Too low i don't think so ?

[richyb]

Just had my hba1c results of 44.1. Strange as I am sometimes above 10mmol. I am on omnipod 5. But using in manual mode as auto was sending me above 10mmol very often for long periods. I do not hypo think only twice in 2 months slight. My doctors surgery going to phone me as they do not like me being this low. Also my Dsn. Will not be happy who is also going to be on touch soon. I should not be in manual. Want to come off omnipod completely. Maybe T slim or just a standard pump.
Appreciate any coments.

 

[oldgreymare]

Hi @richyb, an HBA1c result of 44 suggests an average BG level over 2-3 months of 7.3 mmol - (I think still a diabetic level). Of course you know that you can have periodic higher and lower readings. Best practice guidance for diabetics using CGM (or flash monitoring) is to focus on time in range (between 3.9 - 10 mmol) with a target of 70% TIR or more. If you can consistently maintain your current HbA1c with hypo incidents of less than 4%, then your diabetes team should be supportive, but many HCPs are still using older (pre CGM) guidelines where higher BG levels for insulin using diabetics were preferred due to the risks of unnoticed hypos. You may find the attached helpful - you can always tactfully ask your team if they have seen this.

Re the Omnipod 5, as well as any other hybrid closed loop system, be aware that the AI algorithm the pump uses is very dependent on the data it has been 'trained' on. This will be data from a very large cohort of pump users and will be a broad representation of the typical pump users behaviour. This is used to set the initial HCL pump settings and I believe these are often tweeked by the pump manufacturer to aim for higher BG levels at start in order to avoid the risk of hypos. Then as the HCL user automatically sends data back to the algorithm, it 'retrains' to be more specific to the that individual pump user. This recalibration appears to take between a few weeks to several months.

I am very new to using a pump having just started with an Omnipod DASH which will be very similar to running an Omnipod 5 always in manual mode. So far so good, but I really want to use a manual pump for at least a year to truly understand it before even thinking about a HCL.

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic - PubMed

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these...

pubmed.ncbi.nlm.nih.gov

 

[Juicyj]

Hi Richy, it's only because they think you run the risk of having increased hypos at this level, a chat with a DSN will clarify this is not the case, so don't worry if they say anything, time in range is the best indication of how we are actually doing, I find the HbA1c a slightly archaic method to measure this by and your DSN will more than likely agree too. I once got down to 42 and felt amazing for achieving it, knowing how much work goes into managing this daily, I now tend to sit around 52 on the Tandem and would like to get this below 50, hey ho work in progress !

 

[Chas C]

I'm on the t:slim and have an HbA1c of 43, have been down to 41 (last year) but was very hard work. Now much more relaxed and spending less effort managing and happier.

 

[jaywak]

I was told by my consultant about 18 months ago that my HbA1c of 44 was far to low even though I hadn't had a serious hypo for years but will admit to going low quite often and was told it needed to be about 50 , since using the Libre 2 cgm I managed to get my last HbA1c to 49 , the Libre prediction was 51 , that was 6 months ago and my Libre is predicting an HbA1c of 50 and my tir is 85 with lows at only 1% so I guess he will be happy with that .

 

[Nicola M]

Your doctor would have an absolute fit if they saw my last HbA1c coming in at 38 and my doctor was very happy with that based on my Time in Range results.

 

[jonathan183]

Hi @richybYou may find the attached helpful - you can always tactfully ask your team if they have seen this.

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic - PubMed

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these...

pubmed.ncbi.nlm.nih.gov

It's not very reassuring when they mark hypo as hyper on all the figures

 

[richyb]

Hi Richy, it's only because they think you run the risk of having increased hypos at this level, a chat with a DSN will clarify this is not the case, so don't worry if they say anything, time in range is the best indication of how we are actually doing, I find the HbA1c a slightly archaic method to measure this by and your DSN will more than likely agree too. I once got down to 42 and felt amazing for achieving it, knowing how much work goes into managing this daily, I now tend to sit around 52 on the Tandem and would like to get this below 50, hey ho work in progress !

Hi juicy
Yes I am aware of what you have said. I try to get a high time in range, very often high 90%, just lately its dropped as my body requirements has changed. Going to write a new basal prog today. Thanks very much for your input much appreciated. I know you are very knowledgeable and often I agree with you. Would like to discuss your T slim thoughts perhaps via private messaging please sometime.

 

[richyb]

It's not very reassuring when they mark hypo as hyper on all the figures

Many thanks had a close look. I am definitely old category 71yrs as of yesterday. Type1 for 58yrs nearly

 

[oldgreymare]

It's not very reassuring when they mark hypo as hyper on all the figures

@jonathan183 Good catch - perhaps I'm overfamiliar with the typical cgm bar chart - never spotted the wrong labels but I think (hope) the text is more accurate, maybe time to reread.
@richyb