Continuing the discussion from Need feedback:
I read @Helmut’s comment last night and woke up this morning thinking about it. I’ve observed that the medical consensus regarding time in range has decided to use the 70-180 mg/dL (3.9-10.0 mmol/L) as a standard. I realize that they likely just want to create a landmark that they can use for comparison within the population of people with diabetes.
A dark side of that choice is that many patients will view that range as “normal and successful” for someone with diabetes. I, for one, have decided that while they can utilize that range for their academic, clinical, and research purposes, but I created and live by my own comparison range for metabolic success.
To begin with, I don’t start to observe physical symptoms of hypoglycemia until I hit 65 mg/dL (3.6 mmol/L). I spend a fair amount of time in the 65-69 mg/dL bracket and question, why should I concede this metabolically normal for me statistical turf? My performance as measured by my Dexcom CGM provides important feedback to me and helps sustain my motivation.
The higher limit that they set at 180 mg/dL or 10.0 mmol/L is unambitious, uninspiring, and tepid for me. I currently use 140 mg/dL or 7.8 mmol/L. I’ve also used 120 mg/dL for a time but decided that even gluco-normals do spend some time in the 120-140 mg/dL (6.7-7.8 mmol/L) range.
The important point, I realized, is that they don’t spend much time in that range. Their healthy pancreas pulls down their post-meal sugars back below 120 in relatively short order. I use my average glucose level to help monitor this reality. I shoot for under 100 mg/dL (5.6). If I can keep it at that level, then I know that I don’t have much of the 120-140 component in play.
Neither mine, nor your blood sugar metrics, @Helmut, represent well the diabetic cohort, unfortunately. So, I think that the 70-180 standard, while uninspiring to us, does help a considerable portion of our brethren. I know because I lived with A1c’s up into the low 8’s for a time. An A1c of 8.0% represents an average blood glucsose of 183 mg/dL (10.2).
For someone who uses the 70-180 range to motivate them to pull down excessive hyperglycemia into a better range, then I think that is useful. I think that reaching for better, in every human endeavor, is a helpful guide.
For those who find it easy to to fit their glucose statistics into the 70-180 range, I encourage them to lower the upper level down to 160 and then 140 to challenge them to reach healthier glucose metabolism.
I’ve read recently that only 12% of the American population can be considered metabolically healthy. That amazes me. But I see the level of obesity and the poor nutritional choices people make and tend to believe that alarming statistic. The demonization of dietary fat, especially saturated fat, has not served us well. Processed foods, especially grains, have contributed to our ill health. The low fat craze that started around 1980 also show the start of obesity and type 2 diabetes in this wildly unsuccessful population level experiment.
Our species can trace its roots back to about two million years ago. Evolution is a relatively slow process, especially when measured by our short lifetimes. Humans began cultivating grains about 10,000 years ago, only 1/2 of 1% of our two million year evolutionary track.
I think it’s one of the reasons we modern humans have suffered metabolically. It has made even worse impacts on our health when we figured out how to mass produce highly processed and highly palatable foods to consume. That combined with the public health decision to try to separate us from fats (meats), a nutrient that coincided with the rapid (evolutionarily rapid, that is) increase in brain size was a poor choice from my perspective.
In summary, I think that the 70-180 time in range (TIR) standard adopted by academics, clinicians, and researchers will help most of our group but individuals should be encouraged to tighten those limits to a healthier range when possible. Reaching for better is always better!