Too many hypos and ‘elderly’?

[SB2015]

The past week has been a wobbly one, as I have allowed my concerns about the information regarding the impact of T1 on those that catch Covid get to me.

I have been grateful for the analysis of the news reports by @Docb , @everydayupsanddowns and others. However when Mike posted a reference to there being a danger from the ‘elderly having too many hypos’ I wondered what the definition of ‘elderly’ is and what is ‘too many hypos’. This was in connection with the info about having too lower HbA1c. Can anyone help?

And now a minion rant please.
Before all this started I had got myself into a much more relaxed frame of mind. I had more realistic expectations of myself and stopped trying to push my HbA1c ever lower. This gave me a much better balance in life and I definitely felt a lot more relaxed.

I know that I just need to be sensible, with appropriate self distancing, hand washing etc. We have continued much the same even after the restriction were lifted a little. Our only concession being to travel a little further afield for our walks, but focusing on more remote areas, and steering well clear of beaches. I have also walked with one other friend at a distance on a couple of occasions.

We are happily enjoying our garden and all that we have got done over the past few weeks. I just don’t want to feel so worried, but logic is struggling to come to the fore.

Just needing to let of steam a bit and have a moan. I know that there is nothing more that I can do and just need to keep things in perspective.

 

[everydayupsanddowns]

However when Mike posted a reference to there being a danger from the ‘elderly having too many hypos’ I wondered what the definition of ‘elderly’ is and what is ‘too many hypos’.

From memory the example I (possibly mis)quoted from the conference was a T2, mid 70s-80s who was put on hypoglycaemic meds at quite high doses to ‘aggressively‘ target a 6.5 A1c, and then had a fall, fractured a hip and lost independent living.

 

[everydayupsanddowns]

Here you go Sue...

Wrong population for you (T2), but a study suggesting a target A1c of <8% when you have a life expectancy of <10 years, especially if the PWD has long diabetes duration and comorbidities.

Management of Type 2 Diabetes Mellitus in Older Patients: Current and Emerging Treatment Options - PMC

Elderly patients with type 2 diabetes mellitus (T2DM) are a rapidly emerging population that presents unique clinical challenges. This diverse patient group can differ widely in terms of physical and mental status, which can increase their risk of ...

www.ncbi.nlm.nih.gov

Sorry if I have caused you any stress and anxiety.

I was simply trying to suggest that chasing an A1c in the 5s isn’t always the right strategy.

 

[SB2015]

Here you go Sue...

Wrong population for you (T2), but a study suggesting a target A1c of <8% when you have a life expectancy of <10 years, especially if the PWD has long diabetes duration and comorbidities.

Management of Type 2 Diabetes Mellitus in Older Patients: Current and Emerging Treatment Options - PMC

Elderly patients with type 2 diabetes mellitus (T2DM) are a rapidly emerging population that presents unique clinical challenges. This diverse patient group can differ widely in terms of physical and mental status, which can increase their risk of ...

www.ncbi.nlm.nih.gov

Sorry if I have caused you any stress and anxiety.

I was simply trying to suggest that chasing an A1c in the 5s isn’t always the right strategy.

Thanks Mike. It is not you causing me stress, it is my reaction to what is happening at present.

Thanks for the clarification about the article. I am definitely glad that I stopped trying to push my levels down before this and know that it lead to a much more balanced approach to life. I am aware that I am beginning to allow my old ways to creep in.

I am still not sure how many hypos each day in a T1 would be classed as too many, but also know that there is an element of ‘it depends’. I pick up most of mine in the high 3s, or even very low 4s so usually stop them in their tracks, and head off others using the Libre output. However I read in here some references to the damage we do ourselves by having ‘too many’ hypos. Aaaagggh. I just need to get a grip.

 

[everydayupsanddowns]

I am still not sure how many hypos each day in a T1 would be classed as too many, but also know that there is an element of ‘it depends’. I pick up most of mine in the high 3s, or even very low 4s so usually stop them in their tracks, and head off others using the Libre output. However I read in here some references to the damage we do ourselves by having ‘too many’ hypos. Aaaagggh. I just need to get a grip.

Fortunately, because you have access to Libre data, you can use the international expert consensus for ‘time in range’

from memory less than 4% below 4, and less than something else below 3.5. 70% between 4 and 10 is seen as excellent if I remember right.

I’ll go have a look for the link I posted when it was published

 

[everydayupsanddowns]

I was half right... it was less than 4% below 4, and less than 1% below 3

Time In Range - useful for Libre / CGM wearers

I've been meaning to post this for ages, but kept forgetting! At the ADA this year the international consensus paper on TIR (time in range) was published by a panel of experts with a huge amount of knowledge and expertise in supporting people to use continuous data to help manage their...

forum.diabetes.org.uk

 

[SB2015]

Thanks Mike

I am usually much more focused on TIR than HbA1c. A much better measure of our control.
I need to remind myself of the sensible strategies.

 

[Bruce Stephens]

I was half right... it was less than 4% below 4, and less than 1% below 3

And LibreView has a nice new AGP report page showing this kind of breakdown. (The phone app and reader just show lower than whatever you set as the bottom of your range.)