Doctor said A1C is too low for a Type 1

That erm "non-compliance" makes my blood boil. Since I ws over 30 years old when I was dx'd with type 1 - I was originally dx'd with type 2. In spite of presenting with classic type 1 symptoms, 5'6", less than 100 lbs, peeing all the time, vcouldn't put on weight etc... When my bg's weren't improving with diet and exercise, then oral meds - I was scolded for being non-compliant! Maybe its not me - maybe it is the treatment that's not working. Anyway, an attending in the ER when I was brought in with DKA coma got it right from the get go. Why can't we have labs that are as good as a helathy person , and often better than the general population? If our A1C is good, our lipids are probably good as is our cholesterol. We have that right.

My goal is 5.0. I’ve met it before. My most recent was 5.5 and my pcp and my endo (finally broke down and got one) both are supportive of me pushing it lower as long as I’m not having serious hypos. (Both of those docs also have grown t1 children as well). I personally think that doctors who try to tell people they should accept elevated a1c’s reflect low expectations of diabetics in general, and that doesn’t sit well with me.

Just a quick aside from a T2: I have a lot of T1 friends. Of course an A1c includes lows and highs. The nature of an average, after all.

But, from what I have gleaned, if one is paying attention and monitoring one's #s with great attention, lower A1cs will be good, ultimately...

Anyway, blessings. Do more research. Especially here. It's ok to mistrust a doc who says you need to have a higher A1c......

Sam, re: your comment about loqw expectations for people with D. Here Here! I agree. Granted I am active in the DOC, thus exposed to people with D who are motivated, capable, smart and diligent about their D. Why do some MD's have such low expectations? Especially after they've met us. I finally convinced my endo that I was doing things right (in spite of my 5.2 A1c's) and she introduced me to colleagues like it was show and tell. I didn't know whether to be complimented or insulted.

Except to win a lawsuit you’d have to prove damages. I would agree there’s be a case to argue that there had been some damage but diabetes doesn’t translate very well into the court system and, of course, the medical industry’s standards for BG levels are not very strict.

I doubt there’s that many lawsuits as they’d be defensible by arguing it’s the patients’ fault for not following directions of the all-powerful doctors.

Most of us who are on the DOC are an anomaly to physicians. My endo says he hardly ever meets diabetics with a1cs under 8, much les in the 5's or 6's. That is why you and I are ometimes " On display" in medical settings.
God Bless,
Brunetta

Kristi, the CGM can be used a bit more effectively to dampen out the swings and catch the lows, but it's a bit more work (not a lot, but some).

The high and low alerts on the G4 can be changed, as I'm sure you know. Take advantage of that... I do routinely!

If I've had a bad morning with high Dawn Phenomenon, for instance, I'll set my G4 low alert for 100 (up from 70), then aggressively treat the high. Correction bolus as suggested by the pump. Again in 2 hours. I keep this up until I get a good downtrend. Note that I am taking insulin according to correction values and IOB, the pump doing the bookkeeping and calculations.

Of course, this is all approximate, so I will adjust the suggested bolus based on my experience as well. Still, not exact science.

I use the G4 to then catch things as they are heading into normal territory. When I alarm at 100, I take a look at the IOB, and if it's way out of line with the needed 15 point drop to get to my target, I'll preempt the drop with some glucose, enough to counter the extra insulin hanging around.

For example, my correction factor is 1:10. So, if I have any downward pointing arrow at all at 100, IOB over 2U, I'll "reverse correct. My I:C is 1:4. Suppose I have 3U at 100, with the angled down arrow. I'll pop 5 skittles (5g), a bit more than 1U of reverse correction, planning on BG settling around 80.

Then, I reset my G4 for a low alert at 90. When it goes off, I reassess again just like already explained.

Doing this, I avoid many lows that would have caught me off-guard. I do try to be as precise as possible when carb counting and bolusing so I don't have to go through all the extra work described above (and waste insulin, and gain weight, etc.). Still, when I know I'm in a situation where the "usual" input/output of my BG metabolism is going to be a bit wacky (and tough DP days are one of those cases), I make use of my CGM, its settings, and capabilities to the fullest.

Remember, the CGM runs 5-10 minutes behind plasma glucose, and there is a 15-30 minute delay in insulin and glucose absorption. This is why you need to fiddle with the CGM low alerts at high BG levels and get ahead of the problem.

well, too many lows certainly can cause long term damage as well, including but not limited to hypo-unawareness (very dangerous)...too many lows effect our brains and the way we cognitively function...so, i'm this doctor is also interested in 'long term' as well.

How "certainly" is it? I don't see doctors beating down a path to study hypoglycemia because it's "very dangerous" but, at the same time, I've perhaps dropped off a bit in terms of awareness as I don't sweat through clothes, sheets, etc. as regularly as I used to but I still feel a pretty perceptible "buzz" when I drift down to the 70s and below. Much of the time, I'm not headed down "full speed ahead" so it works out ok but I am not sure I'm finding the doctorspiel that lows cause long term damage to be that credible.

That's why I strongly - yet politely - ask them to refer to me as a person who has diabetes. Not as "A Diabetic" To me "diabetic is not a noun, and is used as a noun with very negative connotations. That isn't to say that I am ashamed of having diabetes. Indeed, sometimes it is a source of pride since I am handling things well. And... on a lighter note, it signifies that I am good at math! It really fries me when people who should no better - i.e. medical professionals,are of a mind that having diabetes means we are less - less intelligent, less disciplined, less capable. You get my point (or the point of this rant).

I always avoid the term "diabetic" too, except in the group "Diabetecs Who Run Marathons" here but somebody else came up with that.

Well, I just got a "nasty-gram" from on of the endos in my CDE's practice. Saying my A1C was too low. It was 5.3 To me that's smack dab in the middle of "normal" I don't have swings between hypers and hypos, I am soo ticked. Why the assumption that my A1C is the result of too many lows when it is due to a lot of hard work. I am not looking forward to my appt next week. Yeah, I micro manage, but at least I have the tools and the brains to micromanage. Yeahm, I have a few lows - who doesn't, but not that many. I have been working very hard to minimize them and now maybe one a week - and I catch them early. I also don't go above 150 often. Grrrrrrrr. Thanks for letting vent. I did find a chart that conwerts the A1C into the average bg,. %.3 = 105bg. I don't see that has harmful. And I guess I also have to re-explan that I am not a big eater - never have been. If I could take a pill for my nutritional needs, I would and skipping eating altogther!
Thanks for reading my rant.

I recently switched from injections to the pump--been pumping about a month now. I'm also using a Dexcom G4 CGM. I hardly ever get lows and am really strict on my carb intake. My endo told me she'd like to see my A1C at around 6.4 and that she didn't want it any lower. We also made adjustments to my basal rate and my correction rate, but she said that I may be taking too much insulin and that she wants to see what happens in the next month. I am also trying to lose some weight and have been unsuccessful with diet and exercise. She believes taking less insulin will help me lose weight. If this doesn't help, then she will be putting me on symlin, which I am curious about.

Rant away - even people without d (PWOD) are below 70mg/dl 5% of the time - so if you're only having one low per week then you're doing far better than the PWOD's. But as has been said numerous times on this particular thread and on others people like you are NOT the norm and are NOT the kind of PWD (patient with D) that their endos, CDE's, dietitians etc deal with on a day to day basis. So it is a matter of re-eduating the "educators" to what is possible with truly obsessive control and micro-managing. If you're willing to put in the effort to have what is essentially normal blood sugars, then you're health care providers should be willing to put in the effort to actually look at your numbers and realize that your A1C does not deserve a "nasty-gram" but congratulations and encouragement to continue on what is a very difficult thing to achieve.

Dr. Richard K. Bernstein (diabetic for 64yrs. type1) says in his book Diabetes Solutions that all diabetics are entitled to the same blood sugars as non-diabetics. Most doctors he said are afraid to be sued in case you go low.
You can't sue if you lose your eyesight, have your legs cut, have a heart attack or go on dialysis. His recommended sugars are below 5%.

I've had similar information from my former endo when my A1C was 5.5. I politely ignored him.

I not only resent the assumption that a "normal" A1C has to be a result from widely fluctuating bg's (I mean some of us - rather a lot of us here do a great job managing). I also am not very happy about the way some docs hold rx's over my head. For example, my pump is wearing out. The buttons don't always work - it is 7 years old now) and it can take several attempts to enter a bolus, bg etc. I had a lot more lows on MDI. I admit, part of the problem is that I am new to the practice after re-locating to a new city. I have decades of records from my former home, but "they" aren't "interested" in seeing those... I've been in the 5.2 - 5.5 A1C range for about 10-12 years now. I would love to ignore them, but right now I am campAigning for a new pump. I'd cash insome savings to to it out of pocket - but I need that Rx!

Thank you Clare. The only "chronic condition" I don't successfully deal with is lots of typos! Typos, not hypos (oooo I made a bad pun). Anyway in my message above yours, it should say "5.3 A1c = 105 bg average". I understand that perhaps the doctors don't see very many people who work as hard as we here do. But I shouldn't have to defend my management practices again anjd again. I should try to get the endo who has the most people with type 1. Maybe that would change things. I don't know. I don't mean to say anything negative about people with type 2, but I do think that type 2 is harder to manage because of the nefariousness of insulin resistance and because insurance won't cover enough strips or pumps (if they are on insulin) for people with type 2. And I don't hear of this bad attitude towards people with other chronic conditins like you do towards people with D. Oh my, another rant...

The first time I showed up at my endos office with an A1C under 7 (it was 6.1%) he forced me to do a Medtronic IPro CGM trial because he was convinced I had to be hypo all the time to have gotten it that "low". Now to be fair to him prior to that 6.1 the lowest my A1C had ever been was 6.9. After close to 20 years with him, I finally changed endos in December and can't even begin to tell you how much happier I am with my new one. My clinic notes actually say "A1C remains very well controlled with a reading of 5.7 at today's office visit" instead of "erratic blood sugar control".
I don't know the patient distribution of this endo over the other one at the clinic, but since T1 only accounts for 10% of the D cases overall, I can't imagine either one sees a predominance of T1. If you can find an endo who sees T1's (and is not a pediatric endo :) I would definitely align myself with that doctor.
But regardless you definitely should not have to defend or justify your management practices to anyone least of all someone in the medical profession.