Exactly. If you never get below 80…you aren’t capable of 100-120 enough!
I never worry about being low if it’s above 55, I mean I treat it and it doesn’t feel great…but to me it isn’t as dangerous as being hyper and getting sick (nausea) because I still have the cognitive ability to treat and feel better in 15 minutes vs. 5 hours if it gets above 200.
All - Thanks for the insight and encouragement! Thanks for listening to me vent while “hyperglycemic-grumpy.” I’m glad I’m not out of line on my reasoning or dosing strategies. I felt pretty good with my assessment of the results at this visit and know I can do even better by treating rises a bit more proactively!
As others have said, find a new endocrinologist. She is living in the past, when there was an A1c debate debate (target 6.3 and below) vs. 6.5~7. However, that debate was settled on the lower values definitively in a paper published roughly a year
ago. (My Endo was one of the researchers determining this much longer ago and has been taking this position for some time, my A1c in the 5.4~6.2 range most of the time Type 1 for 56 years).
Alsso, she should have immediately reviewed your bG/carb intake records and DME settings to look for indicators of changes needed.
There are other steps and tests she could/should have taken, but it sounds like she would be unaware of them.
PS. Research your next Endo before you make an appointment.
When I went on my pump My Endo was not consulted with regard to Settings. My Medtronic trainer (a T1 for 30 years) and I decided on my Settings. I now periodically make changes which I subsequently advise to my endo. He occasionally makes suggestions, but I am in control of my Settings.
I sometimes constantly change my settings, like right now I have 3 basal programs, I just started a 3rd one again as I wanted to make several more significant changes and wanted to be able to flip it back right away if it didn’t work.
When I first got my pump, I read through the instructions and set up the settings before the rep trainer came, but I hadn’t started using it yet. She came with a list of settings from my endo to set it at and said that she wasn’t allowed to deviate from it. Needless to say I said I’d keep mine in it. I had allowed for the fact that I liked to drop between 2-3 in the morning and that I had dawn phenomenon so I needed more in the wee hours. My endo didn’t say a word about the different settings when I saw her next as she’s a type 1 and I’m sure well aware of the variances that can occur!
Remember, only 17% of young t1’s are under 7 and 21% of adult t1’s are under 7…and the reason they changed it was to reduce the amount of hypoglycemic deaths. When you are hypoglycemic more often, your body will develop unawareness, which is very dangerous. If you are around 100 mg/DL and run, or engage in heavy activities, you’ll be hypoglycemic… however, if you start at 180 or 150, you’ll probably end up at 100 which us safer. Also, when I spoke with the Dexcom representative, he taught me their unit uses interstitial fluid, which is slower than blood but the reason it is revolutionary is it will give arrows to help you manage your diabetes. It seems like everyone expects their cgm to be 100% accurate all the time, when the glucometer manual tells you it may be slow during meals or insulin…
Here you go, @Donman90. The paper, published in 2013, is entitled, Recommendations for Standardizing Glucose Reporting and Analysis to Optimize Clinical Decision Making in Diabetes: The Ambulatory Glucose Profile [AGP].
Here’s the “gluco-normal” AGP from the cited report. Note the 2.1% of daily readings < 60 mg/dL (3.3 mmol/L). This is > 30 minutes on average each day and commonly occurs in the 4:00-8:00 a.m. time frame.
That’s very interesting. Note that this was just one non-diabetic. However, the footnote does link to a study of 32 “normies” with somewhat similar results. They were under 70 2.7% of the time.
Here’s the relevant portion:
NGT subjects (n = 32) had a mean CGM of 102 +/- 7 mg/dL, ranging between 94 and 117 mg/dL and averaging 105 +/- 8 mg/dL daytime and 97 +/- 6 mg/dL overnight. Glucose variability, as expressed by the interquartile range, was 21 +/- 4 mg/dL (range, 14-29 mg/dL). Stability in glycemic control (hourly change in the median) for NGT subjects averaged 3 +/- 1 mg/dL/h. Subjects with diabetes (n = 30) were significantly higher on all glycemic characteristics with the exception of the percentage of hypoglycemic (CGM <70 mg/dL) episodes for type 2 diabetes (2.9%), compared to 2.7% for subjects with NGT.
I have also had success using principles from Bernstein Diabetes Solutions and his utube series Berstein Diabetes University. He is strict low carb, but he also has heaps of information about use of insulin and other meds that can be useful even if you decide not to go as low carb as he recommends.
LOL. And I disagree with your disagreement. AFAIK, it is common knowledge, and my decades of experience that “tight” control means more lows because tight doesn’t mean what you think it means; it doesn’t mean perfect numbers, it means the absence of habitual highs. Keeping one’s bg’s “tight” REALLY means avoiding highs. You can disagree with Marie and me;that’s fine. I just wanted to chime in on the side of what I’ve known the term means. Cheers!
I’m glad I’m not out of line on my reasoning or dosing strategies. I felt pretty good with my assessment of the results at this visit and know I can do even better by treating rises a bit more proactively!
