Good time in range

[Miss Piggywig]

I am looking at lowering my HBA1c I am 5 weeks into diagnosis. No honeymoon period I've gone from 25% in range and 36% high. I'm now 75% in range with only 1% high. So pleased I'm making headway. (Some days things just don't seem to work but more better days then bad). My question is to get my level down to low 60's what % in range or average level should I be aiming for?

 

[In Response]

The current recommendation is 70% in range with no more than 5% of the time in hypo.
The benefits of more TIR are offset by the mental impact on achieving this without closed loop.

 

[kkapo18]

The current recommendation is 70% in range with no more than 5% of the time in hypo.
The benefits of more TIR are offset by the mental impact on achieving this without closed loop.

Time in range also goes up to 10 mmol. Personally I set my boundary at 6.5 (but that's just me) and aim for atleast 70%.

Still think the guidelines of going up to 10 is far too high.

 

[jaywak]

I am looking at lowering my HBA1c I am 5 weeks into diagnosis. No honeymoon period I've gone from 25% in range and 36% high. I'm now 75% in range with only 1% high. So pleased I'm making headway. (Some days things just don't seem to work but more better days then bad). My question is to get my level down to low 60's what % in range or average level should I be aiming for?

If you are 75% in range and 1% high am I correct in thinking you are 24% low ? if that is the case I think you should be addressing that problem first .

 

[In Response]

Time in range also goes up to 10 mmol. Personally I set my boundary at 6.5 (but that's just me) and aim for atleast 70%.

Still think the guidelines of going up to 10 is far too high.

Wow! Why do you think 10 is fat too high?
Have you looked at Libre graphs from people without diabetes? They will spend less than 70% of their time between 4 and 6.5mmol/l. You are trying to achieve something which is unnatural and may lead to diabetes burnout.

I agree that spending long periods of time at 10 or above is not ideal but trying to restrict yourself to less than 30% of your time about 6.5 is crazy.
Take a look at people who have lived for 50, 60 and 70 years with Type 1. They spent the majority of their lives not being able to manage their BG even with a finger prick. Yet, they are still alive.

Twenty years ago, I was diagnosed with Type 1. I was finger pricking for the first 15 years so no idea about TIR.
My current TIR (using the recommended range) is around 80%, my HBA1c is consistently low 40s, I have no complications and intend to keep it that way. And when I talk about complications, I mean physical and mental complications whilst maintaining and very full and active life of which diabetes is a part but does not dictate conditions.

 

[jaywak]

Wow! Why do you think 10 is fat too high?
Have you looked at Libre graphs from people without diabetes? They will spend less than 70% of their time between 4 and 6.5mmol/l. You are trying to achieve something which is unnatural and may lead to diabetes burnout.

I agree that spending long periods of time at 10 or above is not ideal but trying to restrict yourself to less than 30% of your time about 6.5 is crazy.
Take a look at people who have lived for 50, 60 and 70 years with Type 1. They spent the majority of their lives not being able to manage their BG even with a finger prick. Yet, they are still alive.

Twenty years ago, I was diagnosed with Type 1. I was finger pricking for the first 15 years so no idea about TIR.
My current TIR (using the recommended range) is around 80%, my HBA1c is consistently low 40s, I have no complications and intend to keep it that way. And when I talk about complications, I mean physical and mental complications whilst maintaining and very full and active life of which diabetes is a part but does not dictate conditions.

Exactly what I was thinking but you beat me to it !

 

[kkapo18]

Wow! Why do you think 10 is fat too high?
Have you looked at Libre graphs from people without diabetes? They will spend less than 70% of their time between 4 and 6.5mmol/l. You are trying to achieve something which is unnatural and may lead to diabetes burnout.

I agree that spending long periods of time at 10 or above is not ideal but trying to restrict yourself to less than 30% of your time about 6.5 is crazy.
Take a look at people who have lived for 50, 60 and 70 years with Type 1. They spent the majority of their lives not being able to manage their BG even with a finger prick. Yet, they are still alive.

Twenty years ago, I was diagnosed with Type 1. I was finger pricking for the first 15 years so no idea about TIR.
My current TIR (using the recommended range) is around 80%, my HBA1c is consistently low 40s, I have no complications and intend to keep it that way. And when I talk about complications, I mean physical and mental complications whilst maintaining and very full and active life of which diabetes is a part but does not dictate conditions.

 

[kkapo18]

Sure, and I agree i'm probably on the extreme end having just been diagnosed, so this will very likely change over time.

I'm a pretty active and outgoing person too, so appreciate these levels will not be sustainable.

I'm hoping at some point to be given the opportunity to use a pump, which I think might make the management a lot more simpler!

 

[Nicola M]

My last “statistics” were 80% in 3.9-10 with 1% below 3.9, 18% 10-13.9 and the rest above 14. With all of that in mind my last hba1c was 48 so really going up to 10 I don’t think is that big of an issue but each to their own I suppose!

 

[EllieM]

I'm hoping at some point to be given the opportunity to use a pump, which I think might make the management a lot more simpler!

Yes and no. I am certainly getting much higher TIRs with a pump, but the closed loop technology is very keen on avoiding hypos. The pump I'm using aims for a bg of 6.2mmol/L so there is no way I could expect it to keep me under 6.5. (Admittedly that is just one pump, and others are probably different.) And after 4 weeks on the pump I am on 0% below range and 8% over, so I'm very happy, specially as the reason I qualify for a pump is hypos.

And as a long term (54 years) T1 I can confirm that too many hypos can result in loss of hypo awareness and hospitalisations due to coma. Not fun and one reason why diabetic teams don't like their T1s to aim for very low bgs.

Now I appreciate that the situation may be very different for a new T1 with (hopefully) more residual insulin production, but am still slightly sceptical as to the aim to keep below 6.5mmol/L.

 

[kkapo18]

Yes and no. I am certainly getting much higher TIRs with a pump, but the closed loop technology is very keen on avoiding hypos. The pump I'm using aims for a bg of 6.2mmol/L so there is no way I could expect it to keep me under 6.5. (Admittedly that is just one pump, and others are probably different.) And after 4 weeks on the pump I am on 0% below range and 8% over, so I'm very happy, specially as the reason I qualify for a pump is hypos.

And as a long term (54 years) T1 I can confirm that too many hypos can result in loss of hypo awareness and hospitalisations due to coma. Not fun and one reason why diabetic teams don't like their T1s to aim for very low bgs.

Now I appreciate that the situation may be very different for a new T1 with (hopefully) more residual insulin production, but am still slightly sceptical as to the aim to keep below 6.5mmol/L.

Thats interesting the pumps aim on avoiding hypos - as you say, maybe not the best if you are wanting tighter control.

I'm currently taking 12 units lantus before bed and 1 unit novorapid before meals, so believe i may well be in a honeymoon period, but this could also be attributed to my very low carb diet.

Oh and why I'm aiming below 6.5 is simply to avoid any long term diabetic complications. Think there's some pretty strong research to back up for every increase in a1c, brings about higher risk for certain complications, but again, it's each to their own in terms of what they have in terms of goals! I'm sure overall health etc comes in play too!

 

[Nicola M]

Adding onto what @EllieM had said I am also on hybrid closed loop (Medtronic 780g) and there are 3 blood sugar targets it can aim for, 6.7, 6.1 and 5.5. You can set either of these although 5.5 does make me uneasy because you do risk that with auto corrections for the pump to get you down to 5.5 it can be overly aggressive and you’ll go further down than 5.5. Other people’s experiences may be different but I wouldn’t feel comfortable with a target of 5.5 especially with driving as well. With my target of 6.1 I’ve gone below that a fair few times with corrections.

 

[CJa]

I am looking at lowering my HBA1c I am 5 weeks into diagnosis. No honeymoon period I've gone from 25% in range and 36% high. I'm now 75% in range with only 1% high. So pleased I'm making headway. (Some days things just don't seem to work but more better days then bad). My question is to get my level down to low 60's what % in range or average level should I be aiming for?

Hi, my suggestion is to aim to start the day lower. Perhaps 4 to 6mmol/L. I generally have a better day if I get that first blood level right.
Another suggestion is to be flexible with your basal. I change mine frequently to accommodate changes in my dietary intake. If I have a big dinner I bolus accordingly and increase my basal (aiming for 40-50% TDI).
Finally, everything you eat increases your blood sugar. This includes fats such as butter and cheese and protein such as eggs and meat.

 

[becca59]

It was interesting reading this thread. The divide between just diagnosed and long timers stands out somewhat.
I don’t mean to be rude or dispiriting to those early in your journey, but with those expectations on relatively small amounts of insulin at the moment you may be setting yourselves up for a fall that has you beating yourselves up. Yes be proactive and have a goal, but be prepared for that goal to be like going up and down a mountain as you progress so that you don’t end up feeling too guilty.

 

[Miss Piggywig]

If you are 75% in range and 1% high am I correct in thinking you are 24% low ? if that is the case I think you should be addressing that problem first .

Sorry no I haven't made this clear. I have 76%in range 24% just out of range (10-13) and 1% very high (over 13). I would really like to say below 7 but I've been told this is unrealistic. Guessing it's baby steps.

 

[Miss Piggywig]

My last “statistics” were 80% in 3.9-10 with 1% below 3.9, 18% 10-13.9 and the rest above 14. With all of that in mind my last hba1c was 48 so really going up to 10 I don’t think is that big of an issue but each to their own I suppose!

Thank you for this it shows I'm not to far off. My average according to my Libra is 8.5.

 

[Ushthetaff]

As a person with numerous complications due to diabetes , I understand people’s dilemma , but it’s all about achievable goals.Living with diabetes is hard enough without the pressure of maybe somewhat unrealistic achievements , yes it is possible to keep bs between 5 and 7 personally for me to do that it would mean I’d be doing. Nothing else than looking at my results and testing , fortunately I have a life and it’s not all about diabetes. My issues came as a result of YEARS AND YEARS AND YEARS , of, of HbA1c being in the 100 + range . Now I try to keep my bs between 5-10 , doesn’t happen all the time and I don’t worry if it goes a bit higher for short periods , I’m never stressed about my bs I just deal with it cause let’s face it I’m the only one who can do anything about it . if my time in range is above 60 % I’m happy . I’ve been told professionally that I’m doing really well , was also told I’m far better looking in person than on paper so that’s a bonus , will say I must look absolutely minging on paper then hehehe