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Should we even be trying to get fasting blood sugar under 95?

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jun 18, 2015.

  1. Theo's dad Joe

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    http://perfecthealthdiet.com/2011/11/safe-starches-symposium-dr-ron-rosedale/

    here is an interesting article/debate that looks at a lot of research and different point of view. They are selling a book, but please not the studies that they have cited.

    It raises some questions for me. One is, should we try to achieve fasting blood sugar in the 80s when the best health markers and longevity (among non diabetics) matches up with a fasting blood sugar of 95-100 (as long as it is not the result of insulin resistance). I mention non diabetics because it eliminates the problems of hypoglycemic events, so if you eliminate hypoglycemia, and insulin resistance, people live longest with fasting blood sugar of 95-100, not 83 or 74.

    If the 99 fasting blood sugar is due to insulin resistance which T1Ds are not particularly likely to have, then it is "optimal". Likewise the research shows that an HbA1C of under 5 is negatively correlated to longevity for non-diabetics (again to remove the possibility that it is risk due to hypoglycemia). Even if you have not hypoglycemia, there is no benefit from going under the low 5s, and there is statistically harm from doing so.

    Another question I have is, should we even try to get kids under 12 any lower than 150 at bedtime and should we even try to keep their peaks under 200, or is that normal and maybe even a part of growth hormone signalling at that age?
     
  2. Christopher

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    I don't know the answer to your question(s) but just something to consider: You will never know your child's true, exact bg number. There is going to be a varience of 10%, 15%, 20% who knows how much. So when you are talking about the difference between a bg of 85 and 95, I feel like that may be splitting hairs a bit. But maybe I am misunderstanding your point.
     
  3. Theo's dad Joe

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    Whether there is a variance or not, people are still going to set targets. I've read that some people will set a pre meal target in the 80s, but if 99 fasting produces the lowest hazzard rate and greatest longevity (sans insulin resistance and hypoglycemia) then there might already be a counter regulatory effect raising peaks if pre prandial is set below 90ish.

    I've also read that kids have a normal growth hormone and cortisol secretion around bedtime that regularly pushes their blood sugar up to around 150 so wondering if trying to manage to a target for bed under 150 is harmful. In reality there is very little research I can find on what are real world normal post prandial and bedtime blood sugar for kids especially. Several graphs show that adults even some up 10-20 pounds around bedtime from a nighttime release of cortisol and GH. Is it really "correcting" BG to eek a kid down under 150 in the middle of the night if you have the technology to do so remotely and without interrupting their sleep?
     
  4. njswede

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    Your kid must have one HECK of a honeymoon to even be thinking in terms of +/- 20 points. Given that we're on an I/C of 1:30 and a Lantus dose of 2-3U, I'd say we're still in honeymoon, but I'm extremely happy if I can keep him within a 100 point range over 24 hours. We're averaging about 130 mg/dL, which the endo says is good enough.

    Or am I just the worst diabetic manager ever for not being to keep him in a range that tight?
     
  5. sammysmom

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    Like Christopher said, 80-95 could be the same number so I am not too worried about that. If my son feels "wonky" waking up at 80 and that is where I have his target, then we raise the target. Simple as that. We really never do know what numbers really are so the best you can do is go by what the meter says and how the child feels when at that number. Regarding type 1's not having insulin resistance.....once you are in this game for a while you will know that they certainly do have insulin resistance at different times and it can be a bear to deal with. It happens are can happen often. Teenagers are notorious for insulin resistance. There is no research for real world bedtime blood sugar for kids because all kids with t1D are different. My kid does not have a night time cortisol release. Never did. His is at a different time. You do what works for your child and when that stops working, you change the routine to fit the need. We correct when needed. Our son corrects when needed. It is proven that the lower the blood sugar the better and we do our best. Social, emotional and physical health also come into play so that is why there is no one true answer. You do the best you can and teach your child how to live in this world with T1d. It is ever changing. Fasting bg, night time bg, it all comes with a set of circumstances that can not be defined. Looking for the definite answer will drive you crazy.
     
  6. Christopher

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    You are doing fine. I honestly think mertdowg has very unrealistic expectations (no offense meant at all, mertdawg), and that over time he will (I hope), have a more realistic expectation of managing Type 1 diabetes in children.
     
  7. Christopher

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    When you say kids regularly have bg of 150 at night, do you mean kids who have Type 1 diabetes or kids that don't? If it is kids that don't, how would you know that their bg is 150 in the middle of the night? And if it IS kids with Type 1 diabetes, there are so many variables that effect night time bg levels that I would be very surprised if you could say with certanty that kids regularly have bg of 150 at night. What does "harmful" mean?

    Once again, it is very hard to make blanket statements about children with Type 1 diabetes. So to ask, is a target of 150 at night "harmful", you have to ask, is the child in honeymoon, what did they have for dinner that night, how much activity did they have that day, what age is the child, how long has the child had diabetes, if female are they on their menstrual cycle, are they fighting an illness, how often are you checking bg at night, do you use a CGM, etc....

    There are a lot of parents on here, like sammysmom, that have been dealing with this disease WAY longer than I have. If you don't listen to me, please listen to their advice. It feels to me like you are trying to micro-manage this disease, and I think that is a normal reaction in the begining. You want to "beat" this thing, to "control" it. You will come to realize over time that you can't beat this disease, and that you can't control it. What you can do is manage it to the best of your ability. But maybe you need to learn that for yourself and no one can convince you otherwise.
     
    Last edited: Jun 18, 2015
  8. wilf

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    You should do what you think is best for your child, and what is reasonably achievable. Your views on both those points will evolve over time.

    Right now you have the luxury of obsessing over little things like this, because it doesn't much matter what you do and your son's blood sugars will be pretty good to excellent. It will not always be this easy. :cwds:
     
  9. wilf

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    In answer to your specific question which is the title of the thread, my answer would be YES.

    He is honeymooning, and he will normally wake up with a fasting blood sugar of under 95. So if he's not, it's probably because you're doing (or not doing) something to mess up his body's still considerable ability to get him to under 95 over night.
     
  10. MomofSweetOne

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    We try to have my daughter at 100 at night. Hardly ever happens, though! If she is under 100 right before bed, then we give a glucose tab to boost her up to 100. A huge motivator in that is to optimize the odds of sleeping through the night without triggering the Dexcom alarms. Diabetes is a marathon, not a sprint, and the amount of night awakenings has taken its toll on both of us.

    My daughter feels best when her BG is under 170. Recently, we've seen far more 200s and 300s than we used to see in, but I've overhauled her pump settings and we're seeing much better numbers. I was so used to adjusting basal with puberty that it hadn't occurred to me that her ISF and carb ratios would be changing with the incredible growth she's undergone in the last 5 years.

    The better control shows in her personality. She's much more cheerful and energetic. It is worth the effort to manage tight control unless it is causing friction in your relationship. For me, my daughter is on board with wanting her A1C in the 6s, so we work pretty well as a team most of the time. For me, it's worth the hassle of weighing food, using a calculator program my husband wrote for us to have things as exact as possible when home.

    We were basal testing this a.m., so I let her go lower than I would ordinarily. She was at 67 when I woke her, and she was dizzy and shaky. It wasn't a pleasant start to the day for her. Ideal for her is the 80-150 range, she says, and 70s are better than 170s.

    Editted to add: The nighttime increase in BG that you're mentioning can be addressed with pump basal settings. With MDI, you're much more at the mercy of the insulin action, which is also a reason to run a child a bit higher in case the insulin peaks during the night. We were told at dx that it was safer to give Lantus in the a.m., but after a few weeks of BGs increasing through the night because of the growth happening, we were advised to change it to bedtime to use the peak to combat the nighttime climb. It worked for us.
     
    Last edited: Jun 18, 2015
  11. Lori_Gaines

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    I agree 100%.
     
  12. Nancy in VA

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    With a pump and a Dexcom, we try to get as close to "non-diabetic fasting" as possible overnight. Emma last eats at 6-6:30pm, so there is no reason we can't shoot for a flat number around 80 from 10pm - 7am. Growth hormone, activities, miscounted dinner carbs, etc, always factor in to not meeting that goal, but on a normal day with no illness, growth hormone, or excess activity, our goal is to have the basal set in such a way that she'll get to around 80 and stay within 20 or so points of that all night. No reason they can't have an in range number for that long of a period of time that they aren't eating.
     
  13. Theo's dad Joe

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    Kids without. And not in the middle of the night, at bed time. I found a couple online sources that said that "normal" for non-D kids under 12 was 100-150 at bedtime, and that Non-D kids under 100 at bedtime sometimes get hypoglycemic at night and so doctors often recommend a snack. The same sources said that you can find a non-D kid under 12 between 100-180 almost anytime depending on what they've been doing and digesting and that they may even have occasional PP numbers as high as 225 and never develop problems.

    I doubted those sources so I asked a former research colleague who works with (non-D) kids and he said that kids can pop up over 180 all the time, and DO go up to 130-150 at bedtime often due to cortisol and growth hormone but that people who don't test kids, even pediatricians and endo's don't really know what is normal for non-D kids up until about age 12. Maybe he's wrong too, I don't know, but if the goal is to get NORMAL blood sugar as much as possible then we have to ask if anyone really knows what normal is for a little kid. We have blood sugar and even glycation may have.
     
  14. Theo's dad Joe

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    I am not micromanaging anything. I give my son a unit with each meal which is within a range of carbs and he comes up in range at meals and bedtime, 75-95 for breakfast, 80-110 for lunch, 95-115 for dinner and about 100-120 at bedtime. I'm not doing anything right now, I am asking if there is actually a valid reason to set a target before a meal at under 90 just for the sake of being a little lower, or whether that is some kind of unfounded belief that 85 is somehow "better" than 95. And I gave evidence that people with the lowest health risks excluding hypoglycemia and risk of FUTURE development of insulin resistance tend to have fasting blood sugar above 90, not below 90.
     
  15. Theo's dad Joe

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    My question here is, what if it is normal for non-D kids under 12 to have their blood sugar go up around 130-150 before bed. What if that is part of the normal circadian rhythm? I'm not saying that they should, I'm asking why we think that there are not normal, growth promoting ebbs and flows in blood sugar like with other cyclic biological factors? Do we have any foundation for bringing a kid down to 110 from 140 when they are sleeping? I am asking because I read a poster who wrote that she would give her 5 year old a micro dose by remote if she woke up and saw her close to 150 in the middle of the night.
     
  16. Theo's dad Joe

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    On an unrelated note, is there a way to contact a mod to change my screen name? I just grabbed an old one that I used on another site a long time ago because I wanted to ask a question, and I would rather change it now?
     
  17. Theo's dad Joe

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    I don't have any expectations. I am not asking about my current management, I am asking if 80 is better than 95 all else being equal, because I've read posts that say that it is better, and found research that says that its not healthier to have blood sugar run at 80 than 95 even independent of hypoglycemic risk, and if it is not the result of insulin resistance.
     
  18. Theo's dad Joe

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    i am asking if setting a target below 90 ever makes sense, as I've read people doing. Again, see other posts.

    I don't do anything. I can give him 10 extra grams of carbs at lunch and he comes to dinner at 105 right now. I've given him half doses when I wasn't sure he could finish and he's come to dinner at 105, and uncovered popcorn at the movie theater and no change.

    By the way, if you don't mind sharing, or in a PM perhaps, what do you usually see for just pre-meal blood sugar right now in honeymoon. Is there still a lot of pre-meal variability or is it more 1-2 hours post prandial? I decided that we would only test 4 times a day as long as every measurement was in range, and wait to get the dexcom (they are processing me now) and see what the next A1C is. I decided two weeks ago to manage less given that we are 100% in range, and try to benefit from relaxing more while we still have the luxury.
     
  19. jenm999

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    We aim for a lowish (100-120) BG at night mostly to compensate for higher volatility during the day. While it may be true that non-D kids have BGs around 150 at some point after going to bed (and I believe it given the amount of insulin my son needs between 8 and 11pm), aiming for a lowish and steady number at night gives us more room for error during the day.

    I am also working very hard at internalizing the adage "perfect is the enemy of the good" and I suspect that's true for a lot us, who (I'm guessing) tend to be highly educated and motivated to do the very best for our kids. For two reasons - I believe the professionals who tell us that an A1c under 7 will bring their risks of complications close to that of those without D, and that striving for an A1c under 6 reaches the point of diminishing returns; and because it the lack of sleep, lack of fun and intensity of managing to perfection takes a real emotional toll.

    That second paragraph isn't really on topic but I'm going to leave it because that seems to be the recurring theme here.
     
  20. sszyszkiewicz

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    Upon waking 80 is better than 95 because then you have a little more room for the breakfast spike. So for example I feel it is better my DS is 165 when he gets to school vs 180. Generically speaking I prefer lower at wakeup so he doesnt go to school groggy. We prebolus at breakfast and make sure he is dropping before he starts eating to cut into the spike.

    This is our practical response to a practical problem
     

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