What numbers should I be aiming at?

[pottersusan]

OK you experienced diabetics out there:

• What BG range do you aim to be within?
• What range is good for waking up?
• What is a good Hba1c?

I'm getting rather frustrated by being told one thing by one person and something else by another person (all so called 'experts').
I am trying hard to improve my control, but it's hard when given conflicting information - I'm not sure I want to call it advice. 😱

 

[Northerner]

The NICE recommendations for Type 1 are:

Adults with Type 1 diabetes (NICE 2015)

• on waking: 5–7mmol/l
• before meals at other times of the day: 4–7mmol/l
• 90 minutes after meals: 5–9mmol/l.

HbA1c should ideally be below 48 mmol/mol or 6.5% in order to significantly reduce the risk of complications.

These are ideals, and there may be many reasons why they are difficult to achieve. I've been very fortunate to have had levels in these ranges much of the time, although the post-meal readings can often spike up into double figures due to the unpredictability of insulin action and digestion of food. I have to say, if my levels were at 5.0 mmol/l 90 minutes after eating it would most likely mean I'm going to have a hypo unless I eat something else, since the insulin will still be reducing levels for a few more hours! 😱

 

[pottersusan]

Thanks for that info.

If only I never achieved double figures! They've been happy with my hba1c being in the high 60's😱 which I am not satisfied with. I'm hoping when I have my next test, I'll at least have reduced it to the 50's. 🙂
It can take over an hour for the insulin to start doing anything. So I've been trying not to eat until my bg is around 5.5 or 6 to reduce those spikes - only possible by having a very close relationship with my cgm and overcooked food

 

[Caroline]

We are all different but as a general rule of thumb you should be some place between 4 & 7 although your doctor/consultant my advise something a little higher. Because I had been running high for along time with no hypo awareness I was told to aim between 5 & 11, but that is unique to me and others will differ. A lot of things will affect number like how fit you are, what you eat and how old you are

 

[Ralph-YK]

I've been told recently by a GP at my practice that a Hb1Ac of 47 is very good.
What you should be airming for I've no idea, as I've still not got that from the doctors yet.

 

[Austin Mini]

I aim for a BG of 6. After twenty-eight diabetic years I can keep my BGs around this figure. Thanks to Lantus I can now wake in the morning with a BG of 6 to 8. My HbA1c is 54.

 

[Amigo]

I'm type 2 and although NICE guidelines tell me 7 or less on waking and no more than 8.5 two hours after eating, I've read a fair bit of research that suggests this may be too generous to avoid long term complications. However as I'm not on medication, I have to accept that I'll do well to stay within the NICE guidelines and do try to. Anything less than 6.4 puts a smile on my face to wake to! 🙂

What I'd like to ask the 'D everyday Veterans' on here is how significant is your ability to quickly restore a spike back down to reasonable levels? I know it's the spikes we need to avoid but on the occasions when I've had an over generous meal (like lunchtime), I can shoot up to 10 (which is very bad for me) but I'm back down to 7 in less than an hour. I know this isn't the answer and I shouldn't be going up to double digits anyway but I'm not a saint and I've no chemical safety net to catch me (nor do I want one!). But do you think I can I infer from this that maybe my pancreas hasn't yet gone into total retirement? 😉

 

[Amberzak]

I've had real problems controlling my sugars, despite trying. So they were really happy with my hba1c of 8.7. That's the lowest it's ever been for me. But I've just had a blood test since being on the pump, don't know what that is yet.

On multiple injections, I aimed to be lower than 10. like you, I was told one thing by one person and another by someone else, which resulted in me feeling like a constant failure. Not good.

On multiple injections it was unrealistic for me to expect to be within the NICE perameters. Even now it's difficult. I asked for realistic goals that I could achieve.

My current goal is to have no more than one hypo (lower than 3) a month (this month I've gone below 3 twice, which is still amazing because I used to hypo daily) and to be under 10 for at least 50% of the time.

I know others who would say that a reading of 8 would be too high, I'm happy with a reading of 8. A year ago I was happy with a reading of 11, now I consider that too high. Goals are not just individual, but they change as our needs change.

Also, when I'm ill, I allow more flexibility. The key is to not be hard on yourself. I got into one awful state about my sugars. Older members on here will tell you that. But as long as you are testing regularly, reacting to your tests, spotting patterns, and seeking help, you're on the right journey.

 

[Amberzak]

As for insulin time, yeah. The higher you are, the longer it takes for insulin to work. I've noticed if I'm over 15, I can test two hours later and it's still 15, despite giving insulin. Avoid the temptation to give more insulin at this point. This is called stacking, and was the number one cause of my daily hypos before. The hypo would then cause a high, and I'd keep swinging.

 

[khskel]

As a fellow creon junkie I can fully sympathise with you. As you will doubtless know one of the potential side effects is hyperglycaemia and another one is hypoglycaemia so in my opinion is that just try for something as stable as possible. I sometimes find that my BG can have dropped two hours after my evening meal and then risen by bedtime. It could well almost halve by the time I've woken up so I aim for between 5 and 9 to avoid beating myself up for something that's probably not my fault.

I'm still a relative newbie compared to many on this forum so feel free to ignore me.

 

[trophywench]

Yes @khskel - but you and Susan are in a different place to all of us 'ordinary' Type 1s. It seems to me that taking creon, either the creon itself or the cause of your having to take it - is somewhat akin to a T1 getting gastroparesis, but with 'knobs on'.

I mean sometimes even when we haven't got gastroparesis we can suggest stuff to Amanda which will work well for her - but you both have different and/or additional challenges which TBH I haven't a clue how one might handle. And so - you are now both part of my learning curve - and I bet Northerner and others feel the same.

But - strikes me, you are correct! perfection ain't going to happen - Austin Mini is a complete enigma as far as I'm concerned. FWIW - my HbA1c has been around 53 (near enough 7.0 since 2011 apparently - though I reckon it's far far longer than that excluding several years of complete bananas prior to 2010 - so I conclude, that's what my body has decided it's happy with. Occasionally my fingerprick BG may be 23 and occasionally it may be 2 - but as long as there's a reason for it that I can work out and understand what I should have done instead of what I actually did (eg I've just remembered I had a mince pie earlier - and haven't bolused; oops - 12.1, so had 1.9u correction) and the number I'm always aiming for on my meter whether it be day or night, before or after a meal etc etc - is 6.5.

 

[trophywench]

Oh - PS - when do you reckon I'll get one of these complication thingies that folk talk about? Clearly not for the first 43 years, is it?

 

[Matt Cycle]

A bit like Amberzak I used to aim for below 10 obviously hoping for between 5 and 6. Now I try to aim for below 8. It's difficult though and I can have a 20-odd or one in the teens but like TW can usually work out what has gone on and have a correction. What I have noticed is my hypo awareness has all but gone but I am better able to manage lower numbers. Normally feel fine in the 3's and often feel okay in the 2's. A few months ago I had a 1.2 and was fully functional, compos mentis. Thought the meter was incorrect so checked again with the same result. I wasn't collapsed on the floor I was able to do the test, repeat it, understand the result and have something to eat to correct it.

My last HbA1c in June was 49 (6.6%) which was one of my lowest. The one before was 56. Had the blood test for the latest one last week and am seeing the DN just before Christmas so it will be interesting to see what it is. Even if it is around the same I'll be asking about pumps as I need to try and smooth out the variations somewhat and from what I can see a pump would be best at doing that.

 

[AJLang]

Hi I have gastroparesis which means that my food digests very erratically and often doesn't match the insulin - but it varies so much. Unless I go out for a meal then my partner helps me to carb count everything and I bolus accordingly, but my BGs are still erratic and for my evening meal I have a six hour extended bolus - if I had it upfront I would probably be dead from the subsequent hypo. Yet if I have 30g carb for lunch I can usually bolus 3 units of insulin upfront. I also have to work with my basal because I need extra from about 3am to compensate for food that may still be digesting - sometimes it works, sometimes I go high and sometimes I go low. Waking BGs this week have varied from 3.0 to 137! Having said all of this I usually (not always, but usually) manage to keep my average BG at 7.5 or lower and since being on the pump (3 years) my HBA1c's have mainly been in the 6's. I had one at 5.9 but that was because I was barely eating after Susie died, and another in the very low 7's. I think that my February HBA1c may be a little bit higher because I've been juggling everything with going to University and helping Guide Dogs, but I'm aiming for a HBA1c in the 6's. My diabetic consultant said at the latest appointment that I should be happy if I have an average BG of 8.0 - thank goodness that I don't listen to her for advice. But I do know someone else with gastroparesis that was told that those with gastroparesis usually don't have a HBA1C under 8.5 and I've been told by my pump rep that many people with gastroparesis give up

 

[pottersusan]

As a fellow creon junkie I can fully sympathise with you. As you will doubtless know one of the potential side effects is hyperglycaemia and another one is hypoglycaemia so in my opinion is that just try for something as stable as possible. I sometimes find that my BG can have dropped two hours after my evening meal and then risen by bedtime. It could well almost halve by the time I've woken up so I aim for between 5 and 9 to avoid beating myself up for something that's probably not my fault.

As for insulin time, yeah. The higher you are, the longer it takes for insulin to work. I've noticed if I'm over 15, I can test two hours later and it's still 15, despite giving insulin.

I could quote more!
I always learn something new on here.
In the last week, I've doubled the amount of Creon I'm taking due to specialist dietitian advice. Am now taking 12 x 25000 with virtually everything😱 mixed with apple sauce...ooooh yummy😱😱
Just to add to the joys of spring I'm developing a cold - something I rarely get these days

 

[Pumper_Sue]

Thanks for that info.

If only I never achieved double figures! They've been happy with my hba1c being in the high 60's😱 which I am not satisfied with. I'm hoping when I have my next test, I'll at least have reduced it to the 50's. 🙂
It can take over an hour for the insulin to start doing anything. So I've been trying not to eat until my bg is around 5.5 or 6 to reduce those spikes - only possible by having a very close relationship with my cgm and overcooked food

It sounds to me as if some basal testing is in order and also have a good look at your pump setting to see what you have it set at for blood sugar correction ie. is it set to correct you down to 7 or 5 or what ever then set it to what you want it to be yourself. If you haven't got it invest in pumping insulin by John Walsh (amazon)
Personally I wouldn't have to close a relationship with the CGM as it's reading are 20 mins behind a finger stick and not always accurate. Very good for trends though.

 

[TheClockworkDodo]

• What BG range do you aim to be within?
• What range is good for waking up?
• What is a good Hba1c?

I aim to be 4-6 before meals and 6-8 two hours after meals, but that's in an ideal world!

I like to be 5ish when I wake up - I know it's OK to be higher but I never like waking up much over 6. However, my DSN thinks it's no problem to wake up 8 - less risky than going too low and can always be corrected with breakfast insulin.

"Normal" range (ie non-diabetic) HbA1c is 30-45 so I was really pleased when mine got down to 42, but DSN and consultant were happier when it was 48. They think loose control is actually better than really tight control - I am a bit dubious about this - I'd rather get back to 42! But from what I've been told you'd have to have regular HbA1cs well above 48 to be at significant risk of complications - lots of daily bgl readings in the high teens, not just spikes.

My current goal is to have no more than one hypo (lower than 3) a month

My goal is to have no more than one hypo a day ...🙄

 

[TheClockworkDodo]

Sorry, not sure where that extra bullet point came from - and I don't seem to be able to edit it out 😳

 

[Amberzak]

My goal is to have no more than one hypo a day ...🙄

I hear that. I was the same until I got my pump.

 

[eggyg]

As you know Susan, I'm in a similar situation as you. My DSN has always told me because of my "digestive" problems, ie gastric dumping, no one knows how quick or slow our food is getting through our body. With me it's guess the BGs everyday. There is no rhyme nor reason for some of my numbers. Last night before bed 10.30, I was 9! Had my tea at 6! So goodness knows what it was earlier in the evening. I have also been advised to up my Creon. Luckily still got 40,000s and take at least 3 each meal, although my gastro man thinks I need to take much more, but for obvious reasons I'm not keen.;-) My last Hba1c was 48 so am assuming the highs are outweighed by the lows. I just try and low carb high protein as I don't really know how my innards are working and it seems to work. I am quite hard on myself but I'm the only one who can do anything about it.