How do we feel about the new recommendations for BG management?
Are those primarily for closed loop systems, or for everybody?
A couple things that my Doc said were new and unusual. I would like some perspective from you guys.
1.) A1c doesn’t matter. He’s fine with anything (as long as its below 7) that meets the newly proposed standards for different TIR categories of ‘Normal,’ ‘Low,’ ‘High.’ (I feel like is kinda abrupt change from the last 25 years of endocrinological care).
2.) Sensor accuracy - Dexcom G6 (he says) is said to be ‘Far More’ accurate than traditional finger sticks. So, Dexcom data takes precedence over finger stick data. How does this jive when we see significant error between Dexcom results and lab results? What is our ‘gold standard’ in data? When different devices collect different data results, which one do we assume is correct? (Using sensor data also seems like a dramatic shift.)
More complicated question - At what point is it reasonable for a Doc to claim that you are too disabled to work and support yourself and drive a car? At what point should they simply put you into a group home? What are those criteria? I’m uncomfortable with them holding an axe over my head that simply says, "You are a diabetic and you may sometime get low blood sugar. Therefore, you must not be allowed to make your own, informed medical decisions. You must not be allowed to drive a car if you do not meet all elements of the new standards.’ That seems like a tall order.
P.S. I can’t ever find the standards when I need them. If anyone has them, please post a link. I should re-read.
A1c - I have heard that A1c is an outdated way of gauging BG control, now that we have CGM data to see trends and know if a good A1c is because of stable sugars, or wild swings that just averaged out. My newer goals have been related to Time in Range.
Sensor Accuracy - I’ve heard this, too, but not from a medical professional. It makes sense that newer technology should be more reliable than old, especially since home meters are nowhere near as accurate as we commonly accept them to be. I think this one goes to trends, too, rather than absolute numbers.
I used to assume my libre data was more accurate than fingersticks, but then I got the control solution for my meter and it’s been pretty spot on every time I’ve checked. So now I believe the libre to be inaccurate, specifically it consistently reads low. My last few a1c values compared to libre’s estimate has confirmed this. The issue now is convincing my doctor that my libre reads low and that I’m not having lows nearly as often as the data suggests. My doctor doesn’t necessarily trust the libre data more than fingersticks, it’s just that I give him my libre data and not the readings from my meter so that’s all he sees.
I couldn’t deal with your endocrinologist. I am trying to stay between 65 and 170 and have a non diabetic A1c. If for some reason my BS does creep up to 170 I make sure it comes right back down. Lately I am trying to stay under 155. My A1c is 5.2 and I am happy with that. My A1c number is important to me.
I live in Idaho and consider it to be a fairly backward state, but I was very happy when I renewed my drivers license last week and diabetes was not mentioned. I just had to sign a paper saying that I was mentally and physically fit to drive a car. I only have to renew every five years.
My doctor wouldn’t dream of telling me how much insulin to take. He would if I was having problems but my diabetes is fairly easy to deal with. I do take 7 to 10 shots a day, but that way I stay in range as much as possible. I still don’t want to be attached to a pump, but I might in the future. The doctor is not the boss of my body, I am.
I would be in terrible shape if I relied upon the accuracy of my G5. It is at times off by 10 but it can be off by more than 100. I still finger-stick test several times a day.
I called insurance and they say that I can see as many specialists as I want for a diagnosed condition. I still have time to work this out before critical failure.
I guess I’m not operating much different than you. 70 - 180 goals. a1c = 6.4 last visit.
I’ve never met someone who took sensor readings as the word of God before.
I am 100% with @Marilyn6. I don’t care whether doctors agree or disagree with me about diabetes management. As long as they write my prescriptions, I love them.
I don’t believe this. He should back this up with actual scientific data. Otherwise you won’t convince me that measuring interstitial glucose levels is more accurate than blood glucose levels. CGM data may be more useful, because of the trends, but that’s not the same as accuracy.
I think Dexcom has published really high accuracy measurements. But, then there are also statements that you shouldn’t use it for insulin dosing. They can’t really have it both ways. Of course, we know its not very accurate in practice. I don’t know how to overcome this misrepresentation.
The G6 user experience seems to vary a lot. For me G6 is very accurate. Much, much better than G4 & G5. So accurate and reliable that I always go 9 days without any finger sticks and maybe 3 finger sticks on day one. The 3 on day one give me peace of mind. I would be willing to give them up too.
Ahh, thats the way to express it - as a variety of experiences along a spectrum. Thats what I should have said to the Doc. Darn it! Why dont you guys come with me to these appointments?
This has been my experience, too. At first I trusted the Libre readings and was blousing and treating off them. Then my A1c came back higher (when I’d been expecting lower), and I realized that my Libre, while occasionally accurate, is usually reading 1-3 mmol/L lower than my actual blood sugar. I’ve been using xDrip since then, and it’s quite a bit more accurate. So now my Libre readings say I’ve spent 30% of my time low, which is not true. My endocrinologist appointment is next week, so we’ll see if he freaks out or not.
Abbott has a history of selling meters that read low. My OmniPod PDM read more than 20% low and Abbott had a huge recall of their BG strips. I got about 1000 strips for free as part of this recall. A long time ago Abbott had a quality problem with their strips (reading too high) and people died because of that. This ended up in an expensive law suit. Given the lax FDA requirements, Abbott can sell meters and CGMs with a low bias. This makes sense if the main goal is to be on the safe side.
I read low, too, on G6.
I had the same experience as @Jen, exactly, with the surprise attack high A1c.
Thats why I did so many manuals this round and was able to bump it down from 6.7 to 6.4. The Doc is trying to bump the a1c back up to get the subset of numbers in the LOW category to decrease from 8% to 4%. But, this is just gonna lead to roller coastering and more LOWS.
You all raise a good point. I think that G6 does have more accuracy < 70 - even for me. G4 made very little claim about its ability to read accurately below 70.
G6 does that better. Its better, but far from perfect.
I thought that they all kinda read low on purpose for safety reasons.
