Stupid question

By melissa1987 Latest Reply 2012-03-16 20:35:03 -0500
Started 2012-03-10 17:23:12 -0600

I was wondering my numbers r really good lately always between 4 to 7 . I got a low 2 times in the last month. I was just wondering do u have to get lows to get your a1c lower?

44 replies

Matunuckan 2012-03-16 20:35:03 -0500 Report

I've been Type 1 for more than 50 years now. After age 40, I stopped being able to detect impending lows. That has made me'brittle'. Now, I get 'bind sided' by lows. I always carry glucose tabs, but, even though I try to check my BG, before driving, I have been pulled over numerous times. It has been a good thing that no one has yet been impacted negatively. My Wife therefore, doesn't want me to drive. I don't like it, but it is best for EVERYONE! If You are like me, DO THE RIGHT THING, & DON't DRIVE (unless you really need to). It is hard to swallow, but (as NIKE says) JUST DO IT!

John Crowley
John Crowley 2012-03-13 17:52:38 -0500 Report

So, I guess I have a little different perspective on this topic.

Almost all of the long-term complications from diabetes come from high blood sugars. So, when given the choice between running high or running low, we generally leaned toward running low with my son. Now a couple of caveats. First, my son has very good awareness of his lows. He's never passed out or even really come near unconsciousness—and he's had some pretty low low's. So the risks seemed pretty reasonable to have him err on the side of running low. I do have to say when he got a driver's license, then we were more careful about the lows. And always made sure he had a juicebox in the driver's door of his car.

I do think that many people (particularly type 1s on insulin) accept that in order to achieve a good A1c they will occasionally have a low.

Now, if your lows were super low, where you're in danger of losing consciousness, that's definitely not good. But if you're just running a little bit low and need to drink a little juice or have a glucose tablet to bring you back up, I think that's just part of the deal.

My two cents.

jigsaw 2012-03-13 18:25:51 -0500 Report

Hi John,
Could you be more specific as to what you consider running on the low side. Also, what do believe would be the danger point with lows. I suspect where on the same page, but I've noticed a great deal of varied opinions on the subject.

Type1Lou 2012-03-14 14:50:24 -0500 Report

This can be a somewhat individual reaction; what may cause problems for others, may not be a problem for me. I can usually sense when my BG is dropping too low. I don't feel uncomfortable with BG's in the 70's but start to feel it when it dips into the 60's and have also had it dip to 29 when I was still conscious but starting to be incoherent. I always carry glucose tabs or gel with me in case I'm away from home when it happens. What I learned is that I must ingest a fast-acting carb (e.g. glucose tabs, gel or liquid, juice (OJ or Apple), raisins, table sugar mixed with water in a pinch) to treat a low to get it back into safer ranges. Cookies, cakes and candy bars are NOT fast-acting carbs. Going on the pump in August has greatly reduced the incidence of serious lows I was having when on MDI of Novolog and Lantus.

jigsaw 2012-03-14 19:04:42 -0500 Report

Glad the pump is working out for you. I'm amazed that you were down as low a 29 and remained conscious. Only once, I double dosed on Lantus, and my bg dropped like a rock to 40! I thought I was going to pass out. Fortunately I got enough fast acting carbs into my system quickly. That's an error I hope to never make again. Thanks for the info!

Type1Lou 2012-03-15 07:16:48 -0500 Report

That 29 was last summer, before going on the pump. Even though my husband administered glucagon, he did drive me to the ER where I was observed, confirmed that my BG had been low and released once it got back up.
This hasn't been repeated since…and I hope never again. We do have a glucagon kit with us though, just in case.

John Crowley
John Crowley 2012-03-14 12:11:27 -0500 Report

So my son's target range was 80 to 120. We were always very comfortable when he was running in the 80s and 90s. And if he was in the 70s and a meal wasn't too far away, we would usually not do anything to correct it (unless he felt like he was really dropping.)

Like I said, we had the luxury that my son was really aware of the feeling of dropping low and was a very good judge of the difference between simply running low (like in the 70s and holding steady) and dropping fast.

jigsaw 2012-03-14 18:45:41 -0500 Report

Thanks John, sounds like excellent #s to achieve. I'll bet your son is doing well, and very thankful for his aware , concerned parents.

jigsaw 2012-03-12 10:53:15 -0500 Report

To get to the point, you definitely want to avoid lows! They are unhealthy and could be dangerous in some instances. The best way to get a good a1c is to keep your bg well managed. The best way to keep your bg well managed is to be as much informed as possible.

pixsidust 2012-03-12 10:40:20 -0500 Report

My doctor told me lows are more dangerous than Highs
Regular lows are signs other organs are failing/being damaged.

Finding that middle ground is what we are shooting for.
For me its 90-110 BG to feel my best. I will be happy with up to 120BG.

Your units of measurement…are they different than in the US?

Raybie 2012-03-13 10:03:19 -0500 Report

I definitely agree that lows are dangerous. Shortly after I was DX'd I had a friend who was helping me but then he died during a overnight low. I'm still scared of overnight lows so I always have a good meal about 1 hr before bedtime. I like to have my fasting bg at 130.

KarynCandy29 2012-03-12 09:31:04 -0500 Report

Hey Melissa,
No Question is a stupid question..I'm new to diabetes , so i don't have an answer but just wanted to say thanks for posting this question,,It's one at some point I may need to know..Thanks for posting it..I will enjoy reading the replies!

Type1Lou 2012-03-11 18:45:15 -0500 Report

Dear Melissa,
Your A1c is an average of your BG readings over the past 3 months. Those of us striving for tight control are more prone to having lows. Since going on the pump, my incidence of serious lows has greatly diminished. Personally, I feel comfortable with readings anywhere between 70 and 120 (don't know what that is in mmol) although my endo set my target range between 110 and 120. Are you considering that any exercise you do may naturally lower your blood glucose? Since going on my pump, if I plan on taking an hour-long brisk walk, I set a temporary basal rate in my pump at 0% for 90 minutes (30 minutes before the walk and for the hour of the walk .) This helps me to avoid lows during that time. I also bolus based on the carbs I eat. If I overestimate the carbs and give myself too much insulin, that also makes my BG drop. The overall goal is to avoid the lows but it's not always easy.

GabbyPA 2012-03-11 11:55:30 -0500 Report

The idea is not to have lows. They do lower your A1c number, but that is not how you want to achieve that. You want a balanced level to be your reason for a lower A1c.

annesmith 2012-03-12 00:40:08 -0500 Report

Yeah..thanks for reminding range is so wide that I have been working on stabilizing my numbers more—crackers, something I have not eaten for at least 5 years, has been helping's not a cure of course, ha, ha, but about a week ago I ate crackers with cheese ( cheese is bad bad bad for my super high tryglycerides-ha) , but I had not felt that good ( after eating the crackers) for YEARS. According to the last doctor I saw , I have big receptor problems in my insulin producing cells. It seems to all be so simple ( diabetes), yet , just when we think we have it all figured out, WHAM…something makes us question it..ha. For example, one of my tests showed I produce 4-10% maximum of my own insulin. I think 3 years previously, the antibodies test I tested positive for, but just barely..wait, it does make sense..oooooohhhhh…it can be so exasperating..I mean, when I'm sitting down and eating lunch or supper, one of the last things I'm thinking about is specifically which cell is working and which isn't—it's impossible for me to see it..ha. Okay, I see my whole picture now—I barely produce my own insulin and I barely am positive with the antibodies test—is SATAN trying to test me?—-HA, ha, ha…seriously, because, I am with the guy that is type 1.5—I can't remember his name..I sure wish he'd come back—WHY am I in a barely category?—-excuse my sarcasm…I mean, it'd be a lot simpler if I were ONE type completely or the OTHER type…seriously, it seems to me then ( I could be wrong here) that I fall right in the middle—neither type!——On that note of good humor ( even though it is serious) , I will go over my patterns again…ooooohhhh…man, either a person is one or the other arent' they? Ha, ha,ha..Satan become me…just kidding…ANNE

Type1Lou 2012-03-14 17:16:06 -0500 Report

I can so relate to what you're saying! Although I'm clearly a Type 1 (unlike you) the MDI that had worked for many years started causing me scary morning lows around 2 years ago. I finally saw an endo in Dec 2010 and last August, started using an insulin pump, which I LOVE! I still encounter days when my BG's don't make much sense to me and other days when I've over-indulged and the BG's show it but the incidence of lows has greatly diminished. Just when you think you've got it all figured out, life throws you a curve! I've learned that my life with diabetes is a constant adaptation.

annesmith 2012-03-15 01:24:48 -0500 Report

Yes…I'm happy that someone can relate to what I was saying. The hospital said I was type 1 without a doubt, but, I won't go into detail on all of that. I came to the conclusion I am LADA, because I am brittle…heck , I'm not making much sense I guess. The sooner I get a new endo, the's not been easy to find one open where I live. I am almost ashamed I don't have a regular endo now…it's been 4 years, and I have found tons of general practitioners open for patients, but no endos. I Just keep putting it in God's hands. I do know that the insulin I had in the emergency room cleared my vision up and I had not felt that good for at least 20 years. I did not realize how bad I felt until he gave me the insulin. I got to a point where I was just numb to the bad effects of high blood sugars. The only time I go low is when I do something really stupid, like go for my run and walk on an empty stomach, or drink hot strong black coffee with no food in me..yes, unfortunatlely, I used to do that all the time, and I pay a price for it even today. People are still astounded that my highs are between 300 and 600. Not that it's something to " brag" about—I did not mean to come off that way. I used to know a couple of people a long time ago that, seriously, anytime a person would say " I don't feel well today", they'd say " Oh, I feel worse than you." Then, if someone would even sneeze, they'd sneeze twice—geez. A little humor there for everyone..ha, ha, ha. It drove most of us crazy—it was in high school..we'd see one of them coming around the corner, and man, we'd kind of go the other way..ha, ha. I am glad your insulin pump is working so well for you!!! I bet you were ( are) relieved you don't have to worry about lows anymore. Well, I look forward to talking with you again soon!!!!!—Sincerely, ANNE

melissa1987 2012-03-11 12:03:59 -0500 Report

Ok so my goal should be to be between 4 n 7 all the time ?

GabbyPA 2012-03-11 12:07:30 -0500 Report

If you can keep a more consistent range that will give you a more true picture. I say this mostly because some people go low to keep a low A1c on purpose. It is a dangerous practice and the more normal range you can will keep your safer and healthier overall.

annesmith 2012-03-15 01:29:01 -0500 Report

Yes, you have helped me a lot. For a long long long time, I was so worried about disappointing the doctors and nurses, and I was also inexperienced in keeping consistent numbers, that I think in the back of my mind I was trying really super hard to keep a low A1c on purpose. It is a very dangerous practice. I used to know a young lady—she was diagnosed adult onset type 1 diabetes at the age of 29..she kept taking her insulin on an empty stomach, and she drove her A1c down to 3.3. It was awful to watch. ANNE

melissa1987 2012-03-11 15:23:20 -0500 Report

Yeah I'm just doing a lot of walking lately and it's making my sugars go down… I eat the way I'm supposed to. I dont really care eaither way if my doctor puts me on meds or keeps me on insulin now because I'm so used to it and it don't bother me much anymore. Kinda scared to go on pills actually I don't know how many I would have to take or anything about them but I do think it would be abit easier to travel n stuff

GabbyPA 2012-03-13 08:44:35 -0500 Report

Insulin generally has less side effects (except the lows) so if you are used to it and it works, I would keep that instead of oral meds. It sounds like you are doing some great things. Just watch the lows and if you are getting too many, talk to your doctor about reducing your insulin requirements.

Caroltoo 2012-03-11 16:19:25 -0500 Report

Yes, pills are easily portable and no concerns about temperature. I took one small one a day for over a year, then went to half, and now to none. Made a really simple routine.

Old-n-Grey-n-Wiser 2012-03-10 22:13:55 -0600 Report

Don't forget Melissa is one of our Canadian friends she uses a different scale for B/G readings.

Young1s 2012-03-10 22:28:37 -0600 Report

Thanks for the reminder, Tom. Her readings of 4-7 would read 72-126 for us.

northerngal 2012-03-11 14:43:14 -0500 Report

Thats a little low. My endocrinologist recommends 130-160 to avoid lows. (I don't get symptoms, so have to be extremely careful about what I'm doing, when, and for how long) I've had it over 40 years and still bicycle over 1000 miles each year, so its definately possible to stay active and its a great way to control bs and to keep your sanity! You will have highs and lows, its limiting how many and recognizing when it happens and correcting it as soon as possible. Keep up the good work.

Young1s 2012-03-11 15:03:00 -0500 Report

I've been told 90-130 and have heard others here say 80-120 but your range is a first. Personally I don't want to see any numbers upwards of 160 unless it's after I've eaten something, but if this is working for you and your doctor says your healthy then good for you. We're all different so it's about finding what system or plan works best for each of us individually.

northerngal 2012-03-12 12:53:20 -0500 Report

I've also had it for 40years (giving away my age here) and my body has not produced insulin in several years. I was type 1 from first diagnosis, but I have no doubt that I still produced some. As time went on, that gradually decreased to none. The longer you have it, the more complicated control can be. MD's try for numbers as close to normal as possible when you are first diagnosed, but after several years (20+) I think you'll see a more broad range of "acceptable" numbers. I had an advanced degree rehab specialist tell me that she had never seen a1c numbers close to mine in 20 years of work, including type 2 patients. Thats why I'm able to bike and jog after so many years of it, but I'm starting to see complications now and its not fun. I've been told that I'm stubborn, so maybe in that respect its a good thing. I'll never quit. Thanks for responding.

Harlen 2012-03-10 20:51:11 -0600 Report

There are only the ones you didnt ask that are silly
No it is best not to have big lows
Just know that an A1c is over three months of time so your doing good .
Hest wishes

Caroltoo 2012-03-10 18:44:07 -0600 Report

No, you don't have to get "lows" to lower your A1c, you have to maintain a lower average of BGs. That usually means a tighter, smaller range of readings — not as high anymore, and more closely grouped.

If you get real lows, it will lower your A1c, but it is a dangerous way to do so and isn't as healthy as lowering the highs and having all readings in a tighter grouping.

BobbieNJ1000 2012-03-10 19:47:49 -0600 Report

Plus, real lows can often be followed by highs, so it seems unlikely to have any good effect at all. Plus I don't function well when low. I'd be happy to keep in my target range for the most part, and skip lows altogether. Working on it!

Set apart
Set apart 2012-03-11 07:12:31 -0500 Report

So true, I try to follow the 15 minute rule, but every nowand then, panic when I am too low and as I carb up to stop the sweats, I end up with a spike!

BobbieNJ1000 2012-03-11 11:58:26 -0500 Report

I did that just the other day. Argh! When I'm low it's hard to control the craving before that feeling goes away. So much better when I can keep BG on an even keel.

northerngal 2012-03-12 12:59:26 -0500 Report

Your body will also automatically dump any glucose stored in the liver when you get too low. It basically goes into life saving mode and any available glucose is used. That may be part of why you get the spike. Normally, it stores a certain amount that isn't being used and won't be until there is an emergency. But if you try to carb load like athletes do, you'll have high readings. Definately a balancing act. God didn't create junk! The spike is common and tough to avoid.

Nick1962 2012-03-10 19:00:31 -0600 Report

So right Carol! It's called trying to skew the curve, and you mathamatically can't possibly endure enough lows to offset the highs to get an acceptable A1c. It takes some time melissa, but you'll get there.

Caroltoo 2012-03-11 14:47:11 -0500 Report

If you are doing it intentionally, it's trying to skew the curve. As I read her statement, I thought she was more concerned about the possibilities of lows like the ones she had so badly when she was taking insulin and not wanting to have them.

melissa1987 2012-03-12 16:10:40 -0500 Report

I am so not! I do not like lows who does? I am not doing this intentionally ! I eat my meals I just work out now . Whatever I think I'm doing good so I don't care what any of u guys think! DONE

Caroltoo 2012-03-12 16:16:39 -0500 Report

Of course you aren't. You are doing very well.

I was replying to a comment someone else had made … he did misunderstand what you were saying. On you cell phone, you don't see the context of the discussion thread. If you check it on your PC, you will find that he also apologized for misunderstanding your intent.

Caroltoo 2012-03-12 16:14:04 -0500 Report

You are doing well, Melissa, in fact you are doing very well.

Unfortunately on your cell phone you can't read the context of the discussion. I was replying to Nick about a misunderstanding he had about what you first posted. His apology for misunderstanding is the next post on the column.

Nick1962 2012-03-14 09:05:08 -0500 Report

No, my apologies Melissa, I didn't mean to say you were doing it intentionally. I thought you were thinking that lows were possibly a good thing in getting a good A1c. You are doing well, so keep it up! Again, sincerest apologies for any misunderstanding.