I got started on a CGM 3 months ago and worked dang hard to get good numbers and especially hard on staying out of hypo range. I set my CGM to alarm at 75 so I could stay above 70 nearly all the time. And I worked extra hard to make sure Clarity would say my hypo risk was “MINIMAL”. Which is a little tricky because as average bg gets to 125 or lower, it seems to harder and harder to hit MINIMAL.
So I go into the endos office, super proud of 91% TIR, just 2% of the time below 70 (to tell you the truth, half of that 2% was sensor wackiness in first 12 hours on non-presoaked G6 sensors)… and the visit largely consists of getting lectured about one day in my data a month ago when I spent maybe half an hour in 60-70.
So flatliners… is it actually possible to run an A1C in the 5’s and actually spend 0% of the time below 70?
Most annoying! I feel for you. My CDE harped on lows consistently, too, until I told her that lows invariably go hand in hand with highs and that she should be concerned and helping me avoid the highs. She looked at me funny and has since laid off on the lows. I think all health professionals’ diabetes training centers on the dangers of lows, which are minimal with today’s technology. They have nothing to hound you about otherwise.
I had the same experience. My CDE didn’t like the lows. She said being in range 70% of the time or more is what I should aim for. I was in the 80s. Also I had a list of maybe half a dozen lows that according to my meter were not lows. Since I go every 5 months to make sure Medicare is happy I will put up with her not liking lows. She’s helpful otherwise. I will probably go armed with more meter data next time. I’m impressed with your numbers.
There was a brilliant post not long ago equating T1 to walking a tightrope not for a few minutes but 24/7. Basically it’s impossible not to fall off the rope. On your next lecture ask this fool if he or she could walk a tightrope not for 5 mins but 24/7 without falling off - If that does not get their mind right nothing will.
Some of us cannot feel our lows anymore (and cannot afford Dex and its alarms.) Speaking of alarms, the thing I worry about is that if too many diabetics are running that low, what happens if you are all of a sudden at 40 or 50 and cause a car accident? They are going to start blaming us for being road hazards. Just sayin, people need to know their safety zone. I see bright flashing lights at 60 and mentally slow way down. No way could I drive at that level.
Two things on this: one is that, to be fair, their deepest training, the hippocratic oath, as it is usually summarized: “First, do no harm.” The second is a strong corollary to that, but more complicated, and something we T1s kinda take for granted but is in fact very peculiar if not unique: they are prescribing us a dangerous, potentially deadly drug, and totally relinquishing control over how much we dose ourselves with it to us.
Taken together, those two things add up to something that goes strongly against the medical grain. One can think of other dangerous pharmaceuticals that are only administered under direct medical supervision, and not a few more that are left to the patient to self-administer but at a set, medically-declared dosage and time of day. But none of those constraints apply to insulin, where there’s just no way to do it but to let the patient administer it him or self, at varying amounts multiple times a day, 24/7/365, according to formulas subject to multiple variables environmental as well as biological, each of which is subject to change day by day and hour by hour. In effect, we have to train ourselves in a medical discipline that is outside the training of non-specialists (and even some specialists seem to be fairly clueless), whether we have any particular scientific bent in our nature or not.
And whereas the risks of running high are, up to a point, pretty long-term, the risks of overdosing are severe and very rapid, so that “do no harm” thing kicks in pretty strongly on the “look out for HYPOS, ya idjiot!” side of the equation.
I totally share the frustration from our side of the fence, but I do get where the hypo-fear comes from on theirs. I think it’s analogous to how parents of T1s feel when they have to send their kid off to school and trust her to manage it on their own. No matter how well trained they are, it’s just a sketchy situation from the caregiver’s side.
I have had hypos. I have never needed assistance. I think our ability to respond appropriately to a hypo varies with the individual. Night hypos and the fact that I live alone a half mile from the nearest neighbor is the reason I got the t.slim x2 with Basal IQ. Not sure I want it. Not sure I need it. But it can’t hurt to have it.
I think the author misunderstood the definition of a severe hypo vs a hypo.
BTW: I have been to ER twice (unconscious on the way) for hypos in my past 37 years as a T1. So I think I appreciate at least some of the risks of hypos as well as what an example of a “severe hypo” might be.
Unlike the author of that article! However I can see how even a medical professional, even one who supposedly specializes in diabetes, might not be familiar with the risks and incident rates in the same way you or are I are.
The endo I’ve had for the last year has yet to lecture me about hypos even though I freely admit to having one or two a week. That being said they are rarely severe and I haven’t needed assistance with a hypo for years. My below 70mg/dl percentage is 3% for the last 90 days and that is pretty consistent with my usual control. My A1C’s are usually in the 6’s but the last 2 have been in the 7’s and our appointments have been focused on trying to figure out why that is.