A1c Success and the Importance of Insulin Timing

John Crowley
By John CrowleyCA Latest Reply 2009-05-04 06:43:31 -0500
Started 2009-04-10 10:13:26 -0500

So yesterday was my son's endo appointment. He was so nervous he could barely contain himself. And you must understand, that is not at all like him.

But over the last year, his A1c has been steadily climbing. It hasn't been due to teenage rebelliousness or anything like that. More like teenage "over-scheduling-itis." :-) He's a very responsible kid, but he's carrying a heavy load in school, he's working, he's involved in church and sports, and he's just got normal "kid" stuff to do. Diabetes sometimes is lucky to be thought of at all.

But two 9+ A1c's in a row were enough to really get his attention. After his last appointment, we made some adjustments to his basal rate and his insulin to carb ratio. He committed to doing more testing—especially after meal testing. And our Doc really emphasized that bolusing 10 minutes before eating is essential to bringing down the A1c.

Well, for the last three months, my son has done "a little" more testing. But he's been quite diligent in giving his insulin as close to 10 minutes before he eats as he can.

Well … yesterday, the nurse took FOR.EV.ER to bring in the A1c results. My son squirmed like a little kid as we waited and waited.

Then the nurse poked her head in with a big smile and handed him the A1c sheet. 7.8!

I though my son was going to get up and dance! He was so thrilled. And when the doc came in he was so great too. He was genuinely happy for my son's turnaround. But then he gently reminded him that he can do even better.

He looked at the print-outs from the tester and observed that instead of a good systematic approach to testing, it looked more like "whenever the mood strikes" testing. :-) He gave a suggestion that I thought was pretty great for a teenager. He suggested that once a month, he have a "hell week" of testing. Test 7 or 8 times a day for a week. Get all the data you need to see if your pump settings are where they need to be. Then go back to normal testing for the rest of the month.

Oh, yeah, and kdroberts, I did remember to ask about a reference on the study he told us about last time. He had told us that bolusing 10 minutes before meals was shown to lower A1c by 1%. So I asked where I could read the study. He said he heard it reported at one of the national meetings and that as far as he knew, it hadn't been published yet. He said he'd let me know when he saw it published somewhere. But our experience certainly confirms the finding. My son saw almost a 1.5% decrease.

So the bottom line is: for those on insulin, make sure you're taking your fast-acting insulin 10 minutes before you eat. It really does make a big difference.


14 replies

Melissa Dawn
Melissa Dawn 2009-05-02 13:11:43 -0500 Report

I started doing this as much as I could in the past year or so. My A1c's have gone down nearly 1% as well… from 7.9 to 7.1 after I first started doing it. I thought my latest A1C would be much worse — I'd had so many infections during that 3 month span that I felt they'd been out of whack. I was very nervous to see what had become of my all time low A1c. Despite that, it was only up to 7.2 which was much better than I expected.

I've been testing near 8 times a day on average, and it helps — I don't spend as long being high because I know I'm high sooner.

Congrats to your son! That's huge progress! Thanks for sharing!

Lanore
Lanore 2009-05-04 06:43:31 -0500 Report

Hmmm with my high number right now…I am going to try the 10 mins before and see if it makes a difference.

Congrats to your son.
Lanore ;-)

Least
Least 2009-05-01 14:42:26 -0500 Report

Thanks for the advice, what a good idea! I've tried this out before but need to be more consistent. It is encouraging to know that it does produce long term results!

2009-04-12 19:12:50 -0500 Report

John, please tell your son congratulations and way to go! I've read some of his old posts and he's an awesome young man. You and your wife should be very proud! I saw my family this weekend and I watched my niece eat 4 pieces of chocolate cake and she was drinking a milk shake!! (No, she's not diabetic.) I can only imagine how hard it is for a teenager with Type 1.

Again, congratulations and job well done! Take care, Angie

dj7110
dj7110 2009-04-12 16:33:54 -0500 Report

Congrats to your son, Think I'm going to try this too. I have been taking my humalog just prior to eating and my last A1C was 8.1. Does make more sense to give the insulin a chance to start to work when it is most needed. Hopefully my numbers can come down some also.. David

14BB2
14BB2 2009-04-12 01:24:36 -0500 Report

Thanks for the info! I've had Type I for 55 yrs. (yeah, I'm OLD!) and have been on the pump for the last 15 yrs. I guess I'll try bolusing 10 min. before I eat & see if that helps my A1c's. They've been around 8+ the last few times & this doesn't make me or my Doc happy!

The pump is a different ball game, I know, but it has given me better control and lots more freedom, overall.

Kudos to your son!

alwaystryin
alwaystryin 2009-04-11 14:21:33 -0500 Report

What impresses me as much as the content of your story, is the determination your Son shows at that age. That's a tough age to also have to deal with T1 also.

We mailed my Wife's A1C test today and should know in about a week.

Great job. And John if you don't mind me asking, what do you use in determining the insulin to carb ratio? 450/500 rule?

2009-04-10 12:49:22 -0500 Report

That's great news John. I'm sure as he gets older it will all get easier for him but it's a good thing he's active, keeps them out of trouble.. LOL I've been through two teenage boys and neither of them had diabetes so I can't imagine but he seems like a good kid!! Kudo's to him!

*Judy

Sarguillo
Sarguillo 2009-04-10 12:18:13 -0500 Report

Congrats to you and your son. Yes, its his congrats but to you also. As far as 10 minutes, it stands to reason. If you shoot 10 minutes before you eat, then eat, both the insulin and sugars should react about the same time or so. That would not let the BS numer rise. Good thought. Thanks for sharing.

BeckyJ
BeckyJ 2009-04-10 11:42:11 -0500 Report

Congrats on a lower A1C. Your son obviously is taking an interest in his numbers. Sometimes it's very hard to keep testing up with such a hectic schedule and it adds on additional stress. I love the idea of the one week a month testing. As for the 10 minute before meal bolus my Endo told me about that when I switched insulin types and it has made such a BIG difference. I think more people should be aware of this. Previously I had been told within 30 min and I would take my shot then wait to eat sometimes even forgetting how long ago it was, ended up with terrible lows then rebounds. Now I make sure that it's right before I eat. Still stuggling with Insulin ratio's. Endo suggested pump but insurance doesn't cover so I have to continue with injections. It's a constant battle for everyone and to be able to handle it as well as your son has at his age is AMAZING!

Splender
Splender 2009-04-10 11:01:21 -0500 Report

Congratulations to your son's A1C!!!! He did a great job and I know you must be very proud of him. That one week a month hell week I think you called it, sounds like a great idea, it's not a long time to look at and it will go by fast.
I would like to wish all my friend a VERY HAPPY EASTER! Take Care. Talk to everyone later.
Helene.

kdroberts
kdroberts 2009-04-10 10:25:01 -0500 Report

Very interesting, and encouraging for you guys too. I'll try the 10 minute idea to see what happens, I do it with breakfast but not lunch and dinner. Dinner may be tricky because when I've delayed eating after dosing I almost always go low enough to need treatment which means I end up going high.

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