The thing that bugs me the most about the "you're too low..." static from doctors is that running high doesn't seem to be a very reliable proof against lows. Even if you run on up, there's still the potential to crash out from correcting highs. I am not aware of any studies showing this however it's very much in line with my experience as I had many more hair-raising hypos (intensity...) when I was less controlled than I am now, although my A1C was higher. Higher doesn't equal safer. Flatter is safer and, at least for me, although I know some other folks who have reported this as well, the path to flatter has been through tighter control and lower A1C. I'd like to see someone test this out but, unfortunately, I'm not a research scientist/ doctor/ etc.
I completely agree ar and Terry, Sarah and A. My entire "D Team" is hypo-phobic. I on the other hand am hyper-phobic. So I do my best to meet them in the middle at glu normal. I have not had a severe hypo since Dec. 2011 when my control was crappy, my idiot endo had me on a sliding scale and I couldn't have told you what basal or bolus meant. I was taking 30 units of lantus at night and up to 20 units of Humalog for a meal because my blood sugar often hit 250 before dinner and the lantus had crapped out at 15 hours or so. I fired that endo and finally took control but it is always a work in progress.
Flatter is better. For me flatter is being achieved with a dexcom and omnipod. Last week I sent my CDE the pod and dex reports for the previous 2 weeks the BG Avg was 106, min 46, max 209 and SD of 27. I was really pleased with them because the lines were a lot flatter and I had stayed in my target range of 70-150 87% of the time, 6% below, 6% above. Her response was "nice, should midnite basal be lowered a bit?". I responded no, I like sleeping soundly between 85-100.
I am seeing her next week for the first time since I started using the pod. I am reasonably happy with my control right now and though she may want to change some pump settings I will not let that happen.
I'm trying a new endo, hoping to find some connection to deal with the calf cramp issue running. My old one left and I saw the new one who, faced w/ a hard to read A1C sheet told me it was 6.2, up what, 20% and just rattled it off. I'd already seen the legible 5.2 on the computer screen and told her that but the general demeanor was less engaging. I'm going to try a less-convenient, larger clinic that I'm hoping will be able to connect with some sports-injury resources for my leg. If not, well they can crank out rx's too. I will be intrigued to see what they say about my shenanigans as I've been working out tons, eating pretty well, not drinking, can almost see my abs (@ 45!), etc. 7 day AVG is 92 with like 88% in range so I'm not looking for tons of help but I would like someone to get a bit more engaged, who'd at least double check if my A1C spikes like that.
You're right about all of them being able to write rx's which generally is what I need them for anyway. I usually end up teaching my endo far more than she teaches me and at this point it is the same with my CDE. There are a few more kinks to work out with a pump as opposed to MDI, but so far the progress has been steady and while I haven't stopped drinking - as that is not necessarily a goal for me, I have lost about 30% of my body weight over the last year and can see my hip bones again so I'm a happy camper.
I am MDI also. For the last 6 months I really have been lucky with the best control of my life. I split my Lantus into breakfast and dinner (22 U each). I can skip meals (and the associated bolus) with no problem - BG stays flat. I went to an ultra low carb regimen and my PostP BG really flattened out. I target 80 - 100 pre-meal and right now hit the target 92% of the time. Three hours post meal I target under 120. I will do a correction if my post meal is over 120. I just have to factor that into my next bolus calculation because a good part of the correction is still in my system.
I devoutly avoid heavy workouts or anything resembling a workout.
My endo had for years encouraged my to work on my "lows." I usually experienced them because I was chasing "highs." Getting rid of the carbs was the key for me since fats and proteins metabolize at a slower rate.
Disclaimer: I am not bragging and am not a virtuous T1. I am gobsmacked by my current control. Just about every struggle I read on this site, I have experienced in my 42 years of T1. So when I share this kind of info. I just want others to know that change can happen.
Congrats on your improved control beechbeard. Lowering my carb intake has certainly made a huge difference in improving my control and helping me take off almost 60 pounds. I was nervous starting the omnipod pump in May after 38 years of MDI, because I had worked my butt off to lose the weight and one of the "side effects" of pumping is generally weight gain. But after 3 months I have continued to lose not gain and I am within a few pounds of my goal. I don't do ultra low carb, averaging about 100g per day, but that is enough to keep my blood sugars in line, and give me enough energy to run around a racquetball court for an hour.
Clare and AR - Flatter is better. In all my years of visiting doctors I've never heard that advice. It's always a warning about lows!
I don't like the disconnect I feel when a CDE/dietitian tries to tell me I need to eat more carbs. And this after she complimented me on my BG control. I asked her, "Where do you think my A1c came from?"
For bedtime, I shoot for 100 mg/dl. That seems to be the bedtime number that will allow me to hit my morning fasting target of 70 - 80 mg/dl. Those are the numbers I think of as being attainable and within a generally accepted normal BG range. If I hit those specific targets 25% of the time, I'm happy.
I'm 80-120 for bedtime and between 60 and 99 for fasting, in general, around 80% of the time.
Between meals, anything between 70 and 119 is acceptable. I'll hit that range 80% of the time. Anything above 120 at any time will be corrected for with insulin. for my out of range numbers, 12% are hypos that need correction, 6% are highs below 180, and 2% are highs above 180.
That's about as good as it's going to get for me and I try hard not to freak out when I'm outside of my range, but I'll still get occasional way out of range highs, or go on a vey bad BG streak lasting days, that turn me into a self-doubting, sobbing mess.
Such good info..thanks to all of you! Yes, congrats to beechbeard, you too Clare. AR, good luck with your new endo! My CDE told me monday that high blood sugars cause weight gain, this I believe to be true. Not high high where we're throwing ketones and losing weight but high enough where we're not able to move glucose out and creating 'insulin resistance'..i get like water retention when this happens. Better control, better health over all. I agree, as close to 'flat' as possible. It's not even about the numbers so much ("I'm not a number"..ha, isn't that an old Bob Seiger tune)...it's how the numbers feel. I too am somewhat hyper phobic, I hate highs. For me they feel like I'm trying to navigate through a pile of quick sand. I remember when first Dx, the very first Endo I saw who started me on insulin in her office and put me in the hospital. I still have the ADA card she gave me, she wrote "140 2 hrs ppl" and goals are to get to as close to 'normal' blood sugars as possible. Unfortunately she left the practice and moved out of state. But that's always stuck with me. So, why do these other providers encourage higher numbers? CDE monday told me too to eat more carbs, (I have been trying to do this). She said increased fasting BGs are because of liver dumps. Again, maybe that's true but we're supposed to be able to fast and stay somewhat flat; isn't it the role of the basal to stop the liver dumps? Rising BG's mean incorrect basal, that's the beauty of the pump, to adjust accordingly. IDK, I restart (AGAIN) pod on tuesday with her, as we had to wait to see how much I needed to decrease my levemir to start. So, fingers crossed. I just am not going to set a goal of higher Blood Sugars to appease their hypo fears. I feel good with good control. I have no idea how people function with going all over the place or high blood sugars, anything close to 200's feels awful to me. THANKS!
thanks, I'm gonna print some of these off and show me CDE on monday.:) I swear, it's like I'm the only T1 who wants somewhat decent control or something.
I am not bragging and am not a virtuous T1. I am gobsmacked by my current control. Just about every struggle I read on this site, I have experienced in my 42 years of T1. So when I share this kind of info. I just want others to know that change can happen.
Well said, beechbeard. I try to convey this tone when I write about my experience but sometimes I feel that I miss the mark. I've never been a show-off. That's not my style. In fact, I've never been much of a joiner. I'm quite surprised that I've participated consistently here for several years. I find I am more motivated with sharing some personal break-through so that it can help someone else. In my 30 years with D, I too have experienced just about every struggle that people write about here.
I was a little taken aback recently when one comment here made some critical remarks about people that post about their success. I won't repeat the exact adjective he used but it had the "teacher's pet" kind of sentiment.
Congrats on your excellent BG numbers. Once you experience that kind of control and enjoy how it makes you feel, it makes you want to sustain it. I have more good days than bad and I'm working on restoring the control I had before a recent month of travel and a downgrade in control. I now have two good weeks behind me.
Like you, the primary reason for my success is my lowered carb diet. As soon as I exceed my "carb intolerance threshold," I jump on the all-too-familiar BG roller coaster.
Best of luck!!
You've hit the OC Diabetic jack-pot on his site.
Your CDE is right about high blood sugars leading to weight gain, but it isn't just the high ones that cause it, it is the roller coaster of low to high. The sliding scale for insulin meant I was always feeding the insulin. I was constantly low from a massive amount of basal insulin taken once a day which I had to feed and then high from having to constantly feed the lows. It was a crappy, roller coaster ride straight to weight gain. The goal of the DCCT (diabetes control and complications trial) was to get to and maintain as normal a blood sugar as possible given the constraints at the time of insulin types and pump options. The study conclusively proved that lower is better as far as complications. The original goal A1C of the DCCT was 6.05% but they found that the patients on the intensive insulin treatment were having too many hypos so they adjusted the A1C goal to I think 7%, maybe 6.5 but I don't remember. Considering this was 1985 ? That was a fairly difficult A1C to achieve. But the study was stopped because it was so overwhelmingly obvious that the more intensively managed patients had fewer and less severe eye, kidney and other complications. The closer they got to normal blood sugars the better the outcome.
Since the study and subsequent EDIC followup of the patients it continues to be proven that lower is better. And yet when I approached my CDE and told her of my goal to get my A1C to 6% her response was "aim for 6.5 lower is not always better". When I pressed her to provide me with a single study that supported her claim that "lower is not always better" she could not come up with one so I have strived for lower. I'm not going for Bernstein low but I think the high end of normal is not only achievable but it makes me feel so much better physically, mentally and emotionally. 5.5-6.0 is what I now aim for whether she supports it or not. It's certainly not like she can babysit me or remotely change my pump settings anyway.
You are hardly the only T1 who wants decent control, Sarah. You have lots of company on here.
I agree that we should all toot our horns when we achieve good success and support each other in doing so. I do always feel the need to insert a caveat that 1. Excellent control is not an easy achievement and 2. Some have more difficulty with it than others. The reason for these qualifiers is not to be a "downer" or to detract from someone's achievements but to prevent those who don't achieve the same kind of success from feeling they are "diabetic failures".
That's a wise practice, Zoe. As a writer, one always has to consider the various readers. I try to do that but I know I'm not perfect.
I was on that same roller coaster for years. With the flat control I went from 7.1 at start to 6.6 3 months later to 6.0 a couple of weeks ago. Don't feel hungry, don't feel heroic but do feel comfortable that a 75 3 hours after a bolus is not going to put me in hypo.
Sounds silly, but being able to do that and not worry makes me smile.
I think we are an unusual group seeking decent control, not here on tudiabetes or in the D.O.C.,but in the world of diabetics, we are.
Many endos and medical care professionals rarely see diabetics, type one or type two, who aim for or even know how to aim for decent control. They are afraid of lows for their patients because they fear lawsuits and assume that most of their diabetic patients on insulin have no clue of how to use it nor how to manage blood glucose levels. They do not try to educate their patients because they see so many that have not taken on the onus of diabetes self-care, that they assume they do not want to know. Vicious downhill slide. Diabetic patients who do not know, do not even know that they do not know about diabetes management. Doctors see that but do not inform them or suggest anything other than traditional treatment: sliding scales and chasing blood sugars, and regularly eating more to avoid lows. Patient stays"out of control". Dr. prescribes more "old skool" techniques, patient loses interest and is disillusioned, doctor says "Oh well" and then sees other patients who have "given up", on self care, assumes all diabetics have given up.. so he/she does not try to present anything other than the office traditional diabetes care.
Sorry for this stream of consciousness rant. I am just concerned
God bless,
Brunetta
Fasting 70 to 105, all other times 70 to 115
most days I meet this self assigned set of limits
I agree completely with your stream of consciousness. In fact one of my first blogs here was about setting goals. Because in my previous 37 years of D, NOBODY had ever set any goals for me or my D self management. I set what I felt were achievable, measurable goals - like getting my A1C down to 6 or my weight down to 150. At the time I had fired my endo and had an appointment 3 months later with my new one so I also had a time frame to work with.
I did meet my goals except for getting my hypertension better controlled, but that required medication, not just an effort on my part. But when I show my CDE the dexcom data or the pump downloads, she can show me 100 other patients who are not even close to decent control. I know it must get wearying to have a patient load like that. So I can forgive them for offering the traditional D care, just don't try to foist that crap on me.