I use a set point of 160. That is a bit low by some standards and higher by others. However, I keep it at 160 because a little insulin at 160 beats lots of insulin at 250. When I am able to correct with a unit or two I often avoid much more and longer time at higher ranges.
Everyone does our diabetes a little differently and I would like to say that if what you do to manage is good for you, it is good for me. I expect the same courtesy.
I also use 160. I find that setting my thresholds is a balance between optimal BG control and the annoyance factor of alerts. Periodically I use 150 or 140 but the increase in the number of alarms drives me crazy and I donāt necessarily think that my BG control ends up better.
Thank-you for posting this citation, @AE13. I thought the 140 (7.8) number did have some foundation in scientific studies and was not merely diabetes fora myth.
This is a bit of a segue. If you keep your range below 140 / 7.8 how do you manage to keep your driverās license? My endo warned me about hypo unawareness years ago and it started happening. I have changed my range significantly to keep the hypo unawareness controlled. Do your Doctors renew your driverās license based on your devices sending alarms when you are too low to drive safely?
Huh? You need your doctorās permission to get a driverās licence?
Either way, I donāt find having a tight range causes hypo unawareness, but everyone is different. I try to keep my blood sugars under 6 as much of the time as possible, having my upper alarm set at 7, and can always tell when Iām low.
So my bottom CGM alarm is set to 4.5 (81). That way I rarely go low because and I have time to treat an impending low before it hits a low number.
I never have had hypoglycemic unawareness, but have found that using a cgm and avoiding lows I am able to better detect a low.
With that said, I am human and sometimes when I am in the middle of something (yardwork usually) I ignore both my CGM and low symptoms and think maybe I can just get a bit more work done before I treat this low 
Been there, done that, many times. Some day Iāll learn
Well, Iāve spent some time looking for reputable published sources that cite the 140 mg/dL (7.8 mmol/L) post meal blood glucose as the threshold where damage may begin to occur.
I found this 2011 Guideline for Management of Post Meal Glucose in Diabetes published by the International Diabetes Federation.
Now I know that a āstrong associationā is not the same as causation, but it appears, at this time, at least according to this source, that post meal hyperglycemia above 140 mg/dL (7.8 mmol/L) may harm your health.
Full citations are available in the 2011 guideline document.
.
So when Iām doing low carb, I actually have fewer severe lows (slightly more mild lows), while also having a lower average blood sugar, because the variability in blood sugar also goes down so much. So while I do end up becoming more used to blood sugars in the 65-80 range, Iām still just as if not more sensitive to quickly dropping blood sugars, because that happens much more rarely, and Iām still sensitive to blood sugars in the under about 60, which is when I worry. Part of getting better control for me included becoming more comfortable with blood sugars that were slightly low and not aggressively treating them. Iād probably feel much less comfortable doing that without my cgm though.
My Alberta driverās license has always been Class C. My GP has to fill out a form every year stating that I am capable of driving. My Endo has written letters on my behalf which allow me to have my license for 3 years but then I need another letter from Endo. I have done this for over 30 years.
Ah ok, didnāt know about that so was surprised. I think in Ontario there is no issue unless a doctor believes driving would be dangerous and contacts the Ministry of Transportation.
This is similar to the situation in the UK for anyone taking insulin (based on EU regulation). The rules were significantly tightened a few years ago (despite an absence of any evidence of increased accident rates)
Licences are issued on a 3-year basis (in the absence of a medical condition they do not need to be renewed until you reach 70 years old). You have to fill in a medical questionnaire and provide details of your medical practitioner. The form includes questions on hypo awareness and instances of severe hypoglycaemia (defined as requiring outside assistance). Two severe hypos within a one year period result in an automatic suspension of your licence for 1 year. Insulin users who wish to drive vehicles of over 3 tonnes in weight or carrying more than 8 passengers need to apply for a special licence.
The ātwo severe hypos and you are outā ruling has caused a lot of problems since until recently this has included overnight hypos whilst asleep if these have required ambulance assistance.
The new rules also require that you carry out a blood test before driving and at at least 2-hour intervals thereafter. Driving with a BG of less than 4.0 is an offence and counts as driving under the influence of drugs. The testing rules are actually a useful counter in cases where doctors try to restrict testing strips (despite NHS rules to the contrary).
This is valuable information, but ā¦
We have to be careful in how we interpret and act on this information. Key words in the above statement are āappears to beā and āassociationā. This means that there is not a direct, causal relationship. Further, it also means that it is critically important to consider your results in light of other bits of lab work that your endo and/or primary care doc might order.
Put more simply, itās more important to look at the whole picture rather than just one part.
I like Laddieās approach of balancing BG control against annoyance of alerts.
140 sounds great but if the reality is you are going over it all the time then no point in alerting something for which you already know. It simply causes the alerts to slowly get tuned out into the background chatter.
My preference is to set alerts such that an unexpected BG level will be recognized and acted upon.
After 38 years of being very attentive to medical alarms I am so over it. Wish it wasnāt so but itās where Iām at. So I set my alarms at vibrate only with a low of 70 and a high of 200. And on the rare occassions it sounds Iām all about giving it due attention. But the reason it seldom alerts is not because Iām some kind of wonder diabetic. Rather, Iām looking at my status about every 15 minutes.
Anthony, I have been following this chat for awhile and been thinking about all the things I could say. And I guess, I finally willš
Been doing this for almost 47 years, pumping for 27 years and CGMās on and off for many years. Been in support groups that people would introduce themselves and A1Cās always come up and some of those numbers I could only dream about. I was usually in the upper 7ās lower 8ās but always felt ok with those numbers. Over the years I have tighten up a little but still not where many here have gotten to. But my competitive nature has had to take a back seat and I have realized that if my numbers work for me, thatās is all that matters. I have my low set at 80 ( trial demands more paperwork if blood sugar falls below 70 & I hate more paperwork!) and my high was 240, than 200 and now 180. Do I think I will keep creeping down, probably not. Itās a good number for me. A1C goal for me anything under a 7.5 and Iām ok with it. And yes I am very happy under 7.0 but I donāt beat myself up for being 7.2. And while the goal is 7.0 for most people or ADA standard of care guidelines, that doesnāt mean itās for everyone. And while I donāt have those super tight goals and numbers, I am still complication free and pretty darn healthy. Do I have genes that protect me against all those complications, maybe. Am I lucky, maybe. But it works for me and will probably not work for the next person.
My other take away here is that while we have all this great technology, I always wonder if we are using it to its fullest. CGMās with the alarms and how many different ways you can set the alerts. Pumps with temporary basal, or suspend mode or extended bolus etc. So much they can do for us but sometimes the training on how to use them isnāt always the best.
So please donāt let others and their numbers/ goals make you feel bad. I only worry about what my goals are and really donāt worry about others. And the reality is that many on this forum have a very good handle on their diabetes and know what to do and are willing to put the time and effort into it. While many with diabetes just donāt. So find your middle ground and be happy where you are at, if that is where you want to be. And if not, little tiny baby steps. Donāt try and fix everything all at once. Good luck and isnāt it great getting outside and getting your hands dirty?! Love gardening also, just turn the pump way down for those big gardening afternoon!
Ugh. These days the Endo and diabetes medical world seems to have an inordinate fear of lows that arenāt really low. So if you are 75 you would have to make sure to correct before you get to 69?! Thatās a bit nuts. I love being 70.
Iād kill every forest in the land with the amount of paperwork I would have to do for that.
Are you able to share info about your clinical trial?
Iām in the ViaCtye stem cell trial at UCSD. It was the first cohort. Just safety & procedural. Trying to see what works & what doesnāt. Like big devices in front or back, upper or lower. Using drugs, not using drugs. Thatās what trials are for just figuring things out. And logging, logging and more logging. And you should see the binder size for just one person. FDA requires a lot of documentation. Hence the reason I set CGM for 80 instead of 70 to try and head off more loggingš
