I was diagnosed about 15 years ago and had poor control for the first 10 years (HBAc1 65-80). Since self funding a Dexcom G6 CGM , I've managed to get this down to 43-48 and mostly 65-70% in range, but still rather more of a rollercoaster than I would like. Mostly sticking to low carb helps. I had my regular appointment with my endo recently and our conversation was regarding my pattern of nighttime lows. He made the observation that in long standing Type 1s, he worries much more about the risks associated with hypos than the risks of developing/accelerating complications. Although definitely linked to higher BGs, the onset and severity of "diabetic" complications can sadly be a bit of a lottery and is also influenced by lifestyle, genetics, etc.I've had type 1 nearly twenty years and have become very engaged with things in recent months, more engaged than any time previously. I feel like the general message from my clinic was that an HbA1c of 50-53 was really good, but then when you look it up on here or Diabetes UK it says it should be 48 or lower. I've never been in the 40s but I am aiming to get there as soon as I can.
I recently met up for coffee with a woman who has had Type 1 almost forty years. She has good control, no complications and is 59 years old. She said she's been told it's fine for the time in target on the Freestyle Libre to be 60% (hers is much higher). Well I'm sorry but that's irresponsible on the part of whatever doctor or nurse said it, because being between 3.9 and 10mmol 60% of the time is not going to be enough to save someone from complications.
My HbA1c has always been 50-something. I think it's got as high as 57, maybe even 59, and never officially lower than 53. I used to think this was really good but I now feel like my clinic has misled me. I thought I was one of the well-behaved diabetics with good control but in the last few months I've really had a lot of doubt about that.
I was reading about the former Tottenham player Gary Mabutt who has lost all feeling in his feet and had a situation where a rat ate part of his foot on holiday. He was in his late 50s at the time, so not even that old. Surely someone like him would have had "good control" over his life? I worry what I've been told is good control isn't going to be good enough. The idea of losing nerve feelings is so terrifying, it makes me want to never do anything fun again and just become an out and out health freak.
So if you're still complications free, sounds like a great starting point to see if you can improve your control going forward. Have you been offered a Libre? Tried a DAFNE course? Pragmatically changing to a healthier lifestyle may not be sustainable if you don't enjoy it - work out how to incorporate fun too!
@RobertJ an HbA1c of 48 and below for a Type 1 is a fairly recent addition to the NICE guidelines I believe. Probably in part because of the now widespread use of CGMs. In the past without this sort of monitoring hypos were a real concern. Hence the HbA1c level was set higher.
I agree that 60% in range on a 3.9-10 would concern me as I have mine set at 4.2-8.5 and aim for 80%+. However this lady is obviously happy and we all have to manage this condition in a way that we can live happily with.
Complications happen when blood sugars are constantly high, not now and again.
My consultant told me blood sugars above 13 constantly over years not days or months is what causes complications.
I read that even if you keep bloods in the normal range you can still get heart disease and other complications, so when I read on here people go into panic mode because their bloods are 7.9 I just ignore it, whereas when I was diagnosed I was panicking.
And Just because he was a footballer doesn’t mean he kept good control, yes they are fit yes they run around but it’s not to say he didn’t drink beer, eat rubbish and not keep control.
I’m told between 6-10 are good numbers to aim for and I’m sticking with it.
I found myself more stressed staying under 7.8
I’m sure the research over the years Has learnt them a lot and I put my trust in them.
But do what you feel is right and makes you happy.
Yes, I agree with this, well-said!@RobertJ I think it is more complex than setting the same targets for all because we are all far more than diabetes.
A Hba1c of 40 with 100% in target is a great target but at what cost? Obsession over numbers, avoidance of exercise, limited diet, women going on the pill to avoid hormonal variations, ...wrapping oneself in a sealed chamber and never leaving the house for fear of getting ill?
I know I am exaggerating to make the point that managing diabetes is a small part of managing our lives and our lives are all different.
The other thing to consider is overall health. I am not talking about "general health" which can be improved with a lower blood sugar. I mean more critical illnesses which make diabetes more challenging or, unfortunately, limit life span. Again, I know my example is extreme but, if you are terminally ill, is it better to get the joy out of a cake or avoid it because it might push blood sugars up?
@RobertJ I think it is more complex than setting the same targets for all because we are all far more than diabetes.
A Hba1c of 40 with 100% in target is a great target but at what cost? Obsession over numbers, avoidance of exercise, limited diet, women going on the pill to avoid hormonal variations, ...wrapping oneself in a sealed chamber and never leaving the house for fear of getting ill?
I know I am exaggerating to make the point that managing diabetes is a small part of managing our lives and our lives are all different.
The other thing to consider is overall health. I am not talking about "general health" which can be improved with a lower blood sugar. I mean more critical illnesses which make diabetes more challenging or, unfortunately, limit life span. Again, I know my example is extreme but, if you are terminally ill, is it better to get the joy out of a cake or avoid it because it might push blood sugars up?
Hi @Nicola M, an HbA1c of 43 sounds incredible. When you say your consultant told you to aim for 70% in target, do you mean when the target is set to 3.9-10? I think that's a solid thing to aim for. I'm on 80% at the moment but for most of the last five years I've been in the low sixties probably, which is not good enough.
I now want to make 70% or more the new normal.
Yes, 70% when it is set to 3.9-10I find it very attainable, more times than not my daily TIR is above 80% but I don’t worry if sometimes it is in 60% or lower range as we all get those bad days and generally it all balances out over the 3 months anyway!
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