As I mentioned above, I checked back with my last full page of numbers and in 3 1/2 weeks I had 7 lows with the lowest being 51. That's perfectly acceptable to me. I wish I could get my highs down to that few but don't think it will happen. But one factor I think contributes to a good A1C without excessive lows is prompt correction. The less time spent at high numbers the better your A1C and more importantly, the less your chance for complications. So I test and correct promptly and have fine-tuned my ISF to 1:35 during the day and 1:60 at night which seems to work well for me.
Gina,
I do not think there is any know or published data about what is too many lows or what is too low. What I known is that:
- Lows have very serious short term risks to a diabetic’s health.
- Your brain’s main fuel is glucose and if you go low your brain may not be getting enough fuel. Some long term diabetics have gotten memory problems (especially short term memory) that has been attributed to frequent hypos.
- Lows can hypo unawareness over the longterm.
- As per my endo: a non-diabetic can have their BGs drop to the 60s and still be normal.
I believe lows are just another risk, similar to highs. Suppose you test in the 40s 2 times a day for the rest of your life. You have a higher risk of experiencing some of the problems above. This could be similar to a diabetic having a higher risk of complications if all their A1Cs are always 10.0?
Please understand, I am a T2, so I don't have the challenges that someone with T1 necessarily has. I am on a 4-5 shot/day MDI regime and I follow a strict low carb diet. I go below 70 mg/dl once every week or two and it has been "a while" since I was below 50 mg/dl. This is why my doctor got off my back, because I was able to show her that I was not risking hypos.
I attribute my success to Bernsteins "Law of Small Numbers" Blood sugar swings occur because of errors. Errors from my meter, errors in my carb counts, errors in my calculations and dosing. And it all adds up. If I have high blood sugars, large carb counts and big insulin dosing errors, I have high blood sugar swings. So I work hard to reduce those sources of errors. I wash my hands very carefully before testing, sometimes repeating tests. I eat a strict low carb diet, most of my meals are stuff I make so I know what goes in them and can count my carbs. And then I work hard to take a proper dose of insulin. My ideal is to never have to correct.
I understand your frustration, I think many share exactly the same problems with blood sugar swings. My point was that getting really tight control is not just about trying to hit a target blood sugar after your meal, it is about reducing those blood sugar swings.
capin, extending my honeymoon is exactly what im trying to do! i know its not proven but i feel like if im not overtaxing my brave little pancreas, he will put up a good fight and keep pumping out whatever insulin he can!
im also all about bernsteins law of low numbers. ive read his book but not following his diet-cant give up fruit or yogurt!
5.6 is awesome. when my endo was explaining how my brain needs glucose and blah blah blah, i was listening and can see her point (a bit). she is a good doctor, listens to me and will tell me what she thinks i should do. before i left she said something like she was giving me her professional opinion and that i needed to take it on board but she knows im going to do what i want. "allá tú", like "do what you want". which sounds like what im gonna do!
thanks a lot to everyone for responding. its ínteresting to read all of these different opinions and learn about everyone else´s experiences. it´s too bad that D isn´t the same for everyone so we could just look in an old medical journal for all the answers.
im still waiting to wake up one day and open my eyes and not have any D stuff in my house. i always go to bed with a "no night hypos, no night hypos please" and wake up with "please dont let that f*ckin D crap be on the table when i open my eyes".
As long as you aren’t having a lot of lows, I don’t see anything wrong with an A1c. of 5.5. Mine are usually about 5.7 or 5.8 but my last one was 6.2. Your endork has his levels set high. The American Association of Clinical Endocrinologists suggests below 6.5 and Dr. Bernstein thinks that is high! Your endo is doing his patients a disservice by pushing that high of an A1c unless there is some problem that would warrant someone having a higher one.
This was on page 8 of their position statement. They used to have a blurb about the closer to normal you can keep your A1c, the less likely you will have complications, but I can’t find that one right now.
https://www.aace.com/files/dm-guidelines-ccp.pdf
3.Q5.1.1. Outpatient Glucose Targets for Nonpregnant
Adults
• R15. Glucose targets should be individualized and take into account residual life expectancy, duration of disease, presence or absence of microvascular and macrovascular complications, CVD risk factors, comorbid conditions and risk for severe hypoglycemia. Glucose targets should also be formulated in the context of the patient’s psychological, social, and economic status (Grade A; BEL 1). In general, therapy should target a A1C level of 6.5% or less for most nonpregnant adults, if it can be achieved safely
(Grade D, BEL 4) (Table 7) (3,4). To achieve this target A1C level, FPG should usually be less than 110 mg/dL and the 2-hour postprandial glucose concentration should be less than 140 mg/dL (Grade B, BEL 2) (Table 7) (3).
6.2 is in the awesome range. we can meet in the middle somewhere btwn 5.5 and 7.
wow ginay! glad you got a new endo! You must have felt terrible! below 50 only twice a year?!? hahaha!
yeah im not too big into the pump after seeing my friend insert it. that plastic needle thingy is loooooong and though sometimes when im fed up with carb counting etc i DO wish i was a robot, turning a bit droid with the machinery and tubing and random beeping....i dont know! good luck with the new endo!
Thanks Capin. Yes, I have short-term memory problems. And especially yes to "lows have very serious short-term risks to health! Last week I woke in the middle of the night with a low of 20! Thought I was "dreaming", retested and meter said "WARNING, LOW BLOOD GLUCOS." DRANK JUICE!!! Was in extreme pain coming up--drank too much juice and went up to 350 within 2 hours--and had terrible brain function including dizziness for 2 days. (Have had 4 lows below 30 since diagnosed in 2009).
You a 5.6, (congrates) HOW DO YOU DO THAT without hypos? How many below 70's and below 50 do you have? Do ever go way low?
A few months ago my husband (who has perfect BG of 100 ALL the time and is definately not a diabetic) said he felt aweful and shaky because he had not eaten, so out of curiosity I tested his BG, it was 78. I think it gave him a little more appreciation of the @#$%*"! I go through at least 5 days a week (I have nice BG's and don't roller-coaster average 2 days per week).
When I was diagnosed my A1C was almost 16. When I got it down to 10 I still felt terrible. I still feel terrible at 7.9!
I appreciate everyone's input here - helping me figure out how to get my A1C down without risking many lows!
7.4 is a very high target, Nell. As Kelly describes below the AACE suggests an A1C below 6.5 and even the notoriously conservative ADA says "below 7.0" 7.4 is an average around 169 which means there are plenty of numbers higher than that. Studies show complications begin at prolonged time spent at 140 (thus the goal of 6.5, though even then you would have many numbers above that average).
My Co-Pilot software that came with my FreeStyle meter actually figures out the Standard Deviation for me. So all I need to do is take the SD divide it by the average and keep that under 30% or so and it means your variability is decent. The standard deviation just measures how many times you deviate from your target blood sugar whether high or low. I find it much more useful than actually how many times I have been high or low, or even the percentage spent high or low.
Thanks Brian. I'm aware you are T2 (have been reading your informative and helpful posts for a long time). I think I am a "pretty good" diabetic as far as everything including hand washing--which is why I am so frsutrated!
I've studied and respect Berstein and try my own version of "Law of Small Numbers" but am not at all disciplined enough or willing to give up ALL "my goodies" as far as food.
I'm thinking my problem MUST BE problem that my basal and bolus insulins are NOT factored correctly! And never have been--though I and my doc have adjusted and adjusted them both trying to get them right.
I have NO body fat! I weigh 105 pounds. I'm HUNGRY! I want MORE FOOD! THAT"S my OTHER problem!!!! Ugh little meals often, although I don't mind low carb.
I'm going to visit your page and read your advice on how to eat well and feel full and satisfied and I better find some yummy stuff to eat when I visit you! (friendly-teasing!) I recently had to quit working just so I could try to manage this stupid D! It's a full-time job in and of itself for me! Not easy to make everything you eat when you are trying to work 60 hours a week and have a life too (come home and walk five dogs--good D-exercise!).
Okay, so I'm not yet three years into this D, so I guess I'm just still figuring out what is gonna work for me!
I really appreciate your response BSC, it helped me re-focus on probably my two main problems: 1. insulin regimin (how much/when to bolus--because I tend to spike after meals even if low carb/good protein including fat and then level out or oops go low; how much basal? cuz having too many lows during the night) and number 2. Food (what/how often). I HATE the "STRUCTURED" eating required now that I have D.
Think (maybe) I'm gonna try (again) to see if I can make friends with that pump.....MAYBE.
Thanks Zoe! I always love and read you here on Tu D. My (former) doctor would definately fuss you out for those lows. (LOL - He would also tell you an A1c of 8.4 is "not bad at all"!)
I'm really "obssesing" thinking my D today because of the recent horrible low I had (see my response to Capin) and because of my appointment with new endo next week.
Thanks pancreaswanted! I LOVE that you Laughed so LOUD about only below 50 twice a year!!! And I also really appreciate you can understand my ambivilance towards pump!
Boy did I really NEED TuD today! (Thanks Manny!)
I've been so emotional about my D lately! What you just wrote pancreaswanted truly truly reminded me that (as that song by Matchbox 20 goes): "I'm NOT crazy I'm just a little unwell!" Thank you, I just had a good cry which I greatly needed--feel so much better now, and I am so grateful to everyone here on TuD!
Diag'd in May, 1st scheduled A1C was 4.6 in August down from 10.8 in May. I followed a strict diet & exercise regimen. My own BG tests averaged around 100... my Doc changed my meds, wasn't unhappy.
Since then, I still diet & exercise... but a little more lax on the diet :)
I say, "Yay me!" lol
Yay you, indeed!
Endork! LOL, haven't heard that one before.
Yea, pancreaswanted and my (former) endo must be in the same endo club, my endo also believed a 5.5 was unatainable and "dangerous."
KELLY! AACE Guidelines! Awesome!!!!! Thank you for the link and your (WOW-YES!) post. Holy Moly! Now I have to run out and buy more ink for my printer RIGHT NOW! I've a ton of reading/studying to do over the weekend!
Hi -
Congratulations on the great A1c!! My endo is fine with 5.7 but was an unhappy camper when I came in with a 5.3 and too many visits to the 50s. I had a session with a CDE who helped me tweak a couple of settings and my A1c went up to 5.7 again with the next test.
I am about 5 years in and still have a little bit of beta cell function. I don't think that is a source of my lows. Rather in my experience working beta cells help keep numbers a bit steadier. They're like training wheels.
A target of 6.5-7 is really a bit on the high side for someone who has shown the ability to do better. If your endo is going to "insist" on average blood sugars over 140, you may have to look for someone new.
Maurie
Someone else invented the endork, but too good not to use! The one I linked was their 2011 guidelines - I didn't see the 2012 come up but they have had that same line the past 5 or 6 years that I have been looking.