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 of easy fat left 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.
So sorry for the delay in responding Jen. I am not aware if the G6 has been approved or not. Because my finances are low my brother has been getting my Dexcom for me. He’s a good man and I am grateful. I am flying to Los Angeles today and have to go through airport security - am hoping there will not be any issues!
Jen - Spoke with the western Canada Tandem rep yesterday, and the G6 hasn’t been approved by Feds yet.
The Tandem t:slim X2 they currently sell in selected Canadian provinces is the G5 supported model without Basal IQ. She assured me that it is completely upgradable (software) to the G6 / Basal IQ version once the Federal Government approves it.
Jim
Don’t know if I should answer this since I have never used a pump and have no idea what a closed loop system is, but I would go for the lower numbers to prevent complications. I am 68 now, and stay right on top of my care, but when I am a lot older I probably will go for higher numbers to avoid hypoglycemia.
I would take the second choice. Actually I’m not terribly far from #2: average BG in mid-90s with std deviation 15-20, 4.9 HbA1c, and hypos (BG<54) less than once/mo.
I’m most concerned with complications of hyperglycemia: peripheral neuropathy (very painful with high BG), retinopathy (in “remission”), kidney failure, blindness, and amputations.
FIASP, 670G always in manual mode, moderate carb diet
Exactly!
I did aim for (and largely succeeded) the approach exemplified by “Day 2” until a couple of years ago. And then I had a baby. I now willingly let myself run a little higher and rarely pre-bolus because I fear collapsing when I am with her and there is no other adult around and especially when she was younger and I had to carry her around 100% of the time. Mind you, I have never collapsed or needed external help with any of my hypos before either, but both are possibilities and in my current life circumstances, I just want to minimize those risks.
It is in fact only now that (for the same reasons and changed tolerance) I am actually using the Auto-mode on my 670G with only slight workarounds to deal with its “hypo-conservatism”. So my current picture is very close to that illustrated by “Day 1.”
Do I see myself ever going back to the other approach? Absolutely, when my child is not so dependent on me. But I also hope emerging technologies and treatments will narrow that gap and make the tradeoff less sharp.
I have been in positions where I’ve been responsible for children, sometimes in situations where they need my attention at all times to maintain safety. I once had an extended, deep low during one of these situations and all I can say is that it shook me deeply. Thankfully, I was not the sole responsible adult in that situation. When I did a practicum where I knew ahead of time that most of my work would be in these types of situations, I went low-carb and basically devoted my life to my diabetes control and my schoolwork. But once I was back to daily life, I just didn’t want to devote my entire life to diabetes management and dietary restrictions, which for me is how low-carb felt (on top of food allergies).
It’s all a trade-off. It varies at different times in our lives depending on different circumstances. But I do know the “Day 2” is a level of control I’ve achieved only once or twice in my lifetime. Getting to that level every day would take an enormous amount of effort, to the point other health needs and life needs would probably be compromised. I think each of us has to make these types of decisions based on the mental energy we have at any given time. The “Day 1” control is quite decent compared to the international average and only looks “poor” when compared to some of the people on these forums.
I, too, hope that technology progresses to a point where I can get a “Day 1” day without dedicating so much of my attention to the cause and/or feeling like it’s a virtually impossible goal.
I had to quit my job at a daycare in order to achieve the control neccessary to try and get pregnant. Otherwise, it was just too darn difficult. Not only can you not test your blood sugar when working at a daycare (less important now I have a cgm, but there’s still those times that symptoms dont match up with the number), but lows need to be avoided like the plague. It’s just not safe to start dropping when 8 little bodies rely on you staying in your right mind. Add to that my increasing frustration with breaks being delayed or just skipped altogether, and it just becomes impossible to maintain those hba1cs under 6. I think when I go back to work, I will have to figure out another career because it just seems like the way daycares are set up now (I had 0 help when I needed it) it’s just impossible to maintain good blood sugar control. It’s a shame because I love the kids, but it’s the reality unfortunately.