Tips for Getting an A1C Below 6

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Last week, I went to my monthly endocrinologist appointment (monthly because I am pregnant).  I got blood work done for the appointment and at the appointment I found out my A1C was 5.5!!!

I struggled for 20 years to get my A1C out of the 8’s and into the 7’s and until 7 months ago, I had never seen an A1C below 7.  I never thought it was possible to get it that low.  I thought people who had lower blood sugars all the time must not eat any carbs and I love my carbs too much to give them up for a lower A1C.  I know in the Diabetes Online Community people are torn over if it’s good to share their A1C or not.  I like to share my A1C because I hope people read my blog and see that it’s not easy for me (and I’ve definitely had my fair share of bad A1Cs) but attaining a good A1C is possible (I never thought I could get a really good number!).  5.5 translates to an average blood sugar around 111mg/dl.  I’ve been hovering between an average of 107 and 120 (thanks to my CGM data) so I was surprised to see my A1C come in at 5.5.

An A1C of 5.5 is listed for what a “normal” pancreas functioning non-diabetic’s A1C would be.  According to sources, you aren’t considered pre-diabetic until your A1C reaches 5.7 and aren’t considered diabetic until it gets to 6.5.  So I am cured, right?!  Wrong.  A LOT of hard work went into this number and here’s how I did it:

  • Pre-bolus, pre-bolus, pre-bolus – This is especially important to remove high spikes from my day so I have more straight lines than roller coasters.
  • Don’t eat more than every three hours – This gives my insulin time to work and my blood sugar time to come down from meals.
  • Try to keep carbs under 50 for meals and 15 for snacks – I try to stick to this rule for the most part, but snacks usually go over.  Also, I’m not perfect.  I will gladly add a 40 carb cupcake to my dinner, setting me over 50 carbs or I will eat a Panera bagel for breakfast that is 80 carbs. I do love my carbs.
  • Changed my target blood sugar on my insulin pump to 90 mg/dl – I had previously played around with a range or 100 as my number, but I’ve found better success keeping it at 90.
  • Use of my continuous glucose monitor (CGM) – This should probably be listed first because I think this has been the main reason that my A1C has lowered.  I spent my entire life afraid of low blood sugars and with the CGM’s help, I’ve been able to overcome those fears.
  • I’ve set my CGM low/high alarm range at 75mg/dl -140mg/dl – This took months to accomplish.  I started my high alarm at 200 (or was it 240?) and every so often I would lower it until I finally felt comfortable with it at 140.  I still go over 140 every day but its a lot less common now that I’m also doing the other steps listed above.
  • Did extensive basal testing to get good rates – This has been especially important for overnight.  My overnight blood sugars hover around 80 or 90 and I think this could be the number one reason my A1C is lower because I spend around 8 hours in the 80-90 range.  If I could only stay asleep for longer, I could probably get my A1C down even lower. 😛
  • Make adjustments when needed to insulin rates – This could mainly be the result of my hormones from pregnancy affecting my blood sugars but I am much more proactive making insulin to carb ratio adjustments when I see two days with a similar pattern, i.e. two highs after breakfast, two lows after lunch, etc.  Before getting pregnant and trying to be so proactive, I NEVER adjusted any rates.  True, I didn’t really pay attention to any patterns either.  I just went along not trusting my bolus wizard and treating blood sugars on a SWAG (Scientific, Wild Ass Guess-from Kerri at Six Until Me) basis.  This wasn’t great but overall it wasn’t terrible for my diabetes care either.
  • Attack lows less aggressively – I used to completely over-treat lows because I wasn’t low very often so I found it the perfect excuse to pig out. Of course, this would always lead to high blood sugars following the treatment.  I have since been more disciplined with treating lows.  I try not to treat when I’m in the 70’s (although I still do sometimes) but I also try to treat with less than 15 carbs.  I used to eat spoonfuls of frosting when I was low but I have since stopped that habit.  I used to pig out on marshmallows when low but now I buy a bag of marshmallows and separate them into baggies by weighing them so I only get 15 carbs per bag.  I eat fruit snacks to treat low blood sugars but instead of eating the whole pack which has 19 carbs, I’ll split the bag in two so I get around 9.5 carbs to treat a low.
  • Weigh/pre-measure food – When I eat at home I try to pre-measure food or weight it before eating, like 3 ounces of carrots are 6 carbs or 100 grams of grapes are 15 carbs and buying pre-packaged food helps a lot too for accurate carb counting.
  • Finally, being pregnant helps 😛 – If I wasn’t pregnant or trying to get pregnant, I wouldn’t be paying nearly enough attention.  Maybe as I get older (and I’m not out of my teens and 20’s), I’ll make my health more of a priority and start paying this much attention to my diabetes even when I’m not pregnant.  The thought makes me feel a little diabetes burnout coming on but luckily I have this baby boy growing inside of me to give me the motivation to keep on keeping on.

It was a lot of hard work but honestly it’s become a lot easier than it was in the beginning and I no longer think of the guidelines above as restrictions or difficulties (for the most part).  I always thought that to get an A1C below 6, I had to be perfect.  Well, I am far from perfect.  Pretty much every day I climb up close to 200 thanks to post meal spikes but I am quick to treat if its needed.  I’m probably out of my range for at least 20% of the day but I think having the good overnight rates is the main reason I was able to get the lower A1C, they balance out my post meal spikes.

One thing I definitely want to point out and stress is that I am pregnant now so my A1C is not the same as a non-pregnant person’s.  I’ve read the the A1C for a pregnant woman is only a 6-8 week average and isn’t a true A1C or three month average.  A few other factors are at play as well so it isn’t an apples to apples comparison but I’m still going to relish in my success at seeing my first number in the 5’s!

4 thoughts on “Tips for Getting an A1C Below 6

  1. These are great tips! I never thought that changing my target from 100 to 90 would make a difference but maybe I should try that. And I definitely need to start pre-bolusing more. Sometimes I do a good job and then other times I just get so lazy!

    • Yeah, I’m not sure how much the target change mattered but I felt like I was never starting pre-meals in the 60-90 range like I was supposed to be for pregnancy so I made the change and I’ve noticed I don’t go too low because of it, but I’m also not as high so I think it’s helped! Pre-bolusing is hard to remember! I usually only do it for breakfast and lunch…trying to improve for dinner and snacks!

  2. I also think it’s important to remember that attempting all of this could be overwhelming for someone. But even applying one of your tips could make a huge difference to someone!

    • Yes, very good point! It took me MONTHS to get to where I can apply them all and not get overwhelmed and the main motivation was the pregnancy…if I wasn’t pregnant, I doubt I would be doing many of them (or care about an A1C below 6).

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