Anyone who has lived with treating diabetes with insulin is well aware of the tradeoff that exists between good blood glucose (BG) control and the risk of hypoglycemia. Those who choose to target glucose levels in the normal range risk crossing into hypoglycemia more deeply and more frequently than those who choose to aim for a higher glucose target.
With the emergence of hybrid closed loop technology comes the promise of changing the calculus of that decision. We will still need to face this same tradeoff but we’ll be able to rationally choose a lower glucose level and more aggressive target with less, but still some, risk of hypo BGs.
I offer you two different hypothetical days of blood glucose control. One contains no BG values below range but the tradeoff is that 34% (about 8 hours) of blood glucose on this day exceeds 140 mg/dL (7.8 mmol/L) and the variability, as measured by standard deviation, is relatively high at 39 mg/dL. Time in range (65-140 mg/dl, 3.6-7.8 mmol/L) is 66%. The BG average for this day is 122 mg/dL or 6.8 mmol/L.
Compare that experience with this second day. This BG day shows 96% time in range but with 4% time hypo. The lowest value settled at 57 mg/dL (3.2). This 4% translates to about 58 minutes. On the upside, this day has a normal average of 85 mg/dL and very low variability at 13 mg/dL (0.7 mmol/L).
My question to you is this: Would you, if you could in some ideal world, choose to live with better BGs and less volatility at the price of some hypoglycemia? Or would you be more comfortable with a higher BG experience with zero risk of going hypo?
Here’s a summary of the two days.
Day 1, higher blood glucose, no hypos.
Day 2, normal blood glucose, 58 minutes in the upper hypo range.
I realize that we cannot order up the blood glucose day we want; this is a bit of a fantasy exercise. I’m just trying to gauge the values of the community in this basic tradeoff we each face when we decide what personal target and associated risk is acceptable to us. I would appreciate in the comments about the rationale for your choice. There is no right or wrong answer here. Thanks.
If you could, which day would you choose for yourself or your loved one?
- Day 1, higher blood glucose, no hypos.
- Day 2, normal blood glucose, 58 minutes in upper hypo range.