I was told my control is too good for my age.

[ElenaP]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

 

[AndBreathe]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

Erm,......... and she lived?

I do know that NICE guidelines for those with a few miles on the clock suggest it is safer to run a little higher than be constantly treating hypos, but your guidance to you seems,.well,............ bonkers!

In your shoes, I might be looking elsewhere, but what do I know?

 

[Ushthetaff]

Proves my theory on DSNs about as much use as a handbrake on a canoe

 

[Nicola M]

So... your pump is doing what it's supposed to and your DSN is unhappy why again....?

Seems a bit over the top and bonkers but who am I to know!

 

[Antje77]

Can you fire her?
There are absolutely no guidelines saying to aim for less time in target based on age or any other circumstance. There are some outdated (before CGM) guidelines on hba1c, but time in range, no.

 

[Hopeful34]

So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

Well I know what I'd do - my body, I have to live with the consequences of my actions (including time in range) not a DNS. Fortunately I have a lovely one, who is a type 1 on the same pump as me which makes a huge difference. Really sorry you've had this experience when your time in range is so good. It's not easy, and she should be encouraging you, not in effect telling you off!

 

[andi51]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

 

[Yoga Tam]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

Restore your settings to what they were and move your diabetes care to another team member or another setting or just simply make the decision to go along, listen and nod politely and then continue to do what you know is correct. What on earth is she talking about? She is basing her treatment decisions on what makes her feel comfortable rather than what is best for your long term health. I cannot even find the words for how much this exasperates me. The bottom line is, she does not have to live with the consequences of her dangerously poor advice. You do. I would not dream of worsening my control without an absolutely solid reason to do so.

 

[andi51]

Maybe you need a new diabetes team. I, like you have excellent control and often remain in target 92% of time. I've had diabetes since 1965 and because of my control I have no diabetes complications! So keep up the good work and you'll remain well.
I get nothing but praise from my wonderful diabetes team here in Dorset.

 

[.gurley]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

She`s right, hypos at your age are actually more likely to kill you!

 

[CheeseSeaker]

<smiling> I think the delivery of the message was a bit 'cr**p' but the meaning was good - the idea is to get your settings so the pump/loop doesn't need to suspend delivery, it just works all day ok - that will stop any other scenarios where settings are incorrect, causing any other issues (crashing lows caused by unexpected exercise etc.

You shouldn't need correction doses on a pump (it should be able to cope with 'whatever' comes at it) - hopefully your DSN will get you there and you can use your pen for 'decoration around the home' etc and never actually use it ;-)

 

[CactusMand]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

 

[CactusMand]

I frequently get told that I am running my blood sugars too low for my age despite being in target range 85% of the time. I am 63 years old and have been type 1 for 40 years - if I interviewed someone with 40 years experience of anything I would do them the courtesy of respecting they must have learned something during that time. I know the levels I am comfortable with being and work hard to maintain this. Have come to the sad conclusion that having met loads of diabetic nurses and doctors over the years none of them has been a type 1 so they just don't understand what it's really like. They can hide behind data and the latest facts and figures but they will never, never, really understand. Sometimes you need to trust you know what works for you.

 

[Annb]

I am in the middle of a similar discussion with my diabetic nurse. I'm 79 and have been T2 for many years (probably since 1967 but it wasn't diagnosed until 2010). My control is, apparently, too tight. I'm clearly not able to judge for myself (with the aid of a sensor) when my BG is dropping low. Obviously I'm just thick! So thick that I'm taking no notice. I'm not taking much bolus insulin these days - only if I eat something carby - reduced from 20-30 units every meal and reduced basal as well - from 60 to 48 units. I'm comfortable with that at present but intend to do "better", from my point of view. But then, I was told that I would never be able to lose weight either - by the dietician attached to the diabetes clinic - but I have managed to drop from almost 19 stone to just over 15 stone. Not good enough for me, but I'm getting there. Why can't these trained professionals see reason? I am me and I know what makes me feel better - they don't.

 

[RTI]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

Hi,
What your doctor probably said, that the bolus insulin you are taking for eating is to much and therefore the pump was stopping many times as the glucose was going low. Therefore she reduced it, to reduce the amount of lows.

Thats just a guess, probably it would be better to ask her again and that she explain it to you.

Question:
Have you fixed insulin doses for your meals
or are you counting cards and adapt your insulin doses ?

Ralf

 

[ElenaP]

I am in the middle of a similar discussion with my diabetic nurse. I'm 79 and have been T2 for many years (probably since 1967 but it wasn't diagnosed until 2010). My control is, apparently, too tight. I'm clearly not able to judge for myself (with the aid of a sensor) when my BG is dropping low. Obviously I'm just thick! So thick that I'm taking no notice. I'm not taking much bolus insulin these days - only if I eat something carby - reduced from 20-30 units every day and reduced basal as well - from 60 to 48 units. I'm comfortable with that at present but intend to do "better", from my point of view. But then, I was told that I would never be able to lose weight either - by the dietician attached to the diabetes clinic - but I have managed to drop from almost 19 stone to just over 15 stone. Not good enough for me, but I'm getting there. Why can't these trained professionals see reason? I am me and I know what makes me feel better - they don't.

Well done, for losing that weight. It will take some willpower to keep on with the good work, but best of luck with avoiding statins, and with low carb way of eating.

 

[PaulAshby]

Well I know what I'd do - my body, I have to live with the consequences of my actions (including time in range) not a DNS. Fortunately I have a lovely one, who is a type 1 on the same pump as me which makes a huge difference. Really sorry you've had this experience when your time in range is so good. It's not easy, and she should be encouraging you, not in effect telling you off!

It was probably a suggestion, if you're not happy about it don't worry, you're the decision maker, not them.

 

[davidjb]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

That sounds crazy! How can anything be 'too good'?

 

[James OBrien]

Erm,......... and she lived?

I do know that NICE guidelines for those with a few miles on the clock suggest it is safer to run a little higher than be constantly treating hypos, but your guidance to you seems,.well,............ bonkers!

In your shoes, I might be looking elsewhere, but what do I know?

Now that the information is out there for us to manage ourselves. The powers that be have to catch up, and stop thinking, “one size fits all”.
The higher our blood sugars are, the more chance of future complications. My sugars are between 4+7. No carbs, No statins. No processed foods and no tin food products. No oils. Only full cream milk. All contain sugar.
My future is now in my hands. Not Pharma.

 

[oldgreymare]

I wish the medics would treat my conditions, not my age. Just this afternoon, the DSN said that my range in target ( 85% ) is too good for my age. She said that people over 75 should be in range only 75% of time. (???)

My answer was that as I have very few hypos, I cannot see where the problem was. She said that insulin in the pump was suspended too often. When I suggested that it shows that the pump (t:slim X:2) was working correctly, preventing hypos. But apparently I was in the wrong. So, she reduced the the daily total amount of insulin in the pump, 'to keep me safe'. She now wants me to send her readings for two weeks when I have not made any corrections with a pen.

@ElenaP

I sort of get where she is coming from. I self funded my Dexcom 6/7 for the last 4 years and have always shared data with my hospital endocrinology team. This got my hospital reviews elevated from senior registrars (already very experienced) to the top research consultant. He did support my goal to max out my TIR target, BUT with a big proviso that I must aim to keep lows to under 4% and very lows to under 1%, preferably 0.

His rationale was that anyone with long term T1 that has mostly avoided complications due to high BGs, is now much more likely to be at serious risk due to lows. Unfortunately my readings showed persistent night time lows, and this led to an approval for a pump (not HCL enabled) in spite of an otherwise very good HbAc1.

If your pump is doing frequent suspensions, it does suggest too much insulin being delivered for your basal requirements. If your DSN is correct, then hopefully you can stay within a tight TIR target, without changing anything else. Why not see what 2 weeks monitoring shows? Then decide what else may need tweaking, if anything.