I’ve been working SO hard to finally get an A1C in the 7’s and HOPEFULLY = / < 7. However, Thursday evening I started to go high seemingly for no reason, I gave a correction and went to bed thinking it would sort itself out. By morning I was too high to read, felt nauseous, thirsty, peeing a lot. I was thinking DKA, so I downed electrolytes, changed my pump, nothing. Did an injection with a pen, nothing. Finally went to ER, and he said I wasn’t in DKA, but was right on the cusp. Took ER all day to get me down to normal numbers, and then I had a low. They gave me OJ, and then it started to go high. They sent me home. I went higher, and higher all night. By morning I was high as can be again despite corrections all night. I decided to change my pump again, but this time use brand new batch of insulin. I went higher!?!? Called the nurse hotline and was told to go back. I did, and while I was in there waiting for new blood test results I started slowly coming back down, then was in relatively normal range, things seemed to sort themselves out. Dr. has no ideas, nor do I. Only thing I can think of as the initial culprit was that I’d been having some stubborn highs all week after starting Trazadone (which I took for 5 days and stopped that evening because I worried it was giving me IR and I didn’t sleep any better), also my BF picked me up in an embrace and it tugged on my pump chord Thursday evening, which perhaps could have wiggled the cannula out, but with all the pump changes and injection by pen I can’t see why that didn’t fix things, it was only when I changed the batch of insulin, but then if the insulin wasn’t working, why would it suddenly go from not working well to not working at all.
It could be a perfect storm of things, but I have no explanation. I’m feeling normal now, but tired. numbers are mostly back to normal, but a bit of resistance in the mornings which isn’t normal, but not too bad.
ANYWAYS, I see my A1C which was predicted at 7.2 (and I was hoping to get it to = / < 7.0 by my blood test this upcoming weekend) is now 7.5. Can I lower it quick this week? I know it isn’t the point, but for me it is really a goal. Is there anyway?
It’s always like waking into a new world everyday with diabetes. As you wrote it may be a combination of things. The drug trazodone is known to cause issues with BG management in diabetics, but I don’t see exactly what. You might consult with a pharmacist as they really know drugs.
The following is from the U.K. National Health Service.
If you have diabetes, trazodone can make it more difficult to keep your blood sugar stable. Your doctor may advise that you monitor your blood sugar more often for the first few weeks of treatment with trazodone, and adjust your diabetes treatment if necessary.
Speak to your doctor if your blood sugar levels are causing you concern.
@jo_jo Sorry you’re having a bad time. My first thought is: If you have a CGM, A1c shouldn’t be your focus. It’s one component of what should be looked at. It can give mis-impressions of how you’re doing too. Yes, ADA, docs, JDRF and other seem to emphasize A1c over all, but you need to understand what the number represents and how it’s determined. An A1c in the 6’s or 7’s can easily hide very unhealthy wide-BG swings. If you use TIR, GMI, SD, and COV, you’ll KNOW how you’re doing! Check out https://diatribe.org/understanding-average-glucose-standard-deviation-cv-and-blood-sugar-variability to understand the acronym’s and math. Various apps can do the math for you. My second thought has already been addressed by @CarlosLuis: prescription drugs can and some OTCs can impact the reagents used in both finger sticks and CGMs. Third, there’s little you can do in a week to effect a lower A1c, short of being very low the entire time and that’s not desirable for your health. Keep in mind, diabetes isn’t a sprint, it’s a marathon; set your goals for the the long-term. And feel free to remind me of the same…I need the reminder once in a while too!
Since there are warnings about Trazodone and Bg control I would expect that’s the culprit. I know it’s not in the same group but if it’s anything like what prednisone causes, prednisone can cause high blood sugars that stubbornly won’t come down. People literally sometimes take double the insulin to deal with the highs prednisone can cause. And it’s a stubborn high, which means your BG doesn’t respond well/fast to dosing. The other thing I found was at some point all that insulin that you’ve had to take all of a sudden decides to work and you drop pretty suddenly. It can take days and even longer for some people to get out of your system and return to normal.
There are some drugs notorious for causing issues,and then add we can all be different in our reaction. It can make it tricky sometimes. I know with Toradol injections about 12 hours later my blood sugars plummet for some reason even though I never took any extra insulin. A Cgm is really a blessing for these things.
As for your A1c. It’s an average of the last 3 months. The last 30 days play the most significant influence on it though. So feasibly you can change the outlook in 30 days but I don’t think even a week would be enough to make any difference.
@jo_jo Sorry for what you’ve had to go through recently. Glad that you’re on the mend. Trazodone actually did the opposite for me. The prevailing theory at this point is partially because it is an appetite suppressant, so no snacking and weight loss, partially because of the anti-anxiety aspects of it, and at least partially because who knows???
I was eventually using 6 units less of Tresiba a night, and no bolus. I don’t know why it made me so insulin sensitive.
All of this is to say, we (and drs) work on educated guesses much of the time, so please don’t sweat your A1C changes when there’s so much in play.
Wow. Nothing worse than a quixotic reaction to a new medication but, as @CarlosLuis and @Mariethm observed, every day is a new adventure and everyone reacts differently to everything. Like you - I am hyper-vigilant about even the small stuff, yet I tend experience many of the initial negative side effects we always hope to avoid. FWIW - my endo, liver specialist, hemo/oncologist and GP are all affiliated with Mt. Sinai, and I communicate with all of them regularly through the ‘patient portal’, especially when one prescribes a new drug. I use my GP as the ‘point man’ - he’s great, and he really seems to have a good sense of my overall situation, so he gets the last word. I feel like having them all easily accessible to me, and to each other, helps to avoid some potentially negative drug interactions, and at the very least, increases my already fragile peace of mind. I don’t know if that level of communication is available to you, but if it is, take advantage of it. It sounds like you have a lot of different doctors in your life, too, so be proactive.
Wow that’s great! I wish I had access to a patient portal platform! My GP and Endo are great separately, but don’t communicate with one another. I try to keep my GP informed with what my Endo suggests and she always cc’s my Endo on labs.
So my A1C ended up being 7.9, which I am happy about. I wanted to be in the 7s, and wondered if I could get to 7.0 or lower, but that will have to be next time. I’m so glad it was 7.9 vs 8.0 because I KNOW that while it shouldn’t, that one little point would have left me feeling so defeated. I worked so hard to get in the 7s from years in the 10s/9s/8s. Going to try hard for < / = 7.0 over the next few months!