How I Maintain a 6 Percent A1C Without an Insulin Pump

Using insulin to manage type 1 or type 2 diabetes is complicated stuff. Almost everything you eat requires at least one dose, and exercise and other factors change the insulin math considerably. Insulin pumps make it pretty easy to deal with these complex daily changes — but you don’t need an insulin pump to thrive and reach your A1C goals. 

No method of managing insulin is perfect — or easy. Insulin pumps cannot guarantee an A1C under 7.0 percent any more than multiple daily injections (MDI) can, even when combined with a continuous glucose monitor (CGM) in a closed-loop system. Regardless of how you take your insulin, you have to put in the work. The only difference is what that work looks like.

I used an insulin pump for the first 10 years of my life with type 1 diabetes. For the past 15, however, I’ve used MDI to take my insulin with insulin pens and syringes. My A1C has been in the 5.7 to 6.1 range for about 12 years. 

Here are a few things that help me reach and maintain my A1C goals with MDI:

Make Frequent Small Adjustments to Your Long-Acting Insulin Dose

If you’ve been taking the same long-acting basal insulin dose for years and years, chances are it needs some fine-tuning. Even a 5 to 10 percent adjustment can make a big difference in your ability to reach your blood sugar goals. 

For example, I know I need a 10 percent increase in my basal dose the day my menstrual cycle starts. I know I need a 20 percent increase the day after Thanksgiving! I know a weekend of eating a few heavier, indulgent meals means I’ll probably need that 10 percent increase by Sunday night to help me stay in range on Monday.

Tiny adjustments make a big difference.

If you often struggle to keep your blood sugar down during the day, don’t just blame it on mealtime insulin doses. A boost in your long-acting insulin dose can make it so much easier to stay in range after eating.

Big adjustments can be necessary over time, too. When I was 19 years old, I was sedentary, overweight, and eating a mishmash of heavily processed food. I needed 32 units of long-acting insulin back then.

Today, I need about 9 to 10 units of long-acting basal insulin. The difference? I’m very active every single day. I eat a much healthier diet. And I’m much leaner. That decrease from 32 down to 10 units happened very gradually, making small adjustments while my improved lifestyle habits gradually changed my health.

Talk to your healthcare team to get support when fine-tuning your long-acting insulin dose.

Take Small Doses of Insulin to Correct Mild High Blood Sugars

If you spend a significant portion of your day with blood sugars in the 150 to 180 mg/dL range, your A1C will inevitably be around 7.0 percent. Using an A1C to eAG (estimated average glucose) calculator, you can see that reaching an A1C of 6.0 percent would require an average blood sugar of around 126 mg/dL.

This means you’ve gotta take the time to correct those mild highs. You can’t let them sit. You can’t spend your day hanging out above 150 mg/dL if you want an A1C near 6.0 percent.

Correcting mild highs on MDI often means taking very small doses of insulin. Just a smidge! One unit is probably the smallest dose your pen will allow, but it can make a big difference. Some people even switch to using the NovoLog junior pens because they allow for half-unit doses!

It’s really about being willing to take the time to address that mild high, or prevent one, with another injection.

For example, I know my blood sugar will rise every morning between 8 and 9 a.m. I practice intermittent fasting, and my liver notoriously releases a burst of glucose every day during this hour because I haven’t eaten breakfast. My liver is trying to give me fuel, but I need more insulin to go with it.

I can’t increase my long-acting dose to address this because I’ll end up low at other times of the day. Instead, I take a minimal amount of rapid-acting insulin to address and prevent that liver glucose spike. 

Be proactive. Correct those mild highs and find those times of day when you need a smidge of basal help by adding a small bolus.

Adopt a Routine for Most of Your Meals

I’m not suggesting you eat the exact same foods every single day for breakfast, lunch, and snack, but a little consistency can go a long way in simplifying insulin management during the day.

For example, I practice intermittent fasting most days until 1 or 2 p.m. My first meal of the day is always a meal I’m very familiar with, which means I know exactly how much insulin to take with it, too.

This consistency sets me up for success. If I were to eat something random and impulsive for my first meal of the day, I’d be significantly more likely to spend the afternoon high or low — or on a roller coaster. 

I’m not eating the exact same thing every day for lunch, but I generally choose one of the following:

Apple with peanut butter
Raw veggies with hummus, and slices of muenster cheese
Big salad with cashews and strawberries

There’s nothing magical about those meals besides the fact that I’m very comfortable dosing insulin for them! This sets me up for success in the second half of the day.

Be Intentional With Your Food Choices

Insulin pumps offer significantly more flexibility when it comes to taking little nibbles of food here and there, because it’s so easy to deliver boluses and schedule complex bolus patterns. That’s much harder to get away with on MDI, using insulin pens or syringes.

Grazing and snacking can mean more work keeping up with injections, accidentally stacking insulin, and trying to keep track of slow-digesting meals and insulin on board.

Instead, be intentional about your meals. For example, eat your breakfast and then stop eating for three or four hours. Let that injection of rapid-acting insulin for your last meal do its work without complicating the “scene” with more food an hour or two later.

Sit down with a piece of paper and figure out when you want those intentional meals to be!

For example, I know I feel best when I eat my first meal by 1 p.m. Then dinner between 6 to 7 p.m. and dessert around 9 p.m. If I’m particularly hungry in the afternoon, I might eat a small and simple snack of veggies and protein around 3 or 4 p.m.

It can also help to intentionally make some meals of the day lower in carbohydrates than others. For example, I eat my highest-carb meals at 1 p.m. and right before bed. My dinner is usually very low in carbohydrates, just veggies and protein. Those lower-carb meals are easy to dose insulin for, making it less work to stay in range.

Be Proactive and Take Good Notes

All of these tips have one thing in common: It’s about noticing the little details. You don’t have to eat a perfect diet or obsess over your blood sugar levels. Instead, you’re just paying attention to smaller details. Those details add up! You don’t have to do any of it perfectly, just make the effort and ask yourself, “How’s this approach working for me?”

Is your current lunch routine throwing your blood sugars out of range for the rest of the day? What changes can help you stay in range more easily?

Are you constantly chasing high blood sugars? Frequent corrections for high blood sugars can lead to frequent lows! Talk to your doctor and make some small adjustments in your long-acting dose.

Do you find yourself making frequent impulsive decisions around food? Take a little time to map out a food plan that gives your day a little more consistency without obsessive planning.

Little adjustments make all the difference!

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