Lowest A1C you've ever heard of in a T1?

I take a more conservative position with regard to targets. What constitutes ideal? My answer is the experience of a healthy non-diabetic.

The clinician’s quickly conclude that that’s an unrealistic goal to target. My answer to that is if you’re going to target an ideal, why not target a really great number? While I may not be able to achieve what gluco-normals do without any effort or thought, the act of shooting for better will likely produce better results.

My sense of the gluco-normal glycemia is this:

  • Time in range 65-95 mg/dL = 90%

  • Time hypo, < 65, = 5%

  • Time severe hypo, < 54 at < 1%

  • Glucose variability < 15 mg/dL SD, and < 15 CV (SD/mean)

  • Time hyper, > 140 mg/dL < 5%

  • Average BG <= 90

I know these are lofty goals and I don’t often hit them but targeting them materially gives me better performance. For me, aiming at unambitious goals does not motivate. I’d rather shoot for the moon and accept the inevitable less lofty but still healthy metrics.

This is an individual thing; there is no one correct standard. The targets that cause you to reach for better are your best targets. But, once you reliably hit your targets, do you ratchet them up?

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My aim is 95% and less than 3 percent low. And 0 percent very low.
I’m not always able but I’m almost never less than 90 percent

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I’ve had Type 1 for almost 30 years (since childhood) and my A1c tends to be between 6.5% and 7.0%. I’ve had a few in the lower 6% range, but it takes an enormous amount of sustained daily dedication to achieve that. And if I ease off at all in my efforts my A1c easily rises into the 7% range.

I’ve found each piece of new technology has helped my A1c and overall blood sugar stability. The transition from NPH to Lantus was significant, as was the transition from Lantus to a pump, and the addition of a CGM years later.

I’m likely switching to the t:slim soon, and am hopeful that, just maybe, the closed-loop feature may finally allow me to get into the upper 5% range for the first time if I really work at it. But even if it just allows me to stay in the mid-6% range without having to devote so much daily energy to maintaining control, that would be life-changer.

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Control IQ definitely allows me to get A1Cs in the mid 6’s consistently without as much vigilance.

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Can’t give the medical definition of “harm” to you due to severe lows. What I know is that my endocrinologists over the last 20 years pay far more attention to the lows than the highs on my reports. And give me the most advice about avoiding them.

Sometimes a severe low can happen gradually over hours so that you don’t really sense it’s happening. The ones that happen relatively quickly are the most dangerous, I think, because you don’t know where the bottom is.

Giving a short-acting dose and forgetting about the time, anticipating a high carb meal and dosing accordingly, only to find you didn’t each much, stuff like that can cause dramatic drops…

Seizures, blackouts (especially while on the go), going into shock - I’ve gone to sleep in my own bed & waked up in a hospital bed and it’s not pleasant. The Effects of Low Blood Sugar on Your Body](The Effects of Low Blood Sugar on Your Body

I have had a recurring A1c of 5.3 for several years, aided by using Dexcom, Tandem pump with Humalog, and intermittent use of Fiasp for some carb-rich meals or treating hyperglycemia. I also try to walk at least 3 miles every day.

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Dave, I have great respect for lows which is the reason why I haven’t gone anywhere in 63 yrs without some form of glucose. I fully understand lows, and am very fortunate that I have never fully passed out because of one.

What I am saying is that in my life, highs have hurt me much more than any lows I have endured. Yes, a low could easily kill me, and that is why I am so careful, but for me highs, which I had mostly during decades of urine testing, have caused me more harm. In my opinion physicians should also warn their diabetic patients about all of the severe harm that highs can cause.
Hopefully most do. I haven’t used a physician to treat my diabetes in 30 yrs, so I don’t really know.

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