I’m sure it doesn’t work for everyone, but for me exercise is such an important tool. IF I want to treat myself to a more carbohydrate heavy meal, a run before hand keeps my levels almost flat.
In regards to the original post, a 4% time in hypoglycemia for me is actually my target. Ideally I’d like it even lower, but that’s still what I aim for. Ironically, it’s a level my endo and CDE set with me as I often struggle with too many hypo’s
Hm, I have to be careful with exercise. Brisk walking usually reduces my bgl, but more strenuous (and I’m never sure what the actual trigger is just circuits or running or weights) causes extreme highs.
My last a1c was 6.2 and my endo congratulated me on it, however he knows that I don’t like going low and we have discussed my low treating practices. That being said even if my Dr did not approve of my low a1c I would disagree with him and continue to do what I think is right for my health. BTW my libre for the last 90 days says I am below target 1% of the time but my 7 day report says I am below target 3% of the time so it absolutely varies and I am ok with that. I also agree with other posters and the OP that those percentage statistics on our cgms are skewed since they often don’t catch up or sometimes are just plain wrong.
Thanks for these insights! It’s also helpful to have the Goldilocks label for this situation. The basal level being too high is intriguing and seems weirdly counter-intuitive - I will definitely look into this. The other strategies are ones that I look forward to improving.
Ahhh … Aerobic v. Anaerobic exercise. The general rule is aerobic will typically lower your BG, while anaerobic will raise it.
As for your NP? Is this an endo NP? Does this person have credentials from AADE or the Endocrine Society? The advice you received sounds very much like a Primary Care Physician who doesn’t spend much time with T1Ds. There’s just so much wrong in the advice you received that it’s hard to know where to start, but it’s wrong in a way that suggests a poor understanding of the goals. A few highlights to me:
The ADA recommends an A1C of 7.0% … as a MAXIMUM! It’s been that for what seems like forever.
6.3 vs 6.5 is seriously not enough of a difference to care about. Granted there is some literature out there that points to diminishing returns once you start dropping below 6%, but as long as you’re not having a lot of severe lows, keep doing what you were doing!
4% of your time low and 1% under 65 is worthy of a high five (and your NP should have been leading the cheers)!
Virtually all docs in the diabetes space seem to have an inordinate fear of lows. IMO with today’s tools as long as you’re paying attention, the worry is minimized (and you obviously are).
Keep that low % and work on bringing down that 22% high range. There’s your real goal.
Adjust on your own? Yes! Absolutely! You are the expert on you. Your NP is your advisor.
Great post! I personally get arond the higher blood glucose for Anaerobic excercise by giving a small bolus prior to doing the activity. Having said that, it requires a level of discipline to then eat after.
I have heard people on pumps often increase their basal rates to get around this, I’m not a pumper though.
I wonder, does your Endocrinologist actually suggest you shouldn’t make changes at all without consulting them?
Yes, I’ve only seen the Endo once, and the NP-CDE 3 times. We moved last summer. The first appointment they both changed all my rates and I was very uncomfortable with it and the Dr was like “just relax, what’s a little higher in the grand scheme…we’ll fix it back later. You worry too much.”
The second appointment I got mildly scolded for adjusting on my own. The NP wanted me to upload to Carelink so she could tell me what to change…every time.
This time, I had changed everything again, but my numbers were much better than the first two times because I stopped waiting to see what would happen. She again said she wanted me to call her before changing anything. But I change stuff almost weekly depending on what’s going on. I always have. I’m not sure why they are so old school. The Medtronic trainer said they were “conservative.”
I just set my high alerts really tightly at 140, before making my ratios more aggressive or changing the AIT. So, I’m constantly microdosing. Today it has worked. I’m going to try to not mind the constant alerts. And then see what needs to be adjusted after 4 days. It looks like my AIT is 2.5 hours based on sugar surfing though. 
May not be PC but I would have told them to go **** themselves.
Good for you.
Don’t let anybody push you around.
Good for you!
IMO, you can’t be old school while using the latest technology.
Any health professional who mandates that a type 1 Diabetic must consult them before making changes to their dosages is dangerously out of date with their thinking on treating type 1 diabetes.
I don’t know what it’s like in the U.S, but I’ve never once met an Endocrinologist who thought I shouldn’t have autonomy in making dosage changes. In fact, I can’t even imagine how you could live with this disease without doing that? I re-evaluate what I’m doing daily if not hourly.
I don’t know if it’s possible, but if that is their approach I’d definitely be looking for another provider.
Update, so yesterday I bumped down my high alert and was able to mostly maintain an under 200 all day, I was so attentive with it though. Constant monitoring and correcting…which why is it not correcting on its own? Why does it not micro bolus enough to fix highs to 150 anyway?
Today it was 154 when I woke up at 6:15. Tried to bolus for correction. Wouldn’t let me. It started rising immediately, so at 6:50 when it was 180, I took a correction with 10 “caffeine carbs” added in. Still rose. I’ve taken 2 more correction doses and changed out my infusion set and I’m still riding 275 at 11 am.
So I downloaded to carelink and called the NP line and said “you need to look at this, something isn’t set right, I shouldn’t be fighting this hard and still have hyperglycemia. It’s beyond frustrating.” I’m going to make her look at it. And then when she calls I will say, “I’m going to make adjustments because I can’t have you do them every 3 days. That’s way too much on you and very inconvenient for me. Because I’m the one who feels sick to my stomach and depressed while waiting for you to catch up.”
This must be so frustrating for you - 
Welcome to my world. I have a endocrinologist who want my A1c around 6.5 and a nephrologist who want it around 7.5 because of Kidney impairment.
Why does the nephrologist want it higher than the endocrinologist?
That’s it. I’m done, done. I finally called the office again 4 hours later and talked to the front office. Because I haven’t been lower than 200 all day (while checking and dosing every hour) and am spilling keytones. And really wanted to let her know that it needed to be changed. They got a nurse to check with the NP. She said the NP reviewed my carelink upload and wanted me to change my overnight basal setting.
Y’all, I use auto mode and that is what she messed up on Tuesday… we didn’t change any basal settings at all.
I just changed all my settings back myself and called a different providers office. I’m getting a new endocrinologist. I’m so disgusted with this…and I know I’m cranky because I’ve got high glucose still, but that was completely unacceptable.
I didn’t read the entire thread, but I’m not onboard with diabetics on pumps (who ONLY should be on a pump if they understand all of the basics) not doing their own adjustments after a brief time upon going on one’s first-ever pump. This isn’t a disease that can be managed remotely or not in real time. That’s my honest opinion and if anyone doesn’t agree, remember, I’m only expressing my opinion and not trying to talk someone into doing things “my” way.
I am really so sorry you’re having such a hard time. When you meet with your new endo you might consider going over the question of whether auto-mode is for you. You might be happier playing with your basal, correcting when you need to correct, etc.
You’re going to get back on track and remember what someone on TuD told me when I was stuck in the 200s for a stretch - a 200 isn’t dangerous in the short run. You have a long life ahead and if you take back control all your good days will make this ugly stretch much less significant.
Maurie
A non-diabetic spends over 5% of the time under 70. Unless I’m consistently going under 60 I don’t give it much thought. I would much rather be at 69 than 169.
I once brought the results of a study that showed this phenomena to an endo who was trying to use my 5% under 65 mg/dL (3.6) as a warning to me. I showed her that gluco-normals often spend 5% of their day under 65. She then conceded that she wore a CGM once and this is what her numbers showed.
I wish I could say that this conversation extinguished her overly fearful warnings about severe hypos to an end, but that wasn’t the case.
I think 5% low with a low standard deviation can eliminate most of the danger. I know endos feel professionally obligated to warn us about severe hypos but I wish they’d give it a rest. I, moreso the most patients, fully understand the nature and threat that severe hypos can be. But I don’t count a hypo as severe until it falls below 54 mg/dL or 3 mmol/L.