At a fundamental level, my ultimate objective as a T1D is to maintain my sugars in the normal range at all times. (As a reminder, the normal range is 80-120 mg/dl.) But this is not realistic for me, or any T1D, 100% of the time.
Instead, I focus on the following three goals: 1) Low A1C, 2) Percentage of time in-range, and 3) Quality of life.
1) Low A1C
As a review, a T1D’s A1C (or HbA1C) is a measurement that tells the percentage of hemoglobin in the blood that’s coated with sugar. The A1C measurement is determined with a simple blood test every three months. The more hemoglobin in the blood that is coated with sugar as a result of high blood sugars, the higher the A1C result will be, and vice versa.
I have a personal goal to always maintain my A1C levels in ‘normal range,’ from 4.7–5.6%. This might sound like a tough goal to achieve, but from experience, I can tell you it’s 100% achievable.
Please note, this might even be different from what your endocrinologist recommends. The reality is, though, the closer you stay to the normal range, the better off you’ll be in the long run when considering long-term consequences.
2) Percentage of time in-range
While A1C is always going to be king, the concept of ‘time in-range’ is critical to understand as well.
When I was younger, my doctors and I used to think my blood sugar was in control because my A1C was relatively low. I would go into my endo appointments every three months and leave with congratulatory praise from my doctors because, at the time, A1C was the only thing that mattered.
If my A1C was low, nobody cared how I arrived there. What nobody realized, though, is that I never really felt ‘normal.’ I remember about half of high school and college schooling passing by in what I now know to be a state of groggy high blood sugar or scary low blood sugar. I was correcting myself constantly with extra carbs and insulin. Of course, this state of being took a ton of time and energy out of me, and almost never landed me in a predictable state of wellbeing—or ‘in-range.’
As time went on, though, my ability to clearly visualize my sugar levels got better. I then realized a low A1C could be achieved two different ways. 1) A T1D can—as I did when I was younger—maintain blood sugar averages at a low level but have dangerously high standard deviations in blood sugar levels throughout the day. Bad idea. Or, as I do now 2) maintain blood sugar averages at a healthy level and have low blood sugar standard deviations.
Standard deviation stands for the variance in blood sugar numbers throughout the day. In the graph below, you can see my blood sugars were fluctuating throughout the day. In other words, I was riding the “blood sugar rollercoaster.” In this example, my blood sugar levels averaged about 120 mg/dl. But, my standard deviation during the day was a whopping 80! This means my blood sugar levels ranged from as low as 40 mg/dl (120 mg/dl – 80 = 40 mg/dl) to as high as 200 mg/dl (120 mg/dl + 80 = 200 mg/dl). The result was that more than half of my day was spent either fighting a low blood sugar level with food, or a high blood sugar level with insulin. Let me tell you; THIS IS NO WAY TO LIVE!
To fix this issue, I set myself a lower standard deviation target of 30. This means that with an average blood sugar level of 120 mg/dl, my blood sugar level range is narrowed from 90 mg/dl to 150 mg/dl. Therefore, my new ‘in-range’ blood sugar level is 90 mg/dl to 150 mg/dl. The more time I can spend in this range, the better I feel. After understanding this concept, I realized that if I could spend every day with an average blood sugar of 120 mg/dl and be ‘in-range’, then I could also feel, act, and look completely normal 100% of the time; instead of just 50% as I did before. As a result, at the age of thirty-six, I’m playing the best sports of my life, sleeping better than I did before I was diagnosed twenty-one years ago, and I’ve been able to live my life the way I want to live it…a far contrast to my early years with T1D when each day was a challenge.
Please remember, though, that ‘in-range’ is a relative term since each person’s target range might be different.
The actual range you choose is crucial to your success. For example, if you set your range too high, at 160-220 mg/dl, and your standard deviation relatively low, at 30, you’re not doing yourself any favors. This equates to an average blood sugar level of 190 mg/dl. As a result, you’ll risk negative long- term consequences due to having, on average, high blood sugar. Remember, 190 mg/dl is well above the normal target range of 80-120 mg/dl.
I can’t tell you where to set your range. But as a reference, I set mine as close to normal as possible, at 90-150 mg/dl. This range gives me an average blood sugar target of 120 mg/dl and a standard deviation of 30. As a suggestion, you may want to start with a slightly wider range for yourself if you’re new to the concept; perhaps try 80-180 mg/dl, giving you a larger standard deviation of 50.
You can tighten your range as you improve your T1D management.
3) Quality of Life
A lot goes into measuring the quality of one’s life. But, for a T1D, I think the following two factors need to be the most carefully considered:
- Time spent managing T1D, and
- Amount of materials management— (sometimes there are a LOT)!
When thinking about quality of life, there are specific questions I ask T1Ds in my network, like: “What are your hobbies?” and, “How difficult is it for you to get up and travel on a moment’s notice?”
If the answers are, “None” and “Impossible,” their quality of life is probably taking a back seat to T1D management. This, in my opinion, is also no way to live. Let me be clear. Nothing in the world matters more than your T1D management. But, if the method you choose to manage T1D ruins your quality life, you may want to consider different management methods. As you’ll soon discover, there are several.
~ Tight Sugars