What is the most challenging part of your diabetes management?


Most challenging for me is not only managing my T1 diabetes but also my 5 year old sons T1 diabetes too.


I’ve been T2 for 12 years and have been able to keep my A1c around 6.0 to 6.4 for the last two years since I got my CGM. The lows and highs are not as bad and easier to manage since I have the G5 CGM. Walking 10k to 18k steps a day helps a lot and of course watching carbs and fat intake. I my BS gets too high, climbing stairs or walking fast help a lot. All of my doctors are quite happy with my management. I have no nerve or eye damage (so far). My insurance is great! Incidentally, I asked my doctor how many of his patients manage their T1 and T2 as well as I do, his answer as a hand full or about two dozen our of his over 300 patients with diabetes. I found this to be a bit shocking… I live alone with my dog, I walk, hike and travel alone and I work by myself. I still go out with my friends and have a few (light) beers and a meal a couple of times a week. When walking I carry two cans of orange juice plus some mini-snickers and a spare BG meter, just in case. When out hiking I carry OJ, water and grain bars. I also keep a detailed log on my computer in excel with 7 BS readings a day, meal summary, activity codes, all insulin use and any relevant notes. I still keep a log even after getting my G5 CGM. As far as I am concerned the secret to T2 management is knowing how it works with me, keeping a log for reference and sticking to a management plan, with tweaks along the road as conditions change.


Guys, I just wanted to reply to this thread and see if anyone else feels the way I do. But the thing that has always been hardest for me with my diabetes is the fear of going low, which causes me to keep my blood sugar higher than what I deem “ideal,” just so that it lessens my anxiety.

Does anyone suffer like I do in this way?


I’ve often read in the medical literature that hypoglycemia is the primary treatment-limiting characteristic of insulin. Hypos produce a gut-wrenching metabolic existential threat. Failing to feel fear in the face of that is not human. I think that fear is rational but you must find a way to deal with it.

I’m sorry to say that I don’t share that same shade of fear and I believe I have made peace with the idea that a hypo could be my undoing. I’ve come damn close a few times in my diabetic life. I accept that I don’t retain 100% control of how my life unfolds.

You raise a great topic. I hope you elicit some responses.


I think you need to do what works best for you.

With today’s technology, we have better tools that help to safeguard against lows. Can you separate the fear from the real probability of you having significant lows? For me, my concern for complications helps motivate me to walk the fine line between the two.


Subway’s salads are great! I get one of those and my husband, 6’6" and thin, eats a foot long with no problems




Please do not assume that others bodies react the way yours does. Each of us is a unique individual and must do what one must.

I manage my A1C to 6 or below and still was able to avoid hideous highs or lows through vigilance and careful eating.

Why is the low A1C so important to me? Because my body cannot tolerate high glucose and even small increases in my A1C over time being painfull neuropathy episodes in my feet. On the one hand I wish I could relax more (just got Dexcom G5 - it’s early days but am hopeful it will make a big fmdifferebce) - yet having a sensitive body "keeps me honest and has protected me from most T1 complications so far. fingers crossed.


I am currently keeping to a low carb diet but not having too much intake of red meat isn’t easy, especially when cereals are completely out of the question and bacon, sausages and black pudding take their place. I am however now getting more good carbs from vegetables because there are now choices such vegies as cauliflower or broccoli rice which are excellent! I greatly miss toast and marmalade above all else and this can be my biggest downfall on a low carb diet.


Fear of hypoglycemia has always been a limiting factor for me as well in my blood sugar control. Hypoglycemia can kill me in the next hour, but complications will take a good decade or more to kill me, so when faced with this alternative, the safer path to take is clear.

Now especially, with studies showing that A1c levels below 7% are correlated with higher all-cause mortality in both type 2 and now type 1 patients, what is the point of risking death every day from strict control when it may not even be as helpful as was once believed? It is vital to keep in mind the studies showing that at least some of the etiology of diabetic complications is due to genetic factors inherited along with the propensity to develop the disease and to the continuing autoimmune reaction attacking organs of the body other than the pancreatic beta cells, since these suggest that controlling blood sugar may not be addressing the whole problem and so may be paying fewer dividends than once believed.

Finally, if you have been diabetic for a while with no complications, you may be in that select group of patients with a genetic resistance to the development of diabetic complications involving a special protection of DNA from alteration, so you may be struggling to control blood sugar when you don’t need to, though unfortunately, you can’t tell! I wonder how many patients in that category have died of hypoglycemia trying to address what for them was a non-existent problem?


The mental pieces.

If we can alter our perspectives, our perceptions, our beliefs, our feelings about all the different moving pieces of this pretty disease… we’ll turn out just fine. It is a critical piece very few receive the tools we should be given…



Hi Gracie! Welcome to the forum. It was not my intention to offend you. Let me explain why I made the statements I did below. I welcome your input, and I’m glad that you’ve been able to lower your A1c and are able to avoid hideous highs or lows! Congratulations!

I do not expect everyone else’s body to react like mine is. As stated above in the thread, I also have a low A1c- lower that yours even. I think it’s important to reduce variability when lowering your A1c. It sounds like you’ve also prioritized this in your diabetes care.

I think that a very low A1c coupled with frequent instances of severe low blood glucose levels is unsafe, and someone experiencing both would be better-served by having slightly higher numbers and fewer instances of severe low blood glucose levels. Reducing variability while lowering the A1c is important.

I am not presuming that others will experience their diabetes the same as me or must use the same tools to reduce their variability or A1c. I am however saying that if an individual has a very low A1c and frequent instances of severe hypoglycemia, then they should re-evaluate their treatment and make changes. Seydlitz has complained many, many times on this forum of severe hypoglycemic episodes (including injuries he has experienced as a result of these). He also has an A1c of 4.9%. I wish that he would talk about what changes he is making to reduce the severe hypoglycemic episodes…


How’s your stress level? Is it different the beginning of the week as opposed to middle and end of the week?


Hi K…87: thanks for your very kind reply. I almost tried to figure out how to remove my post. I sound like a know it all who has this whole thing figured out. Actually, I had not meantto reply to you, but to Seyditz who - I thought - apoeared to be saying he could not lower his A1C below 10 or 12.

Actually, I spent the evening wanting to eat my words about managing my glucose as I watched my Dexcom look exactly like a wretched EKG - as I spent time on the phone with a friend who wars upset and grazed on - of all things - oyster crackers.
A T1D’s worst nightmare to “lose count of.” Spent evening compensating - not wanting to stack. Not able to trust the CGM yet other than trends. Stayed between 67 and 159. Can’t say I feel very well. But waiting for a flat line again.

I have no business advising anyone else about this matter. Need to put the O2 Mask on and get myself leveled out first.

Sign me: Humbled & Trying Hard in River City


I’d say almost none. It’s rare for hypoglycemia to actually kill someone, as dangerous as it can be for some people. It happens, but it’s extremely rare. Moreover, I would wager that someone striving for the best control that they can would be less likely to die from a hypo than someone with numbers all over the place and no real grasp of what is going on. You just keep posting the same thing over and over again. You are not interested in discussion, hearing viewpoints from others, or re-evaluating your way of thinking based on what others have said. There is 1 study that supports what you are saying and most of us non-academics understand what the flaws are with it. Not one person on this forum would recommend an A1C in the 4s if you can’t do it without danger. A doctor who recommended this would lose his/her licence. I agree with many things you say by the way. I do think genetics plays a bigger role than any of us understand, and that the end goal shouldn’t be to enrich pump and CGM companies but rather a cure. Telling people over and over that tight control is dangerous and futile, based on your negative and hypocritical experiences, is dangerous and futile.


Yes, I can find the contradictions confusing too.

We all experience something similar at one time or another :slight_smile:. Sounds like you handled it as well as you could!

Glad you’ve joined us here :slight_smile:


I wouldn’t underestimate the risk of death from hypoglycemia in patients treated with insulin. Just read the study by Philip Cryer, “Severe Hypoglycemia Predicts Mortality in Diabetes,” Diabetes Care, 35 (9) 1814-1816, which says:

“Finally, in addition to case reports of hypoglycemic deaths in diabetes, there are an increasing number of series reporting hypoglycemic mortality rates. For example, recent reports indicate that 4%, 6%, 7%, and 10% of deaths of patients with type 1 diabetes were caused by hypoglycemia. It is sobering to think that as many as 1 in 25—or even 1 in 10—patients with type 1 diabetes will die of iatrogenic hypoglycemia. Obviously, life-threatening episodes of hypoglycemia need not be frequent to be devastating.”

Insulin is a potentially lethal drug which we take every day, usually many times a day. If you take enough and don’t consume calories to match it you can be dead within hours. Half of severe episodes of hypoglycemia occur during sleep, and since hypoglycemia can make sleep more profound, the very danger that requires the patient to wake up and seek treatment immediately is exactly what keeps the patient asleep. Add to that the fact that the body’s response to insulin, food, and exercise, the variables affecting blood sugar which can be measured and controlled, is often highly unpredictable, you have a formula for producing highly irregular blood sugar values and their associated risks.

In my own case, I chose to keep my A1c in the four range over the last decade as an experiment on myself to see what difference it would make. The result has been disastrous, since while before that experiment I needed laser photocoagulation treatment for retinopathy every 20 years, after introducing stricter blood sugar control I have needed it every 2 years, and my ophthalmologist has described the worsening of my retinopathy as ‘rampant.’ Now there is research suggesting that rapid tightening of blood sugar control can temporarily worsen retinopathy, but it is supposed to improve the condition over time. What I wonder about, however, is whether in a highly labile case of diabetes, rapid tightening of blood sugar control may result in numerous tightenings and loosenings in sequence, so that there is never a long-term improvement over time to correct for the worsenings. Perhaps I’ve contributed something to ophthalmology!


Thanks so much for the welcome. Dexcom training very helpful. My CDE was encouraging and really complimentary of my efforts over the past 8 years (thus is a new office for me). I was hard to dx and difficult to treat too - for reasons s I won’t get into in depth here. Grateful things seem to be settling down vs roller coaster I’ve been on past 8 years.

Anni Macht


I don’t think an A1C in the 4s benefits you in any way. You don’t wear a CGM and have lots of hypos, how do you know you aren’t just bouncing between high and low all day and it’s averaging out in the 4s? I definitely don’t think this is safe or advantageous. It isn’t normoglycemia. I agree with you to the extent that treatment goals should be individualized, but this doesn’t mean no one should shoot for normal A1Cs. It means that some people shouldn’t if they can’t get there without dangerous hypos or bouncing up and down all day, or the method of getting there should be re-evaluated (i.e. cutting down on carbs vs. carb counting for just about anything).


The fact that 50% of severe hypoglycemia incidents occur during sleep is the key driver of diabetic death rate from hypoglycemia. As I said, hypoglycemia can deepen sleep, so the very problem that the patient must wake up to address keeps him or her from waking up, creating a vicious and, ultimately, lethal cycle.