Someone on the forum, different thread, raised some eyebrows when she wrote something along the lines of ‘more time in range, higher glucose’ as a positive, and to some degree she was right. For many of us - not all, since some have both very low A1c and high TIR - a slightly higher average glucose translates into a higher TIR, avoiding excessive lows and the rebound highs.
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I try to stay between 60 and 145 with most of my time being spent between 80 and 100. I can reach 145 before I jump on the exercise bike after breakfast or lunch. I never drive when I am below 85 or 90. I suppose some people would be alarmed that I regularly go down to 60, but I have had very low A1c’s for a very long time so a 60 doesn’t usually affect me too much. I have never been hurt by a semi low, but I have been hurt badly by highs throughout my life.
Some folks can go through their diabetic lives with few complications from higher A1c’s but that didn’t work for me, I wasn’t that fortunate. I have to have a non diabetic A1c and at least 80% TIR in order to keep complications at bay.
Everyone is different.
Below is a screenshot of my Tandem tconnect CGM summary data for the last 30 days. Clearly I’m not anyone’s idea of an exemplar of well managed diabetes. But this is the life as I am living it.
Note that 400 is apparently the point that the G6 CGM maxes out. I assume my actual BG was higher during the period that CGM value was recorded. 
John, most of your readings are very good!
The way I live my life would be a real pain to many if not most people.
In the past I do not think I went to extremes as much as I do now. For roughly the last year (?) I’ve been having problems with insulin absorption. My t:slim x2 C-IQ pump routinely posts this “Control-IQ High Alert” warning message.
“Control-IQ has increased your insulin, but your sensor readings remain above 200 mg/dL. Check your cartridge, tubing, site, and test your BG.”
While I am not sure what the heck is happening with the insulin, I do not believe there is a simple occlusion. I have learned that if I simply wait “long enough” my BG eventually (slowly) drops.
I have always rotated my infusion sites and I am not aware of having any scar tissue. (Though I also can’t seem to find anyone who can tell me how to detect the presence of scar tissue. 
)
So I don’t know what the heck is going on with my insulin absorption these days. But one of the consequences is that my BGs have tended to go from one extreme to the other. I’m trying to bring them within a tighter range, but it’s a process with no apparent easy solution. 
But my situation does illustrate that Tandem’s C-IQ is not a panacea. If you have a body that responds well to infused insulin, then C-IQ may give you great results. If you have a body like mine that no longer responds the way C-IQ assumes it will, then C-IQ can be more of a “meh”.
I am so sorry to hear this John. This sounds very frustrating.
Thanks for the input, Marilyn. My ethnic background is Jewish Russian, Rumanian and Lithuanian, so I guess that’s kind of northeastern European.
I had a wonderful hand surgeon who did my carpal tunnel and trigger finger surgeries. Since the Dupuytren’s wasn’t that advanced, he recommended not doing it until I was much older, since it can come back. I had read about aponeurotomy and he and I talked about it…he didn’t do it at that time but, after we had several long conversations about it, he actually went to Florida, where many doctors are trained in it, and learned how to do it. Sadly, he retired a couple of years ago, and I wasn’t yet ready to do anything.
Not sure if there’s anyone else in the greater Boston area who does it. There was a surgeon in North Adams who did it, but that’s about a 5 hour drive from here. There are a couple of docs who do the Xiaflex treatment, but I haven’t heard good things about it.
Nice that you haven’t had any recurrence in several years…that’s awesome!
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I kind of enjoy the challenge of TIR. I have managed 5 days straight in range 100 percent however it requires quick thinking.
Since moving to dexcom/tslim i have cut off the highs and limited my lows by a lot.
My a1c has been around 6 for 6 months now.
But it really depends on what you call in range. I go by 60-179.
However I aim for 80-125. I’m probably only 50 percent in my optimum range.
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nice work!!!
Palpate your infusion site areas. If you feel any lumps or bumps under the skin then that is scarring. I have quite a bit of scarring and was worried pump therapy wouldn’t work for me. However I find my absorption to be the same on a pump as on MDI which is not great or reliable but the algorithm does eventually handle highs although I do go low more than I would like from exercise which so far nothing has seemed to fix.
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I remember reading magazines & posts years ago about people in the low 5’s, while I was happily maintaining it in the mid-to-upper 6’s with a lot of exercise. Continuous glucose monitoring, started 18 months ago, changed everything. Have only been above 6.0 once since and most recent was 5.3. Knowledge is everything.
4.5 - 5.6 is normal range for non-diabetic.
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I have been a Type 1 diabetic for 55 years now and on a pump for the last 5 years. Since I started with the pump, my A1cs are typically between 6.0 and 6.5 However, I have no idea what a “typical” value would be. That is just my experience and mine alone… (As a side note, I have no complications from diabetes.)
My lowest A1c was 4.7% and my most recent was 4.9%.
My A1cs consistently run about ~.5% below the value predicted using my average bg level.
My 30-day agp report is below. I spent 5% of my time above 160 and 1% above 180. I’m happy with 1% below 55 and am working to reduce time spent in the 55-65 range to 2-3%. I don’t remember the last time I had a severe low- cgms are lifesavers.
I use Afrezza, Humalog, and Lantus. I’m overall happy with my circumstances and control levels but am considering a tandem pump to try to get my overnight numbers in a tighter range - ideally 80-100. However it looks like the Control IQ will only target 110, so I’ll probably wait until something comes out that will let me target lower. I also will want to retain my access to Afrezza if I switch to a pump because I think it is very helpful when planning is difficult.
I’ve had diabetes for 25 years and no complications yet. knocks on wood
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Ken, you have escaped frozen fingers, locked fingers, frozen shoulders, and carpel tunnel? You have been very fortunate!
My lowest was 4,4%. I participated in a medical experiment and was told that my bg should never go higher than 6 mmol/l (108 mg/dl). So I did. I used a pump and regular bg-meter at the time.
First of all, congrats on your excellent glucose management. Your case complements mine where I run ~0.5% higher than my average glucose level suggests. This shows that the A1c is not a precise indicator of glycemia as its one tenth of a percent resolution implies. TIR is a much more reliable measure. It’s also more useful to inform improved glucose management tactics.
Do you ever calibrate your Dexcom? If so, what glucose meter do you use? Do you ever compare your glucose meter to a lab-drawn plasma glucose measurement?
I, too, like Afrezza, but after finding out that my insurance will not longer cover it, I’ve learned to live with fewer doses of it. I went from averaging 4x/day to 1x/day.
Your skilled use of MDI to produce the numbers you report is impressive. I suspect if you applied the same diligence to using a pump, even one without an automated delivery system, that you might improve with a lower average and less time spent low. I do, however, consider your current time spent low as reasonable and acceptable.
If you consider the actual time (instead of a percentage) spent hypo, it does color your perception. Every percent equals about 14 minutes. Four point three percent comes out to about 62 minutes. It looks more significant expressed that way.
Mitigating that number, however, is your relatively low glucose variability. If you are hypo and live with large variability, the situation is much riskier. Your use of a CGM and also paying attention to its data stream makes your time spent under 65 mg/dL safer.
Your risks represented by time in the < 54 mg/dL range rise significantly. With a 0.9% time < 54, that means you spend, on average, 13 minutes per day in this much riskier zone. Anything you can do to reduce this time is worth the effort. Your CGM use and vigilance soften even this risk but it’s worth keeping it down, if possible.
I often find that time < 54 occurs at a similar time each day and making adjustments can reduce my time in this riskier zone. I hardly ever am able to reduce this number to zero without materially degrading overall performance. I favor keeping the < 54 number to <= 0.3% (< 5 minutes average/day) as ideal.
Terry, I have been down in the 40’s and even 30’s many, many times, and when younger I am positive that I was in the 300-400 range quite a bit.
Now I know what those high numbers did, but how have the low numbers harmed me? My memory at 70 isn’t quite as good as it once was. I seem to be struggling with word finding, but so are my non diabetic 70 yr old friends.
I really don’t think I have lost IQ points, I have never blacked out completely, and have only needed someone else’s assistance a handful of times in 63 yrs.
I certainly don’t like spending time that low, but how has it actually harmed me?
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I can’t answer that question, Marilyn. One thing that worries me is the possibility of a hypo triggering a heart arrhythmia. An extreme case is the “dead in bed” syndrome of teen T1Ds.
I also worry that whatever counter-regulatory (to counteract severe lows, < 54 mg/dL) systems that have protected me in younger years are now wearing out. It would help us if out natural glucagon production could kick in when we drop low.
We all know with visceral certainty that a severe low is a stressful event. While the human body can endure many stressful events, it can sometimes trigger more serious situations.
Oh great Terry4, give me something else to worry about! LOL Thank goodness at night I am usually steady at 80-90. Occasionally I will drop to 65 or 55 but I am woken up immediately by my CGM. This works when my CGM is actually giving me accurate numbers which it doesn’t at least 50% of the time.
Since I was a little kid, I have always had glucose on my person, I have healed my ability to feel when my levels are falling so I am always hypo aware, and I never purposefully skipped an injection like many teens do.
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I didn’t intend to alarm you but T1D, as you well know, does not play nicely!
I’m sorry to read this as I enjoy much higher dependability with my CGM. I can rely on “accurate enough” data well over 95% of the time. Your restored hypo-awareness is a blessing and it doesn’t need any charging or calibration.
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