I think it depends on life circumstances. Currently, I would choose the lower option because I am trying to get pregnant, but it has been a massive amount of work for me. Despite being in range (70-140) around 80% of the time, I still have a standard deviation in the high 30s, and the sugar has dropped to the 30s (no idea why) and risen to 350 (cannula was bent). My last hba1c was 5.6 and the cgm says the average is between 106 and 122 every day. Trying to get lower leads to bad hypos more often, which is scary, but my life is about diabetes management right now so its doable. However, i don’t want to live like this forever. I like to travel, and try new things, and dance all night if that’s how the mood takes me. I don’t want to worry about having to stop for an hour to get my blood sugar up. So, while I would choose the lower option now, 2 years ago I would have chosen the higher option, and in another 2 years I will probably choose it again because in normal circumstances I want to try things I don’t know how to account for and I need a cushion for lows more than highs.
Yes per my Nephrologist BS’s less then 130 put undue stress on the kidneys but on the other hand above 200 is stress to other parts of the body. Eye and heart .
The question you ask is a bit of a ‘trick question’ imo, because not all hypos are equal. I eat very low carb and my A1C is 4.9. I also do competitive high intensity sport which creates a lot of basal variability. My basal can fluctuate pretty much from day to day from approx 10u - 18u per 24hrs. After exercise I experience extreme insulin sensitivity and yet I shoot up even without food at approx 10 am. This spike happens most days but not all. So there is a lot of variability. I manage to keep my SD at below 22, but this is where my battle lies. For me the SD is more important than the A1C and better indicator of control. Mine is OK, but not great. Because of the above I do go low frequently but I am not concerned because my lows always happen in slow motion. I eat so few carbs, and take very small doses of insulin so it is very rare that I get plummeting blood glucose levels. I may drift down to the mid 50’s and it can be annoying to have to continuously much glucose but I don’t consider this a problem. What would be a big problem is an SD of say, 30 and sharp highs and potential lows that could leave me disoriented. An A1C between 6 and 7 may seem OK, but after 35 years with this I can tell you it is not. All my complications have been reversed after 2 years of LC but I will never go back.
For me I prefer to aim for as non-D as I can. I was born with poor kidney function, and at age 15, my parents and I agreed that I would not do dialysis. I signed the no to dialysis paperwork at age 18. I was Dx’d with T1 at age 30, and am now 66 so transplant isn’t an option (too old for the pancreas kidney combo) Not waking up from a hypo is a better end than dialysis and the limits it puts on my love of travel, ability to relocate etc.
Not all PWDs are represented here, of course. And there are many many - who would agree with what you are projecting that doctors would say. I work with people with diabetes, and as I’ve said on here before, there is not the same sanguinity (made up word) by a long shot to go low.
THANK YOU!!! And not everyone experiences the same complications at lows and at highs.
When you say very low carb diet, are you in Ketosis? I’ve found the low carb diet I’m on (<20 grams / day) and running on ketones is far preferable than carbs.
As well as not seeing rollercoaster blood sugars, I find I can easily mange lower blood glucose levels (under 3.0). While this transformation happened almost immediately upon entering ketosis, it took me a couple of weeks to become more comfortable running what doctors would describe as hypo blood glucose levels.
Fun question. I very much enjoyed reading it. Honestly, I’d be fine with either of these. No difference, to me personally, one way or the other.
Hi Jim, I am definitely fat adapted but I never experience high ketones. I am not sure why. I have never been above .2, even though like you I eat less than 20g per day.
@halvdan - Would I be wrong if I guessed you’re more of a leaner / smaller physique?
I dropped 30 pounds (intentionally) over the past 4 months, during which my ketones typically ranged from 1.0-3.0 mmol/L. There were several times during 48 hr fasts that ketones went higher, as high as 6.9 once, but my blood sugars were always well controlled (CGM) and never any danger of DKA.
More recently I’m maintaining my current weight of around 150lbs, still at well under 20 grams/day carbs, and my ketones are far lower (only 0.1-0.5 in morning). It appears there just isn’t a lot more easy fat to burn
That’s interesting. Yes, I don’t have a lot of extra fat on me. I weigh about 140 lb. even during fasting the highest my ketones went (once), was .5. But I do t often measure tbh.