Hi,
@kitedoc , there's a bit of a quantum shift going on at the moment to do with what a safe a1c is.
More and more people are now using cgm. Some areas here are funding Freestyle Libre on the NHS, more areas will hopefully do so after they see how it works out elsewhere, and many people are privately funding it.
Being cautious about a low a1c is perhaps understandable when we're on strips alone. The lack of visibility which strips alone give means that hcps are very often correct when they see a low a1c and assume it's only achievable through lots of hypos.
But it's a completely different picture when we're using cgm. Because we're getting to see a more or less real time moving picture of our levels 24 hours a day, instead of a few momentary strip snapshots, we can be a lot more precise about timing and dosing, see more clearly how we respond to food, and take small steps to keep in range by the odd 1 or 2 u here, or 4g there, just to gently nudge it, without risking crazy lows.
One thing which is sometimes underestimated in getting a low a1c is simply avoiding highs.
I've got a transmitter attached to my libre which turns it into "proper" cgm with high and low alerts.
The low alerts are obviously good for all the usual reasons, but the high alerts are also very useful. I've got mine set to 7.6.
So, if I'm sleeping and it turns out I miscalced the last bolus, or my basal is being temperamental or the hundred and one other reasons why I might trend up during the night, it means I'll be woken up on the first 5 min reading above 7.6, I can then think about whether I need a small novorapid correction to lower it a bit.
Now, if I didn't have this set up, there's a every chance I might have woken up to find that I'd been above 10 for several hours.
Just being able to stitch those above 8, 9, 10 readings before they happen makes a big difference to lowering a1c, and will also give me steers on basal adjustment.
I've certainly had times in the past where docs have said they're worried my a1c was too low, but, more recently, I've showing them the statistics on my cgm and explaining how I'm doing it and why it's safe - it's partly through running at 5 to 7 for a fair bit of the time, but also largely just avoiding above 10, and they're not seeing any major hypos in the figures.
I think some docs are now becoming more comfortable seeing lower a1cs once they see how they're arrived at, but there will likely still be a fair number of old school hcps who stick to the old ways.
My GP is quite accepting of it all - she was joking last time I saw her about 30 to 40 becoming the "new normal"!