig: Exactly. Are you feeling like you want to get on a pump soon?

Laura: I don't think I can because I'm so low in insulin.

Craig: I don't remember what the minimum was.

Laura: I think you have to have at least eight and I'm only at five for the daytime. Then the base was only seven.

Craig: Yes, I could look it up.

Laura: For now I'm okay. I'm in the rhythm. It's not been that long, so it's fine. Who knows, in another six months I could be where I need to increase my insulin. Then I can look at it.

Craig: What did she think about you having in the Dexcom?

Laura: Well, she told me she was just at a conference. One of the presenters was talking about how this is the way to go and every patient should have this because just by having a Dexcom and changing nothing else, your A1C can come down one point just because you have it. She said her question to him was, "How do we get it for patients if they can't get insurance coverage or that coverage still makes them pay so much?" He was just like, "I'm with a really big health system, we don't have thought."

[laughter]

Laura: She's like, "That doesn't help." They were very interested in my Costco experience. I think that might help some other patients. I said, "Look, it just seems to be that their insurance will not cover it." Then they get a letter from the doctor's office saying, "It's not covered. Can this patient get it?" At least they can look into it to see what the price is, if they can afford it.

Craig: I guess it's good that you've gone through this. It sucked, but if you're able to now help other people because you've figured this out that's some good.

Laura: Well, it's something. Do you have to wait until you're on your third or your last sensor before you can order?

Craig: You can set up automatic refills, but I do that through Dexcom. Then they just send it. You might be able to do it sooner if you just call.

Laura: Right, but I've seen some people online who have said, "Oh, and then my sensor went out and I had no other sensors." I've already asked for the next three even though I'm at number two, so that maybe can keep one ahead, so then if one does blow out or doesn't work or something, then I at least have the option to get the next set. Though does Dexcom replace it if it doesn't work?

Craig: If it doesn't last the full 10 days, they'll replace it.

Laura: Well, that's good to know because I didn't know that.

Craig: Then did you restart- you restarted the second one?

Laura: Yes, but It only lasted like two and a half days and then it went crazy.

Craig: Are you going to just keep restarting them?

Laura: I think if I can get two days out of it, then that'll be good.

Craig: That adds up over a year. Right?

Laura: Right.

Craig: Then you'll have extras.

Laura: Well, at least I'll know that I'm at least one ahead. I'll always have one extra.

Craig: Just in case.

Laura: If I can keep reordering it and the right amount of time, the same as insulin.

Craig: The fear is that it dies and you're on vacation or you just can't get another one for a few days. Then you're without it for a week.

Laura: That's why it's good to have an extra.

Craig: Did she have any other thoughts?

Laura: No, she was just like, "You're A plus, plus, plus, plus." [laughs]

Craig: Do you feel like you're doing, A plus, plus, plus?

Laura: I feel like I'm doing-- I know from you too, looking at my blood sugar, I'm doing well. I know, especially with the Dexcom now, if you look at the graph, I know where I'm supposed to be. If I'm in that zone, I don't obsess about it, like if it goes to 200 it goes to 200, or if I start to drop, I'm not panicking. I think I'm still learning what to take and what not to take when I get low. I don't like to take juice because I know--

We've talked about this before too. I feel like it spikes and it drops again. I'd rather catch it early enough that I could take two-inch piece of a banana, which is going to be a little longer to absorb. Then I worry, is it absorbing quick enough? It's like I'm still trying to figure out, do I take a little shot of juice and then eat something that's more?

Craig: Maybe, and I've done this before, you have your juice that hits your system. Then you take a handful of almonds that doesn't have carbs. You don't end up with 30 grams of carbs in you.

Laura: You're making something in there that's a little more--

Craig: Exactly.

Laura: Every night, I still take a snack.

Craig: Still.

Laura: I'm doing okay with that. My overnights are great. She said that's okay. It's just four crackers and it's maybe a little less than a tablespoon of peanut butter between-- That's what I have. I don't get any lows. Now that I said that I'll get a low tonight, but usually I still wake up at like two or three and wake up and then I'll check just to see. If I'm hovering around 85, I go back to sleep because I figure, "I'll hear the alarm if it goes low." It doesn't because when you have your blood monitor, there's no way I would have known when I was in the middle of the night.

Craig: Yes. You're still setting alarms to wake up in the middle of the night?

Laura: No, I don't set alarm. I wake up all on my own. It's like I just wake up. I think maybe I'm still in this--

Craig: Your body just knows you're anxious.

Laura: It's just my sleep pattern isn't quite the same. I think I'm still just adjusting, but I feel like I'm getting enough sleep. It's not like I'm up every hour or it's not like I'm up checking all the time. If I wake up, then I think, "Well, I'll just look. I'm up."

Craig: Well, that's easy. It's just weird that you're-

Laura: It could be subconsciously, but then I go right back to sleep. As long as I go right back to sleep, I'm thinking, "This is okay." I'm not laying there, worrying about it. Do you know what I mean?

Craig: Yes.

Laura: For now, it's okay.

Craig: On the next episode of Thicker Than Water, Aunt Laura hears a diabetes joke at a baseball game.

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Thicker Than Water is production of Beta Cell. It's produced by me, Craig Stubing. As always, a very special thanks to my Aunt Laura. Our theme song is by Nino Ragonese. If you haven't yet, subscribe to Beta Cell wherever you listen to podcast, to get all of our shows downloaded on to your listening device as soon as they're available. If you love Thicker Than Water or any of the Beta Cell shows, you can support us on Patreon. Not only will you get the satisfaction of helping the show, but you'll get access to our exclusive supporter-only podcast, Out Of Range After Dark.

I’m Craig and this is Thicker Than Water.

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