I just had my endo visit yesterday. My A1C is usually between 5.7 and 6. Yesterday it was 5.7 and my pump printout had lots of 60ish & 70's in it. My endo says thats too low.I haven't had a really low, low for quite a while. I thought I was doing good!! He advised that even though its not terribly low, it will not help my hypounawareness which I've had for years. I have become somewhat of a numbers perfectionist. After 52 years of T1D, it just comes naturally. I hope he doesn't fire me cause I think I'm doing great!
I think you're doing great too! I wouldn't even count those as lows. I don't count as low anything over 60 (let alone 70s, which unless it is at bedtime sre perfect numbers imho).
I attended a meeting last week at the offices of Glu in Boston where the 2 doctors responsible for the Bionic Pancreas talked about it and 2 of the participants who were currently using the device answered questions. One of the questions posed to the researchers was: What A1C are you targeting for the Bionic Pancreas ? The answer was 6.5%. The researchers stated there is no evidence that getting it any lower than that will have a material effect on long term complications. They also said attempting to get the algorithm to achieve "euglycemia" leads to too many hypo excursions. Granted their definition of hypo is 70 and below.
I agree with everyone here, it isn't the number of hypos, it's the severity of them that counts. I can drift in the 65-75 range for hours at a time. But the dexcom is a straight line with a forward arrow, so there is no urgency to eat 15 grams of carbs and test. On MDI I found this very difficult to achieve but since getting the pod my blood sugars move far more slowly so it's easier to catch them rising or falling and correct it.
The information from the dexcom system is invaluable and I try to keep my hypo excursions to 5% with a target of 70-150. So far I have been pretty successful but it is a challenge every single day. I sure wouldn't want to be criticized by my endo or CDE for challenging myself.
I think that playing the odds is a generally good thing to do. I try not to be an alarmist but I think one of the problems with our current information is that there doesn't seem to be a whole lot of data out there for diabetics who do maintain A1cs under 6.0.
It's definitely good to know that the odds of developing complications are heavily in your favor if you can keep your A1c around 6.5. For me, though, it's like closing the barn doors after the horses have left. After years of uncontrolled diabetes, I'm dealing with complications now. The literature on diabetes complications generally agree that diabetes complications are difficult to reverse, even with "good control". But good control is defined as being under 7.0. I haven't been able to find anything on diabetics who maintain A1cs under 6.
I've managed to keep my A1c under 6.0 for going on 3 years now. Granted, I'm only a sample size of 1, but my complications have not only stabilized, they have improved. I still feel like I have a lot of work to do and luckily for me, I have care providers that are supportive and encouraging about my goals and treatment plan.
To me 6.2 is the maximum of good control. It is equal to an average of 120 mg/dL. The 6.5 is clearly not acceptable to me (and 7 is just an insult to all of us). With 6.5 the average of 130 mg/dL is uncomfortably near to the average of 140 mg/dL where research is expecting the first signs of complications for T2 diabetics (glucose toxicity). The gap of 20 mg/dL is also important in respect to the typical inaccuracy of our meters. To me this is a reasonable safety margin. However with complications your tighter control is more than reasonable. I would do the same in the strong belief that some things can slowly be reversed.
What complications have you experienced, and what degree of improvement have you seen?
I was wildly out of control for over a year, and just got everything up to snuff 3-4 months ago. The only complications I have are neuropathy, and paradoxically the pain and tingling started after getting it under control.
My endo and I (as well as lots of literature out there, anecdotes, and similar experience/opinions here) believe this is a good sign -- the neurons were not gone yet, and are recovering. I understand this recovery period can last as long as several years for the peripheral nerves, especially in the feet. (read an interesting research article that theorizes this is caused by mitochondrial migration, which takes as much as 3 years for the little guys to go from the cell body where they're born, to the end of the long axon that goes to the foot).
I have/had the trifecta: peripheral neuropathy, nephropathy, and retinopathy. By my most conservative estimation, I'd say I was out of control for at least 5 years.
Based on my microalbuminuria and other tests, I was in stage 2. Today, microalbumin is undetectable. I don't actually think it was that bad 3 years ago because spot urine exams are pretty twitchy, but something was going in then that isn't going on now.
Like you said about neuropathy, the pain actually got worse for awhile there, but now it's much better. I never experienced pain excruciating enough to stop me from doing anything, but now I barely notice it.
As per many reports, my retinopathy got worse when I brought my BG under control very quickly. I went from an A1c in the 9s and 10s one month to mid 5s a few months later. I went from mild non-proliferative to moderate to severe non-proliferative with DME, 4 months ago I finally saw improvement in the DME with much fewer aneurysms and much less bleeding.
My opthomologist used to tell me that there would be a possibility I would need laser or injections the next time he saw me, but at least he's stopped making that comment. I sued to go every three months for checkups, now it's back out to every six months, so I am encouraged.
I've had the same optho for as long as I've been diabetic and he's definitely been the most critical and encouraging. He's very happy to see me in the 5s, no questions asked, and I'm happy to oblige.
I know this was long, but one last observation. Even though things were getting worse on paper after I came back under control, I just felt so much better. It was like night and day going from BG averages in the high 200s to more reasonable numbers in low 100s.
I agree with most of the other comments as far as what is considered a "low". My biggest issue is that most carbs process through within 2 hours while my insulin appears to take about 3-3 1/2 hours to process, so most of my "lows" occur around the 3-3 1/2 hour mark (I always refer to it as the "tail"). I have become a lot more aware of this, especially for dinner because if I go straight to bed, my CGM consistently goes off 3-3 1/2 hours later.
Wow 9's and 10's to mid 5's is a huge drop congratulations. I am encouraged to know the years of "self abuse" did not leave any truly permanent damage. I did not have such a dramatic drop and did not have any measureable or noticeable complications before the drop to below 6, but I so agree normal blood sugars feel so much better not to mention I sleep better, have more energy, and usually wake up in a better mood.
I don't know which insulin you are using, but I did find apidra has a much faster action and a much shorter tail. For me it was done and gone in about 2-2.5 hours.
I agree completely about the 60's and the way lows that hit a certain number affect you.
Or it's just old age...
Thanks!
Yeah, ironically, it was constant and debilitating lows that sent me spiraling out of control.
When I say debilitating, anything below 60 had me curled up fetal position on the floor. I was lucky enough to have an extended honeymoon so I was just way sensitive to R for a long long time, and NPH was just so darn unpredictable. So, I spent my first 5 to 10 years with A1cs in the 5s to 6s, but it was painful. So in an effort to avoid lows, I took less and less insulin. Next thing I know, 5s and 6s became 7s and 8s, then 9s and 10s.
Really, I just rediscovered that insulin dosing was important to a T1 diabetic.
Lows just don't scare me anymore but blindness, amputation, and kidney failure do. Hopefully, I've struck a happy enough medium between an acceptable tolerance for lows, and tight control. I still don't know if the self-inflicted damage is permanent or not, but I intend not to repeat the same mistakes either way.
I think the biggest problem with these sort of discussions is that there seems to be very little science studying any effects, pro or con, of running your A1C in the 5s all the time and the "lows" which, to artists like us becomes sort of subjective. To me, a "low" is when my family turns into space aliens and I leap over the couch or pound my head against a concrete floor while I'm lying on the ground. 60 and thinking "I'd better to eat something..." isn't a low. I deal with it and move on. I was 68 when I finished the Chicago Marathon last year but knew I'd be fine b/c they had beer (312, wheaty and pretty carby...)and, much to my amazement, potato chips at the Gatorade Sports Science Institute tent where I dropped off some blood for their experiment.
Chuck Yeager wasn't concerned with safety when he "lit the candle" and broke the sound barrier. He had a stick of Beamon's. I'd like to see some clever doctor and/ or scientist say "ok, I'm gonna buck the system and see what these 5ish people are doing to do that...." It's not like we aren't out there. Talking to doctors who've been trained that what I'm doing "can be dangerous, danger is bad, ergo, you are bad..." can be absurd. If anyone implies that, they lose immediate points. They can be redeemed if they have a prescription pad but they lose a bunch of credibility immediately.
non diabetics waking up in the 60's really? i've never heard of that and have never tested that when testing friends/family at all hours. and yes, 60 is low for an insulin dependent diabetic and it does bother me a bit when people on here say it isn't and encourage it. our meters also have a 20%+ variance...so, heck, maybe it's really an 80 maybe it's a 40. yes, they're going to happen but we are like cars driving without breaks, steering wheels, or an accelerator...!
IMO, no type 1 should aim for BG's in the 60's even in the 70's really for pete's sake, that's too close to low. I too don't want to be driving next to someone who's in the 60's BG's that's not even normal for a nondiabetic. so, where's the threshold then, if a 60 isn't low, how low do you deem it acceptable, 50. good grief. Indeed, there is no evidence which supports extremely low A1C's for T1's (5's etc..) can rule out complications compared to a safer higher 5.8 or 6%, but have a bad low and hurt someone or youself, that's a danger. It effects the BRAIN, lows do, and everything else. If we're not 'reacting' to BG's in the 60's, have no symptoms, even in the low 70's...that's no a good thing, that's bad and clear path to hypounawareness.
“Normal” fasting blood glucose according to the labs at the local hospital are 60-105. I am an insulin dependant diabetic, and I also keep my fasting blood glucose levels within those ranges, successfully. Test a few more people… Recently another member on here mentioned a health fair at their workplace where he employees were tested and the MAJORITY of the non diabetic employees fasting levels were in the high 60s.
I agree 60 is sub- optimal… Especially with BOB… But it is not an unhealthy level. By yes I do believe levels in the 60s are normal for non diabetics…
Please see page 205 of this report for the 14-day CGM statistics on a glucose normal person. This person spends 5% of their time below 70 mg/dl and 2.4% of their time below 60 mg/dl. This duration and depth of blood glucose is low but it apparently representative of the range of a non-diabetic's glucose metabolism.
Diabetes is darn hard to control. If we can make use of the 60's in a fashion similar to non-D's then I say do it. I'll be the first to caution that anyone shooting for these targets better have their BG volatility tamed with a relatively low standard deviation.
Mainstream medical thinking may not now see any large marginal benefit to seeking A1c's sub 6.5%. Do you trust that the current mainstream medical thinking on this issue will hold firm as the years advance?
Just look at the exquisite BG control that a healthy glucose metabolism exerts: average 90 mg/dl, standard deviation of 15 (wow!), and an inter-quartile range of 17. The body knows what good BG is; it's plainly drawn on this chart. This is phenomenal control well beyond the current realm of tools and techniques available to the common diabetic.
But should we disregard this standard that's displayed on page 205 just because it's too hard to achieve? Or, perhaps we should hold it up as a target to aim for. Even though we know we can't be perfect, shouldn't we at least shoot for a worthy target?
To each, his/her own. I, for one, will be happier (and likely healthier), in the long run, shooting and missing a worthy target than shooting and missing a mediocre target!
I don't "aim" at the 60s, I aim at 85 and hit as outlined earlier in the thread. If I hit 60, I don't freak out. If hit 40 I freak out more. Sometimes a lot more so, of course, I try to avoid those. I'm not entirely buying hypo-unawareness, at least for me. I still feel pretty darn buzzed at 50-60. The main hazards for me are when I'm doing something interesting, e.g. kibbitzing or if I prebolus a lot, thinking "I've got 30 minutes" but I really have 20...