I've been a T1 Diabetic for 22 years and have had no complications from the disease yet. I played football and baseball in high school and baseball in college. I still stay in shape and lift weights at least 3-4 times a week.

Most of the time when I tell people I am diabetic, they laugh and say that there is no way you can be diabetic.

I usually average around a 6.5 - 7 A1C and have gotten my numbers in much better control since I got a pump about 5 years ago. I sometime wonder how I ever made it without my pump.

I'm always looking for advances in medicine for T1 diabetes and good to see others doing the same!

How has everyone been doing lately? My numbers have sucked because of a combination of poor eating habits and laziness. I also think my overnight basal rates are off, but haven't been motivated to do an overnight basal rate test. Probably should do a complete test of all my basal rates sometime soon. I'm also seeing a new endocrinologist in Jan, so I don't want to have garbage numbers for my first appointment.

I only see my endo once per year. I see no reason to do it more than that as I am pretty stable. I just took my labs on 12/1 and got my lab results shortly thereafter. This is how it turned out:

A1C: 5.3
Triglyceride: 42
Cholesterol: 148
LDL: 83
HDL: 57

Electrolytes, Kidney, and Liver functions are all within the "Good - no changes needed" range.

I am slowly considering moving over to a pump, however. I have had a few very serious bouts of hypoglycemia that snuck up on me and I was unable to detect. I think moving over to a short acting insulin exclusively (Humalog) would alleviate some of my problems. At any given time, I've got three different insulins in me, each with different effective timing.

I started the research process on pumps yesterday. I seem to have a preference for the Animas Vibe, which was just approved in the USA on 11/25. It has a cordless receiver with a CGM built in. It may not be available for purchase for a few more months, so I think i will wait for when it becomes available before I seriously consider transitioning over.

Watching youtube videos of other diabetics and their insulin pump experiences does give me pause, however. It seems as if most of them - at least the ones I watched - have not achieved the level of control I have just giving daily injections of three different types of insulin.

Still thinking about it, but would be interested in hearing some of the board's experiences with different pumps.

More thoughts in the am but nobody will stop you from using different typestyles of insulin with a pump. It's more normal than you might think.

I think the Animas vibe is not tubeless, but does prevent you from having to carry around the Dexcom receiver, no?

We have experience with MiniMed, Animas, and Omnipod(current). On all three companies we went through 2 revision cycles prior to moving on.

Minimed my experience was the customer service was pretty poor. It was early on and there were several failures. We were going through a pump about every 3 months or less. They came out with a new model and it was actually worse and at that time Animas was buying in warranty minimed pumps for Animas pumps so we made the switch with nothing out of pocket.

Animas was great, loved their reps and the pumps were reliable. The sites however were trouble. Only later could you choose which infusion site to use, but by then omnipod was coming out so we test drove that and had no issues and went that way.

Still happy with omnipod. A few bad pods here and there, but by and large the most reliable of the three we've had.

I know all three have come a long way and all are good now. The UI on omnipod is great imo. And it seems animas has gotten with the program on this as well.

What people don't really realize is that any of these companies will allow you to demo their product prior to purchase for weeks at a time. Encourage you to test out a few as the subtle differences can make a big impact long term.

Thanks, culdeus, that was very helpful.

I'm about to hit 10 years with Minimed, first a 715 and now a 725. My experience with Medtronics' customer service has been outstanding, especially after moving their phone center from SoCal to San Antonio.

I have a horrible diet. I absolutely love carbs and indulge in them excessively. I'm able to keep my A1c's in the low 5s without much trouble. At one point, my doctor had my cut back on how aggressive I was for fear of too many lows.

EMY - do you just do a great job at counting your carbs? How do you keep your A1C in range?

I actually had never had any training before getting the pump. Then, I learned how to count carbs and do a pretty good job. I should have been dead after 20 years of not knowing a thing about carb counting.

The pump really made things easy and I went from A1c's well above 10 to great control.

My son has been t1d from age 8 and he is now 15. He does all of his own management and has been on a mini med since age 9, he is on his second now. His last a1c was 7.6 and he has no evidence of complications. We are planning to upgrade to one with a CGM prior to sending him to A&M. We have never had any issues with mini med.

kid doc,

I always hesitate to make a post like this because everyone has their own way of dealing with this disease. I know some people may take offense when other people suggest a different way of doing things, but I'm going to make it anyway. Just be aware that I make this post for no other reason than concern, so please don't take offense. I feel a need to make the post only because I remember how discouraged and depressed I felt when the bad news started rolling in. I wished then that somebody would have suggested a different way earlier on.

I was diagnosed when I was 11 and ran my diabetes with a1cs of 7 or higher (really between 7 and 7.5) for the first 22 years. This will take a toll on your son. The whole reason I switched my method of control was because my body started breaking down. It was discouraging and depressing as the toll on my body of high blood sugar started to manifest.

As I'm sure you're aware, just because you don't see the complications does not mean that they're not there, and a1cs of 7 or higher are not good. Once again, I ran things like this for the first 22 years, but did not start to see the damage till about year 21 or so.

Once again, please don't take offense. Best of luck to you and your son.

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...and a1cs of 7 or higher are not good...

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correct

For a teenager the target A1C is 7.5. This is primarily due to the risk of hypoglycemia is not worth the slight long term improvement that tighter control gives for that specific age group as far as their emotional and neurological development. As they age into the 18+ group then the goal for A1C drops to sub-7.

The vast majority of teen T1's have 10+ A1C, it is a very challenging disease to treat in this age group. We expect & hope for his control to tighten as he matures physically and mentally with the help of cutting edge pump/CGM technologies that are on the up & coming horizon.

Thanks for the input though it is interesting to see how other people grapple with such an annoying and dangerous chronic disease.

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The vast majority of teen T1's have 10+ A1C, it is a very challenging disease to treat in this age group. We expect & hope for his control to tighten as he matures physically and mentally with the help of cutting edge pump/CGM technologies that are on the up & coming horizon.

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Wow, that's crazy. I would not have guessed that. Makes me feel better about my numbers in the 6s -7s in high school.

Edit to add: I guess I don't really know any other diabetics, besides one guy in college who said he didn't really test his BS that often...

According to the Bernstein methodology, an a1c of 7.5 is an equivalent blood sugar of 200.

All of the a1c charts I have seen show an estimate of 175 = 7.5%. Which is what his endo told us as well.

Here is a link to current treatment guidelines.

http://www.diabetes.org/newsroom/press-releases/2014/diabetes-association-sets-new-a1c-target-for-children-with-type-1-diabetes.html

I think this has been in the works forever. DITB is becoming a greater risk than elevated A1C and this is causing the change in protocol. This has been in the works for several years and our Endo contributed to some of the data/research.:

"The evidence shows that there is a greater risk of harm from prolonged hyperglycemia that would occur if children maintained an A1C of 8.5 percent over time. This is not to say we are no longer concerned about hypoglycemia, but we now have better tools to monitor for hypoglycemia," said Jane Chiang, MD, Senior Vice President, Medical and Community Affairs, American Diabetes Association and one of the lead authors on the Association's Position Statement. "The 7.5 percent target is evidence-based; however, we want to emphasize that blood glucose and A1C targets must be individualized to safely achieve the best outcomes." - See more at: http://www.diabetes.org/newsroom/press-releases/2014/diabetes-association-sets-new-a1c-target-for-children-with-type-1-diabetes.html#sthash.TB3QYEfR.dpuf

culdeus - why do you say DITB is becoming a greater risk? Just curious. Seems like it has always been a risk and would be exasperated by keeping extreme control over low BS or not testing near bed time.

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culdeus - why do you say DITB is becoming a greater risk? Just curious. Seems like it has always been a risk and would be exasperated by keeping extreme control over low BS or not testing near bed time.

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Oh for sure the risk has been there, but with pumps and CGM you are seeing people try to maintain A1C in the low 5s and 4s on these Gary Taubes-ian based diets or else correcting everytime they see a 140+.

Perfect becoming enemy of the good with the rise of all these monitors and sensors is dangerous.

The focus needs to be on TDD not rising over time with A1C falling. TDD:A1C ratio over time is going to be the new predictor of long term health. (Higher and rising TDD being the greatest predictor of DITB)

TDD can drop by smart exercise, fat loss, and diet changes. Of course, those also will reduce all cause mortality just on their own, but it's all related.

TDD = Total Daily Dosage?

Perhaps my view on things is too simple, but if you want to live to the same life expectancy as a non-diabetic, you must run your sugars at non-diabetic levels.

Too simple?

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TDD = Total Daily Dosage?

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Yes, sorry.

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Perhaps my view on things is too simple, but if you want to live to the same life expectancy as a non-diabetic, you must run your sugars at non-diabetic levels.

Too simple?

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Yes. I think long term this approach will be debunked. A1C as the end all measure of control will fall away. There's a certain bell curve where too low an A1C will cause issues for T1D and too high will as well.

The sweetspot is not emulating a non T1D. That's for sure. Finding that sweetspot is going to take decades of data, however and people are living with this now.

These new guidelines are a step in the right direction though.

RWC - do you mind providing a little more insight into your diet? I am curious as to what you eat to keep your carb count so low.

Well no doubt reasonable people can disagree. I find that when my sugars fall into a groove, I very rarely deviate more than +/- 8 points from my average blood sugar for any given time of the day. It is very predicatble. I've posted my averages on this board before for pre-breakfast, post-breakfast, pre-lunch, post-lunch, etc. Because it is so predictable, risk of hypo etc. is somewhat minimized.

I know where my sugars are at at almost any time of the day without checking; although I do check frequently any way. The troubles I've had with hypoglycemia occur when I venture off the path sort of speak. Either there is a change in schedule, change in routine, change in diet, or a change in dosage -- any of the aforementioned can cause me trouble if I'm not careful. Most of my really bad hypoglycemic episodes occurred while I was awake in the afternoon, not at night while I was sleeping.

I control my diabetes through my diet, three different types of insulin, and heavy weights exercise. As I've mentioned before, Levemir, Humulin R, and Humalog is what I use to keep myself in check. My meals typically consist of a protein and a vegetable. If I eat any fast acting carbs, it is typically not more than a tablespoon of it. I use the weight lifting to help me maintain my weight (I'm 6'1 and ~185 lbs). If I start to drop weight, I'll snack on nuts (eat two full oz of nuts for a mid-morning snack and an afternoon snack). I also drink a lot of heavy whipping cream. The cream gives me lots of calories without too much of a spike in blood sugar (cream has hardly any carbs to it).

I very rarely cheat on my diet. In fact, in 9 years of eating this way, I cannot think of any time where I went and cheated on my diet because there was something that I just "had to have". I'm very meticulous about how I manage my diabetes. Like I wrote before, when you've had this disease as long as I've had it, your margin for error is small. The body can withstand years of abuse, but damage does occur on some level. It's just a question of how long before the damage manifests itself.

It wasn't till I took control of my own diabetes that I achieved these results (with significant help from the Bernstein book). I've had many endocrinologists over the years give me bad advice (congratulating me on piss poor a1cs, giving me a poorer standard for test results than the non-diabetic because I was diabetic, trying to push me to a statin for cholesterol levels that were only slightly out of range, etc.) Quite frankly, I don't trust doctors. It wasn't until I took control of my own diabetes that things started to turn around for me, but that was not because of any of the endocrinologists I've seen.

Once again, I was breaking down 9 years ago. Today, any damage that I had has reversed. I have no gastroparesis, neuropathy, vision damage (diabetes related), etc. Kidneys and organs all still work like a non-diabetic, etc. After 31 years, I feel very fortunate. I attribute this to running my sugars at a level of a non-diabetic.

Perhaps conventional wisdom may switch one day about tight ranges on blood sugars, but for me, what I do works.

The problem is 99% of Americans do not have anything close to the food or physical discipline you have, it is pretty impressive but your plan would not work for most people because they simply are human and cannot maintain that level of excellence.

And no I am not being sarcastic that is very impressive.

Conventional control might not be best for Type 1 diabetics

At first I thought this was an interesting article because of the discussions we have had on here about the right level to aim for.

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But a University of Pittsburgh-based study published online Tuesday in the Journal of the American Medical Association has found that tighter diabetes control after diagnosis, with a goal of staying close to the upper end of normal blood sugar after diagnosis, extended longevity for those with Type 1 diabetes.

"We can now confidently tell doctors and patients that good, early control of blood glucose greatly reduces any risk for early mortality in people with Type 1 diabetes, usually diagnosed in children and young adults," stated study leader Trevor Orchard of the Pitt Graduate School of Public Health.
The study focused on 1,441 patients followed over 27 years to compare the impact of intensive vs. conventional control strategies during the first seven years after diagnosis. Forty-five deaths occurred among the intensively controlled group as compared with 64 deaths among those treated conventionally.

While statistical significance reflected only a modest benefit for the intensively controlled group because of the small numbers involved, the 19 fewer deaths in that group were notable, given the fact that few deaths were linked to hypoglycemia.
"There was concern that increased control might incur an increased risk of death," said Dr. Orchard, a graduate school professor of epidemiology, medicine and pediatrics. "Now we are saying that risk is not being realized and intensive therapy overall leads to a reduction in mortality."
Any higher risk of hypoglycemia was offset by eliminating or delaying such diabetes complications as heart disease, stroke, cancer, kidney disease, nerve damage, limb amputations and blindness, among others, he said.

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But then I saw the ranges that they kept the patient groups in -

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The HgA1C blood test, known as A1C, determines blood sugar levels for periods of months, with the normal range generally considered to be 4 percent to 6 percent. In the study, the intensively controlled group maintained an A1C level of about 7, while the conventional therapy group was about 9.

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Is that not extremely irresponsible to keep a group of patients around a 9 A1C??? I know its not the perfect measure by any stretch, but a 9 would indicate that they were aiming for a bs level or 215 or so! Are most studies based on patients that have very minimal control over their bs levels? Seems kind of pointless to compare a 7 to a 9. Of course the 7 is going to live a longer, healthier life.

Pretty useless study. Goes to highlight how difficult it is to actually find a treatment group to evaluate treatment courses.

Yeah, I totally agree. Why waste time and money on that even?

That study has some validity. There is a concern among endocrine docs that too tight a control can actually increase the risk of death due to overnight hypoglycemic episodes. This fairly large longitudinal study illustrated that may not be the case. Back when my son was first diagnosed I kept very tight control of his DM where his A1C was in the 5.5-6 range and I was warned by my seasoned endocrinologist to back off as the risk of him having seizures or death due to hypoglycemic episodes was very real with that low an A1C. This study is saying that maybe that is the wrong advice and tighter control may be better long term with very low risk of death in the short term.

Of course a 7 vs a 5.5 is very different... as is a 7 vs a 9. As a physician and father of a diabetic I think the 7-8.5 range is reasonable at least in the pediatric phase of life where control can be challenging and the body is undergoing tremendous physiological changes. As you move into early adulthood I think it is reasonable to expect and hope for tighter control more in the 6-7.5 range.

Note this is IMO not according to any solid published data except where I specified such studies.

Just had a check up last week. My A1C was 7.5, which isn't great (except maybe to some Pitt researchers ), but honestly better than I expected after a couple of crappy months, treatment-wise. All my other tests came back healthy, which was nice. Since the visit, my numbers have been great (at least for me). I think I've only been over 200 three times in 10 days, with most tests coming in between 80-140. Really feel like I have things under control, at least for now. I've been eating better at dinner and laying off the snacks around the office - funny how that works, right? Anyways, I'm shooting for 6.7 or lower for my next A1C. I know A1C can be overrated, but if I get a good A1C, it means I've been doing the right things and taking care of myself to get there.

This is the last stop before a no ***** glucose testing system:

https://abbottdiabetescare.co.uk/our-products/freestyle-libre

Available today I think.

Hmm, only available in the UK. How much more accurate than the sensors will it be anyways?

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Just had a check up last week. My A1C was 7.5, which isn't great (except maybe to some Pitt researchers ), but honestly better than I expected after a couple of crappy months, treatment-wise. All my other tests came back healthy, which was nice. Since the visit, my numbers have been great (at least for me). I think I've only been over 200 three times in 10 days, with most tests coming in between 80-140. Really feel like I have things under control, at least for now. I've been eating better at dinner and laying off the snacks around the office - funny how that works, right? Anyways, I'm shooting for 6.7 or lower for my next A1C. I know A1C can be overrated, but if I get a good A1C, it means I've been doing the right things and taking care of myself to get there.

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Great job!!