Ideal a1c and "time in range"

I hope not @CJ114 . Unless you are being facetious? I’m definitely on the other side of the fence with the definition of tight control. Tight control to me is keeping my bg in range, neither high, nor low, and that time in range is … high.

This is not to say that I am enjoying such at the moment :grimacing: But, that’s a different story.

7 Likes

Not sure why you conflate “tight control” with TIR. Have you not read, or heard from your own doc how concerned they are with dangerous lows if you practice tight control?? Did you not look at the link I provided?

Depends entirely on what you are comparing tight control to. If you’re comparing it to running high all the time, yes, you will get more lows when in tight control, because odds are you will have some lows, vs having very few if any when running habitually high. If you’re comparing tighter control to having more frequent highs that return to in range regularly, my guess is you’d have fewer lows, because bringing down highs can lead to overcorrections.

1 Like

Sounds like you either didn’t read the link I provided, or totally discounted it.

No, I didn’t. I think you just missed my point, but it’s cool.

didn’t read it, or didn’t discount it?

Didn’t discount it, was just making a different point.

For me, in terms of both frequency and severity of lows, running high all the time definitely produced the least, and having tight control definitely produced more than that. However, what makes for the most by far is what I’d describe as roller-coastering control, times when I’m having more highs than when I’ve got things tighter, but am aggressively treating them with insulin. So depending on whether someone is moving to tight control from being more elevated all the time or from a roller coaster pattern, it may result in either an increase or a reduction in lows, especially more severe crashing ones—when I’m really doing well with control, I do have lows, but they tend to be far milder because I’m not usually dropping fast, and those just aren’t concerning or disruptive in the same way.

2 Likes

Generally, tight control, or alternatively intensive management, often brought with it more hypoglycemic incidents. TIR is slightly different, similar but more recent, so that rather than trying to keep blood sugars as normal as possible, it expressly avoids highs and lows. For me, it implies a tolerance of slightly higher BG, with the understanding that lows can have more, or at least different, negative effects.

The latter has come about with the advent of CGMs, and for some of us, better TIR means lower average BG, avoiding lows and rebound highs, and alternatively, lows from overcompensated highs.

Note: I didn’t realize until after writing this that this is an old thread, but from some reason it was in the top of the topic list, so I responded to it. Since I wrote it already, I’m leaving it…

I am not a type 1 and am waiting to get a CGM, but I have a lifetime of experience with electronic measuring devices, calibration and use. There are definite differences between finger stick BG and that from sensor measuring glucose in the interstitial fluids. There is a lag in the changes. From what I’ve read it can be anywhere from 5 to 17.5 minutes. I’m going to post an interesting snip that does a pretty good attempt at describing the difference between Sensor Glucose and Blood glucose. Interesting which one lags the other depends on whether glucose is rising or falling. Supposedly CGM software attempts to compensate for lag.

I already know that if my insurance approves a CGM for me I will continue to test BG with finger sticks especially if the CGM looks a bit off.

When on the rise, the BG value is greater than the SG that follows behind it. But when moving down the tracks, the BG in front is now less than the SG value.

A few points to remember when using CGM with your MiniMed® 530G with Enlite®:

  • SG and BG readings will rarely match and are expected to be different
  • A greater difference between SG and BG will be seen when your glucose is changing quickly, such as after eating or after taking a bolus of insulin
  • And most importantly , always confirm with your BG value before deciding to correct a high or treat a low glucose
    Why Sensor Glucose does not equal Blood Glucose | Medtronic Diabetes

I don’t want anyone to be discouraged from using a CGM- we just must be aware of the short comings of any measuring device. I tend to think in terms of trends. I will be glad to get a CGM so that I will feel more comfortable when I am on my road bicycle. I am not usually hypo unaware, but I had one experience on my bike that put the fear of hypos in me.

I was on an easy, not training ride when I thought something was wrong with my bike. Fortunately there was no traffic as I was weaving from edge to edge. Anyone who has experienced hypos knows that the brain is stupid without glucose.

I was close to my cousin’s country store. I sat on a bench and tested 40mg/dl, I ate glucose tablets and it got up to 60, I ate more and got to 70 but still shaky. I went into the store where Teresa was cooking. She knew I wasn’t well. I told her I just needed some time, but the smell of the bacon was a delight. Make me one of those bacon sandwiches and maybe I can ride home.

Sorry for the long post, it is a personal fault.

3 Likes

Successful management with TIR as the primary tool directly reduces blood glucose variability.

With variability reduced one can lower average BG without increasing risk of hypoglycemia.

This is a powerful truth about TIR that could be better absorbed by both people with diabetes and their medical professionals.

3 Likes

It looks like you responded to my post, but I’m not really sure. Was that intentional?

That’s great that you’re getting an Cgm. I’ve never used a Medtronic cgm, but my Dexcom cgm has definitely been helpful and it’s actually very close to the bg value on my meter most of the time. There’s a lag of about 10 minutes, so if I’m falling or rising the cgm value will differ from my bg value. Otherwise, the numbers are generally quite close.

Yes I intended to reply because of this:

This particular statement makes no sense. If your bg was 168 and the sensor showed 72, then the sensor was incorrect- point-blank. Eating faster-digesting sugar would only raise your bg value more. It would have no effect on the accuracy of the sensor.

I think that the sensor was just not keeping up fast enough with the change in BG.

As to Medtronic, I know they are pump makers, pace makers (my wife has one) and I used their equipment in maintaining gigantic lead acid batteries in telephone central offices. Actually I just got word, I am approved and will receive a Dexcom G6 soon.

I was replying to the above idiotic statement made by laceyma’s nurse practitioner.

The lag time is certainly a problem, but if laceyma’s meter says her bg levels have come up, then she doesn’t need more sugar. Her sensor is just lagging.

2 Likes

That lag is only 5 min. That’s the time it takes to go from blood to interstitial fluid.
The cgm will calculate for this. So it come out sort of real time.
There is no big lag that will be causing a delay though.
I find my sensor reading pretty spot on. Even when I’m low
But if I feel low I take some carb immediately. I don’t wait.
Yesterday I was hiking my cgm said I was 74, I felt low so I ate a carb gel. And I bounced to 133 very fast.
I didn’t have my finger stick meter with me. I checked at home. I was 87 and it read 90. No idea about earlier but carrying some carb is still a good idea

I misread lceyma’s post, Thanks for humoring me with an explanation.

1 Like