Had an office visit with my Endo this week and was so excited he would see that my latest A1C was 5.9. He really burst my bubble by saying it was too low. For the past couple years I’ve been in the mid-6 range and as low as 6.2. He was always excited to see that and that I had a high percentage of in-range with almost no lows. I’m completely mystified what has changed. He reduced my basal rates used by my Tandem pump and Control IQ. I’m confused and discouraged. For 23 years I’ve heard “tight control”. Will have a conversation with my cardiologist this week.
Dear goddess that is SO old-school. Totally a left-over from the pre-CGM period when finger-sticks and A1C were all we had, and A1C being an average raised the concern that anything below 6.5 or so was the result of too many hypos. I got yelled at about this too, but I associate it with R/NPH-MDI and other practices of the dark ages. I mean, there is a point to it if you are using older tech, but it REALLY has no business persisting if you have a CGM, which you clearly do if you’re running Tandem CIQ.
In other words you’re doing great; it’s your endo who needs to update.
I’ve heard that before.
It might be a little bit of a liability thing for him because its unusual for him to see that A1c, but as long as you aren’t seeing a bunch of lows, I would disregard his advice.
Do you feel healthy? Are you having lows? Those are the things you need to worry about.
There are lows in the reports but almost all are false lows that start day 7, 8, or 9. I only have 1 actual low every couple months. I feel fine. It seemed he was acting a little strange like I just caught him coming out of a strip club. I really don’t know what is going on. He has been progressive and aggressive about treatment in the past.
I would change your settings back to where they were I don’t know what you consider low but one reading below 55 every few months is spectacular control. If you mean you only dip below 70 every couple months with a 5.9 A1c that’s almost unbelievable.
If it were me, I would put the rates back where they were and ignore his comments. Besides, CIQ does not rely on basal rates much. I don’t think this endo is up to the modern technology, especially that offered by Tslim with CIQ. Don’t worry about him. You did very well indeed!
If you have cgm, then the risk is minimal in my opinion. I would keep it tight. This is your best defense against blindness and kidney failure
When I first moved here my A1c was 5.3 and my new GP said, be careful you don’t go too low. A month later I was seeing my new Endo and she didn’t say a word about it.
Since then I usually am around 5.1, with the lowest being 4.9 and the highest 5.3. Never a word is said about it, just I’m doing great. My GP never said another word about it and I just got a new GP and he said I have great control and my endo just keeps saying I’m doing great.
However I also maintain a 96-98% TIR and usually have less than 2% lows and either less than 1% or none at all very lows. I don’t put up with my Dexcom misreading lows. I check it and calibrate it as it has a tendency to want to try to trend below what I am at. I really can’t stand it putting the wrong low numbers onto a graph that I feel like I am being judged on.
They really want less than 4% lows, and some really don’t even like to see 3%. I suggest you calibrate your Dexcom so there are not false lows on your graphs. The endo has no way of really knowing they are false lows and that might be what is causing an issue. A low A1c can be caused by peaks and valleys versus rolling hills. Because that just means that new A1c is possibly being caused by too many lows from what he sees? If your graphs have less than 2% (possibly 3%) total under 70 and none or less than 1% under 55, then he shouldn’t be upset about it. You didn’t say what your numbers are. But it might be the numbers he’s seeing and a change that caused an issue?
My A1c’s have been 4.6 to 5.4 with one 5.8 for the last almost 20 yrs. Many of those years were without a CGM. If a person is careful these numbers are very doable without going too low. I’ve only had one doctor who thought my numbers were dangerous. She sent me to an endo who told her that my numbers were excellent.
Type 1 dx 1959
I am usually in the 5.4 to 5.8 range and My CDE usually suggests I should be a little higher. I have never seen her tell me to go away however. LOL I have been seeing her for 28 years.
I hear the same song and dance every time I go see my endo too. I am usually 5.0 - 5.2 (for YEARS) and she still complains. In one ear out the other for me, and I don’t allow any changes to my settings without a thorough conversation and a detailed reason. Even then the changes are minimal. My endo is extremely old school as well, and can barely grasp any new tech. The NP/CDE is much more in tune with the tech, and tells me I am going fantastic with my AIC, TIR and nearly zero lows. You can take a stand and have a serious conversation with your endo, or simply find a new one.
My team looks at the a1c and then looks at % of time I am under 70. And if it’s pretty small, I get no grief.
I usually run between 5.8 and 6.2. So I’m also not as low as many of you. If your doctor is worried about the low a1c then maybe point him or her to your time under70. No one has suggested I’m running too low for many years.
I used to be ecstatic over a 6.8 before cgm. Now if I saw a 6.8, I would be panicked.
Not saying everyone can achieve that, but I’m used to my lower a1c s and pretty much no one is going to convince me to let up on it.
They say not to look a gift horse in the face - I don’t quite know what that means but it is time to give yourself a huge pat on the back. Keep up the great work
The expression is Don’t look a gift horse in the mouth. If you look at the teeth of a horse, you can estimate its age.
So if someone gives you a horse you should just be grateful.
Clearly the endo dies not know how to manage T1D using a Tandem pump. It may be time to turn and walk and not look back. This is extremely poor medical advice on managing with CIQ. Judging the daily management success of bg using any AID or pump using an Algorithm I’d NOT done using the A1C, it is a subjective guess at what your average bg has been for the last ~90 days and is not capable of assessing daily management. CGM data and the pump activity data ard key to accurately assessing daily management.
You’re doing pretty great if the low % is less than 4, that’s what he should be looking at and if not the endo can do nothing but F—-up your health in general and your daily management.
Keep up the progress.!!!
There is a difference between actually having a A1C at 5.9 and having greater than 95% TIR, and having 5.9 with a lower TIR sub 90% for instance. If you have a lower TIR, your endo could then reduce your basal rates to try to keep you in range and stop driving you so low.
You could have so many lows that you become more resistant to the feeling of being low, which can also be harmful.
If your TIR is greater than 95% during your 3 month period than I would totally disagree with the endo.
Example, I recently had my A1C checked and I was 5.6 with the tslim x2. My TIR is 96%. My basal profiles are really well built, and my carb counts are very good.
What is your 90 day TIR on Clarity?
That is kind of a useless number unless you also specify your Clarity range.
My ClarityTarget Range, for example, may be quite different from yours:
Day (6:00 AM - 10:00 PM): 55-150 mg/dL
Night (10: 00 PM - 6:00 AM): 55-130 mg/dL,
Asking for a 90 day clarity range is a time range. the range should be the accepted glucose mg/dl 70-180, no matter what time of day.
Open the Clarity app. On the bottom go to Summary tab, and then at the top click on the 90 day tab.
You will be given a percent in range. That percentage is important to understand if the endo has a legitimate concern, or if people in this thread are encouraging against a legitimate concern.
Although time in range (for most people) recommended by ADA is 70-180 mg/dL to help keep individuals within a range that should minimize long-term complications, Clarity allows you to set your Target range outside of that parameter, which is what I do as it enables me to keep my A1C/GMI more in line with a non-diabetic.
Some of us have important reasons for setting our Target range outside of the ADA guidelines and we are very fortunate that Clarity allows us that ability. As technologies and medications improve, TIR can keep tightening up, even if the medical industry takes years to adopt a tighter standard.
I respect your opinion, but I thoroughly disagree. That is the definition of Hypoglycemia (55-65), and non-diabetic running in those ranges would only experience such blood sugar when being deprived of carbohydrates. If you experience that level of Hypoglycemia long enough, you will become immune to to the symptoms of Hypoglycemia. Although some individuals will pass out in those ranges and others won’t. You could be starving your cellular system glucose in an attempt to achieve an A1C number. This is no different than what I stated above, artificial lows.
The overall point is to understand the individuals TIR. Adding in custom criteria is a valid opinion, but doesn’t address the core question as to whether to the endo is providing legitimate concern.