I’m wondering how often those of you who try to maintain fairly tight control on their numbers go too low? (And then what does “too low” mean, for you?) Especially those of you without a pump who do MDI (but for those w/ pump I’d be happy to hear your thoughts as well). I know 80 is a great number to be at while fasting, but it’s so close to going hypo it’s hard to do (I find).
I try to be 80-110 in between meals and 70-100 overnight, and I don’t even care that much about spiking after meals, as long as I’m maximizing my time in range, but I still have to deal with lows and it’s so annoying, I hate feeling that way. Usually for me the lows are during the day, because I just took too much Humalong for the meal (overnight’s not so much of an issue sincee I go to bed 5-5.5 hrs. after eating dinner, so my numbers are pretty stable at that point.)
(To clarify - I do not go to bed with a 70 blood sugar. I just mean that I try to not bottom out below 70 overnight, which hardly ever happens if I’m 100-110 before bed (often I bottom out around 80, sometimes higher), but I also do not want to be much above 100 for eight hours, given the body likes it best at 80 for fasting. So I try to have a good fasting blood sugar overnight, which I think is reasonable (and attainable).)
Of course I never TRY to take too much Humalog - I keep very careful track and records of all my meals/insulin/#s, and base my insulin dosing on past experience… and still… ugh. I think I’m getting better, there’s just so much variability and it’s such a slow learning curve (10 months into my diagnosis)…
Regarding lows, I think about it more in terms of how long I’m hypo. I really try to limit my time in the 50s, and I try to avoid 40s altogether. I feel like multiple brief excursions into the 50s aren’t as big of a deal as an hour in the 40s. Obviously I don’t want to aim for either, but I’m just saying that I think limiting the amount of consecutive time you spend really low is really important.
People without diabetes spend time in the 60s, so while I don’t want to hang out there for a long time, I don’t think it is unhealthy to be in that range.
I use a Dexcom cgm, and my target #s are <1% of the time below 55 and <4% below 65. I usually meet these. It is more challenging for me to meet the second target.
I aim to keep post-meal spikes below 150 and always below 180. I’m not perfect, but I generally do pretty well with these targets.
I primarily use Lantus and Lyumjev. I also use Afrezza sometimes.
I’ve had diabetes for 25 years, and my average bg level is around 110.
I think there are many factors that influence what goals are set and at what times. As more people get “smart” pumps that use cgm input to increase/decrease insulin delivery, then lower goals can be achieved.
If some is on mdi, and has very unpredictable schedule of work, exercise, meal timing, sleep hours, etc, they would likely use higher targets.
I am using Tandem pump with Control-IQ, which uses dexcom cgm reading to add or reduce insulin delivery, so before I even know I’m trending low, pump reduces basal, and don’t have to do anything to get back in range.
But if I were on MDI, I agree with your comments, which I did while on previous pump and MDI with older insulins 30+ years ago.
For sure - I know I can aim for tight control because I (fortunately, since that’s what I like) have a very consistent schedule. Anytime I do have more activity than normal, I need to aim for higher bg’s for just that reason. Thanks for your thoughts!
That’s actually where my Clarity numbers are as well, as far as time spent below 55 and 65, respectively (actually I stopped using Dexcom b/c it was too inaccurate for me - so who knows, probably those percentages weren’t even totally accurate, for me personally; but that’s what it said).
So when I do go low (for me definitely below 70 - I don’t even like going below 80 during the day, b/c I can feel it and am already so tired of that feeling) I nip it in the bud immediately, so I don’t spend a whole lot of time low, I just hate going there in the first place. I too have read that normals go down to 65, sometimes even lower! (They also spike way more than people ever realized, which is why I don’t worry too much about post-meal spikes, but more so about hanging out above 140 or so for hours. I aim for below 180 as well, but there are many days of the week I hit that, and sometimes above. But I make sure to get back down!) Anyway thank you for your input.
I try to stay between 65 and 150. I eat much of the same sorts of food every day and exercise an hr a day. I rarely count carbs, but know that I eat about 275 healthy carbs a day. I hate going down in the 40’s and try not to hit the 50’s very often. I stay there for just a very short period of time.
I am very strict about what I eat and how much exercise I get, just because it is easier to control my diabetes, and takes a lot of the hassle out of it. I have been a type 1 for 62 yrs. I keep my A1c about 5.1 but am questioning whether that is necessary. Not sure what I would change though in order to have a higher A1c.
My range is set for TIR is 65-160. However my alerts are set at 80 and 130. I aim to stay around 90-100. Under 60 and I can start to feel it so I try to start correcting usually if I go below 70. It’s usually because of guessing wrong at dosing or mistiming of dosing or dosing and exercising because I see my numbers going higher than I want but I’ve already dosed and I get on my exercise bike to stop it.
I usually like to be at 95-100 before going to sleep as sometimes I like to drop in the wee hours and that gives me a little cushion.
Thanks for your response! It’s great to hear from someone who is able to keep their #'s where I aim to - especially o/night. I feel more motivated now. It sounds like most T1’s deal with lows (i.e. under 70) somewhat frequently (like, a few times week maybe?), it’s just a fact of life you just have to deal with if you want to keep your numbers from staying too high overall… ?
I think our target bg range is like the lines on the side of roads. We aim to not cross them, but don’t get too upset if we do. Its a good “safety net”. (My other analogy is walking a tight rope. Few people can do that without the help of a balancing bar, and don’t beat themselves up when they need to use it!! )
This is a little weirder one to answer. I had to think about it. So I played with my numbers on clarity.
I probably drop to 65-70 pretty consistently, I’m not at all sure as I haven’t really paid attention to how often I go there? I am really only concerned about trying not to go below 65 because I screw up my TIR or not going below 60 because I don’t want to be.
But if I look at my reports right now , I am
65-160 is 97% 1% low 2% high
70-160 is 96% 2% low 2% high
So 1% of the time I am between 65-70? 1% between 54-65. (less than 1% below 60, never below 54) That 2% high I think is snorkeling as I used to never be high. DP will cause it too. But after 2 hours of snorkeling my numbers shoot up and it’s a stubborn high. I am experimenting what to do but I don’t want to get close to being low because I’m out in the middle of the ocean and prefer not worrying about it.
My endo never says a word about it as overall my numbers are good, I think she uses 70-180 and I’m at 97% TIR in those numbers.
Great numbers - kudos! Thank you for your input. It seems even with the best of control, going low can’t be totally avoided, but can be kept under 2% (which I do already, since as soon as I’m low I correct, I just hate having to!! And it can screw up a bolus for the next meal, too…). Anyway, I know it’s a constant-management disease, so I guess all that’s pretty much what I should just expect to have to deal with from now on…
I aim for tight glucose control and am fairly successful in my quest yet I’m far from perfect. I leave the perfect performance to those with a working pancreas!
The International Hypoglycemia Study Group produced a report in 2017 in an effort to standardize hypoglycemia reporting in clinical trials. Here are their recommendations.
Proposed glucose levels when reporting hypoglycemia in clinical trials
Level 1
A glucose alert value of 3.9 mmol/L (70 mg/dL) or less. This need not be reported routinely in clinical studies, although this would depend on the purpose of the study
Level 2
A glucose level of <3.0 mmol/L (<54 mg/dL) is sufficiently low to indicate serious, clinically important hypoglycemia
Level 3
Severe hypoglycemia, as defined by the ADA (6,7), denotes severe cognitive impairment requiring external assistance for recovery
My current 14-day Clarity report shows < 0.2% time at < 54 mg/dL (3.0 mmol/L), defined as Level 2 above. My goal is 0% and I find < 1% as acceptable. This is an average and I can often go two weeks between these more serious hypo events.
Level 1, measured as < 70 mg/dL (3.9 mmol/L), is defined as an “alert level.” I shift this threshold down to < 65 mg/dL (3.6 mmol/L) because that’s the level that I start feeling symptoms.
As I’ve written elsewhere on this site, I think we are all better off thinking about reducing glucose variability before considering absolute glucose levels. If you first reduce glucose variability then you’ll find it possible to safely reduce hypoglycemia and increase time in range.
Zero point two % of my time is at < 54 mg/dL. That’s equivalent to about 3 minutes/day. This does not trouble me since my low glucose variability (standard deviation = 18 mg/dL or 1 mmol/L and coefficient of variation = 17.9%) means that my glucose trace approaches this dangerous hypo range slowly, at a very shallow angle. In other words, I have ample time to get a warning and do something about it.
I have lots of lows, everyday, it is just my normal. I prefer to be lower than high, a lot of people do. My bg swings a lot sometimes rapidly.
Lately I don’t always treat a low and I have found they often come up themselves, lol. Yesterday I was shopping, dex beeped a bad low coming on, I meant to test etc. but forgot, I did turn off basal for a bit, then I went home and realized as I was driving home I had forgotten about it. Dex said it went up to 70’s when I got home, fs was 65 later on before dinner. I drank some juice before eating.
A pump is much easier to manage all of this if you have my type of bg issues, Turning off basal is a miracle really.
