Tight control?

If you adhere to a narrow range of say 90-100 mg/dl like me, do you accept the fact that a 90 is just a step away from a 70 or 60?

Is this a real question or is it theoretical?

This is such an amazing notion that it floors me! If you can stay (or have your child stay) within that narrow range, I am not sure how you get anything else done besides diabetes management. More power to you though if you can do that. I guess.

To me (I am not one you want to answer this!), 90 mg is 20 mg from 70 and 30 from 60. My BG can drop or increase 100 mg in a very short number of minutes. But then, I am not and never will be as tightly controlled as you or your child, whichever the case may be.

It will be interesting to see what the tight-control folks say.

If you are asking do I accept that I am going to dip into the 60s on a fairly regular basis trying to maintain tight control, the answer is yes. I try to minimize those excursions but accept them as inevitable.


It's not theoretical. It's the range my endocrinologist wants me to be in. But I'll be honest. I'm not always in that range, lol. But I was just wondering if anyone else has that range and some of the low results?

Yeah, I accept them as inevitable to as I try to ward them off.

Ok, I'm a bit confused, DD; are you saying you adhere to that range - stay in 90-100 or that is what your endo wants you to be in. And if that is what your endo wants you to be in, does he know anything about Type 1 and how hard/impossible that is for the vast majority of Type 1's?

+1 Except that I don't do that dipping on a regular basis. I worry more about a high bg than normal ones though 60 - 70 is not something to make a goal. I don't find being in a normal range impossible, my normal range is 85 and I am happy there. I don't control my diabetes, I manage it. Yay for pumps!!

I don't think that anyone "adheres" to narrow range but I aim at 85-90 and am always consider numbers that aren't there as something think. I want my BG to be flat and have put some effort into being confident that my basals are, in fact, flat and if I'm at 90 I'm not going to end up at 70 unless I do something (take insulin, walk dog...) that will get it there. If I am at a stage where I want to do something, like run or walk the dog or whatever and need to boost my BG, I have a glass of skim milk or handful of jelly beans and don't really think of either as a "big deal" to do. Similarly, if I spike up to 120-30 after a meal, a 30-40 point boost, it's not bad but I keep an eye on it and, if I see 122-125-127 on my CGM, I figure it's what I want but if I see 122-128-140, I might reevalute what I ate or the IOB or whatever.

My target range is 90-110...but this is just a setting on my pump. Over the past 5 years my A1c average is around 5.7 with the lowest being a 5.0 and the highest being 6.7 which was just a few months after my Liver transplant in 2012, I was taking prednisone everyday. My BG has never been stable but I do my best to steer it down a narrow path but I do run off the road on a regular basses....

It's not unusual for me to have a 60 or a 200+, but I use my CGM to get back in what I consider a safe range under 140 as soon as possible.

After years of obsession with BG control I have come to the conclusion that there are many more ways for me to die so I stopped obsessing over diabetes related issues and just do the best I can to live a healthy, faithful life.

My body gets weaker everyday, it's a battle none of use can ever win, but my spirit and faith can grow stronger each day and that's where I focus my attention.

Very good excellent comments and thanks. I agree.

Best wishes.

I agree as well. I test 8-10 times a day (or more if needed) and promptly correct for any highs. I eat moderately low carb and my last A1C was 5.9.I have occasional lows and more than occasional highs. I could reduce my carbs still further, get a cgm and watch my blood sugar every 5 minutes throughout the day and be woken up throughout the night but I don't want to live that way. D already takes up way too much real estate in my brain. All power to the flatliners but for me it isn't worth what it would take to get there (if it were even possible for me). YMMV.

Yes, I accept that targeting a tight range makes one vulnerable to hypos. Trying to stay within a 90-100 range, however, does not seem practical for me. To begin with, gluco-normals do not spend 100% of their time in that range. If that it is your target, then what do you do when your BG ranges to say 120 after a meal? Do you add a BG correction targeted at 100 even though you probably have significant insulin on board (IOB) from the meal?

If you choose to do that correction, then you end up "stacking" the insulin and the chance of going hypo is high. This narrow target range seems to me as a guarantee to end up roller-coasting much of the time.

I accept the reality that the "normal range" is close to the hypo range. I strive to minimize my BG variability so that the danger of hypos is mostly reduced. I consider BGs in the 60s to be my "buffer zone" as my body does not go into BG counter-regualtory action until I'm less than 60. 60 is an absolute firewall for me and I vigorously defend it with fast-acting glucose.

I "target" 85 when I correct and my acceptable BG range is 70-140.

I've always accepted the fact that targeting normal blood glucose levels makes necessary dancing at danger's edge. My doctors over the years have been much more nervous with this proposition than me. But then again, it's not their skin in the game. Targeting normal blood sugar without also targeting reduced BG variability is a much riskier game.

Interesting thread. I've been in super super tight control (A1C~5.5 or less) and a little less tight control. I've relaxed a little because it was just too exhausting to keep it so tightly controlled, and had trouble with the fact that I would easily become hypoglycemic with exercise/activity. I now shoot for an A1c for around 6.0-6.5. I'm a type 1, on insulin. Not sure if someone with type II would have less issues with hypoglycemia as typically less sensitive to insulin. . . .

John, hammer/nail. Dart/bullseye. Spot? On.

I don't think there is a diabetic (not pre-diabetes, not IGT, etc. -- diagnosed as having to progressed to diabetes) that can maintain BG in a 10-20 mg/dl range. Heck, most non-diabetics with none of the genetic defects, healthy, fit, etc. do not stay in a 10-20 mg/dl window.

I think what's been confused here is a target, rather than a range. And to confuse things more, it's not as simple as a "target"... The appropriate target changes depending on metabolic state.

Two states, generally, are important to D management: Fasting, and digesting. The digestion state/phase is active from starting to eat to 2-3 hours after finishing a meal. Broadly speaking, BG peaks about 1 hour after eating -- this varies a lot, of course, depending on what you eat, and your own unique metabolism, but as a rule of thumb, it's sound. Fasting state is any time after 2-3 hours until eating again.

The behavior of the digestive and endocrine systems, as well as hepatic, adipose, and large muscle tissue is quite different in each of these states. How BG and insulin dance together impacts things like targets and treatment.

All that said, the targets I shoot for, similar to many many people here, are as follows:

  • Fasting: 85 mg/dl
  • Digestion: <140 mg/dl peak
I'll administer corrections as needed during fasting to get to 85 if I'm more than 10 mg/dl off. During digestion, I simply leave it be and let the meal bolus do its work, but I am careful to pre-bolus (for me about 30 minutes) to get ahead of the digestion glucose spike that's gonna hit.

I'd say about 75% of the time I'm successful. The other 25% I go over 140 and depending on what I ate may shoot as high as 180. I don't sweat it when that happens.

I learned last thursday just how much of that success (in my view) is due to my management, and how much is just "my diabetes isn't that bad". Met my wife for lunch, and had left my Omnipod controller at the office. Knowing I'd be back within the hour after eating and could bolus then, I went ahead and had a modest carb (30g) lunch. Pretty typical for me.

An hour after starting the meal (about 20 minutes after finishing) I bolused. BG at the time was something like 140, and rising.

It peaked at 250. Same lunch I'd eaten a gazillion times, same insulin amount, when done right I usually top out at 130 and then head back down, settling in the 80s by 3 hours after starting the meal.

Took me until I got home after work (5 1/2 hours after finishing lunch) to get it back down to the 80s. I was back under 140 around the 4 hour mark.

So, lesson is, I'm a full-on diabetic. An insulin dependent T2 diabetic. While unlike a T1 I won't go into DKA and die without exogenous basal insulin, my pathetic pancreas is just barely capable of holding my BG, not able to lower it. The incident was an eye-opener for how well one actually can manage their BG with the right tools.

I consider BGs in the 60s to be my "buffer zone" as my body does not go into BG counter-regualtory action until I'm less than 60. 60 is an absolute firewall for me and I vigorously defend it with fast-acting glucose.
Terry, could expand on this a bit? How do you "tell" when your system is trying to respond to a hypo condition (i.e. counter-regulatory)?

The 60s seem the same way for me they do for you, at least as I interpret things based on hypo symptoms. I don't get any significant signs until I'm down close to 60 for a while, or drop into the 50s. I definitely don't have hypo unawareness, but I also don't seem to be in a hypo metabolic state in the sixties, judging by symptoms.

Thing is, I don't trust symptoms as a very precise indicator. I guess I can infer some things about this based on what happens naturally to my BG when in the 60s, and I don't do anything to bring it up. I suppose if it stays there, at 65 say, the glucagon system hasn't kicked in. Is that the sort of data your drawing your conclusions from?

(you can see the engineer in my rearing it's head with this post :-))

Targeting a tight range doesn't make you vulnerable to hypos, shooting or pumping insulin makes you vulnerable to hypos. When I ran higher 7s or whatever my "peak" A1C was, I'd hit high numbers and correct them. Admittedly, I didn't use any sort of scientific formula or anything like that. Also, if you are targeting a broad range, like the 140-180 after meals, that's a big difference. I want my total meal "delta" to be 40, not to aim at a 40 point range. I've noticed that using a more normalized target also "cooks" your data and provides a better feedback loop for me. If my numbers are off a few days in a row, I can start thinking "do I need to do something here?" It could be a carb counting blunder or it could be a slight adjustment is needed. I don't think that's crazy or obsessive or anything like that, it's simply playing to win.

I agree that targeting a tight range doesn't make you vulnerable to hypos but it does make some of us vulnerable to frustration. A blood sugar reading is ideally just data but some of us have less ability to calmly face an unwanted number than others. Loosening targets is a way of allowing ourselves some additional peace of mind even as we aim to maintain good control. We all have limits and some of them are rooted in our dispositions.


Yeah, I'd say this is a pretty good summary of the dance. I'd just add that the between meal time, after the peak and before the next meal, is usually when I do all my existence as a living human being sorts of daily activities. That means that the times when my BG should be the most stable are complicated by any number of variables. I do a good job, generally, of keeping my BG in the target range of 80-140 around 80% of the time according to my records. What happens the other 20% of the time is a total crap shoot though.

I guess the incident that summarizes best the kind of crap shoot I'm talking about happened a couple of months back. I entered my first jiujitsu oompetition in over 10 years. I did everything I had done to keep my BGs under control through training. Limited my food intake and insulin dose to guard against a competition ending hypo, dropped my basal, checked my BG regularly leading up to my first match, and basked in the glory of six months of preparation coming to fruition right before my eyes.

What I wasn't prepared for is the absolute adrenalin rush leading up to my first match. I watched my BG go up from a perfect pre-competition level of roughly 100-120 at the weigh-in to well over 300 five minutes before stepping on to the mat. Over the course of my matches over 30 minutes, I don't ever remember dosing so frantically just to keep my BG under 400. Luckily, I didn't crash as spectacularly afterwards.

So, we do what we can. Short of giving up on all that living between pre-meal doses, I'm not sure what else there is to do.

I an not so worried about lows, as about the quickness some of them hit. And I have read about some of the CGM users still having low lows, they just have that alarm that tells them they're headed into a danger zone.