Interesting, at least in this study that data wasn’t all that close.
Your glucose management can also be measured by Time in Range (TIR), when glucose levels are between 70 to 180mg/dL), Time Below Range (glucose levels below 70mg/dL) and Time Above Range (glucose levels over 180mg/dL).
Time below 70? Meh. Not something I stress about. I think 60 is much less damaging than 180.
Too bad I can’t access the original study. I’d like to know whether the GMI in general overestimates or underestimates the A1c.
I think this is a very important limitation of the study: “A perfect comparison would require a GMI and A1C taken on the same day with 60-90 days of CGM data.”
“The average period for a CGM report was 24.5 days (the range was 14-144 days)”
In addition, I must say that I don’t think this makes the study worthless. It’s good to have some scientific evidence that you can’t extrapolate from 3-4 weeks of BG data to 2-3 months. It wouldn’t come as a surprise to me if many clinicians regularly printed just 2 weeks of data and took that as indicative of the past few months.
That the GMI and A1C differed substantially for a majority of participants was very interesting to me since I am usually “off” by 0.5% as well.
In my case there’s a curious difference between the Freestyle Libre desktop software and the Libreview.com reports. Reports generated on the same day have different estimated A1cs and GMIs. The desktop software was closer to my last measured HbA1c.
My xDrip A1c estimates from Dexcom G6 readings track closely enough with a medical office A1c test that my Endo wants the 30 day reading when we have virtual visits. She already has the data from my Tandem pump. I don’t think exact percentages are very important, but whenever xDrip tells me I have had a good A1c and TIR day it’s a real boost. Gotta do better tomorrow!
Not quite sure I’m “meh” at 70; anything below 65 and my hands are shake yet and my mind’s fuzzy. Also, I find once I break 70, I tend to drop more quickly, it’s like my body says “Hey! If we’re going down, let’s go down quick and in style!” On the good side, I’ve found if I make a “small correction,” maybe 1/2 a glutab at about 75-80 (w/moderate down arrow on CGM), then wait a few minutes to see an impact, I can head off dropping below 60.
Over time your body can get used to lower blood sugars if you spend a considerable amount of time there. When my son was first diagnosed anything below 100 used to have him shaking like a leaf. However, there is data to suggest that once you are over 65 you should have a higher blood sugar average than before.
I managed to adjust myself to 50mg/dl when I was first up in Oregon; lost in translation, I was used to mM and managed to do the division wrong, then stuck with it. It probably helped that I was “high” quite a lot.
Being new to actually being in tune with my sugars all of your comments caught my attention and curiosity.
Eric mentioned low at 70 was nothing and I thought ‘holy crap I fell off at 75 somedays’ then Eric chimed in amd I felt better. I then thought that I was scared to go under 90 at one point.
The moral is I think my BG was so high for long(had a 14 A1C) that it tool.my body time to get back to normal.
Also learned about TIR from this article. I have enjoyed Playing the TIR game with myself and now it will be an even better tool.
Thank you all so much for your insights and encouragement.
FYI per xdrip my 90 day numbers are A1C estimate 6.9 TIR 72%
Congrats on sub-7 numbers! That is a big deal! Always good to get better at the diabetes “game”. And yes, glad you are appreciating the insights and encouragement, that is why we exist. Honestly, we would be lost without this group. My son was diagnosed 5 and 1/2 years ago and we were lost puppies wandering around in the wilderness of cinnamon cures wondering how we were going to do this, and then we met a bunch of great people and created this little corner of the web to keep passing on what we were learning. Thanks so much for staying around and contributing.
Another part of it is the slope of the change. I guess I should have been more specific and said a flat 70 is nothing. If I am dropping quickly, and happen to test when it is passing the 70 but on its way down, that is totally different. I can actually feel low at 100 if it’s dropping.
I think the important thing with BG is “where’s it gonna be 15 minutes from now?”
I agree with the theory but the complicated thing for a lot of people who have professional licenses dependent on their physical health is that they are evaluating for “hypoglycemic episodes” and those are a big red flag whereas elevated blood sugar is not at all
@Sam I think this is the perspective my current Endo is coming from. Her advice last December was to aim for 100-150. When I questioned this at a January appt (and after doing some research myself) and suggesting 90-140 goal (I questioned a few over 200’s in the afternoon/evening), she commented at my age (65+) its better to err on the higher side and not to worry about 200-220’s unless its frequent/continual. I still like to keep it down under 140, except an hour or two post meals. Still figuring what’s right and what’s feasible. Managed to get my A1c from 10+ last Nov, to 6.6 last month and other numbers (Cholesterol, etc.) were good too, so was pretty happy and hope to keep them down.
Keeping your A1c in the 6’s is what is recommended, I believe, based on the literature is that correct @docslotnick ? It would be if you venture into the 5’s that things are potentially too low based on the work that has been studied for people over 65.
@Chris I think your advice is sound, though my PCM says recent studies for folks 65+ indicates upwards of 7 or a little more is acceptable IF not incorporated with bouncing between highs and lows frequently, i.e get a reasonable range and stay there as much as possible…seems good advice for a lot things!
It sounds like you’re doing it right. For myself I like an A1C in the high 5’s rather than the 6’s on the theory that it does reduce the likelihood of damage.