When I was in school, I hated math and most things that involved numbers. I was good enough to get by but I definitely focused my efforts a whole lot more in the areas of art and science. Fast forward to now and numbers have come back into my life, whether I like it or not*. Aside from the fact that my job forces me to be involved in payroll and budgeting, I feel like living with diabetes forces us to do calculations all day everyday.
It makes us consider crazy questions like….
“If I gave myself x number of units, y number of mins ago, and ate z, can I go for a run 30 mins from now?”
Yes, it sounds like the math test questions from our collective nightmares and yet it’s what we do all day, everyday. Then we layer on things like target ranges**, basal rates, minutes of exercise and the list goes on. Out of all of the number nonsense, the target range is something I think is worth paying attention to.
According to Web MD, “Normal blood sugar levels are less than 100 mg/dL after not eating (fasting) for at least eight hours. And they’re less than 140 mg/dL two hours after eating.
During the day, levels tend to be at their lowest just before meals. For most people without diabetes, blood sugar levels before meals hover around 70 to 80 mg/dL. For some people, 60 is normal; for others, 90 is the norm.”
According to the CDC, “These are typical targets:
- Before a meal: 80 to 130 mg/dL.
- Two hours after the start of a meal: Less than 180 mg/dL.”
I’ve also talked to a number of Type 1 diabetics and it seems many of us have vastly different target ranges. For example, during my CGM training, when the diabetes educator was discussing setting up the alarms she said something like, “Don’t set it too low or you’ll be waking up every hour. 200-250 is reasonable”. For reference, 200-250 is DEFINITELY way out of normal range but I thought to myself, “Sleep is important! I don’t want to be waking up multiple times per night!” So initially, I thought I was being conservative setting my pump to wake me up at 170.
Now, I laugh at how naive I was back then. If you’re wondering about my targets, I now have them set to this schedule:
- 100-120 from 8:00pm-4:00am
- 70-90 from 4:00am-8:00pm
- 120 in automode***
- 150 for an automode temp target
Many diabetics ask me why I have such tight target ranges but the way I see it…
You can fix a low at 80 before you go low or at 60, once you’re already low. You can fix a high at 100 or you can wait until 150, 180 or 250. In my mind, If I fix it at 100 or even 120, I’m much more likely to stay in range than if I don’t take any action until it hits 150, 180 or 250. Remember my “fast acting” insulin takes 20-30 minutes before it starts to take effect and 2 hours before it is at peak strength. If I’m not starting to do a correction dose until I’m at 250, how high will my blood sugar go before it starts to come down? If I give a small correction at 120, I will likely avoid reaching 180 altogether and probably won’t go low either.
I’m also asked frequently…
“Isn’t your pump buzzing all the time?”
I honestly can say that I don’t think it alarms any more than when I had a wider range. What I can say is that my bloodwork, including A1c, is much better, than before. Since A1c is reflective of your average blood sugar over a 90 day period, generally, more time in range will give you a better A1c.
Another important consideration related to target range is standard deviation.**** If you’re swinging from 40 to 200 regularly, you can still end up with a decent A1c if your average blood sugar is normal. For example, (40+200)/2 = 120 average. 120 itself is fine but obviously, swinging from 40 to 200 and back wouldn’t be an ideal, let alone safe situation.
Most medical professionals I’ve spoken with agree that a more stable average blood sugar is preferable, even if it is slightly higher. This would mean a lower standard deviation aka flatter CGM lines would generally be better and hopefully lower the risk of the complications associated with having diabetes for a long period of time.
Ideally, I want to stay healthy well into old age and that is why I keep such narrow target ranges. I don’t always hitman targets but I figure even if I just get close, I’ll be better off. If you look at my most recent Quarterly Diabetes Tracking Post, you’ll see my average sensor glucose was 117 with a standard deviation of 30. This means my typical range was 87-147 in that timeframe. Clearly off from my targets but not too far off “normal”.
So what is your target range? How do you adjust it for time of day, workouts or anything else?
*Okay, so I am a closet personal finance nerd and I might enjoy numbers when I see my bank account growing.
**For my non-T1 friends, target range is the range you try to keep your blood sugar in.
***These are standard automode settings that can’t be changed but I also fuss with my pump in automode so I’m typically hanging at lower number, even in automode.
****Now, I’m really taking you back to math class. The standard deviation is a measure of the amount of variation of a set of values. A low standard deviation indicates that the values tend to be close to the mean (average) of the set, while a high standard deviation indicates that the values are spread out over a wider range.
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The content on this site is not intended to be medical advice. Always consult your doctor before beginning a fitness regimen or adjusting your diabetes management strategy.