Having a different target is different than having a different range. Your target may be higher than mine or the pumps’ but should still be somewhere within that same range, and your time below range and far below, should be no worse.
That you rely on CIQ for hypo protection suggests that your night basal rate and/or bedtime glucose levels aren’t right yet, or possibly you are being overreactive to compression-caused alarms. Having a personal target of 60, and a simultaneous a problem with persistent highs suggests that your glucose variability, your ICR, CF and your ability to respond manually to prevent and correct highs, (especially persistent highs) , which is what you must do in sleep mode for highs, need improvement.
In short, you as a system/process aren’t stable. Without a stable process as a foundation, tight management of anything to reach specific goals is difficult at best. Without relevant metrics, management to reach an arbitrary number is impossible.
Aside from A1c being an average that doesn’t indicate hyper- or hypoglycemia, why or when it happens, calibrated A1c tests have an “accuracy” of +/-0.5.
When I was last tested, my CGM weekly reports going back 90 days showed I was consistently having an average weekly glucose level around 126 mg/dL with a SD of 20 or less. The A1cNow test said 5.3. That’s like an average BG of 105 mg.dL - normal.
There’s NFW that A1cNow test was accurate! A1c does not indicate quality of control AND it is not an accurate or a dependable number that you or any doctor, can use to make rational decisions about what changes you should make. A doctor who tries to without analyzing available CGM data is undereducated, out of date and not following ADA/AACE/international best practices. With 75% of all PWD not reaching the high A1c targets, the A1c "gold standard’ isn’t gold for therapy. It’s a measure of the effectiveness of medicine, that effective therapy is not being prescribed and universally afforable.
My personal target is reaching a goal I can measure day by day, achieve and maintain. I have a long range goal of getting my glucose under good enough control that I can bring my average down safely, with no time below 70 mg/dL. That corresponds to an A1C close to or below the diagnostic criteria for diabetes and lower than my endocrinologist feels comfortable with. I use response patterns and daily and weekly CGM and BGM statistics, not A1c, to tell me how I’m doing continously, inform my decisions and keep me safe.
To do this safely, I needed to get good enough control that I won’t be dependent on pump automation most of the time. Instead it will be like level 2 automation to warn me when unexpected things happen.
But I recognized that this is a complex project not a simple one, and with the tools that I have the most effective approach I can take is to address problems one at a time starting with the most potentially dangerous and serious, and use what the pump does as data to refine my management technique.
As an engineer I believe that trying to override a relatively stupid but complex algorithm makes less sense than modifying the process it tries to control. So Im using experiments to get good metrics and minimum lifestyle modifications to get the results I need.
When I started using a pump in April 2022 my first objective was protecting from night time lows.
This is when I’m most vulnerable. For most of my adult life my sleep quality was terrible because I was afraid of hypoglycemia.
So I started with a t:slim and Basal IQ and counterintuitively raised my personal lower range limit to 75mg/dL I then completely eliminated nocturnal hypoglycemia by determining my basal profile systematically using the pump in “manual” mode, doing tests to recalculate my ICR and CF making a very minor adjustment to my diet.
Then I upgraded to Control IQ. While it did keep my night time glucose level higher than before it’s not an immediate concern because I was still having drops from pre-meal boluses and high peaks after meals.
I tackled the peaks by adding fiber and reducing carbs from one meal at a time. This reduced my TAR to 2 percent. Then I experimented with extended boluses to flatten the curve and eliminate rides that required Control IQ to intervene. Finally I’ve started lowering the curve.
Imo It’s more important to flatten and lower the curve to an always good level than to try for near-near normal levels part of the time, especially when that is my time of greatest hazard…
I’m very close to where I want to be .
This was my last seven days:
And all day yesterday (2300-2300,).
I still have work to do, dinner Is a complex problem to be cracked unless I forego variety, but now it’s easier.
I use Xdrip+ for monitoring because it’s able to give me much finer and multiple indications as well as a much much better display than Dexcom or Tandems screens plus better analysis tools for seeing near real time effects.
I don’t know that it’s possible for anyone else to successfully use the exact approach I’ve taken but I believe that it’s usable with some modification for you to get to a good stable safe plateau before seeking a lower safe target than mine.
