After nearly 30 years of having everyone in the T1 community see and say a bgl of 5.5 is the perfect of course it is a hard sell to see why a pump that is brought to the market with a soft target of 6.7 is the best for all of us. What we don't link together though is the movement to move away from the average result that a A1C result gives us to a time in range percentage as a best practice.
So first of all lets look at the 2 individual numbers -
A1C - This is the blood test that looks at the 3 month average bgl and we use it as a measure of how well we are doing with our T1D management. As with all averages extremes happen and can have some major effect to the result. This result doesnt identify the highs and lows that are still happening each and every day. To see these we need to delve into our numbers and make adjustments from there. So is the A1C result a true reflection of management???
Time in range - So what they are trying to look at now is the amount of time that we as T1D's are within your given range. The CGM technology that we now have accessibility to allows us to be able to have a range that will be the best to be seen within. From diagnosis I was always told that if my level was between 5 and 10 mmol then I will be safe and minimise the chance of complications in the future. What was difficult though was to really see how long I was in that range with random snap shots using manual bgl tests. Now that the CGM technology reads our bgl every five minutes we are actually given extremely valuable information that determines how our control truly is.
Now back to my initial comment around the best number being 5.5 and not the 6.7 that the new Medtronic 670g pump has come to market with. Medtronic have made the first move to really focus their practice on emphasising the time in range readings and in doing so has created an algorithm that not only aims to remove some of the burden from your day to day thinking but also keep you within a range that will help minimise highs and even more so lows. It is now understood that the dangerous lows have a significant effect on the health of the brain as it takes a significant time to recover after a serious low and hence can never be good. I know that as I have been recovering from the dangerous lows I can sometimes go hours with a fog over my brain and thoughts which is not only scary in the short time but also for family and long term.
With a simple look at my pump now I can bring up a graph summary that shows me the average amount of time that I have stayed within my given range, the amount of time I am below and the amount of time I am above my range. You can also average things over different day periods so you can see the details for an individual day or you can average out over the month. Important as you can track your progress when making changes with your healthcare team.
Keep in mind however to get my head around this concept has taken time as my A1C result for the last 10 years has been in the high 4's or 5's however if I am honest with myself more lows have been sneaking into my days or weeks that I would like. I see the technology coming to market through the 670g and new sensors to be a way to protect us all even more and to elevate some of the burden that we had by trying to work out where our changes to our basal rates are needed.
So, as I go off on tangents, the 6.7 is a soft target which as your pump gets to know you and your patterns tries to keep itself around this number by giving micro boluses in a live setting depending on the live data that is obtained from the CGM. Each and every 5 minutes the algorithm takes the CGM data and determines the tiny amount of insulin that is needed to keep you within a range that minimises the chance of highs and lows. As we are using synthetic insulin and also the fact that we are doing our best to imitate the natural process of the pancreas by counting carbs manually and entering them for a bolus we still run the risk of mis management and either shooting high or going low. As with all things with T1D though my philosophy is to live and learn but learn from everything we do. Mistakes and changes will happen but with the wrong results work out how to next time turn it to your benefit. To say there will never be highs or lows is to say there is a cure. We use technology to minimise these effects and stay within a range that will benefit the T1D, family and partners now and long into the future.
I sometimes see both experienced T1D's, new families to T1D and also new T1D's question if a pump is right, if the pump could fit into their life. For me after 16 years on MDI and 14 years on a pump I would never go back. Not only have I not spent a day within the 14 years without my pump I have never wanted to. Even when my daughter was diagnosed at 2 years of age I was not having her trying to manage on MDI. Now that the new technology and a focus on time in range is upon us I am excited for what the future holds and for results that will not see endo's look down there nose at you questioning their own test results as they then have to look for the extremes which is causing the results. Time in range is just that "TIME IN RANGE".
As I move forward with this technology I realise more and more how it has the ability to make a long term difference. My current time in range is 88%, I have some work to do around my work out periods however to not have to worry about constant adjustments and just watch the device do its job is a great feeling. Keep in mind though you still need to enter the correct information to get the best outcome but I'm prepared for that.
