WILD FLUCTUATIONS BETWEEN HIGHS/LOWS, BUT A1C 6.5. WHAT DAMAGE AM I CAUSING TO MY BODY?

Hi,
I'm going on my 2 year anniversary of being a t1 diagnosed at age 48. i wear a pump and test 8-10 times a day. i've never had an extreme hypo; my lowest ever was 46. but i also have highs on almost a daily basis of 280-350 if i eat more carbs than i bolus for. i'm constantly making corrections because i'm afraid of having a low, so i'd rather go a little high and correct later than take too much and go low.

my concern is what damage am i doing to my body? my endo says it's all about the a1c; that fluctuations don't matter so much. i've stayed pretty steady at an a1c of 6.3-6.5 for the past 2 years, but i'm worried about the long-term results? can anyone comment about this?

Tags: A1cAccuracy, Highs, Lows

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The A1C data seems to suggest you'd be ok however I think there have been other studies around that have shown that up and down can cause problems too. In my experience, when I was "rollercoastering", I felt kind of messed up pretty frequently. Which I treated by getting messed up pretty frequently, which probably was not the best solution? Things have turned out ok and I'm 44 now and seem to have escaped the worst complications for now but one never knows.

could you please explain the y axis. it states relative risk but does it mean: times no risk?

I'm not sure, maybe "relative" to the "straight" population, like at 6% you have a 2% higher risk and at 12% you have 20% higher risk of retinopathy? Still not the worst odds but, given the seriousness of what they are talking about, I'd prefer to do everything possible to stack the odds in my favor!

I think it's all normalized to the risk at an A1C of 6.0.

At an A1C of 6.0, a diabetic already has much higher risk factor say retinopathy than the general non-diabetic population. It's possible that below some A1C, the risk stops dropping but is still higher than the general population. There are just so few diabetics with A1C's less than 6.0 and so little statistics.

And note there are some complications (e.g. hypothyroidism) that seem to be completely unrelated to bg control, and some others risks (e.g. hypoglycemia and "dead in bed syndrome") which increase as A1C goes lower.

If it was normalized to 6%, wouldn't the 6% be zero then?

If it was normalized to 6%, wouldn't the 6% be zero then?

Setting 6% to be zero, would mean that there was zero risk at 6%.

In fact a diabetic faces a substantial life-long risk from many of the complications (especially the ones on that chart) even at an A1C of 6%. And the risk rises rapidly as A1C rises.

The more complete DCCT graphs show the risk evolving as number of years goes on, for different A1C's. But it's still important to note they don't have any data that ever shows the risk to be zero. (even non-diabetics have a risk of retinopathy). e.g.

A good A1c doesn't necessarily mean good control. I, too rode that 30-300 roller coaster for years (diagnosed w T1 35 years ago). I'm now 44, use the Minimed and Dexcom, & things are pretty stable, but do still have occasional high/low moments, but not nearly as many. My A1c didn't change much, but I feel SO much better!! Acidrock is right - you feel messed up when your bgs are swining hard. I didn't realize how messed up till I went on the Dexcom and found out exactly what my actions were doing to my bg's. (I learned the little details that made all the difference, like... "I can't eat cereal for breakfast without hitting a hard spike, I can't run harder than 7mph or will will spike my bg", etc...)
Those bg swings are very damaging to your cells. Everytime your bg is elevated, it can damage your circulation, which is what leads to the blindness, kidney failure, etc... The problem is, you don't feel the damage until it's there. You can't hear your arteries hardening. It is worth your every effort to figure out what causes the spikes to 300 and do something about it. Don't be overwhelmed by the big picture. Find one area you want to focus on (ie: your breakfast & post-breakfast bg) and start working to figure out how to better manage it.
I think we all walk around hoping that what we are doing is "good enough" and only time will answer that.

Nitro, tell us how you deal with having both a pump and the CGM on your body at the same time. I agree with your post, but I noticed that Gayle says she has a CGM and hasn't gotten it out of the box. My thought is that all the diet manipulations can help, but nothing can help as much as knowing where your blood sugar is going, and the CGM is the answer to that. I'm just learning my CGM, but having worn it now for only one month, I haven't had even ONE surprise high or low because the CGM tells me where I am and where I'm going. I don't have a pump now, but I used to wear a MiniMed. Loved it. I can imagine that having enough sites for both the pump and the CGM could be difficult, but maybe you can give us some info that will encourage and reassure Gayle that using her CGM will be more of a benefit than a problem. I do agree with Gayle that it is another "thing" you have to deal with, but I also see the benefits of it as making it more than worth the extra effort and the extra piece of equipment to cart around all day.

I've been pumping for 16 years, so the addition of the CGS was no big deal. I've asked my endo about the possibility of scarring my healthy adipose tissue in my abdominal area, and he said he hasn't seen it yet... I use every inch I can - reaching way over to the sides, go as low and high as I can go... rotate, rotate, rotate sites.
As far as being one more thing to haul around... I'll take that anyday!! It's like complaining that you have too much money! What a gift! Every chance to get better control, jump on it. Statistics for us aren't too pretty... and I don't want anyone else to have to add to those horrible statistics. People are willing to carry a cell phone all day - why not a CGS?! I bet someday they'll be able to get the sensor read-out on our phones... Until then, I'll just add it to my arsenal!

It's just too cool to wake up at night and not have to lie there wondering what my bg is, but too tired to haul my butt out of bed to check it... I just look at my sensor! If I had to give up the pump or the sensor, I'd keep the sensor, hands down. But having both are a dynamic duo! I just wish they'd come out with a faster acting insulin that doesn't hang-around so long, so that we can get more immediate action. (I remember the transition from Regular to Humalog - I thought I'd died and gone to heaven!!)
I will admit, when I'm in meetings with my CGS, pump and cellphone all on vibrate, it can get pretty distracting if all 3 decide to dance!! Again - well worth it!!
You do have to be careful to watch the trends and not over-react to the acutal number. It's so tempting to want to keep bolusing when you're staring at a 200... just gotta remember that the 'rapid' insulin is going to stick around for at least 4 hours, so it will eventually get it's job done!
Alex - gotta know - why'd you go off the pump?

I'm a little over a year late to this conversation, so I'll make it short and sweet.

Just started on a Dexcom G4 CGM and the Omnipod. I wear the G4 on the back of my arm, and literally don't know it's there after the first day. Wear the Omnipod on my thigh, and again, don't even notice it.

The only time I'm reminded these devices are on me is when I bump them on a doorjamb (G4) or something.

As for the display devices, yeah, that's a pain having to carry 3 things around now (phone, G4 reciever, Omnipod PDM). Fortunately I don't have to have the PDM on me at all times, so that stays in my day bag / briefcase (I got this, and am very happy with it, although I had to make two modifications to make it really work for me).

Great reply nitro - I agree 100% with everything you said

Read Blood Sugar 101 on complications. It's online. The question always is, how l-o-n-g a period is needed to cause the complications. Does 1 hour 3 x a day? Does 1 hour of spiking cause damage when it occurs daily in some people?
I have concluded I don't want to try to find out.

I guess my question back is, do you know how to curtail the upward swing?

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