Ok, so we diabetics are always aiming to have a “good control” of the disease, our family, doctors, etc keep stressing that, but the problem I find is … WHAT THE HELL IS GOOD CONTROL ???
My Ac1 is usually around 6 but I get a lot of hypos, I test 8 times a day and still a few times a week I get 200s on my meter, when that happens I shoot some insulin.
I feel we try to get this “good control” but can’t really find it, can’t define it and this creates a lot of anxiety because we don’t really know what in the world we’re looking for.
What you guys think ? what’s your good control like ?
Love,
Santiago
GREAT QUESTION! Can’t wait to hear everyone’s answers…
Good question, Santiago!I think, like most things diabetic the answer is very individual. I think some of us just got stable blood sugars in the luck of the draw, and other people struggle all the time. Remember when we were kids sometimes teachers would use the designation, “most improved”? I think that was a very smart idea. Because for a student who for whatever reason got mostly "D"s and "F"s getting a C was a big accomplishment. Others were “A” students who were depressed when they got an “A-”. If we are lucky enough to have really stable blood sugar we are dismayed at something less. If we continually battle serious highs and/or lows, we are happy with a more steady number.
So I can only answer for me. I generally have “pretty good numbers” with an occasional “WTF??”. But I do seem to be caught in a cycle I mentioned in another thread of stable basal doses that suddenly seem to go off kilter and have to be changed every couple weeks. But “off kilter” to me means highs that stay under 200 and lows that I can treat with a couple glucose tabs. I had one serious low where I believe I was unconscious and my liver kicked in but it was before I understood insulin dosing and I did something stupid. I have an A1C of 6.3 which I am happy with but would like a little lower. Other people have higher or lower goals. I eat moderately low carb, (around 100 per day) because I can continue to be a vegetarian and to cook interesting dishes at that level. I also have 16 years recovery from an eating disorder so I prefer not to restrict my diet too much. But I also choose not to eat sugar at all (except for those pesky glucose tabs) for the same reason. Those are the choices I make and other people make other choices from Bernstein low carb to eating whatever you want and bolusing for it. My goals are under 100 fasting and under 140 post prandial and I’d say I make that more often than not when I’m steady and when I see a pattern outside that range I do a little wiggling of my basals. Do I have good control? According to my standards for myself I have “decent” control. I would like a bit more stability but as a Type 1 I’m not sure that will happen, at least not on MDIs. Other people have different definitions for themselves and I look forward to hearing them all!
Well 80-120 was what I was always told, but what that actually ment Ive really only become aware of in the last year. This forum and the book Diabetes Solution did a good job of explaining it. To me “good control”: is continuously keeping my BG to as closes to a non diabetic (83mg/dl) as possibly all the time e.g., postprandial, after exercise, etc. Additionally, doing this without major highs or lows >65, <120. Theres is my 80-120.
That is definitely a great goal, onesaint. How much of the time would you say you stay in that range?
Ive got to have good goals right? =^) Its really only been a few months that Ive been keeping things this tight. The last week being my best and keeping it within that 80-120 range 70% of the time according to the Dex software.
I think Im starting to sound like one of those people “Oh my numbers are amazing.” Honestly, they’ve sucked for years and thanks to a low carb eating style along with the book Diabetic Solution, this site, and certain folks on it, have I been able to get them this good. =^)
A good control is always keeping in mind the best we would be giving to our eyes,heart, foot,nerves and kidney and keeping the numbers as far as possible in the control range
Thanks Danny, you too!
I tell you what, when I started low carb eating I was hitting good numbers on the meter (8-12 times daily), but if it wasnt for the Dex, I would have had a lot more highs. Ive watched slight slants that Ive bolused for and avoided 160 BGs for 3+ hours thanks to that device.
Nothing wrong with tooting your horn. You deserve it and it can give others hope.
Thanks. Im overly excited, but still need to be humble. I know how hard it is when you see others who are achieving what you want to achieve, but are not. Thanks goodness Ive found something that works for me and thanks to all of you!
Hello Santiago:
“Staying alive” is sufficent control…
Being HAPPY about where you are at, what you are doing diabetes-wise… that’s good control and as good as it gets IMHO.
Stuart
Well I thought I had good control, but I have been using a CGM for two full days and noticed that not even an hour after eating I seem to spike up A LOT higher than I though. When I test at two hours, I am rarely even near 200 but with the CGM i see after an hour I go to 200 or higher for almost every meal!!
So now, I am not sure what good control is…do you need to be in normal range for 60% of the time 80%, 90%?
As others have said, I think “good control” varies for each individual. For me, good control is keeping my A1c around 7% or slightly lower (high 6s). I would LIKE to get close to 6% but have never even come close to this in 19 years of diabetes. My doctors (endocrinologist, GP, etc.) think an A1c around 7% or below is great for a Type 1, even though I always try hard for lower (right now just trying to get back to that range and back on track, though!). I still have daily swings, highs and lows, and find them very hard to avoid.
Hello Laurence873::
Now that is “THE RUB”. What do we do with that information exactly??? Ok, so food causes spikes… last time I checked it is FOOD and supposed to do so! If it does not there is not much nutrition in it.
As long as it comes back down why get concerned in the least?
Stuart
Hello jennifer J:
Hummmmngh… daily swings, highs and lows every day to achieve that 7 A1C… IMHO-fwiw seems to indicate the control is way too tight, and is the direct cause of those bounces. -Gentle shruig-
Stuart
Because the more time we spend above 140, the more likely complications are able to form.
Jessica Bernstein, who produced the movie “Blood and Honey” says that “control” is an illusion and it keeps us anxious (I’m paraphrasing just from her website). I do agree that if we set some arbitrary standard and call it “good” and define all else as “not good”, and if we have trouble achieving that arbitrary standard a lot of the time despite all our efforts, I think we are setting outselves up for disappointment. I think her philosophy is a bit simplistic, though some people swear by it as it has reestablished their peace of mind.
As I said earlier, I think we all make choices that inform our results. For example my choices give me an A1C of 6.3. I may be able to finetune that a bit lower, but to achieve normal range blood sugars I’d have to alter my choices. Some people however, struggle with little connection between what they do and the results they see and for them, I think Jessica’s philosophy might be more relevant.
Good control, obviously, is keeping ones blood sugar low enough to avoid all the complications. I am soooo scared of the complications that I don’t allow the idea of “good enough” control, or “doing my best” control or “doing what I can” control.
Ultimate control would be blood glucose that looks like I have a healthy pancreas. Good control for me is never having a number above 120. I “accept” numbers between 120 and 140, but I don’t like them. Especially fasting numbers.
To me, unacceptable is any measurement above 140. I jump on that and try to figure out what I ate or did or didn’t do and how to avoid it in the future. Often when I get a 144 or a 152, I immediately stop what I am doing and go lift weights or walk up hill for about 20 minutes. (I work in a home office so I am lucky that this solution is available to me). I found that helps lower the numbers and it helps work off the anger and frustration I often feel about it.
If I did this kind of exercise on a more regular basis I may be better off.
With all these lofty goals I am not satisfied with how I am doing. I get some high after-meal spikes I can’t understand. Yea its supposed to go up after a meal, but folks with a healthy pancreas don’t see it go up above 140. (I don’t think. Correct me if I am wrong.)
good control = mean blood glucose in the normal range (110 mgdL for example) + variation as small as possible.
The question is how to achieve that? In my view this depends on what you have achieved so far. You for example achieve a good mean BG as your A1c indicates. At the same time you experience too many lows. So the lows are the problem you need to address.
For me the avoidance of lows begins with proactive thinking. Over the years I developed a knowledge about the energy consumption of my body. I just know that the switch from passivity to activity will have this and that effect when amount x of insulin is active in me. This means additional unplanned activity needs additional carbs. I always use fast carbs like glucose tabs or juice to handle challenging situations. This way I have the carbs in my blood stream right when I need it and I will not be surprised by unwanted carbs coming from slow digestion. As you might have seen my last A1c was 5.4 and this of course comes with the risk of lows. The achievement for me is not the number itself but the fact that I managed to get fewer and milder lows. I am on MDI and like many others I think that there is more insulin active in me than is necessary. So the insulin always tries to drag my BG down slightly. With this strategy I will need to add some carbs at the right places to stabilize the numbers. This is okay for me even if I scratch 65 mg/dL here or there. These mild lows are not very problematic to me and I think this is one of the reasons why I feel comfortable with my current A1c. Of course I do not want to impose my way of treatment on anyone. The reason for writing this is that I want you to see that we T1s need to act smart - and that permanently - it is an ongoing process. In a way we have to outsmart the progression of our blood glucose - thinking about x possible outcomes like a chess computer. Every low has something to learn in it. Analyse the next one and see what you have missed so you can approach the following one smarter. To just react to lows is really exhausting but to catch them proactively is art. Needless to say that I am still working on my Master of Arts in Diabetes Management 
I believe a Master is someone who can be simultaneously a teacher and a student. So my friend, IMO you are one.
Thank you so much.