Doctors and A1c's

If a person with diabetes lives with 5% of their time in the “alert low” range (about 55-69 mg/dL) and none of their time in the “clinically serious” (< 55 mg/dL) hypo range, does that make necessary a doctor’s warning? And the person in question also shows 90%+ time in range.

Thanks for that, Terry. Very interesting data! The 0.4% below 50 mg/dL caught my eye. I think that means 5.76 minutes being below 50, I assume this is for one day?
What does “being at risk” mean?

Not my ‘best’ 90 days by any measure, but it would equate with an A1c of 5.6 (and my Dexcom average has been running spot-on with my A1c for the past year!). Significantly less time spent in hypoglycemia than the “normal profile” – and the one <54 that I did encounter was a sensor failure - NOT a true hypo:

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This would be an average day. The risk would be for a severe hypo, one < 54 mg/dL.

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That’s an excellent AGP, @Thas! As far as hypo risk goes, your 10th percentile dashed green line is riding well above your lower limit threshold.

We simply have a different philosophy when it comes to doctors.

Absolutely I want our Doctors to provide any warnings they consider to be relevant.

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True. On this specific issue, when I spend minimal time at an alert level of hypoglycemia, I would not defer to a clinician’s opinion simply because of their professional credential. I feel my skin-in-the-game expertise and hundreds of thousands of hours of observing my glucose metabolism as outranking their medically tainted advice based more on a sense of legal vulnerability. Many of these same clinicians would be content if their patients regularly spent time in the 180-240 mg/dL range if they never go below 100 mg/dL.

I used to look up to doctors more with respect for their medical expertise. When in glucose crisis, when I went through three endos in five years looking for answers, I learned the hard way that I needed to own my diabetes. I figured out how to get back on a healthy track. Those three “diabetes experts” didn’t have a clue.

I’m no longer angry about that experience and I do value the opinions of my doctors. Their knowledge base has a much wider footprint than mine and I respect that. But in the end, I am the one in charge. When it pertains to matters of dosing insulin for me, I am the foremost expert.

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Please don’t misunderstand me.
I do not defer. Period.

That does not mean I do not want the Doctor to provide any warnings they feel are relevant in their professional opinion.

What I choose to do with those warnings is entirely up to me. (And in conjunction with my T1 who is now old enough to actively take part in their own care decision.)

I understand. This topic is a tired and worn one with me. I have been visiting endos four times/year for over 34 years. I’ve heard every variation of this hypo-phobic warning over the years. I don’t need to hear it again. But I will and I mostly just smile and nod. It still chafes, however.

This is a good case study in why being a doctor is such a difficult job, patients alternate quite readily betweeen criticizing them for not adequately teaching them how to manage a condition, to “I don’t want to hear it” to “I know more than them anyway”
They’re kind of damned it they do and damned if they don’t

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Totally.

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And being a diabetic patient is easy??! This is a support forum for people with diabetes, not one for doctor support.

@Terry4
Sorry for any offense.

This seems to be getting unreasonably heated.

I certainly was not expecting such a response nor trying to antagonize you.

I will bow out of the conversation.

I don’t have to chose one or the other, they are not at odds with one another… I’ll call it a day too…

Sadly, the cost of CGM in BC, at least, is prohibitive to its use.

As a US citizen covered by a health insurance policy, I had always thought that my coverage of my diabetes supplies, including a CGM, gave me better access to these things than a similarly situated person in Canada.

I completed my annual US tax reconciliation recently and I realized that I pay a significant amount for this access. I pay an annual insurance premium of almost $4k USD in addition to a 20% copay for my CGM supplies.

It makes me think that someone in my situation (a retiree) in Canada could afford to pay out of pocket for things like CGM and still be money ahead. Just a thought.

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Yes, but then you have to define what “first, do no harm means” in the context of the individual patient being counseled. So, since a hypo is rightly considered the more urgent situation, it might indeed come “first”. However, if the data provided from a CGM and/or meter (and patient reporting) shows a low percentage of lows, but a higher percentage of hyper BGs … which is doing the greater “harm”?

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I’ve recently looked into jobs in the UK- obviously a different country than Canada. However, the salaries are quite a bit lower than I expected for my qualifications. I’d take a significant pay cut if I moved to the UK. I’d have to buy a cgm out of pocket if I chose to move there, so this is a significant concern to me. I think these lower salaries may be a considerable factor in determining if people are willing to pay for a cgm.