FUDiabetes

Ideal BG range?

I agree with @Eric. So far, for older kids and adults, research has shown that there is no cognitive danger in lows that you survive, but there is in highs.

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The problem is it’s exceedingly difficult to quantify even what “normal” blood sugar actually looks like let alone well controlled diabetic blood sugar, and so many disease mechanisms are unknown. There is more to developing or avoiding complications than simply tightly managed blood sugar. The body is a complex system and diabetes is a complex disease but we always simply conceptualize it as nothing more than blood sugar levels. We are very limited in both our comprehension and in our tools.

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I’ve only been using the cgm for 5 months now - before that I targeted 6.5 to 7 but I generally was 6.75 as my daily basal is so up and down and hard to control even with zero carbs
On the cgm I’m targeting 6.2 or less which would be an average of 130 which I think is good
Once I get the hang of it and sort out the daily basal problems I’m going to target 120 so an a1c of 5.8 which my doctor thinks would be phenomenal
He doesn’t push the lower a1c nor - he much prefers keeping a flat reading throughout the days without ups and downs - he says 6.3 is excellent already as long as its flat - his warns me that going low and attempting 100 or an a1c of 5.1 you are constantly risking 50-70 and the damage that this does to the blood vessels and the brain is far worse than keeping a steady 130

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Actually, there is solid research that shows that lows are not creating long term neurological damage whereas highs are (see Eric’s post with research links):

For some reason, many GPs don’t seem to be aware of that.

I can’t agree more. This would be the roller coaster problem.

Under my current regime with CGM, I rarely go low anymore. By rarely I mean in the last 90 days I am less than 70 (3.8) less than 1% of the time and most of those lows are between 60 and 70.

Yes, my son’s endo (who has a similar diabetes philosphy to me) was on vacation and my wife had to see the vacation coverage. We were looking for advice on early morning highs we were seeing, which we thought may be related to hormones. He did not give my wife any advice on the highs but instead told my wife that a 7.2 A1C was way too low for a 1 year old and that she was too OCD becuase we test 8-10 times a day (no CGM yet). Basically if you do not test at 3am you won’t need to worry about the highs because you will not see them. Really helpfull… given that my son does not get a lot of lows :slight_smile:

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This reminds me of this thread, and of this post of @docslotnick’s:

That new glucose meter system may be ideal for your endo: just the strips with no meter, just read them as you wish :slight_smile: . You may not even have to wake up for it.

From here on I will refer to it as a Reader’s Digest glucose meter…

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i would like my range to be about 75 to 110. but my endo would prefer 120 - 150 his concern is what he considers lows ( anything under 80 ). at 150+ i will deff treat with a correction. but i won’t bother with anything in the 60s unless i am about to bolus for a meal; then i will wait till i am up into my 70s.

if i am trending low in the 60s or the 70s, and i know i will go lower, i will treat with GTabs, chocolate, or juice (if i am in my 40s or less). when i get into my 50s, i start to see bright lights and i cannot focus my attention and i especially cannot see anything clearly. it is too uncomfortable for me to remain in my 50s. i know that eric can be comfortable there, but i just can’t. (and my husband can’t stand me when i go low and take my time to treat it; he wants to attack it immediately. (but i am always kind of stoned when i am low, so i get a bit stupid )

and i also agree with eric that it is better to have a flatline than go bouncing all over the place (even when your BGs appear to be in “target” range.

my last A1c was (if i remember correctly) 5.6 . i am seeing my endo this tuesday (sept 12th) and will have my blood work done. i am eager to see what my latest A1c is. i know, also that my endo will be very scolding of me for allowing my BGs to be lower than he thinks is “appropriate” (no A1c lower than 7% ). but this is the idiot i have been ragging on.

(PS: i am scheduled to see the new endo October 4th with Mt Sinai Hospital; i am looking fwd to having a good rapor with him. but i am also prepared to find someone else if i don’t feel comfortable with him.)

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Thank you all so much for your input! I think I just need to change my thinking in regards to some things (like having a target number to stay around rather than a range - I think that might actually help me). I’m still working on not getting upset when I spike/rise too high. Lows don’t upset me that much, though I haven’t experienced any below the 50s yet (good to know they’re not much to worry about in terms of long term complications…if you survive them anyway :grimacing: ).

@Michel, I HAVE noticed y’all are quite a bit more aggressive, but I think that’s what allows you to be more unlimited - if you didn’t aggressively correct, there would be no way to attempt some of the things you do/foods you eat, right?

I’m trying to get better about correcting, though unfortunately I’m not sure yet whether it’s that my pre-bolus time is off or my honeymooning pancreas is just a lazy jerk (haha) who squirts out insulin belatedly, but I’m afraid to correct most of my spikes (usually in the 150s), because I know an hour later I’ll be back in range - like this morning, spiked from 99 to 156 an hour after a waffle, but by 2 hours I was at 93 with no correction. That happens almost every time I go high.

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Do you feel it is your honeymooning pancreas? If it is, then a very quick correction (you need to catch it really fast) might offload some of the production of your surviving beta cells. Keep in mind, though, that your insulin takes some time to get active – I am not sure what that is for you.

For us, in 25 minutes we see very faint signs. 40-45 minutes from injection it fully turns on.

I’m not sure. :slightly_frowning_face: I was sure it was just my pancreas, having almost a reactive hypoglycemia type effect going on (but of course not going hypo…or maybe I just never let it get down that far? I eat fairly often…). But then I realized when I decided my Afrezza timing was off that maybe my issue is pre-bolus timing. I’ll have to do more experimenting…
I also would probably have to check more often to catch the spike quick enough to correct? I check at 1 hr after food, then at 2 hr if it’s high/low/I’ve corrected. It takes about 30 mins to start seeing the Novolog drop me, 45 mins for real progress. I’m not sure it would be enough time to keep from it sending me low. Again, guess I need to do more experimenting.

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This is almost always the conclusion on any thread on FUD!

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@TravelingOn, there is a lot of research that contradicts this. Even if this article exists, it may well be one of those cases where the total evidence available still shows the opposite view to be right.

Not trying to be stubborn :slight_smile: When I started looking two years ago, I also thought that hypoglycemia would end up being more dangerous. And it is for the short term of course: you can die of it right away.

I take an extremely cynical view on this.

Hypo’s are more dangerous to the healthcare provider, because if you die from it when under their care, it’s bad for them. They didn’t warn you enough!

But if you eventually have complications and die from repeated hypers, that’s just part of the disease.

How cynical am I? Am I over-the-top with this thought? I don’t know.
(Seriously, lemme know if you think I am very wrong here. I know it depends on each endo, and not all endo’s are the same, and all that, blah, blah, blah)

That’s just my take on it. It comes from years of dealing with providers.

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I am not as cynical as @Eric in the general case, but, in this case, I think he is right.

I also understand that medical professionals need to actually fill up a lot of paperwork when their patients’ A1c is too low (?!). Too low, I think, may mean under 7.5% - although I may be wrong.

I think this is overly cynical. At least with our endo, I think what she’s seen is just a parade of kids with, say a 5.8 or 5.9 A1C where she looks at their Dexcom graph and is horrified – hours and hours below 50 or 40, which is why they’re not running a high A1C. And I don’t know if she has any patients who have such low A1Cs who are not running in the hypo zone perpetually – which even if you don’t think will kill you, certainly can’t be good for optimal cognitive function. So she simply doesn’t think it’s possible. I mean, even if a hypo episode was totally harmless long term, Samson acts super loopy and spacey when he is in one. I wouldn’t want him taking a test or doing something like swimming or a bar routine while in the 50s.

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Just to clarify, I am speaking more toward the interaction of caregivers with adult patients.

I know young ones need to be extra careful when they are growing up. I would not advise anything different there.

My comment comes from hearing things from superstars like DaisyMae, who for years was told by her endo or CDE to not get in the pool unless her BG was at least 200. Maddening to me!

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I agree with you @Eric. As I’ve expressed in the past, our Endo would be perfectly fine with Liam having a 250 BG year round because this removes immediate liability from the hospital. But what about the damage this is wreaking on his body that will kill him later. I don’t think you’re cynical at all…realist, as am I. Those are just the facts.

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It’s strange how all people are different. Last night, Liam’s CGM read 87, level, and there was a blood drop to calibrate so I did a blood draw. He was cuddling with me playing games on his phone and just as fine as always. I checked his BG and he’s…47! So I double check just to be sure that wasn’t an anomaly and the second draw was 49. I immediately gave him 1 and 1/2 tablets and asked him how he felt. He said “fine”. For us, for Liam…I never can tell any difference at all in him when he’s hypo versus normal range. I even ask and he doesn’t exhibit any strange behaviors. At times he IS clammy/sweaty, but this is usually only when he’s low and asleep.

I think any Endo should be happy with any A1C that their patient can get AS LONG as they can prove that they’re not accomplishing this by chronically staying in the hypo range as you indicated. If we can get our sons at 6% while maintaining under .4% severe lows and < 4% lows I would think they would welcome this…but that’s not been my experience with any Endo so far. They tell me "he doesn’t need to be any less than 7.5 or 8%. Knowing what I know through my own research and knowledge, I just mentally call BS and stick with the course I’m on. They can complain all they like but at the end of the day if I can manage a good A1C NOW (w/o too many low or severe lows), while ALSO setting him up for a healthy adulthood, I’m going to do that. And I don’t give 2 hoots about how the Endo’s feel about it.

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Well, I can agree with @Michel that GP’s and even Endos and CDE’s don’t seem to be aware of that. I read these studies before our appointment this afternoon, and still didn’t seem to manage to get through.

I think that all signs point to @Eric’s hypothesis about T1D Care:

The (limited) research I’ve found seems to point to episodes of extremely low BG having a possible connection to dementia in elderly patients (BUT they were T2, so that sheds a different light on the connection they’re trying to make to me). Also, in reading through it, I’m not sold that it happens. Also, these are people with repeated hospitalizations due to hypoglycemia - which is obviously NOT what is being discussed in this thread, or what is happening regularly to the people on this forum.


I tend, because I respect the people gathered here, to believe you all over mentioned tidbits of health issues that are delivered unsupported.

And @Sam, this is very true, and I appreciate that you point it out:

EDIT: (Yes, yes, I know, I used an article about T2, but there were lots of things that pointed in this article’s direction, and I felt like it might be one of the things people keep referencing when saying that hypoglycemia will kill off brain cells.)

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thats exactly what i think of my endo :money_mouth_face:

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