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What BG's go with an A1C of 5.3%

Discussion in 'Parents of Children with Type 1' started by Darryl, Sep 3, 2010.

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  1. Darryl

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    In reply to a PM asking what daily BG's look like to go with an A1C of 5.3%, I ran these CGM reports. First by year, then for 8 weeks this summer.
     
  2. Darryl

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    Summer 2008 - A1C 5.6%

    (The bars are the lowest and highest BG of each day, including post-meal highs. The circles are the daily averages).

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    Summer 2009 - A1C 5.3%
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    Summer 2010 - A1C 5.3%
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    Last edited: Sep 3, 2010
  3. Darryl

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    Week of July 1, 2010
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    Week of July 9, 2010
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    Week of July 16, 2010
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    Week of July 23, 2010
    [​IMG]
     
  4. Darryl

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    Week of July 30, 2010
    [​IMG]


    Week of August 6, 2010
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    Week of August 13, 2010
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    Week of August 20, 2010
    [​IMG]
     
  5. Darryl

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    So as you can see, not every week is easy to manage or has good BG's all day long.

    We have (I hate to call them this) unexplained highs and unexplained lows all the time, just like everyone else. We have persistent highs that need tons of extra basal, and persistent lows that need zero basal for several hours even with extra uncovered carbs. The overall A1C remains good though because looking over all time, she keeps her BG in the nondiabetic range whenever she can.
     
  6. Darryl

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    Just a comment on the lows in the 40-60 range that happen often between 8 PM and midnight. We can't seem to do anything about them.

    Her basal currenly goes to 0.10 at 8 PM, yet BG keeps dropping all the way until midnight a lot of nights. Even if she eats 10-20 extra carbs at bedtime, and even if I wake her to have more carbs, it just keeps on dropping, then it finally recovers to normal around midnight and her basal comes back on. No idea why or what else we could do about it.
     
    Last edited: Sep 3, 2010
  7. Lee

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    Darryl,
    Thank you for posting these so everyone can see what you do to get your amazing A1C - but I do have a question, and I hope you don't think that I am being critical - but I really want to know how you feel about lows.

    I personally find blood glucose to be as important to muscles and organs as oxygen. And just like having a low oxygen level will cause permanent damage to the heart (reaching an oxygen level of 88% just once a day puts you at serious risk for a stroke), the same muscles going without glucose cause damage. No - I do not feel like finding an article to prove this right now - becuase it is common knowledge. My stepdad has permanent brain damage and now has the same mental processing of a preteen do to excessive and repeated lows...

    I guess what I am getting at is I don't understand how you see highs to have such a traumatic impact on the body, but you ignore the dangers of lows.

    Out of 56 days of data that you provided, you had a low bs 49 times, and a severe low bs 42 out of 56 days.

    I just can't understand how you think this is safer then having an A1C of 6? No endo in the world would advocate a child going below 70 once a day 87.5% of time, or going below 60 atleast once a day 75% of the time.

    ETA - just saw your above post - can you do a 0% basal every other 30 minutes? Coco is EXTREMELY sensitive at night as well, and this is what we had to do.
     
  8. Darryl

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    Lee,

    Any time you see a low on these graphs, it's already been treated with carbs and reduced basals. So the lows generally don't last long, except for the lows that are "persistent", and those lows especially are treated with many carbs. So the carbs must be going somewhere - it's not as if the body is starved for carbs if she's eaten 20 or even 50 carbs in a couple of hours to keep the BG up.

    As to the research on lows, Ellen mentioned once some articles on how lows affect brain development, but the preponderance of the evidence in large scale long-term studies on people with T1 (namely, the DCCT) showed that participants who had such severe lows as to have "severe hypoglycemia needing assistance" two or more times each week had the best health outcome, the best cognitive outcome, and the best psychological outcome. And yet we're nowhere near that extreme, because when the CGM says 80 dropping, she starts to eat, so her lows are brief and non-symptomatic.

    I guess in 40 or 50 years we'll know what strategy is indeed the best one...
     
  9. Darryl

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    When we cut the basal off, it's for at least an hour. And even then, sometimes BG is just stuck right there at 55. We just give carbs each hour, keep basal off or at 0.1, and wait until BG starts to rise... it's never more than a few hours though.
     
  10. Lee

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    Well Darryl, I have seen the effects of a severe low a day - I have seen a once smart man, who was diagnosed 23 years ago at 49, suffer severe damage due to the lack of glucose. Maybe that is why I am so adamant that a Type 1 should not go below 60 more then twice a week.

    I have seen this disease steal the mental cognition of a strong healthy man. It does not get any clearer then that.

    I would strongly caution people to consult their endo prior to thinking that running a child this low is healthy.
     
  11. BrendaK

    BrendaK Neonatal Diabetes Registry

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    With your daughters numbers being that tight, does she feel lows?

    I'm asking because my mom also has very tight numbers and has severe hypoglycemic unawareness.
     
  12. Darryl

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    I'm not sure how to correlate that to our situation - was this T1 diagnosed at age 49? Was he using a CGM that enabled him to eat carbs whenever BG was below 80? Or were some of his lows undetected/untreated?

    There's another graph I will post shortly showing that even in a very difficult week, the actual time spent below BG 70 was only 7%...
     
  13. wilf

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    Guess it depends on what you call a severe low - how low was your dad going, and how low is Leah going?
     
  14. Darryl

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    Please understand, she does not "run herself low". She takes insulin or eats carbs when her BG is outside the nondiabetic range.

    One endo who I have much respect for, Dr. Kowalski of the JDRF, made an intersting comment in the Artificical Pancreas conference call the other night "
    "The data from the DCCT trial, which is very convincing, and very thorough, and lots of people - any many other trials - suggest that hyperglycemia drives diabetic complications.

    And if you get people down to glycemic targets - not A1C 7% - I'm talking about A1C of 5.5% or below 6%, the risk of diabetic complications is almost eliminated."
    Another nice little tidbit of the results of "running herself in the normal BG range" (if I may coin that phrase) is her doctor's comments on her most recent lab work "This is the best set of labs I've ever seen in a diabetic"... (her doctor has had T1 for over 50 years:)). With that, and no symptomatic lows since she started using the CGM, we're OK with this approach.

    It will be a long time before any of us know for sure...
     
  15. Sandy's mom

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    Darryl, I value your knowledge and resources you share, enjoy reading your posts. But, man oh man, I will take our 6.7-7.1 A1Cs any day and be happy! (I can still fantasize about 5.3:))I hold my breath and thank God for OJ every time my dd or dh drop below 50.
     
    Last edited: Sep 5, 2010
  16. Lee

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    Well - gee, since I said he was diagnosed 23 years ago at the age of 49 - I think that sort of answers your question - don't you? Why even bother asking?

    Was there a CGMS 23 years ago? :rolleyes:

    And it correlates in my mind very easily since I have seen the evidence of harm that multiple low blood sugars can create. Maybe your daughter won't experience side efffects in 23 years like he has, and yes - his lows are extreme at times, but is it really worth the risk to you - since an A1C of 6% is just as safe- according to your quote above?
     
  17. Darryl

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    I can only answer the 2nd question, of course... Leah's BG's will "drift" into the 50's, occaisionally into the 40's. But she started eating and cutting back basal when BG was 79.

    If I may ask, what child here, even with a A1C of 7% or 8%, is immune from BG's in the 20's, 30's, 40's...?
    I am not sure that running BG in the normal range causes more lows, because most of Leah's corrections are so small as to not be risky.
     
    Last edited: Sep 3, 2010
  18. Darryl

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    S
    Sorry, I thought you were referring to a single episode of severe hypo.
     
  19. Darryl

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    Just to be clear, I did not start this thread to promote a low A1C, or our way of management. I was asked the question what BG's look like on a daily basis that correspond to Leah's A1C. That's all.
     
  20. Lee

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    And I appreciate you sharing!
     
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