Just curious, what do all you target as your bedtime, wake up and fasting between meal numbers? Do you achieve them? Do you typically have to give corrections on a daily basis? If on MDI, do you just carb load if going to do a heavy work out? Does your basal (levemir-lantus) keep you steady throughout day and night?
Thanks!
I try to be 4.0 - 7.0 before meals, and below 8.0 after meals. Before bed I try to be 6.0 - 8.0, but I will accept slightly higher than that as well. If I'm lower than 6.0, I will usually eat something small.
In the past I struggled to meet all of those. In the past few weeks I think I have solved a major issue I was having with infusion set allergies. So my control over the past few weeks has been drastically improved. I had a rough 1.5 days yesterday and this morning where I bounced from low to high and back again, but things seem to have settled down now and will hopefully stay that way!
I will add a correction if I'm over 120 before meals. My goal for 2 hr pp is under 140. For bedtime with my pump and my basals set tightly I will correct if I'm over 120 so I don't end up high in the morning. I will correct a low under 70. Sometimes I make my goals sometimes I don't; frankly unless it's something dramatic I just correct and go on if I'm out of target range.
thanks, jen. i read your post with your allergy to infusion sets...so HAPPY to hear you've solved that issue, :) care to convert your numbers...?
I like 85 as a target. For me, the pump wizard seems to work better if the target is small, it cuts doses if it's lower and raises them if it's higher. I like the CGM to be relatively flat as well. It doesn't work out all the time but that's my goal.
I don't carb load if I'm going to do a heavy workout, I eat protein and some carbs after I lift/ do muscly things. For *really* long (for me...) runs, I'll eat some carbs 2x days before. I don't do anything crazy the day before races, very small, light food. Avoid the porta-potty...
My basal keeps me steady day and night. I don't even eat if I am not hungry. And if I am then I just figure the necessary bolus and hope I got it right. On days I bust my hump working or hiking or sun loving then I need a little less bolus. I also like to keep my number around 85 like acidrock23...at all times. My fasting I like just a bit lower because I have my basal set to cover my coffee habit. I don't do a lot of corrections either way. I am not on MDI but I don't carb load for any reason. I just eat when I'm hungry. I fruit and vegetable load most of the time!
Just multiply by 18 to convert Jen's numbers, Sarah.
Not everyone can keep there number "around 85 at all times". Many of us do our best but still have to correct to keep from spending too much time out of range.
So I've read. I was just answering the curiosity that was presented, not making any suggestions on others targets and methods. These are simply MY targets. Sheesh!
For me, "target" is what you aim at. My current CGM numbers suggest I "hit" 70-130 (the pump alert range, or 'lines' on my CGM...) 84% of the time for 7 days or 83% in the last 30 (I am coming out of a "Sturm und Drang" period when I experiemented w/ a reduced basal rate that didn't quite cut it...) but I know that it's hard. I think it's easier to aim at a lower target. If I run low repeatedly, it's not the target that's off, it's the dose, so I take less and try again. If it runs up, it's the other way. I'm constantly fiddling around. Lately, it seems like .8U/ hr is too much but .775 isn't quite enough. Maybe the next stage will be 1/2 hr of each for an afternoon, to see what would happen with that? I am also very lazy though and that would be a lot of work. I am hitting a lot of little snacks on the .8U though, a sign to me that it's too much.
If we are talking about the targets programmed into our pumps, then mine is 5.5 all the time. I should probably raise my overnight target, since it's also 5.5 and I've been having lows at night ...
My pump target is 85. My bedtime target is adjustable since I look at both my BG and the IOB numbers. If I have 0 IOB and a steady sideways 90 then that's perfect. I don't mind going to sleep with a 120 if I just have a slight correction on board. I don't like going to sleep with any down-trends under 90.
I like to go down to under a 100 between meals. I'd like to get up at 90 but that's been elusive lately. I'm happy when I wake up under 125.
I give corrections most days but many of the corrections are small. To correct a 120 to 85 I'll only take 0.8 units. I often correct when I first get up in the morning.
I can't offer you any feedback on MDI as I haven't done it in 26 years.
My CGM targets are between 70-140. Lately I've been hitting that 75% of the time. I also have a goal that my under 70 number is <= 5%, lower is better.
thanks for the replies. i guess i'm a bit confused by this. yeah..so we 'set targets' but our blood sugars fluctuate all day - night long, no? So, say your fasting goal is 85, does that mean you just flatline all day long, without a bolus on board, i.e., if you're more active, go workout, etc...you won't drop, if you're non-active, working at computer, watching TV - a movie, it won't rise? Your basal on you pump just keeps you flat...isn't there a range it comes up and down to? thanks!
I'm not sure exactly if I understand your question. If I wake up at 85 and don't eat till dinner, for example, my BG will generally go sideways within say 70 to 100 band. There will be exceptions to this but it will not usually climb or dive steeply. If I exercise, I will have to eat a small snack without an insulin dose or do a minus 20% basal rate starting one hour before I walk. If my exercise is more vigorous, I'd have to compensate more.
It generally won't rise if I'm inactive, such as reading on the computer. This being the wily and devious diabetes, there are exceptions! Like if my infusion site is in its third day and starting to get tender and a bit stale, my BG could start to rise.
My basal rate, without adding any food, will usually keep me within a 20-30 mg/dl window. That's common for me but I do have my days when things don't remain stable. It's a dynamic game. Just when I think I have things figured out, it changes.
Did I answer the question you had in mind?
thanks, terry. yeah, that's what I meant...like a 20 - 30 point window in terms of basal, blood sugar fluctuations; that's if basal rate(s) are set correctly. thanks~!
I guess I'm just not understanding Endos/CDEs/Pump Nurses when it comes to their idea of good management and 'control'. So, I wanted to hear from all of you. When I suggest to them I like my fasting levels to be between 90 - 110 (I don't like lower then 90 really), they all come back with, 'that's too low - that's not attainable'. HUH? And it's always, 'you should eat a snack before bedtime'. Ah, I have to take insulin, probably, with the snack and why would I want to do that before bed (w/out insulin) and make my blood sugars high before bed. Makes no sense. And, always, "don't correct if high unless at a meal." Why would I want to be high 2 - 3 hrs ppl and not do a correction, come to another meal high then correct. I'll be waiting a good while to get that premeal high down before I can eat. Sometimes they're too focused (almost obsessed, it seems) with our low blood sugars. Ah...hello, we're gonna have low blood sugars, we're type 1 diabetics, it's gonna happen and I (we) can take care of them. It comes off ridiculous to me sometimes...like their ideas of higher blood sugars are better. ugh!
Sarah, that is the battle I have waged with my CDE and the pump educator. When they suggested a target of 120 I said no I wanted a target of 100. So we compromised on 100 and now I have it set at 85. The fact is the pump is basically engineered and programmed so that even if your target is 85 or 90 you will generally end up at 100 or more. The pump programmers don't want to get sued for hypo issues.I know that sounds delusional, but from what I have learned over the last couple of months with the omnipod if I have it set for a target of 85 I am invariably 100 - 120. Yes I do have lows, but they're nothing I can't handle and I try to keep them to a minimum. But I am not going to run high to satisfy my endo or cde.
I hear you with this frustration over medical care teams being very cautious to encourage avoiding lows.
For me, my GP would be happy if I never recorded anything under 4. But I'm pretty sure he would not be happy with the resulting increase in recorded highs...
As for my endo, in our last appointment I tried to get from her what the worry over lows is exactly - is it about going low and passing out and sustaining an injury? or is it about brain/body damage that results from repeated episodes of lows? or is it that repeated lows may mean an increase chance of developing impaired awareness of hypoglycemia? She wasn't really able to clarify thought she sort of agreed in an all-of-the-above kind of way. Her response was to explain that there are "degrees" of lows and mine (between 2.8 and 4.0) are "acceptable" / "expected" ... but I should still avoid them. Hmm..
thanks, clare...i like the new pic, you golf champ, you! i'm just gonna get through this pump stuff w/them and do it on my own...but it's so frustrating sometimes. NO, i don't want to be 150 before a damn meal or 150 or 160 at bedtime, NO frickin' way...and I'm not eating a 'snack' before bed, i'm not 12 and need snack time..ha!
I like what A posted below. I'll ask, what their fears are in terms of lows (like their concerns are greater than mine - ours, I mean I (we) are the ones who go through the lows, not them. I realize Endos/CDE's .probably see a ton of 'scary' stuff in terms of diabetes management...but for those who test and are cautious, treat patients individually and give us some credit. I'm also burned out on 'you're testing too much'. Ah, again..OK, how do you think I maintain a good A1C...by guessing? UGH!
Clare - Too many medical professionals suffer cognitive impairment caused by acute hypo-phobia!
Yes I do have lows, but they're nothing I can't handle and I try to keep them to a minimum.
We have a lot of experience dealing with lows. In fact we're very good at it!
Their distraction by hypo-phobia makes too many medical professionals less than useful in advising us as how to balance quality of life with safety and long-term health. On top of that, unless they are hyper-empathetic or diabetic themselves, they have no real idea how it feels to be D. They look at managing diabetes as someone would who had "no skin in the game!" It's a two-dimensional unrealistic perception of what we face 24/7/365.