Realistic T1D targets

[Catherinegf]

Hi. I am new to the forum and new to diabetes. I am a newly diagnosed T1D. I am on slow acting and fast acting insulin. I have just got my first Libre 2. Which I love and hate in equal measures. I only started on basal in January after a trip to ER. I started on meal time bolus about 2 or 3 weeks ago. My endo has set my libre targets between 4.4 (80) and 140 (7.7). Is this a realistic goal? My last A1C was 6.3 but my diabetes is getting worse pretty fast. My honeymoon period is clearly at an end. I’m just getting used to prebolusing and the affect of exercise on my levels. It feels like there’s a lot of guesswork. I’m really stressed that trying to keep between 4.4 and 7.7 is going to be nearly impossible. I haven’t yet worked out the vagaries of my carb ratio. It’s very overwhelming. I’m a terrible perfectionist. I get really stressed if I feel I’m failing. I am currently going from a number of lows and a number of highs. Does anyone have any words of wisdom? What are your target ranges and target %? Thank you.

 

[Paulbreen]

Hi @Catherinegf and welcome along to the forum I’m sure you’ll find plenty of good advice and help here. To answer your question the targets set by your doctor look pretty normal, if you can keep everything around there you’ll be fine BUT don’t freak out if your going higher after eating because it will happen but as long as you come back down within a couple of hours you will be fine, I’d avoid going lower than 4.4 because you’ll head into hypo territory and hypo’s are pretty unpleasant.
Good luck with your new diabetic journey..

 

[Inka]

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.

 

[Robin]

Those targets are what I’d aim for before a meal, or first thing in the morning, but they certainly wouldn’t be realistic targets for the whole day. My hospital generally sets the 'Time in Target' between 3.9 and 10 on the Libre, and the aim is to get within those parameters 70% of the time. They also like to see us below 3.9 less than 5% of the time. Are you in he U.K? I suspect not, so I don’t know if you have the same pages of data when you download the info from your Libre onto a computer, but there is a model chart that appears on mine, with basically those figures illustrated.

 

[Bruce Stephens]

I've only got Libre 1 (so no alarms) and set the range to 3.9-10 mmol/l. And I follow the recommendations in https://care.diabetesjournals.org/content/early/2019/06/07/dci19-0028.supplemental (so I try not to worry too much so long as I'm >70% in the range 3.9-10 with very little under 3.9 and not too long over 13.3). Obviously I try to do better than that most of the time. The first page on LibreView (AGP) shows the usually recommended targets.

When I get Libre 2 I imagine 4.4 and 7.7 would be reasonable alarm targets (to give me a bit of warning so it's easier to stay in range).

 

[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.

 

[Inka]

I’m more and more happy that I don’t have a Libre actually. So many people are stressed by them and allow them to take over their thoughts. Not aimed at you @Peely66 just a general comment inspired by the love/hate of the OP and the many posts I’ve read here.

 

[Peely66]

I’m more and more happy that I don’t have a Libre actually. So many people are stressed by them and allow them to take over their thoughts. Not aimed at you @Peely66 just a general comment inspired by the love/hate of the OP and the many posts I’ve read here.

Interesting. So you don't have a Libre? Are you aiming for between 4 and 8 pre-meals then?

Yes. The jury is still out especially after the last 24 hours. I think predominantly because I have started obsessing a bit about the numbers...but I also quite like the numbers and graphs (I think I must be a closet statistician) We'll see...

 

[Bruce Stephens]

So many people are stressed by them and allow them to take over their thoughts.

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.

 

[trophywench]

Far too strict limits day by day - yes they would be ideal though people without diabetes won't achieve them 24/7/365 - (bet he can't - and my money's 100% safe betting on that) but when you don't even have a fully functional pancreas - impossible.

I've never had a diabetes consultant, nurse or GP who has imagined I would achieve perfection - they've all been perfectly realistic and assumed that I wouldn't - and they've been correct ! Consequently I've never disappointed them. I have disappointed myself at times but as long as I use the 'well that didn't work' occasions to try and discover how to avoid them in future, and put that whatever it is into practice, then hopefully you'll survive OK to tell the tale!

 

[SB2015]

I used to set the same targets as you were given. These were based on the time when we were just given premeal values, before Libre was around. I stressed about achieving this until I realised that it was indeed impossible.

The internationally recognised targets are 3.9 - 10. I was told if I can be in range more than 70 % that is excellent control. The targets you have been given are unrealistic unless they acknowledge these as premeal targets. It is even more difficult when you are newly diagnosed.

 

[Inka]

Interesting. So you don't have a Libre? Are you aiming for between 4 and 8 pre-meals then?

Yes. The jury is still out especially after the last 24 hours. I think predominantly because I have started obsessing a bit about the numbers...but I also quite like the numbers and graphs (I think I must be a closet statistician) We'll see...

No, not just pre-meal. I test when I want and I’m pretty confident very few controllable spikes escape me. I test 2hrs post-meal and at other times too as needed/wanted.

 

[Inka]

I can scan whenever I want so I don't need to guess what's happening

And I can test whenever I want - same thing. 🙂

 

[Ljc]

I think those targets are far too tight . I assume you have the Libre 2
It alarms when going too high or low ?
I can understand the 4.4 as it’s close to hypo territory but the 7.7 is far far too low , your Libre will be shrieking at you umpteen times a day , which will be extremely annoying for you.

I am afraid some docs and nurses don’t live in the real world and set targets or give advice that is far too difficult if not impossible to follow for those of us who do live in the real world.

I have the previous Libre , no alarms , I self fund mine as don’t have T1 , I have my target set 3.9 to 9.0 , I know others on here have theirs set to 10.
If you have a DSN (you should have) then have a word with your DSN about altering your target range .

 

[Paulbreen]

I would say you got thes targets as something to aim for but there is no harm having targets, most of the time we can only get as close to the target as our lifestyle allows, diabetes is fickle and for most of the time unfathomable so all you can do is your best. Here’s my last 24 hours trace and you can see it’s a roller coaster in this format but in reality it’s pretty flat and about 98% in the libre targets, on the other hand I’d prefer to have it closer to my targets which are 4.5 to 8.0.
Best of fun trying

 

[nonethewiser]

My endo has set my libre targets between 4.4 (80) and 140 (7.7). Is this a realistic goal?

No it isn't, shouldn't be setting such strict target on someone newly diagnosed.

Been doing this for last 40 years & own target for libre is 4 to 8.5, consultant is happy if in range 70%+ with very few hypo's, usually reach target & sometimes exceed it other days fail miserably, that is nature of type 1 diabetes, don't let anyone tell you otherwise.

I’m more and more happy that I don’t have a Libre actually. So many people are stressed by them and allow them to take over their thoughts. Not aimed at you @Peely66 just a general comment inspired by the love/hate of the OP and the many posts I’ve read here.

Only time found it stressful is when not working as it should, had this with libre 1 for time which turned out to be software issue, once upgraded all good & not had issues since. Find device liberating actually, going from 10 bg tests daily to just one, learnt so much from device & continue to do so.

 

[Thebearcametoo]

Talking of targets for finger pricks when you generally only test before meals and before bed so your insulin has hopefully completed a full 4(ish) hour cycle makes aiming for 4-7 a good target but even then you’re unlikely to hit is all the time. With a Libre or CGM you’re going to be able to see all the points inbetween and there’s likely to be peaks in there so it’s extremely unlikely you’ll stay below 7/8 all the time even with perfect timing of bolus and the ‘perfect’ (for you) diet. Even 4-10 is likely to mean you’re not in target all the time. Being able to see the data so you can time bolus to hit when your carbs hit can be really helpful and help with better long term control. And time in range is a good indicator of a good HBA1C but most people will have a lot of variation within that. It can be helpful to see is as aiming for as much time in range as possible rather than always being in range but even then 4-10 is much more common and less likely to lead to frustration. Always remember that your Libre is a tool not a nanny. It will give you more data which will help you to be able to learn what impacts your levels and help you stay in a healthy range of HBA1C. The target may be the ‘best possible’ range rather than the ‘what you will actually achieve’ range and a tweak in your interpretation of the word target may help you be less beholden to it.

 

[Bruce Stephens]

And I can test whenever I want - same thing.

That just gives us a point, though. A scan gives that (well, what it was 10-15 minutes ago) but also some context, so if I'm scanning a couple of hours after eating I can get an impression of how well I judged the bolus by seeing whether the graph looks like it's levelling off. If I'm intending to go for a walk I can see not just that (15 minutes ago) I'm at 5.0, but I can see whether that's going up or down.

 

[Inka]

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.

 

[PattiEvans]

My endo has set my libre targets between 4.4 (80) and 140 (7.7). Is this a realistic goal? My last A1C was 6.3 but my diabetes is getting worse pretty fast. My honeymoon period is clearly at an end. I’m just getting used to prebolusing and the affect of exercise on my levels. It feels like there’s a lot of guesswork. I’m really stressed that trying to keep between 4.4 and 7.7 is going to be nearly impossible. I haven’t yet worked out the vagaries of my carb ratio. It’s very overwhelming. I’m a terrible perfectionist. I get really stressed if I feel I’m failing. I am currently going from a number of lows and a number of highs. Does anyone have any words of wisdom? What are your target ranges and target %? Thank you.

Catharinegf, May I suggest you have a look at the Freestyle tutorials. https://progress.freestylediabetes.co.uk/ They give you so much helpful information on how to interpret your Libre results and time in range etc. I had been using the Libre sporadically over a number of years, but until I had it prescribed some 18 months ago I hadn't done the tutorials and I did find them extremely helpful. There is also a series of webinars you may find useful here https://freestylediabetes.ie/inner/webinar Without watching them again I am pretty certain the parameters for being in target were set at 3.9 - 10. I personally have mine set at 3.9 - 9 and no... I am not in target 100%. The odd day I am is like finding a Unicorn!