For CGM purposes, 70-180 is “in range” for T1 Time In Range percentages as set by medical concensus. A goal of 70% TIR - that is is, maybe a few percent of the time below 70, and less than 27% of the time being above 180, is recommended by at least one medical concensus: https://care.diabetesjournals.org/content/42/8/1593
In the T1 population at large, only a fraction are at or above the 70% goal.
Among the most frequent posters here on TuD, it is common to set much tighter ranges and much higher TIR goals. This is not representatives of broader T1 community.
The CGM concensus paper noted that they decided for CGM purposes they decided to set the range the same for both T1 and T2.
Many of the most frequent posters here (T1 and T2) have set their own personal “in range” measure to be the amount of time under 160 or under 140.
140, 160, and 180 are all elevated and reducing the amount of time you are above any of them will help lower A1C. CGMs provide a more complete picture of “area under the curve” but if your bg’s are completely normal except for just after meals, working on the 2 hour after meal bg target is a great idea.
It doesn’t matter whether you’re T1D or T2D. Normal blood sugar in human beings exists in a relatively tight range. Muddying things up is the conclusion of one recent study that found that only 12% of the population is metabolically healthy.
I believe that normal fasting blood glucose is in the 70-99 mg/dL range. Healthy post meal glucose is limited to 120-140 mg/dL at 1-2 hours.
It seems the human body places a premium on keeping glucose in a tight range. The closer we can keep our sugars to normal, the better off we are, diabetic or not.
I take a skeptical view of doctors’ consensus. When I was diagnosed back on 1984, the medical mainstream consensus was that blood sugar control did not affect the trajectory of ultimate health in T1D. They believed that the disease progressed only as a function of time and genetic makeup.
In other words, the doctors’ consensus believed that it didn’t matter how well you controlled your blood sugar levels. The landmark Diabetes Complications and Control Trial findings released in the mid-1990s concluded that glucose control did matter.
Some doctors and researchers are now beginning to realize, especially with regard to T2D, that it’s actually hyperinsulinemia that is most important. Hyperglycemia does exact damage in the body but it’s hyperinsulinemia that is the early indicator that most clinicians completely miss. Maybe it’s because they don’t want to measure it.
I look at doctors’ consensus with a much more critical eye these days. Medicine evolves; it’s only been a few hundred years since bloodletting was a “standard of care.”
I can understand the medical profession picking 70-180 mg/dL (3.9-10.0) as the standard target range for people with diabetes. Unfortunately, this is still a “reach goal” for many of us.
What I wish gurus of diabetes standards would recognize is that there are still a significant minority who wish to target a more normal range. I wish they would name such a range. For me, the 70-180 range feels patronizing. And if your doctor doesn’t realize that people like me exist, they may jump to the conclusion that our glucose levels are dangerously low.
I myself usually have my meter set to alarm well below 180, so that I have a chance of some kind of correction stopping me from ending up above 180.
The histograms and scattergrams of “T1D at large” population I see in medical journals tell me that typical achieved TIR (70-180 standard) is usually 40%-70%. So for the population at large I think 70-180 range is very useful. And for us top 1%'ers? Why should the docs worry about setting standards for us, shouldn’t they genuinely be focusing on those most in need?
Doctors should be concerned with their entire patient population. Especially when setting standards for the entire patient population. To accommodate what I suggest, it would simply introduce a few lines in the published narrative of their standard.
This is not a “win-lose” idea. By accommodating the distinct minority of their patient population, they can do so without detracting from the needs of the majority. Plus, it sets a standard for the majority group (and more importantly, their doctors) that defines what all of us should be shooting for.
I find that the ultimate value of any goal is creating a good faith effort on my part to achieve it. Shooting for better is not diminished when the ideal or perfect is not reached. The power of any worthwhile goal is in the reaching, not the arrival.
Looking into this issue further, I found this diaTribe resource. It reminded me of what I once knew but forgot. The writers of the standards did address several sub-groups of diabetics including:
Those with gestational diabetes (goal 85% TIR 63-140 mg/dL)
People with medically frail diabetes (goal 50% or more TIR 70-180)
Pregnant with Type 1 (goal 70% or more TIR 63-140)
The standards writers recognized at least three sub-groups of diabetics with adjusted goals. Turns out my goal of 80% TIR 65-130 mg/dL best aligns with the two pregnancy standards. Why is it that clinical experts can carve out a much more ambitious goal for pregnant women yet not recognize that at least a few people would aspire to reach a higher standard?
Looking at this, I find it hard to believe that they couldn’t have easily written into their standard a “highly motivated and capable diabetic” group without damaging the interests of any group.
I know, there’s nothing preventing me from adopting a better goal and that’s exactly what I’ve done. It would be nice to enjoy some institutional cover if I’m ever challenged by some ignorant medico that I’m overdoing it.
"Previously, it is well established that diabetes is associated with microvascular and macrovascular complications, but recently, several data suggest that diabetes is accompanied with frailty as well as disability among the older adults. " (from previous post).
Would be interesting to know the average A1C of this population. My mom is 90, T2 since 50s, still able to get around with walker, after knee surgeries.
I’m with you on this one Marilyn! It reminds me of the term brittle diabetes. I never understood that term.
I always thought it meant a person who was not taking care of themselves and having poor control.
I realize it’s tougher for some people to get in range and stay there.
Still the terms from way back are often bizarre or loaded with judgement.
I have a medical alert bracelet someplace that says “Sugar Diabetes” even more weird than Juvenile diabetes for which I still have a bracelet with that too
Now I want one that says brittle diabetes. Just cause.
those sound incredibly weird now.
I want the excuse. “ excuse me sir your blood sugar is 300 mg/ Dl. “. I know , I have brittle diabetes so that’s as good as it gets!!
“ ohh ok your diabetes is brittle. So it’s ok. Here have some cake and maple syrup “.
Thanks Terry. That certainly wasn’t a fun read. The only time I feel frail is when I don’t sleep well. I have always slept poorly at times even though I follow all of the recommendations for good sleep. I haven’t slept well for decades. Other than being tired from lack of sleep, I don’t fit any of the other definitions of frail at almost 71 with 62 yrs of living with type 1.
My dexcom sensor is not helping with that problem at all. The last one I had was awful at getting anything right even though I soaked it for 20 hrs. I had to replace that one and the one I am wearing now kept waking me with lows under 65 last night. I ate some glucose and when the unit then read 45, I got up and finger tested. It showed 89 so I was never low.
About 1 1/2 hrs later when I had just been able to sleep again, the darn thing went off again with another low which wasn’t the result of the 1/2 unit of Novolog I had taken to help combat the glucose tabs I had wrongly taken. I got up and tested and was 110. These were not compression lows.
At this point I had my husband take the receiver downstairs and put it in the library. I then got several hours of good sound sleep. My husband has suggested we leave the receiver downstairs every night. I have never not woken from hypoglycemia, but now that I am dependent upon the Dexcom, I am afraid that I wouldn’t wake up with a severe low. I don’t know what I would do if I had pump alarms going off too.
Sorry, I think I high jacked this thread. I am really just venting, but getting back to sleep after an alarm is really a problem for me. About 2 weeks of the month I sleep well, and it is usually when I go to bed with about a 120 glucose reading and wake up with a 70-90 reading.
The International Consensus also says goals should be individualized. To me, that includes tighter ranges. But good luck convincing backward thinking endos who believe BG should be controlled such that HbA1C is 6.2% or above, regardless of biovariability.