Realistic T1D targets

[Catherinegf]

No - it’s too strict a target. I really hate it when they do that - they should have a go! I was told 4-12 when first diagnosed, then 4-10.

I try to stay between 4 and 8 but having that leeway at the top makes it better mentally. Also, you’re very newly diagnosed! It’s fine to tell you what’s ideal, but to give you the idea you have to stay between those two numbers all the time is wrong.

Thank you. I thought this was a lot to aim for in my first few weeks of using bolus. I’ll be kinder to myself now.

 

[Peely66]

I'd say that was far too tight a target and the default target on the libre link app is 3.9 to 10.
I've found (as a new Libre user of just 8 days but a diabetic of 30 years and a DAFNE graduate) that using the Libre has really sent me into a bit of a spin especially today I'm down to 36% in range in the last 24 hours which could potentially freak me out. I'm not going to let it freak me out as this is a really steep learning curve getting this much data in such a short space of time. I'm beginning to wonder if more education should be required with this device?

Over the last 24 hours I've forgotten my own advice to just do what I normally do and watch and started reacting.

Well that was an interesting 24hrs. Yesterday I got too caught up in the Libre results and reacted to them with a 36% in target range. Today I just did (on the whole) what I normally do and have 88% in target over 24 hrs. The only thing I did as a result of the libre was 10g of carbs when it warned me I was going low mid afternoon. So, I'm guessing the moral of the story here is not to "over react" to the Libre scans with corrections either way...maybe?

 

[Catherinegf]

That can happen, yes. And I'm sure we'll all be better off when we have closed loop systems so we can stop thinking about it (beyond maintenance and maybe occasional manual tweaks to say we need a bit more in anticipation of eating or a bit less for exercise).

However now I'm used to it I find it liberating. I can scan whenever I want so I don't need to guess what's happening. I don't need to guess what happened overnight (am I tired because I went a bit low, and is that why I'm a bit high this morning?). If I were trying to stay between 4.4 and 7.7 all the time I think that would be stressful, but I'm not so most of the time I scan and indicates green (I'm in range), so I get positive reinforcement from that.

So lows get you tired? I’ve been skipping breakfast as my bloods have stayed lovely and level when I do. Then trying to work out my pre bolus timings. Then trying to work out my insulin amounts to try and stay constantly under 7.7. As a result I’ve been low a lot. A couple of 2.2 hypos and a series of times skimming along at around 3.5. I’ve also felt exhausted and had to nap. Is that because of running low? This whole thing is like trying to learn to drive a car. Except it isn’t a car it’s a goldfish, and someone turned all the lights out and didn’t tell you where the door is.

 

[Ljc]

I can get very tired when low. It’s a bad idea to go to sleep when you know you are hypo or close to it in fact it can be dangerous as you may not wake up.
I also get sleepy when hyper , fortunately I have the tools to deal with that.

Please forget about staying within those unrealistic targets. Even non diabetics go up to 10 at times. Glucose levels fluctuate, it’s normal .

 

[Spozkins]

I think having those numbers as a target to aim for is helpful I you use them as a guide in identifying patterns. As others said it's not worth getting stressed over if you aren't staying within those targets at times. No type 1 remains in target all of the time but being able to see that target range in the graph is the thing that long term can help you to eventually get tighter control.

 

[Ljc]

I think having those numbers as a target to aim for is helpful I you use them as a guide in identifying patterns. As others said it's not worth getting stressed over if you aren't staying within those targets at times. No type 1 remains in target all of the time but being able to see that target range in the graph is the thing that long term can help you to eventually get tighter control.

Sorry but I disagree as The OP is recently diagnosed so imo should not be bringing her levels down too quickly plus trying to keep to those levels is stressing her out .
My target is set to 3.9 to 9.0 others here are set to 10 max these are much more realistic.

 

[pm133]

I do more than one test when I need to @Bruce Stephens I can judge if it’s climbing or falling with judicious use of finger pricks. Yes, they’re points rather than a graph but they’re relevant and carefully chosen points and so give me the information I need.

I used to feel the same as you but moved to a Libre recently to see if I was experiencing any peaks between the finger prick results which could explain my neuropathy.

Nothing was showing to explain it but the pain has now been largely controlled by the drugs I'm on so it's not really a major problem anymore.

Purely from an interest point of view, I can now see everything which happens between my tests because the sensor stores real-time data continuously. So if I test at night and then in the morning I can see exactly what happened overnight. It's fascinating to see when my insulin kicks in because I see my glucose levels start to drop and fascinating to see when my food kicks in because I see the levels rise. I use it to reflect and work out when to jump on the exercise bike for 15 minutes but other than that I don't really use it for anything other than the convenience of getting an immediate reading rather than the fuss of washing my hands, getting a lancet out etc. I now know exactly what chocolate and pizza does to me and I can stop the spikes dead in their tracks and fully reverse them within minutes on the exercise bike in my hall. It's really great for that.

However, if I ever start obsessing over spikes or obsessing over what I eat, it'll be chucking it straight in the bin.

 

[pm133]

Hi @Catherinegf,

When I was diagnosed last year, my DN told me to try and stay 60 or 70% within the 4.0 to 7.0 range before meals and within 3.0 of an increase 2 hours after meals. I pretty much am able to do that but the problem with the Libre is that it gives you all the intermediate time values as well and you absolutely will experience short term peaks outside that 4-7 range within the first hour and a half of eating. Now, unless you intend to abandon all sources of food pleasure from your life by eating little more than lard and water, trying to keep within 4-7 at all times, is simply unattainable. Choose life, is my motto. Not even non-diabetics manage to always stay in the range you mentioned.

My Libre is set at 3.9 to 10.0 and I'm usually about 85% to 90-something% within that range with very few hypos. I'd suggest that was a more realistic range to live by.

 

[Catherinegf]

I think having those numbers as a target to aim for is helpful I you use them as a guide in identifying patterns. As others said it's not worth getting stressed over if you aren't staying within those targets at times. No type 1 remains in target all of the time but being able to see that target range in the graph is the thing that long term can help you to eventually get tighter control.

Mentally it’s not helping me. I’ve been using bolus injections for 3 weeks. All I’m seeing now is failure after failure. I don’t even have a handle on my carb ratios yet. How on earth am I supposed to keep myself from moving outside of a 3.3 (100) point window? I look at my time in target and it makes me feel useless. I think I’m now using too much insulin I’m so scared of going high and I’m ending up spending hours at around 3.5. Last night at 11pm I was walking around my garden trying to stop my post dinner go above 7. Goals are great when they are achievable. When there isn’t a hope in hell of getting anywhere close then they just serve to make me feel like c**p.

 

[everydayupsanddowns]

Mentally it’s not helping me. I’ve been using bolus injections for 3 weeks. All I’m seeing now is failure after failure. I don’t even have a handle on my carb ratios yet. How on earth am I supposed to keep myself from moving outside of a 3.3 (100) point window? I look at my time in target and it makes me feel useless. I think I’m now using too much insulin I’m so scared of going high and I’m ending up spending hours at around 3.5. Last night at 11pm I was walking around my garden trying to stop my post dinner go above 7. Goals are great when they are achievable. When there isn’t a hope in hell of getting anywhere close then they just serve to make me feel like c**p.

Welcome to the forum @Catherinegf

That post tells me for sure that those targets are not working for you.

And I agree with others that those are PRE meal targets only. The official guidance in the NICE guidelines for T1s is 5-7 on waking, 4-7 before other meals, and ideally no higher than 9 by 2 hours after meals (so you may have been higher within those 2 hours).

I really recognise that tendency to ‘prefer to run on the low side’ as that was my position for years, but I would really urge you to switch that around. Spending lots of time below 4 is far more damaging and dangerous than it appears, and will ultimately lead to a loss of hypo warning signs, which are then incredible difficult to restore.

A proportion of time above 9 is absolutely fine. And you can still have an on target A1c which will protect you against long term complications while having almost a third of your readings above target. But if you have that many below target... you will get your self in trouble pretty quickly.

You might find this discussion on the International consensus recommendations for Time in Range for those using sensors helpful. As others have said 4-10 for 70% of the time is regarded as excellent control, provided that no more than 4% of the remaining time is spent below 4 🙂

 

[Inka]

Mentally it’s not helping me. I’ve been using bolus injections for 3 weeks. All I’m seeing now is failure after failure. I don’t even have a handle on my carb ratios yet. How on earth am I supposed to keep myself from moving outside of a 3.3 (100) point window? I look at my time in target and it makes me feel useless. I think I’m now using too much insulin I’m so scared of going high and I’m ending up spending hours at around 3.5. Last night at 11pm I was walking around my garden trying to stop my post dinner go above 7. Goals are great when they are achievable. When there isn’t a hope in hell of getting anywhere close then they just serve to make me feel like c**p.

Ditch the stupid Libre - at least for now. It’s clearly adding to your stress. TBF, I don’t think they should be prescribed to the newly diagnosed anyway. There’s enough to think about without added stress like that. Get your own stability - physically and mentally - and then decide whether to use the Libre again in the future. If you do decide to use it then, you’ll have a better attitude to it.

The biggest concern for newly diagnosed Type 1s and for Type 1s diagnosed much longer, is hypos. It’s more sensible to aim for, say, 5-9, than risk a hypo. Hypos aren’t just unpleasant, they can be potentially very serious. Pushing the newly diagnosed to stick to such strict targets puts them at risk of hypos for a number of reasons, one being that you’ll still be making some of your own insulin. That and the exogenous insulin can easily tip you over into dangerous territory.

This is your diabetes - nobody else’s. Take control and deal with it in a way that works for you. Your post about walking around at 11pm and the mental stress was very sad. Do what you can to lessen that load. Sending you my best wishes.

 

[Catherinegf]

Welcome to the forum @Catherinegf

That post tells me for sure that those targets are not working for you.

And I agree with others that those are PRE meal targets only. The official guidance in the NICE guidelines for T1s is 5-7 on waking, 4-7 before other meals, and ideally no higher than 9 by 2 hours after meals (so you may have been higher within those 2 hours).

I really recognise that tendency to ‘prefer to run on the low side’ as that was my position for years, but I would really urge you to switch that around. Spending lots of time below 4 is far more damaging and dangerous than it appears, and will ultimately lead to a loss of hypo warning signs, which are then incredible difficult to restore.

A proportion of time above 9 is absolutely fine. And you can still have an on target A1c which will protect you against long term complications while having almost a third of your readings above target. But if you have that many below target... you will get your self in trouble pretty quickly.

You might find this discussion on the International consensus recommendations for Time in Range for those using sensors helpful. As others have said 4-10 for 70% of the time is regarded as excellent control, provided that no more than 4% of the remaining time is spent below 4 🙂

Thank you. I will check out the link. I’ll also try and keep myself above 4! ☺️

 

[Catherinegf]

Ditch the stupid Libre - at least for now. It’s clearly adding to your stress. TBF, I don’t think they should be prescribed to the newly diagnosed anyway. There’s enough to think about without added stress like that. Get your own stability - physically and mentally - and then decide whether to use the Libre again in the future. If you do decide to use it then, you’ll have a better attitude to it.

The biggest concern for newly diagnosed Type 1s and for Type 1s diagnosed much longer, is hypos. It’s more sensible to aim for, say, 5-9, than risk a hypo. Hypos aren’t just unpleasant, they can be potentially very serious. Pushing the newly diagnosed to stick to such strict targets puts them at risk of hypos for a number of reasons, one being that you’ll still be making some of your own insulin. That and the exogenous insulin can easily tip you over into dangerous territory.

This is your diabetes - nobody else’s. Take control and deal with it in a way that works for you. Your post about walking around at 11pm and the mental stress was very sad. Do what you can to lessen that load. Sending you my best wishes.

Thank you. That’s is very sensible advice.

 

[Ljc]

@Catherinegf . I must say I agree with @everydayupsanddowns and especially @Inka last posts to you .
That doctor sure hasn’t done you any favours , tbh I too think it was not good for you to have been prescribed the Libre so soon.

Having all that info so soon can be and imo has been harmful to you. The vast majority of folks with T1 do not have a Libre and have live with diabetes for 50+ years
Some here remember the time before glucose meters had been invented, the y had to boil up their wee and look for a colour change .i am just saying this so you can see that it is quite possible to manage diabetes well without the stress the Libre and those Iimo,wrong targets you’ve been given .

So please please Do yourself a favour and ditch the Libre for now as it’s causing you to obsess over your perfectly natural peaks in your blood glucose . Go back to finger pricking , pre bed , on waking and pre meal. If you drive , to follow the dvla rules and of course to treat hypo’s

Micro managing your glucose levels is not doing you any good and as everydayupsanddowns said , you could lose your hypo warning signs , which are absolutely vital to our very lives and are a devil if not impossible to restore .

I am not having a go at you , honest, I am just so worried that you are going to make yourself ill because you are so stressed.
xxx

 

[Bruce Stephens]

Having all that info so soon can be and imo has been harmful to you. The vast majority of folks with T1 do not have a Libre and have live with diabetes for 50+ years

I'm not sure I find that persuasive.

I think it's most likely there's been some confusion in the levels (maybe they're intended as pre-meal targets rather than overall ones, and maybe the confusion's in the doctor's head: maybe they haven't seen the recommendations for people who have continuous monitoring). And maybe if the doctor had said to aim for an average of about 7, try to stay between 3.9 and 10.0 as much of the time as possible and try really hard not to go below 4.0 than that would have been OK?

 

[rebrascora]

I can so relate to what you are going through. I too had those feelings of failure because I couldn't hit the targets all the time or even most of the time.
For me the Libre was a game changer in that respect because of the wider target range of 3.9-10 and the fact that they accept that even keeping within that range is not possible all the time, so aiming for a percentage within that range acknowledges that 100% is not possible. I am still a perfectionist and want to have the best % Time in range that I can and when I can get that up to 93% I feel great but I have to accept that I can't maintain that level of control all the time and there will be weeks when I drop to low 80% or even below, but I seem to be able to maintain it above the 70% time in range that they are looking for, without too much difficulty, so to me that makes me 100% successful. It really is all about perception. Yes, there are very rare occasions when I get it badly wrong and hit mid teens or mid 2s (hopefully not in the same day) but without a Libre 2 with alarms or a CGM I think that may well be normal. There are too many factors which affect BG levels to be fully in control all the time but having the Libre gives me much more knowledge to understand my body and learn how to drive it.

The analogy of learning to drive is actually often used and they cannot expect you to drive perfectly straight away. It takes a lot of time and experience and in the early days when your pancreas may be squirting out a bit of it's own insulin every now and then it is the equivalent of your car having faulty steering as well as you being a novice driver. And just when you start to get the hang of how to under steer or over steer to compensate for the steering fault, it changes again.

Be kind to yourself. You are doing a great job in very difficult circumstances. It will get easier, biut help yourself by following the Libre guidance and increase your target range from 3.9-10 because that will help you to keep out of the "red" hypo land more and if you can get 70% time in range with that 3.9-10 range then you absolutely are succeeding.

For me the Libre was the game changer for giving me more realistic goals and enabling me to succeed in achieving them, so I would say that it is your diabetes clinic who are causing you the problem by setting too narrow limits for someone using Libre. Their guidance is only for using a very limited number of finger pricks. I think langiuage is also a major factor in this and I think you are reading "target" as "limit". Target is something to aim for. A limit is something you should not exceed. It is also about an individuals mental outlook and if you are naturally a quite self critical person, then failing to hit targets will adversely affect you, especially if you are trying your absolute best.

The best advice I can give you if you want to continue using the Libre is to follow the Abbott guidance and you will become more relaxed and successful, but time and experience will also make it easier and there is no short cut to that, so hang in there, you will eventually tame that goldfish! 😉

 

[PattiEvans]

Welcome to the forum @Catherinegf

That post tells me for sure that those targets are not working for you.

And I agree with others that those are PRE meal targets only. The official guidance in the NICE guidelines for T1s is 5-7 on waking, 4-7 before other meals, and ideally no higher than 9 by 2 hours after meals (so you may have been higher within those 2 hours).

I really recognise that tendency to ‘prefer to run on the low side’ as that was my position for years, but I would really urge you to switch that around. Spending lots of time below 4 is far more damaging and dangerous than it appears, and will ultimately lead to a loss of hypo warning signs, which are then incredible difficult to restore.

A proportion of time above 9 is absolutely fine. And you can still have an on target A1c which will protect you against long term complications while having almost a third of your readings above target. But if you have that many below target... you will get your self in trouble pretty quickly.

You might find this discussion on the International consensus recommendations for Time in Range for those using sensors helpful. As others have said 4-10 for 70% of the time is regarded as excellent control, provided that no more than 4% of the remaining time is spent below 4 🙂

Mike thank you for that link which I have bookmarked. It was discussed in one of the webinars that I recommended to Catherine, but I couldn't find it.

 

[SB2015]

Hi @Catherinegf

The messages are consistent from people living with this.
You are doing brilliantly and you have only just ‘learnt to drive’ this condition.

Perfect levels are impossible, and some DSNs make it sound so simple.
You will find your way of managing this. Keep tapping into the practical advice on here, from people living with it every day.

I was interested in reading the Link @everydayupsanddowns posted. I was always more worried about the impact of high levels and it has only been this past year that I have realised how important it was to reduce my hypos, (it’s taken me 12 years!) and to tolerate some levels above 10.

Be kind to yourself. You are doing so well in such early days with the Honeymoon Period making things unpredictable. Well done.

 

[Catherinegf]

@Catherinegf . I must say I agree with @everydayupsanddowns and especially @Inka last posts to you .
That doctor sure hasn’t done you any favours , tbh I too think it was not good for you to have been prescribed the Libre so soon.

Having all that info so soon can be and imo has been harmful to you. The vast majority of folks with T1 do not have a Libre and have live with diabetes for 50+ years
Some here remember the time before glucose meters had been invented, the y had to boil up their wee and look for a colour change .i am just saying this so you can see that it is quite possible to manage diabetes well without the stress the Libre and those Iimo,wrong targets you’ve been given .

So please please Do yourself a favour and ditch the Libre for now as it’s causing you to obsess over your perfectly natural peaks in your blood glucose . Go back to finger pricking , pre bed , on waking and pre meal. If you drive , to follow the dvla rules and of course to treat hypo’s

Micro managing your glucose levels is not doing you any good and as everydayupsanddowns said , you could lose your hypo warning signs , which are absolutely vital to our very lives and are a devil if not impossible to restore .

I am not having a go at you , honest, I am just so worried that you are going to make yourself ill because you are so stressed.
xxx

Thank you. I do appreciate you taking the time to respond. M chilling out about it and I’m going to relax and keep myself out of hypo land. Thank yoi so much for all your kind words and advice.

 

[Catherinegf]

Hi @Catherinegf,

When I was diagnosed last year, my DN told me to try and stay 60 or 70% within the 4.0 to 7.0 range before meals and within 3.0 of an increase 2 hours after meals. I pretty much am able to do that but the problem with the Libre is that it gives you all the intermediate time values as well and you absolutely will experience short term peaks outside that 4-7 range within the first hour and a half of eating. Now, unless you intend to abandon all sources of food pleasure from your life by eating little more than lard and water, trying to keep within 4-7 at all times, is simply unattainable. Choose life, is my motto. Not even non-diabetics manage to always stay in the range you mentioned.

My Libre is set at 3.9 to 10.0 and I'm usually about 85% to 90-something% within that range with very few hypos. I'd suggest that was a more realistic range to live by.

I don’t like lard. great advice. Thank you.