Today was a total epiphany for me. I learned some things today that will change my life. Here is link to today's post.
Warning--I learned some things today that make me feel a low A1C is not as healthy as I was always taught. Low A1Cers might want to take a look.
Cause for thought to read what Spock says about low A1Cs in the blog.
Thanks, marty. I was astounded. Really makes you think a bit differently.
It will be interesting to hear what you think about all this after you've been through the whole program, gotten home, recovered, and had a chance to process all that you've heard and experienced!
Please keep us posted!
Thanks!
marty1492
I know that only you know, Spock if you have achieved good A1C's at the price of too many lows. I had the interesting experience of having two 5.7 A1C's in a row - one caused by lots of lows averaged out with lots of highs, and the other composed of pretty stable numbers. So the same A1C can mean different things.
Having said that this may be very relevant for those who have low A1C's at the price of too many dangerous lows....and knowing people respect Joslin....and hoping you get what you want and need from your time there...lots of disclaimers! Having said all that, personally it sounds like the same old same old "all A1C's below a certain level are dangerous because they are achieved at the price of lots of lows" accompanied by "all lows should be avoided, while highs are no problem". I can't copy exact statements from your post since it is not right here, but it said something like "everyone who was consistently under 180 had the highest rate of accident due to lows". Where does it say that to remain consistently under 180 (or 140 or 120!) means lots of lows??
My understanding is that the DCCT is now considered quite flawed and this imho is one of the examples of such.
Again, I'm glad you are getting so much out of being there to help you switch paradigms and better manage. Nothing I'm saying here contradicts that.
The study was for people who are on insulin? As a T2, I don't feel a higher A1C is safe for me at all, having had a variety of complications with an A1C under 5.5 for 7 years. I've never had a low, so that isn't an issue. I'm so happy you're getting some help, though, and hope it helps you a lot.
In the last two years my goals for BG management have changed drastically. I see a low A1c, sub-6%, as narrow goal that only brings me pleasure after I achieve a few more important measures.
I wear a CGM and follow my data closely. My most important goal is to keep my BG variability, as measured by standard deviation, at the 7 and 30-day marks, at <= 30. (I know some here question the validity of using SD as a BG variability marker, but it works for me. However it's measured, I just want to keep going more sideways than up or down.) Secondary to that, but almost as important, is that I want to keep my BG excursions < 70 to <= 5%. Next, I shoot to keep my BG average <= 110. Finally, I aim to keep my target BGs, 70-140, at >= 80%.
If I can meet all these goals then it will naturally lead me to a low A1c. It'll also be an A1c that I can defend with any endo if they'll look at the facts. I'm not willing to trade mind-numbing lows for a low A1c. Hypoglycemia is a serious drag on quality of life. But I'm also not willing to trade intentionally spending most of my day in the 150-200 range.
I don't hit all these goals all the time. My current SD is at 29 but my average is 113, just short of my goal. Reaching for these various markers is what motivates me.
Spock, congrats on updating your diabetes education. It's a smart investment!
One really needs to look at why those A1Cs and BG are low. If you are eating the SAD and overdosing on insulin to keep your BG down low, then there will be problems. IF you are low carbing and flatlining, it isn't an issue. Also, CGMs are a game changer.
Thanks again for sharing Spock! These are interesting stories although I have to say that I'm sort of disinclined to agree with the Joslin folks but, of course, they are doctors and are *way* smarter than I am. I'm sure they'd have a field day with me...
Maybe the question shouldn't be "do you have any hypos?" but "do you have any car accidents?" *knocks on wood*! Looking at the spiel again, I don't find the allegedly increased amputations due to car accidents very credible. I've investigated thousands of car accidents and seen a very low incidence of amputations. The study says "severe hypoglycemia" increased 2 or 3fold however, I still think that science and studies in general avoid studying hypoglycemia because it's so ***dangerous***.
I have come to find that hypoglycemia, like anything else, can be practiced and managed. Of course, the first hypo I had, I lit a carton of ice cream on fire, trying to defrost it under the broiler (b/c I reasoned inside out/ microwave defrost would take longer...)which is an astronomically elevated probability of lighting ice cream on fire but I haven't done it since. I've followed Spock's recent history and I know she's had some adventures and maybe cutting it too close but I am not sure I agree with Joslin's psych guy but maybe that's something he's developed to get people to back off? It just doesn't make sense to me.
If you look at my post, Shawnmarie, and at Sally's which is more succinct, you will see that we all are supportive of Spock's learning experience and that if she does in fact have devastating lows than she should, of course, do what she can to reduce them. What we are commenting on (and have been commenting on for as long as this website has been in existence!) is the blanket assumption that a low A1C is achieved only at the expense of multiple devastating lows and thus the solution is to maintain high blood sugar numbers.
And the car accident amputation “statistic” cited by the doc sounds really apocryphal to my mind, as someone who works on claims, even involving more dangerous 1980s cars without airbags, etc…
Not claiming their data is wrong, but simply pointing out that not everyone who has a low A1C is doing it by running low and increasing the number of hypos they have.
As has been stated before, the goal of tight control should be a lower A1C coupled with no increase in hypos. For example, staying between 90 and 130 all day. Yes, there are a lot of people with a fairly low A1C who are doing so with a roller coaster of highs and lows, but that's really the opposite of tight control. It isn't being in control, IMHO.
Interesting. I touted all the support I have found on TU all these years. Telling me that everything I learned at a most renown diabetes research and education facilities kind of hurts.
I'm sorry Spock. I didn't mean to imply that you are in any way doing anything wrong or incorrect or learning anything that's incorrect. I've been following your story and I totally agree that having hypos where you require assistance indicates that fixing something is in order.
I still don't believe the psychiatrist that T1 had more amputations and accidents because of car accidents when they were hypo and this is reflected in the DCCT data. The data suggests less complications at lower level. I don't totally believe that 5> 6 because there's no evidence but I think that the reason there's no evidence is because the only kind of evidence is studies and there's no studies because it's "too dangerous."
You have had D for 50 years and have thus "won" the game, actuarially and personally
I agree with this, Shawnmarie and I never used to but I'm starting to really thinking about pushing numbers so low, being somewhat swayed by members on here and not listening to every endo I've ever seen. I don't understand for those who strive for tight or tighter control (pushing the limits, really) seem only concerned with the highs and not the lows, they're just as bad and rapidly more dangerous. We're all going to have this disease, unfortunately, for a very, very long time...imagine being 60, 70, 80 (god, willing) years old with less cognitive function(s) and being hypo-unaware; that scares the h@ll out of me, as much as highs. I had a 43 yesterday, right before leaving for work, while I was just pulling out of my driveway. Crap, I had to pull over and sit for over an hour I was shaking so badly and so out of it - my brain was a total scrambled mess, had another one before bed last time. Some folks on here can or are able to do low A1C's...but, what's the dang point? I saw my CDE today, she too told me anything below 6% A1C is really pushing it. We're injecting insulin with a broken body, none of this is linear a majority of the time.
Perhaps I'm odd but I haven't found that it's pushing it. It's less work, which is always good for me. I realize it's not for everyone but, if you take 10,000 PWD, at least 9900 of them will have been told that < 6 is dangerous. I'd be intrigued to see some evidence of that but there doesn't seem to be any other than stories like what Spock's doc told her. I'd love to see their evidence but, after hanging around online since 2008, I haven't seen evidence to studies that, upon deconstructing the abstracts shared or whatever we get, show that lower BG is dangerous, unless you pass out.
All of my docs are cool w/ my A1C. The last one expressed some alarm when I had some issues requiring assistance (2010/11...) but those were both directly related to my behavior/ errors rather than "my goal". Since then (*knock on wood*, ha ha), things have been ok.
I have had a CGM for years. It changes things, but also makes me more obsessive about staying low. The alerts have helped avoid a lot of problems, but it would be nice to have the problems.
i low carb and certainly don't flatline. low carbs don't do much other then causing me to now bolus for everything i put in my mouth, including now having to bolus for protein because I've made myself so carb sensitive. however, i do continue to low carb...go figure.
No blame and no need to be sorry. You have always been wise and supportive.