Clearly this is nonsense. My time in target is >91%. I am 76 and have been T1 for 53 yrs. If any clinician had said that to me I would have pushed hard for an explanation.. In the NHS some clinicians think their degree gives them academic superiority. Do some research and drop a line to the Medical Director.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.
Some clinicians (yours?) think that people over 75 must be unable to manage their condition. Do as I do and question them for an explanation when they talk nonsense.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.
Some clinicians (yours?) think that people over 75 must be unable to manage their condition. Do as I do and question them for an explanation when they talk nonsense.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.
Back in the day my Diabetes Nurse told me that I was having too many minor hypos and eventually I would lose mental capacity. I did some research which evidenced that minor hypos have no effect on mental ability but 2 or 3 hypos/yr requiring 3rd party assistance 'may' be a problem. Some Nurses behave like this to attempt to show we idiotic patients how clever they are.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.
This is brilliant TIR, but humbly I may take issue with your definition of a hypo - mine is anything showing a level below 3.9, although my endo will allow me to set the CGM alarm bar at 3.5 as I have completed a DAFNE course (also, and I have no idea why, this is might be the hypo threshold set for gestational diabetics).My libre today is showing 92% in range for 7 days and 87% for 90 days , it also shows 29 hypo events for the 90 days which aren't actually hypos but lows , the last time I needed assistance for a low was over 20 yrs ago , i'me quite proud of the fact that I can still have this sought of control after 49 yrs and would be angry if I was told otherwise , out of interest how many hypo events do others have over this period of time?
Even with my lows showing 29 lows below 3.9 in the last 90 days the libre shows this as only 2 % so according to the guidelines that's still fine .This is brilliant TIR, but humbly I may take issue with your definition of a hypo - mine is anything showing a level below 3.9, although my endo will allow me to set the CGM alarm bar at 3.5 as I have completed a DAFNE course (also, and I have no idea why, this is might be the hypo threshold set for gestational diabetics).
"Assisted" hypos/lows is a completely separate categorisation - in UK seems to mainly impact fitness to drive. I have had 1 since diagnosis 16 years ago and none in the last 5 years.
Regarding how many hypos (below 3.9) events I experienced over the last 90 days, this is still more than I and my endo would like - ideally none, but definitely his targets are under 4% (low = below 3.9%), and ideally 0% (very low = under 3%).
I'm relatively new to pumping and this is still a big work in progress to improve my TIR while minimising any Time Below Range.
Hi Jaywak, My last 90 days TIT is 89%%, 51 low glucose events in last 90 days, 1 hypo requiring external assistance in last 4 yrs, diagnosed T1 when taking Cambridge finals in 1970, last 3 yrs HbA1C are 5.6, 5.8, 5.7. Like you I run tight control on BS as I think avoiding the Long Term effects is more important than avoiding lows., and my research says many minor hypos do not inhibit brain performance. Many clinicians think people over 70 are incapable of intelligent thought!My libre today is showing 92% in range for 7 days and 87% for 90 days , it also shows 29 hypo events for the 90 days which aren't actually hypos but lows , the -last time I needed assistance for a low was over 20 yrs ago , i'me quite proud of the fact that I can still have this sought of control after 49 yrs and would be angry if I was told otherwise , out of interest how many hypo events do others have over this period of time?
Apologies for the slight aside but may I commend you for your correct use of "advise" and "advice"?Disclaimer, I know nothing about type 1 insulin pumps but what I do know is health staff are there to advise, not dictate. I would (and do) listen to their advice then decide if i want to follow it or continue with what’s working for me.
*whispers to @In Response , I have an inner grammar pedant too!Apologies for the slight aside but may I commend you for your correct use of "advise" and "advice"?
I often have to hold my inner grammar pedant back from making corrections to common grammatical mistakes.
But there is no reason to hold it back this time.
I'm well over 70 and am the first to admit that my cognitive processes are not quite as sharp as they once were. That may be the result of 50 years of undiagnosed diabetes and BGs running too high for much of that time. Definitely not because of too many lows over that time. The danger of hypos seem to be the reason that my DN wants me to eat carbs and to keep my readings in the 8 - 10 range. The only time I have even low readings is when I have misjudged the amount of insulin I should take for carb eating or when I have been forced into an unprepared fast for too many hours. As long as I can keep off carbs, I can keep off insulin - other than a basal dose. Result - stable 5 or 6's.Hi Jaywak, My last 90 days TIT is 89%%, 51 low glucose events in last 90 days, 1 hypo requiring external assistance in last 4 yrs, diagnosed T1 when taking Cambridge finals in 1970, last 3 yrs HbA1C are 5.6, 5.8, 5.7. Like you I run tight control on BS as I think avoiding the Long Term effects is more important than avoiding lows., and my research says many minor hypos do not inhibit brain performance. Many clinicians think people over 70 are incapable of intelligent thought!
@jaywak, Totally agree - and as I mentioned above I believe 3.5 is the recommended hypo threshold for gestational diabetics, which once diagnosed, will be on insulin. I suspect those suffering from the rare but increasingly accepted condition of reactive hypoglycaemia may also have insights re what BG levels can start to impact our performance.I've read that non diabetics bg can go down to 3.5 on occasions which would be reordered as a hypo on a libre but not actually causing our bodies any harm obviously not desirable if you're using insulin and could then go lower but not actually harmful to our bodies as such .
According to my addition, you have 'lost' 2% that is not attributed to any BG range (could just be rounding effects between the ranges). I only use Dexcom, so not sure how/why this happened with Libre readings. The internationally recommended definition for time in range BGs is 10 - 3.9 mmol with a target of 70+% TIR. Looks like you're easily achieving this!My 90 day Libre results:
> 13.3. 0%
8.3-13.3. 17%
4.8-8.2 67%
3.9-4.7. 11%
<3.9. 3%
T1 D for 54 years; cognitive decline? I’m hoping none, but you’d have to ask my husband, if you trust his answer.
Not sure about Libre’s cognitive ability, or have my maths skills declined?
Sorry my Libre readout seems different to yours , today it is showing above 13.3 as 1% , 10.1 -13.3 as 7 % ,3.9 -10.1 as 91 % and below 3.9 as 1% , low glucose events are 2 for 7 days 4 for 14 days 7 for 30 days and 29 for 90 days , my consultant seemed quite happy with these results last month .
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