"Poor Control " What does that mean?

As ya’ll know from my previous post’s I should say my GP didn’t give me squat to read or learn about diabetes and what to expect and what to eat and not eat:

I hear this term a lot " Poor Control"

What exactly is poor control?

Of course mine goes up when I eat but it always comes back down after 2 hours.

Would poor control be my BG still being high after 2 hours? I am guessing thats what it would mean, or should I say thats what I picture that it means.

Thanks,
Chris

Poor control can me a few different things.
My doctor says I’m well controlled when I don’t have any lows that I can feel. Meaning I’m not passing out or dizzy/ confused

That also means no blood sugars under 55

Also an a1c under 7.0. Mine has not been anywhere near that in a while, I generally run about 6.0 now.

Since I am on Cgm he has added a Time in range of 90% or better.

So if I have all that going on, he will note well controlled.
If not, he will write poor control

Wow. If 89% TIR is poor control then there are only a handful of T1s in the world who are not in poor control. My endo is overjoyed that I am often in the 85% TIR range.

A more typical goal is 70% TIR: https://care.diabetesjournals.org/content/42/8/1593

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In general, I think most would measure this based on A1Cs, and different people might have different A1C goals based on their circumstances and may change. For example, during pregnancy, women may aim for 4-5, as close as possible to non-diabetic range.

Here is a good article.

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I agree. Only my doctor draws the line at 90.
It wasn’t possible for me until I started on a looping pump.

In the old days, billing codes (CPT) were used that used the poor or uncontrolled terminology. I think the use of ICD codes eliminated or reduced use of the term poor or uncontrolled.

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That really depends on what you consider your range and where you set it. The wider the range delta, the better TIR you will have. I set my range between 55 and 120 on my Dexcom CGM and would set it even tighter if it would allow me to do it and I am at 97% TIR or better in that range.

That’s really astoundingly good. See below for scatter plot of 70 T1’s who wore a CGM and had their TIR and A1C plotted. Only one of the 70 had better than 90% TIR. Only about a fifth of them had better than 70% TIR. The majority of T1’s were below 60% TIR.

See here for full study details: https://drc.bmj.com/content/9/1/e001045

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Its all relative. I think a lot of people take issue with vague, highly judgmental statements like ‘poor control.’ Why don’t you ask the GP how he defines ‘poor control,’ and get back to us about what his issue is, specifically. He might not even know.

Whatever he says, we will prob just tell him to shove it.

I’ve come to understand that its a natural part of our illness that we need to periodically tell Docs to take their opinion and shove it. Learn to enjoy it because you will prob have to do it many times in your life. You can quit your job as a patient working for Dr Douche Bag anytime you want to. We’ve all met this guy before.

I recall posting this question before myself, once. The question was, fundamentally this, though, “Am I insane or is he insane?” Experience would lead me to believe that it is him. The fact that you do not know what he means by ‘poor control,’ means that he is not giving you any actionable medical advice whatsoever. He’s not saying, “I would like you to reduce the number of lows below 70.” He’s not saying, “I would like you to decrease your A1c.” He’s just being a judgmental piece of ■■■■. That’s unhelpful. You can pay your mother in law $1,200 an hour to be a judgmental POS and it would be money better spent. His job is to work in partnership with you to help make you a better diabetic.

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Let me make a more genuine effort here to define ‘poor control.’

I will define it as:

1.) Getting arrested for public drunkenness’ when you are not drunk. You have become some level of public nuisance or public safety threat. That’s a hallmark of poor control.
2.) A1c (around) 9 or 10 or above, depending on circumstances.
3.) Becoming a burden on the people around you. If the people around you are getting irritated, that’s a warning sign.
4.) You don’t feel good
5.) Lows are making it difficult to do the things that you want to do.
6.) Your at substantial risk of long term health consequences resulting from poor illness management.
7.) A lack of understanding (or diagnosis) of the illness is causing severe stress and/or unexplainable events (aka ‘critical failures’).

These are pretty universal ‘red flags’ that will manifest with poor control of any illness, not just diabetes. I use the same ‘warning signs’ for epilepsy that I use for diabetes.

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I think @CWM030 has type 2 diabetes, and it sounds like you may be asking:

“Is my current method of treating diabetes keeping my blood glucose levels in a good range?”

I think there are other considerations for people with type 2. People with Type 1 don’t produce insulin, but people with type 2 may want to address whatever could contribute to insulin resistance in the future. I am not type 2, but it seems like reducing insulin resistance is as important as keeping your blood glucose values in range.

People without diabetes have increases in blood glucose levels after eating, but their levels generally don’t go above 160 and usually peak more around 120-140. I think they’re back under 100 pretty quickly- within 1-2 hours.

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@katers87 Yes I am a T2.

Chris

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I really agree that it depends on what is decided as a TIR. CJ114 has an extremely tight range. Mine is 55-140. I try to not fall that low and at times I go over 140. Don’t some physicians use 70-180? I am almost never that high and I drop below 70 almost daily.

I would hate to have a doctor tell me what my TIR should be. If the doctor labeled me a poorly controlled diabetic, because of not having a 90% TIR, I would walk out and that endo would never see me again. He/she would lose one of the best controlled diabetics they have ever seen.

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Yes ok let me be more clear. My personal range is 55 to 160.
But my doctor uses the 70-180 to determine my time in range number. I’m usually in the high 90s on that scale so it doesn’t really matter to me.

If we are not staying under 180 then I have to agree with the idea taht it’s poorly controlled. Same as under 55.

We all get out of range, but it’s a matter of being consistent.

I think it’s much worse to simply tell a diabetic to stay under 7% a1c and be done with it. That used to be considered good control, but I don’t think it is anymore.

It might be good to pose the question
Do you think 89 percent in range for the scale 70-180 is well controlled?
I don’t think it is, but I’m not judging anyone against that level except myself.

Well, I wouldn’t use a TIR of 70-180. For many that would be great though, and who knows maybe it is good enough. 90% at 70-180 might be low enough to prevent complications.

That “poor control” was used a lot early on when coding for insurance. And I remember seeing it once after a doctor visit and was devastated! I was working so darn hard and getting no where. And I remember having a heart to heart talk with my endo asking why that label, when she and I knew I was working hard. And her answer was mainly to help fight with insurance companies to get the coverage I needed, ie number of test strips and pump coverage when we finally got to that point.

She was so helpful and supportive during my struggle getting a handle on things. We tried everything and did what they called “intensive insulin” classes. I did of course lose that label and got much more knowledge to help with that “control”.
This is one of those things that is very, very personal. My goals and your goals are going to be completely different! There is no right or wrong. And please keep in mind your goal now, might not be your goal 3 years from now. My treatment plan is always a work in progress. My goals now are completely different than they were before CGMs.
I mean really if your current a1c is 9, trying for a goal of 6 just isn’t going to happen. It will only cause you to beat yourself for not meeting those unrealistic goals. Talk with your team and ask what they think you should be looking at. Be ok with a higher number. Just because some here are running really low numbers does mean that is where you need to be. Find your “good enough”! I am very happy with my time in range numbers. Not as tight as some but it keeps me safe, it keeps me happy and it keeps my family and friends happy and not so worried. Find your good enough and keep redoing your goals as you get a better handle on things! Good luck!

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In my opinion this is a number we should get from our health care provider. 70-160 for me as she wants to prevent lows and falls. A1C 6.2-6.5 depending on season. I am active ,monitor my blood sugars. Eat pretty well. No CGM as Medicare blocks it. Nancy50

I’m puzzled by your comment. From the Medicare website:

If you use insulin and require frequent adjustments to your insulin regimen/dosage, Medicare may cover a continuous glucose monitor if your doctor determines that you meet all of the requirements for Medicare coverage.

I’m thinking that you either don’t use insulin or perhaps your coverage is a private insurance Medicare Advantage plan, not traditional Medicare. I think everyone with diabetes (even pre-diabetes) should have the option to use a CGM. There’s no better teacher for how your glucose metabolism works.

Hi, in order to have Medicare cover under any plan you must be on meal time insulin. There are no exceptions, the companies that contract with Medicare will not even process my application as I inject 1 a day and 1 a week. If you are not on Medicare ,you can get coverage to cover it. I also have right hand tremors ,low vision, type 2 ,30 years. Still denied. That is my story! Nancy50

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Thanks for the clarification. That’s unfortunate.

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