I’m not suggesting you can’t or should not choose your own targets, but there seems to be very strong consensus from medical professionals that for those of us with diabetes (particularly on insulin or secretagogues) anything below 70 mg/dl is a hypo and should be promptly treated.
You’re right that is the consensus amongst medical professionals-- but as you know they come up with those guidelines to address every human being on the planet-- from the 90 year old person in a nursing home taking NPH and R who is hypo unaware and has also lost much of their senses and judgement, to someone like me with none of those limitations who can evaluate pretty reasonably and make informed judgements about how long ago I took what type of insulin, what I ate, what I’m planning to do physically in near future, my history with comparable trends and patterns, etc…
Just like when they say that people should not allow their heart rate to exceed 220 minus their age— they’re talking to both the 70 year old obese smoker and the 20 year old athlete, but in reality the limiting factor in the formula is only one of those examples
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@Sam19, During pregnancy I had one finger stick on an oral glucose tolerance test of 57. It was not flagged as abnormal because the threshold for normal was <55. When I wore my son’s CGM for a week I spent at least 10 percent of my time below 60, though the one time I ticked below 60 my body almost instantly bumped the number up above that. So I agree with you that for many non-diabetic people a blood sugar below 70 is not really “hypo” territory.
I also agree with @Brian_BSC though that it’s a different story with a person taking insulin. Alpha cells don’t do a great job of directly sensing sugar levels; mostly they are measuring by proxy based on the insulin output of nearby beta cells. So when you are taking exogenous insulin and your endogenous insulin production is dysfunctional or minimal, your alpha cells will not be getting the memo when you drift into hypo territory. For that reason it doesn’t make sense to wait till you are below 65 to eat carbs, in my opinion. For one, it will take longer to bump that blood sugar up than it would in a non-diabetic person’s body, where the glucagon takes effect in five minutes. And for another, absent the glucagon, people actually get MORE sensitive to insulin as blood sugar drops. So you can have those situations where you’re drifting down -3, -4 every five minutes and then once you drop below 70 boom! All of a sudden you’re dropping by -9 even with very little insulin on board. So it makes sense to have a little safety margin to allow blood sugar time to come up before you hit symptomatic territory.
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I’m not making a blanket statement that I do or don’t treat at any specific level I’m just saying I’m skilled enough at this by now to evaluate every situation differently and in the appropriate context of the moment instead of just thinking everything is hunky dory any time my meter says 71 and thinking intervention is required each and every time when it says 69… context matters
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Agreed—if I’m stable at 68, I’m ok with that, both because I have my CGM and also because my hypo symptoms will kick in strongly if I get into the 50s or if I was dropping. Knowing the present rate of change is one of the most valuable aspects of the CGM in making treatment decisions, IMO. That said if I was about to do something strenuous or be in a situation where I couldn’t keep as a close an eye on things, I’d probably treat a little. So yes, context.
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Interesting discussion. I have set my personal BG target range for 65 mg/dL - 140 mg/dL. I don’t feel hypo symptoms until I’m at 65 mg/dL. I used to be more hypo-unaware due to consistent frequent hypos into the '50’s. I’ve also seen 24-hour glucose traces for non-D’s and as an average they spend some time every day below 70 without any adverse health symptoms.
Jen - Experience comes with time. I’ve been T1 for 53 yrs now, and only switched to pump 2 years ago. My peaks are far easier to manage since pumping, and A1C’s dropped from a suggested low-7 range to mid 5’s within 6 months. Did I mention I’ve been hypoglycemic unaware for 20 years (hence the suggested mid 7 A1C range?
Suggest you try this for better control: Work on lowering your Total Daily Bolus dose while increasing Total Daily Basal doses. By upping basals during most hours of the day, and optimizing nighttime basals, not only will your control improve, but your TDD will actually fall. I require far less bolus pre-meal now than before. My TDD is 30% less than a year ago. Total Basal is now 65-75% of TDD, Total Bolus 25-35%
Jim
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Thanks! I’ve had Type 1 for 25 years. My A1c has been as low as 6.0%, but never in the 5% range. It jumped back up to the low 7% range after I was diagnosed with Graves’ disease and my blood sugars went out of control for a while, and it took me a while to get back on track again. I’m fairly sure my next A1c will be in the low 6% range again.
I’m already eating a low-carb diet, so my basal makes up about 75-85% of my TDD, and is (for the most part) set so that I’m flat overnight minus the random highs and lows. I actually think the biggest limiting factor to my A1c are the huge fluctuations in basal and ratios that I experience from monthly hormones. It makes about half of every month quite hard to control (I can keep 75+% of my readings in range in the first two weeks, but that drops to 25-50% or worse for the second two weeks, until I get insulin readjusted, which can rise or fall by 25-35% overnight). I feel like, if I could get these changes figured out (clue in to when they’re happening sooner and respond more aggressively) I’d have a much better shot at breaking into that low A1c range.
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Jen - I know your frustration! While I don’t need to deal with hormonal releases on a monthly basis, I balance my T1 with 2 other chronic (auto immune) disorders: Systemic Lupus and MMN, an immune mediated Motor Neuropathy. Both have me on immunosuppressive agents.
Prednisone is the worst agent for wreaking havoc on BS. Control goes out the window. Last time I needed it my insulin TDD was up over 100%. I won’t do oral prednisone anymore, only IV Solu-Medrol. Chemo drugs are even worse. And of course, there are few options when it comes to dealing with flares
Try not to be so hard on yourself. Running low to mid-7 A1C’s is fine while you’re fighting something else 
Yeah, I’ve heard steroids are not fun. I have a lot of allergies including an allergic/autoimmune disease that affects my throat, and my allergist offered to prescribe oral steroids a couple of years ago. I turned them down because of the blood sugar chaos I’d heard they create, but it probably would have made calming down the inflammation a lot quicker. I do take numerous topical steroids for allergic conditions (nasal spray, inhaler, cream, shampoo) and do wonder at times how much of an impact they or other medications I’m on may affect things. I’ve also read that the hormone that affects blood sugars each month is a steroid, so no wonder it gives some of us so much trouble.
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We’ve found this too with our son. Higher basal results in about the same total daily dose but much lower peaks. I’m guessing it has something to do with suppressing glucose output from the liver once you start to eat.
I feel like artificial intelligence is something that would come in very handy for this type of thing…if that ever comes out on the market. Maybe in 2025, but by then, maybe they’ll have made more progress towards biological treatments or smart insulins.
I’d consider a bihormonal closed loop AP “Artificial Intelligence”. For that matter, I think I already view my daughter’s Dexcom G5 as AI! 
haha! I mean they’re certainly more intelligent than me at 3am trying to figure out why my son’s BG is out of whack. I guess AI refers to specific learning algorithms that are picking up patterns and responding to them based on an expanding dataset. I actually don’t know how all the future artificial pancreases work, but from what I understand, at least the Medtronic 670G is not using deep learning algorithms, and I suspect most of the other ones are basically sophisticated control system algorithms (so no learning, per se, just reacting and predicting), although they may be incorporating some level of historical data.
But the amazing thing about newer AI is that you can basically just explicitly tell a program the “rules of the game” (a.k.a. win at Go, keep BG between 80 and 140 as much as possible), and then it reads through millions and millions ad millions of data points and “learns” the best strategy for doing that. Using that technique, AI has managed to beat the world’s best Go players and chess players, and has come out as comparable to an ophthalmologist in diagnosing diabetic retinopathy. So I have hope that sophisticated programs could pretty soon have the capability to say: “hmm, it’s a Saturday morning at 8am and blood sugar is rising by +18, pancakes are on board, bring on an extra 2 units of insulin.” although in robot speak it would probably look much different.
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Tia - Peaks are a challenge to deal with, simply because your bolus correction increases as your BS rises above 10 (+/- 200 in US). Every individual is different, but for me, I use 25-50% higher correction if BS is over 10 (200).
I think that’s the other reason the extra basal effect works so well. If you’ve already got extra insulin, it dampens the peak and then you don’t get insulin resistant, which means more insulin.
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@Tia_G Exactly. Over time, we all develop insulin resistance. It’s far less with Synthetic (Human) insulin than it was in the days of Beef/Pork insulin, but it still happens. I’ve been on insulin 53 yrs,
By increasing basal carefully my TDD has fallen 30-40%. I still occasionally have wild peaks, bu don’t let that get you down. Don’t obsess over these, rather correct them in a rational manner 
July A1c 5.2
Bs readings
Wake: 84
After Breakfast: 90
B4 lunch: 79
After lunch: 84
Before Dinner: 90
After Dinner/Before Bed: 90
I was Dx’d T1 April 2017 will be 4 years. A1c: 11.7 4 weeks later 8.1 been holding 5.2-5.9 ever since. MDI for 1 year on pump ever since.
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Great job, kimfing!
I am only realizing that this is an old thread - I already uploaded the pic, so here goes, this is my son’s Dexcom from yesterday, his A1C was 5.3% as of last week. You can see a big peak in the morning. He does not have a pump and injects - but he is insulin resistant in the morning. My son is 12, and he is a T1D, on Lantus and Novolog. A C on the chart indicates calibration (he used a test strip). The range is 80-150 (red-yellow).
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