Using Regression Analysis to Predict A1c Measures

My wife, correctly, made fun of me for running a regression analysis using my morning AM blood sugar readings to predict my A1c readings.

I have data from every single morning to match up with my 7 A1c readings.

So, I tested to see if the A1c reading was most closely correlated with the 90-day, 60-day, or 30-day average of the morning readings.

It turned out that it was most correlated with the 90-day reading. For stats minded folks, here were the R-squared results:
90-day: 81%
60-day: 69%
30-day: 66%

I think I was expecting a much higher reading. Even 81% didn't seem that high given that both of these data points measured blood sugar.

On my last reading, the regression predicted a 6.6 and the actual reading was 6.3. It should be noted that the 95% highest and lowest bound was a prediction of 3.2 to 10.1!

Looks like we'll need more data to draw any conclusions.

Jan-Feb Weight Update

I'm posting to keep myself motivated to keep weight under control. I would like to stay in the low 150's. Feb was not a great month.

In Jan, I averaged 153.0 with the lowest morning reading of 151.5 and the highest of 155.

But, in Feb, I averaged 154.8. The lowest was 153 and the highest was 157.5.

The highest reading came today. Now, I need to motivate myself for March.

Increase in Lantis- tracking decline in pacreatic function through Lantus incresases

I wonder if the increase in the need for Lantus can help show the rate of decline in pancreatic output? I'm not really sure if the amount of Lantus I'm on is really a lot or not.

History of insulin after honeymoon period
Started with 6 units on 12/20/2008. Stayed at this level for 110 days
Went to 7 units on 4/8/2009 for 205 days
Went to 8 units on 10/29/2009 for 113 days.
Went to 9 units on 2/18/2010

I'll have to check with my doctor to see if there is a way to see how much insulin my pancreas is still producing.

Latest A1c Results

My latest A1c results went back in the right direction. Here is the history:

3/1/2008	14.4
5/30/2008	7.4
9/2/2008	7.2
11/19/2008	7.6
4/2/2009	7.1
7/10/2009	6.3
10/28/2009	6.8
2/5/2010	6.3

But, my blood sugar readings were occasionally hitting 200+ after a meal. So, I've gone up to 9 units.

Driving and keeping the A1c low is a lot of work.

2009 BG Levels

For 2009, my AM fasting numbers were probably a little higher than I would have liked. I'm still on 1 shot of insulin at night--- 8 units now. I went from 7 to 8 at some point this year.

My average morning reading was 98. A graph of the daily readings is above.

2009 Weight Results

I weighed in everyday, first thing in the morning. I found that this kept my diet on track and kept me motivated. If the weight got too high, I could eat a little less that day.

The above graph shows the results.
Min: 150.5
Max: 156
Average: 153
Jan 1: 153
Dec 31: 153

Based on my size and build, this is a pretty good range for me.

2009 Workout Results

At the start of the year, my wife got me to do the the Lazyman Triathlon at our gym. Over 6 weeks, we had to run a marathon, swim 2.5 miles, and bike 112 miles. This was a good way to do some different workouts.

Around May, I started to keep track of my work-outs- it was a combination of running, jumping jacks, basketball, push ups, the plank, and sit-ups. I tried to do so weight training, but that didn't pan out so well.

Here were my documented totals for the year:
Miles run: 164.1
Minutes of cardio: 1,768
Minutes of b-ball: 2,460
Push-ups: 3,508
Seconds of Plank: 7,902 (mostly in 60 second chunks)
Sit ups: 5,538
Seconds of the Boat: 1,620
Minutes of Weights: 20 (whew, this is bad. before May i didn't write it down, and after May, i didn't do any)

Overall, not a bad year. If you average it out every day (and lump running, cardio, and b-ball together), I averaged about 15 minutes of aerobic, 10 push-ups, 15 sit-ups, and 20 seconds of the plank per day.

Let's see if I can keep this up in 2010!

Technical Article on LADA

Technical article. Still can't find the chart that shows the rate of decline in the pancreas as a function of when diagnosed.

Target Blood Glucose Guidelines

The following are targets as reported by Diabetic Living, Fall 2009:

American Diabetic Association:
Fasting: 70-130
Before Meals: 70-130
After Meals: Less than 180 (1-2 hrs after start of meal)
A1c: Less than 7%

American Association of Clinical Endocrinologists
Fasting: less than 110
Before Meals: less than 110
After Meals: Less than 140 (2 hrs after meal)
A1c: Less than 6.5%

Reader's Digest: Hope for Cure for Type 1 in 5 Years

In Feb 2009, Reader's Digest published an article on some research for a type 1 cure.

Here is the article:

In an exciting study in mice, researchers reversed new cases of type 1 diabetes using the cancer drugs imatinib (Gleevec) and sunitinib (Sutent). The mice were bred to develop diabetes, but none of them got the condition while on either drug. In mice with early stages of the disease, 80 percent were symptom-free after two weeks of treatment-and when drugs were given for ten weeks, results lasted even after the regimen ended. Up next: years of human studies to check safety and efficacy. (The researchers say the drugs will likely work only for people with new cases of the disease.)
Available: Not for at least 5 years.

Sounds interesting. I'm always looking out to see how I can keep these Beta cells working.

Latest A1c-- Wrong Direction, More Insulin

Latest result this week was 6.8. Moving in the wrong direction after the 6.3. I now moved up to 8 units of Lantus at night. Weight and exercise regimes are OK, so it looks like the Pancreas is slowly fading on me.

3/1/2008 14.4
5/30/2008 7.4
9/2/2008 7.2
11/19/2008 7.6
4/2/2009 7.1
7/10/2009 6.3
10/28/2009 6.8

My Weight History

In an earlier post, I mentioned that I got lucky and started diligently collecting my data on Jan 1, 2007, before I was diagnosed with diabetes. This gave me some interesting data to look at.

At some point before Mar 1, 2008, my blood sugars started going though the roof (my A1c on Mar 1 was 14.4).

From this graph, it looks like I had extremely elevated blood sugars for quite some time. This is why I thought my diet was so great-- i was essentially starving to death. It didn't matter how much I ate, I kept losing weight. I was drinking a ton of water (and going to the bathroom a ton) to essentially flush all the calories out of body.

Once, I went on insulin (the little circle on the graph), you can see that my weight shot up!

Since, then, I've had to work to maintain my weight.

A1c Results-- Takes a long time to move that ship

Since diagnosis on March 1st, 2008, here are my A1c results:

3/1/2008	14.4
5/30/2008	7.4
9/2/2008	7.2
11/19/2008	7.6
4/2/2009	7.1
7/10/2009	6.3

For the newbie, these numbers should be less than 7 or 6.5 (or according to some, less than 6.0). The 14.4 was so high that most charts don't even go that high. Luckily, I wasn't showing any signs of damage to the eyes, nerves, kidney's, etc. (at least yet!).

The initial insulin really brought the numbers down to a reasonable level. But, there is still a lot of work to do. And, this is not an easy process. I was already exercising quite a bit and the diet was ok.

It is a constant reminder that it takes daily work to get these numbers where they should be.

I'm still researching how the risk levels really change from 5.5 to 6.0, or from 6.0 to 6.5 as an example. It is hard to get a good answer to where these levels should be. And, it may be that there are just too many factors to consider.

Does Byetta Save Beta Cells

As my honeymoon period wound down and my blood sugars started to rise, my doctor put me on Byetta. The idea was to use Byetta to control the post meal spikes rather than go on insulin right away.

He indicated that in some studies in mice, Byetta restored Beta cells. He stressed that in no way have these results shown to be true in humans.

But, as a diabetic newbie, I was willing to try this approach.

I was on Byetta for about 6-9 months and it did lower my post b-fast and post dinner numbers.

For me, a side effect of Byetta was that it made me mildy nauseous to certain types of foods. I compared it to my wife when she was pregnant-- there were just certain foods that I couldn't stand to look at.

Recently, I went off Byetta in favor of Lantus (insulin) because my pre- and post-meal readings were pretty low.

I hope that Byetta helped preserve some beta-cells.

Unusual Honeymoon Period

On March 1, 2008, I was diagnosed with diabetes. It wasn't clear exactly what was going on when I was first diagnosed.

I immediately went on insulin-- Lantus. I started with 10 units per day and over a short period of days worked up to about 16 units per day. Then, as I started to get some lows throughout the day, I eased off on the number of units. Eventually, by the April, I was not taking any insulin.

I stayed off insulin all summer-- from April until late August. By August, my morning fasting readings were starting to creep up, so I went on Byetta to see if that would help. By December, I was back on insulin.

From what people I have said, this is an usual honeymoon period. But, Latent Autoimmune Diabetes in Adults (LADA), can develop slowly-- and this seemed to be my case.

A Diet That Wasn't So Great

On Jan 1, 2007, I decided I needed to go on a diet. I weighed about 185 and needed to get down to about 170. So, I started eating better and exercising more.

The diet worked better than I could have imagined.

By July 2007, I was down to 170.

By Sept 2007, I was under 160 and still going.

I weighed in before and after Thanksgiving weekend and actually lost a few pounds after quite a few huge meals.

At this point, I was mildly worried, but mostly was giving credit to my great new diet.

By the start of 2008, I was under 150 and now my wife was quite worried. My diet really wasn't that great (in fact, I was eating a lot more food and losing weight). And, I was drinking a ton of water and couldn't go more than 2 hours without a trip to bathroom. I was quickly becoming concerned as well.

On the morning of March 1st, 2008 when I went to the doctor's office, I weighed 142 and knew that something was wrong.

My blood sugar levels were 540 and I immediately started injecting insulin. My A1c Level was 14.2%. I was off the charts and needed to get this under control quickly.

Turns out that a lack of insulin makes it impossible for the body to process food. So, I was actually slowly starving to death. The diet wasn't so great after all.

Within 14 days of going on insulin and eating at my pre-insulin levels, I had gained 8 pounds. It was time for a real diet now.

Why This Blog?

I was diagnosed with Type 1 Diabetes at age 37. Type 1 Diabetes means that your pancreas is failing to produce enough insulin. In most cases, this means that you are dependent on insulin to live. By contrast, Type 2 Diabetes means that your body cannot use the insulin it is making.

My case is a somewhat rare since most Type 1 cases are diagnosed in children and most cases come on pretty fast. Even some folks in the medical profession who deal with Diabetes seemed to be confused by my case.

This type of diabetes is called Latent Autoimmune Diabetes in Adults (LADA) or Type 1.5.

So, this site is meant to help provide and share information on this type of diabetes.