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What do I have to do to get an A1C less than 7 per cent?

In the DCCT, the intensive therapy group achieved the 7 per cent A1C using either multiple dose insulin or a pump. Of course they also had to use blood glucose testing information to make the best dose decisions.

Their success was even more impressive when you remember that they had to use the earliest blood glucose meters and traditional insulin preparations then available (Toronto or regular insulin and NPH or ultralente). Today we have a lot more options, but the basics of Intensive Therapy (IT) remain the same.

IT is a system of matching insulin doses to food, activity and life events, using individualized adjustment guidelines based on glucose results. The self-care behaviours involved include:

  • taking insulin to give both basal doses & meal boluses
  • using some form of carbohydrate (CHO) counting
  • adjusting insulin dose for the CHO amount per meal (bookmark)
  • adjusting insulin for activity daily
  • adjusting insulin to correct for BG out of target (correction bolus)
  • using blood glucose testing at least 3 /day
  • using pattern management to make adjustments to baseline doses as needed (? Monthly)

We know that the more of these self-care steps you use, the better the results. In one of our studies (Jones, Cleave 2006) only people who used at least 4 of these 7 steps regularly reached their goal A1C of <7 per cent.