It's Complicated

 

A lot of subjects revolve around Type 1 Diabetes. Many of those are routinely spoken about at your clinic appointments, with your peers, on social media, etc. That's a great thing! Reading about some diabetes related subjects might help you with your own management or, if you decide to verbalise your own experiences, you could be helping others. It's a win-win situation as far as I am concerned. 

I know some will have issues in reading or hearing about the scary aspects of diabetes. I spent a good part of my life avoiding those subjects at all costs. Even when one of the most scary, diabetes related complications, came to visit me personally I decided the best course of action was to put my head in the sand. That was a poor choice, of course.

Living with type 1 diabetes can be challenging, and there are several potential complications that can arise as a result of the condition. I believe that it's important to talk about these complications openly and honestly, without blaming or shaming people with diabetes. Stigmatising language and attitudes can be harmful and can make it more difficult for people with diabetes to manage their condition.

Let's take a look at some of the most common complications associated with type 1 diabetes:

- Diabetic ketoacidosis (DKA): DKA occurs when the body starts breaking down fat for energy instead of glucose, leading to a buildup of acids called ketones in the blood. This can be a life-threatening condition if left untreated.

- Hypoglycemia: Hypoglycemia, or low blood sugar, can occur when a person with diabetes takes too much insulin or skips a meal. Symptoms can include shakiness, dizziness, confusion, and even seizures. We talk about hypos within the diabetes community quite often yet, still, some find the subject embarrassing.

- Neuropathy: Over time, high blood sugar levels can damage the nerves in the body, leading to numbness, tingling, and pain in the hands and feet.

- Retinopathy: High blood sugar levels can also damage the blood vessels in the retina, leading to vision problems and even blindness. I know this particular one very well. 

- Nephropathy: Diabetes can also damage the kidneys, leading to a condition called nephropathy. This can progress to kidney failure, which may require dialysis or a kidney transplant.

It's important to note that not everyone with type 1 diabetes will experience these complications, and managing blood sugar levels can help reduce the risk. However, even with the best management, complications can still occur. That's why it's essential to have open and honest conversations about these potential complications and provide support to those who are managing the condition.

Unfortunately, people with type 1 diabetes often face stigma and blame for their condition, which can make it even more challenging to manage. Some people may assume that diabetes is caused by poor lifestyle choices, such as eating too much sugar or not exercising enough. However, this is not the case with type 1 diabetes, which is an autoimmune condition that cannot be prevented or cured.

Stigmatising language and attitudes can make people with type 1 diabetes feel ashamed or embarrassed about their condition, which can prevent them from seeking the help they need. It's important to talk about type 1 diabetes in a way that is respectful and understanding, and to avoid placing blame or shame on people who are managing the condition. 

There is often much talk between diabetics about the language used about our condition. Even the use of the word "diabetic" causes some to feel uncomfortable, much as the clumsy "PWD" does. I've repeated this many times previously; We're all very different. The use of some words and phrases doesn't cause me any upset and I believe that to be commonplace among other diabetics. 

What does cause me upset is the stigma surrounding complications. And not just because I've lived through several different eye problems. Indeed, I haven't felt stigmatised in any way for my diabetes related complications, but I know that others have and I know that many others fear talking about their own complications due to the reactions of others. That needs to stop. 

Through my own engagement with the online diabetes communities, I've learned much about my T1D. I've improved my diabetes management and probably given myself a much better long term outcome. If we open the door to discussing complications, normalise the subject, provide support through communities and peers as well as directly in clinic, then I firmly believe we can lessen the severity of complications in many. Why? because fewer will think twice before asking a question online, fewer will be worried about approaching their doctor for advice, the early stages of complications can be picked up on and stopped or slowed down before they become severe.

So, if you've got complications concerns, a question, experiences to share, etc then hit your socials. There are many who will support you and benefit from your engagement. If you experience negativity, use your mute or block buttons. 

If you enjoyed this blog and you'd like to support me over the time that I give to others then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

Diabetes Abuse

 

Living with diabetes can be a challenging experience, and connecting with others who understand what it’s like can be incredibly beneficial. However, as with any community, there can be issues that arise, including abusive behaviour. Unfortunately, even within the diabetes community, there are people who engage in abusive behaviour towards their fellow diabetics. This can take many forms, from bullying and shaming to outright harassment and intimidation.

It’s important to recognise that abusive behaviour is never acceptable, regardless of who is engaging in it or why. No matter how frustrated or angry someone may be, it is never okay to take that out on another person, especially someone who is dealing with the same struggles that you are. In fact, engaging in abusive behaviour towards other diabetics is particularly harmful because it can undermine the sense of community and support that is so important in managing diabetes.

Here are some of the reasons why it’s essential to not accept abusive behaviour within the diabetes community:

• It undermines the support system

One of the most significant benefits of the diabetes community is the sense of support and understanding that it provides. When you connect with other diabetics, you can share your experiences, exchange advice and tips, and find comfort in the fact that you are not alone. However, when abusive behaviour is present, it can erode that sense of support and understanding.

People who are subjected to abuse may feel isolated and alone, as if they have no one to turn to who will understand what they are going through. This can make it more challenging to manage diabetes, as the support that they would usually rely on is no longer available. It’s essential to create a safe and supportive environment within the diabetes community to ensure that everyone feels comfortable seeking and offering support.

• It can have negative mental health consequences

Abusive behaviour can have a significant impact on mental health. For people with diabetes, who already have to manage the stress and anxiety that comes with living with a chronic condition, this can be especially harmful. Abuse can lead to feelings of shame, guilt, and worthlessness, which can exacerbate existing mental health issues or even lead to the development of new ones.

It’s crucial to prioritise mental health within the diabetes community, and that means not accepting abusive behaviour. People with diabetes need a supportive environment where they can feel safe discussing their struggles and seeking help when they need it. If abusive behaviour is present, it can make people feel even more isolated and alone, which can be detrimental to their mental health.

• It perpetuates harmful stereotypes

Unfortunately, there are still many harmful stereotypes and misconceptions about diabetes. Some people believe that diabetes is a result of poor lifestyle choices, and that people with diabetes are lazy, unmotivated, or lacking in willpower. These stereotypes are not only untrue, but they are also harmful and can contribute to the stigma that people with diabetes face.

When people within the diabetes community engage in abusive behaviour, they are perpetuating these harmful stereotypes. By shaming or bullying other diabetics, they are essentially saying that they believe these stereotypes are true, and that people who struggle with diabetes are somehow to blame for their condition. This can be incredibly damaging, both to the individual who is being targeted and to the community as a whole.

• It creates an unsafe environment

Abusive behaviour can create an unsafe environment within the diabetes community. People who are subjected to abuse may feel uncomfortable attending diabetes-related events or engaging with others in the community. They may feel that they are at risk of being targeted again, and that they have no recourse if that happens.

Creating a safe environment within the diabetes community means ensuring that everyone feels comfortable and supported. No one should feel as though they are at risk of being targeted or harassed. When abusive behaviour is present, it can undermine that sense of safety within the community.

If you enjoyed this blog and you'd like to support me over the time that I give to others then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

Diabetes and Blood Pressure

You don't need to have diabetes to know that blood pressure is a thing, an important thing! High, low and somewhere in between - you've most likely had your blood pressure checked at some stage and learned of the results pretty quickly. Me too! I submit to an arm squeezing at every appointment, In fact, I'm pretty sure that I had my BP checked at my pump set up appointment because... I don't know why. It just happened along with my height and weight. Glad to know I'm not too fat or short for pump funding! Phew! There is probably a NICE criteria for that.

BP at appointments, yes! let's focus on that one. I'm one of those "White Coat Syndrome" types. I know that's not the official name for it. Language Matters probably covers it under "Person with anxiety of medical professionals wearing light coloured lab coats" However you describe it, I have it. I think it stems from a real fear of attending my diabetes reviews as a child. If I wasn't passing out from the blood tests, I was being told off about my control, threatened with trips to the amputation ward or working extra hard on my blood glucose diary fiction for the last 90 days. It wasn't a great experience and it stayed that way for a long time.

Medical appointments, I suspect, are not designed to be fun. Today, they're less stressful but they're still not a day out with friends for a lovely lunch and a drink or two. They usually involve losing some of my blood and urine to a stranger and the fear of some terrible news lurks in the back of my mind at each visit to a waiting room... which is always too warm and always contains some absolute knob, coughing up their infectious disease in my face. I'm going off on a tangent. You get my drift, I'm sure. 

Those settings appear to be unwittingly designed to increase our anxiety. For me, that appears to translate into elevated blood pressure, almost every time without fail. I've left many appointments with a rented BP machine tucked under my arm for home readings. On at least one occasion I took 24 hours worth of readings. More commonly, I'm asked to provide 7 days worth of home results. And I do! Of course I do. And they're always normal / within a healthy range or near to it, such as this one from last night:

That's reassuring, of course! I have enough to contend with without hypertension coming out to play. However, it's becoming a little tiresome to be told that my BP is "a bit high" in clinic when it's the clinic setting causing my numbers to nudge up. As is my want, I vented about this on Twitter only a week or two ago. David rightly noted that not only do they check for BP on these machines, they also check for irregular heart beats. I'm pretty sure that my home monitor (above) doesn't offer that function. I'm good with heart checks. We're often told that T1D can increase the chances of heart disease so, it makes great sense to have that particular organ checked out. Blood pressure can give our kidneys something to think about, too on top of the work T1D gives to them.

BP in clinic, though? I'm not alright with that one right now. I'll be providing my own readings and requesting that any taken during a heart check are ignored and not noted. That's going to be an interesting chat with that HCP, isn't it?! 

We check our blood glucose a lot through CGMs and finger pricks. We try to keep it in a healthy range because that reduces our chances of diabetes related complications. Blood pressure is very important for many aspects of our health, too. I believe that frequent monitoring of BP should be seen as an essential aspect of T1D care but that frequent monitoring should be done in our usual day to day environments; home and work. Unusual settings, such as diabetes review appointments, are not places to obtain reliable blood pressure readings. 

Blood pressure monitors are relatively cheap these days. It seems unlikely that the NHS would fund BP monitors for all diabetics so, if you can afford to pick one up, I do recommend getting one for a useful and accurate picture of your blood pressure.

And relax!

If you enjoyed this blog and you'd like to support me over the time that I give to others then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

 

 

Type 1 Diabetes and Sight Loss

 

I am often asked about my sight loss in relation to my T1D. How it came about, how I adjusted, acceptance and advice are often subjects of conversation and I'm very happy to discuss. Complications are a thing for some T1Ds and we shouldn't avoid the subject. Here's a little about my diabetic retinopathy without too many gory details. 

As a person living with type 1 diabetes and sight loss, my journey has been filled with challenges and triumphs. I was diagnosed with type 1 diabetes at the age of 8 and experienced some eye complications due to high blood sugar levels at age 31. Eventually, my eyesight started to deteriorate, and I was diagnosed with diabetic retinopathy.

The diagnosis was devastating for me. Losing my sight meant losing a part of myself, and I had to come to terms with the fact that my life would never be the same. I had to learn new ways of doing things, like cooking, cleaning, and getting around. It was difficult, but with the support of my family and healthcare team, I learned to adapt. I haven't lost all of my eyesight, but enough to be registered as blind. That feels like a very strange thing to type because I'm not blind. If you've met me, you've probably noticed that I can get around pretty well. Indeed, my sight is as good today as it's ever been since my retinopathy diagnosis. I prefer "visually impaired" when describing my sight loss as that's more accurate. Although, some hear visually impaired and automatically assume totally blind - for me that's far from correct. 

One of the biggest challenges I faced was managing my diabetes and my vision loss. I had to learn how to measure my insulin doses, check my blood sugar, and administer my insulin injections without relying on my sight. It was a lot of trial and error, but I eventually found a routine that worked for me.

Living with sight loss and type 1 diabetes has also taught me the importance of self-care. I've had to make my health a priority and take care of my body in ways that I may not have otherwise. I make sure to exercise regularly, eat a varied diet, and keep up with my doctor's appointments to prevent any further complications.

Despite the challenges, my journey has also been filled with triumphs. I've been able to pursue my passions, like diabetes advocacy, writing and public speaking, and inspire others living with sight loss and diabetes. I've learned to appreciate the little things in life, like the sound of birds chirping or the feeling of a warm cup of coffee in my hand.

Living with sight loss and type 1 diabetes is not easy, but it has taught me resilience and strength. It has taught me to never give up and to always find a way to overcome obstacles. I hope that my story can inspire others living with these conditions to keep fighting and to never lose hope. If you get a diabetes related eye complication then it's alright to be fearful, angry, upset and even depressed. Nobody wants that news, but know this; most eye complications can be easily treated and needn't be as severe as mine if you attend your appointments and follow the advice you're given. 

I have written other blogs on this subject with more detail regarding surgeries and treatments. Take a look through my posts and have a read if you're interested in that. 

If you enjoyed this blog and you'd like to support me over the time that I give to others then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

The Importance of Diabetes Community

It has been around six years since I took a deep breath and pressed the record button on the video app of my phone. I blundered through an introduction video, deleted it, wrote a script, blundered through that and deleted it. Eventually, I decided on something that was a few minutes long and sent it to my YouTube channel. Of course, nothing happened. It did get a few views! Really... just a few, but that was enough to inspire me to make more and seek out others who live with Type 1 Diabetes. I'm so very glad that I did.

The last six years have been eye opening, jaw dropping, heart wrenching, gut churning, annoying and, most importantly, absolutely wonderful. The good, the bad and the ugly have all visited my social media accounts. The vast majority of the visits have been good and that's why I'm writing this new blog post. The good has had such a profound effect upon my diabetes, my outlook, my social life and my confidence. The good comes in the form of community.

I think it's only fair that I start with GBDoc. You probably knew that was coming! But, what a remarkable community of people and such longevity! GBDoc has been around for far longer than I have in diabetes social media, over a decade apparently. It has had many guises, many volunteers, a few leaders, thousands of members, several platforms, a website, controversy, love, hate and friendship. Sometimes, it feels like Eastenders with boluses - only the acting is better and the story lines are more interesting. Drama aside, the support and information from GBDoc has been incredible. I wonder where I might be in my T1D journey without this community? Where might you be? I suspect much worse off, maybe less knowledgeable, struggling for tech access, more isolated...

...GBDoc isn't the only diabetes community. Different countries have their own communities and that makes perfect sense as healthcare, access to meds and tech, societal differences, etc can differ hugely between nations. Some communities try to cover a global "scene" and that's cool too. From other people, other countries, other values, other uses of language, we can learn a great deal alongside (for me at least) helping to recognise privilege.

Communities are very fluid places. As time passes, people come and go perhaps because they have gained the help and information they need, perhaps they didn't get what they expected, maybe they died! Many reasons can cause the disappearance of an individual from an online community just as many reasons can bring about new faces. 

In my six years of community engagement I have gained so many friends - I really couldn't list them all without forgetting a few. Some have been friends for almost the entire six years and I hope they remain so for the rest of our days. Some have drifted away, a few decided to not be friends at all after a while. That seems like very normal human behaviour and I'm quite accepting of it. Community makes friendship easier to develop and blossom. If you're feeling isolated and lonely with your diabetes then the community could be the answer.

 Away from being bestie mates with lots of new people, your diabetes could benefit hugely from community engagement. Hybrid Closed Loop (not an artificial pancreas) looks likely to be a hot topic for the years ahead in the UK. Yet, most diabetics are not using that technology right now. That means a lot of learning and understanding is on the horizon for people who may want to try HCL (criteria dependant, naturally). The same was true of Libre, CGMs, Smart Pens and Insulin Pumps - less complex than HCL, perhaps, but the usage experiences of peers have proved invaluable to many.

So, you've got new friends and new tech. Now what? Maybe you struggle with the mental burden of having diabetes? Maybe you've heard of talking therapy? That's exactly what a community can offer. Put your grown up pants on and start talking, tweeting, posting, whatever! You'll be surprised at who understands your issues and reaches out to offer an ear. And it helps! To not feel alone in your struggles can ease your burden even if no immediate solution is found. What is the old saying about a problem shared is a problem halved?

Do you need more? Well, community doesn't always mean serious. I've had some hugely fun days out with my friends from GBDoc, we play quizzes, fantasy football and cruel but funny practical jokes on each other! Other skills are shared via a Stitch Club. Books are read at the same time, films and TV shows via watch-a-longs, hobbies and interests shared and enhanced because of new diabetic friends who just enjoy the same things. Maybe you enjoy gaming? gotcha! Art? gotcha! The list of interests is huge and you'll likely find someone who enjoys the things that you do with no relevance to diabetes apart from being in the wonky pancreas gang.

By the way, serious can also be lovely. Some friendships have developed into more and dating, even marriage, has happened. 

If life dealt you a bad hand with diabetes, you can still win the pot if you play your cards right. I'm turning into Bruce Forsyth. Good blog, good blog. 

If you enjoyed this blog and you'd like to support me over the time that I give to others then check out these links:

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

The Murky World of Diet and Type 1 Diabetes

A subject, today, which never causes any debate or angry opinions on social media; Diet. Yeah, right! If you're only an infrequent social media user, you'll probably have noticed much antagonism when it comes to diets, even a passing remark or a sharing of a photograph can stir up plenty of hostile debate. For somebody who uses social media on a daily basis to talk about diabetes, such as me, then it quickly becomes apparent just how often the subject can stir angry exchanges. For somebody, such as me, who has spent many years in online marketing it also becomes apparent exactly why the fires of diet "discussions" are often stoked.

Firstly, I'd like to clarify that I am not anti any diet. I eat a varied diet which isn't driven by my diabetes. What you or anybody else chooses to eat and the reasons for that are entirely personal to you.

Right! Let's get the marketing issue on to the table. It's cunning, it really is,. You can see how such marketing behaviour works in other industries, too. Politics isn't really an industry but elements of it use the same methods to create noise. That noise comes through fear and hatred. In politics, that is especially dangerous as it can stir extreme views and, following that, extreme events. Trump, Washington, anybody? 

Anyway! in the diet industry, the same thing works all too well and specifically in relation to diabetes where the fear of complications can be wheeled out at any given time. Of course, it's not enough to simply say "If you eat that, you'll have high blood glucose and your legs will fall off" Fear of a terrible complication alone isn't always enough to sell a diet. You might notice that insulting remarks are used, the diet seller will insult the intelligence of the innocent food muncher. That won't often result in a diet conversion but it will be seen by others and nobody wants to be seen as "stupid" or "dangerous" by posting their carby dinner! and wait! Maybe they have a point because they have thousands of followers?! Oh no... What's that book called again? Where can I subscribe to that diet?

Kerching!

What a horrible industry. Preying on the fears and weaknesses of others to increase book and service sales. It's big business. You'll notice many accounts that are no older than 12 months on Twitter, they'll follow many diabetes related accounts, quote the "master" account many times and try to engage with anybody who tweets about diets and diabetes. There are many hundreds of these accounts, created by others and purchased for a small fee by the "master" account and diet merchant. All that engagement, all the impressions, all the vulnerable people who are desperate to avoid complications, filter down to the one person who will be profiting from the sales. There are many people who perform this simple trick, many different diets, some run by the same people who contradict each others diet advice because they don't care about the diet, you, your complications or well being - only your money.

Kerching!

It's not just random people in far flung places or nations with questionable rules and regulations. There are plenty living within the UK and USA. Some may even have impressive qualifications in diets and diabetes fields and that might seem reassuring to you. Don't be fooled. Unless the medical advice that you're given stems from a professional who can read your medical notes and history then it's not worth a minute of your time or a penny of your income. 

Away from the diet merchants and their murky behaviour there are the well meaning folks who have stumbled upon a diet and lifestyle which has worked well for them. What works for one doesn't necessarily work for another and blindly (no complications pun intended) following the words of a stranger on the Internet seems like playing with fire to me.

For instance, below is an 8 hour graph of my blood glucose from the early hours until mid-morning. 

Pretty good, huh?

Now, let's assume you stumble upon that and I'm making lots of noise about the diet I use to achieve this. It's so easy that anybody can do it and all you need to do is send me £500 to find out how it works. I'll mention a few words such as "Carbs are fine" to gain your interest and "You don't want higher numbers and complications, do you?" to stir your fear. 

Still not sold? I have more tricks! I'll engage with the wider community via Tweetchats, Diabetes Chat, DSMA, etc. I'll even attend a few conferences, meet a few people in person and gain trust. I'll mention high profile people who work within diabetes to look so trustworthy... maybe they'll reply and I'll look REALLY trustworthy. Hi Partha.... Hi DiabeticDadUK.... Hi anybody with a few thousand followers. Let's throw in a few popular hashtags to support worthy causes, even more trust!

Still not sold? Then I'll unleash the bots who will quote my diet to thousands of you. So many people are following the diet that it MUST be trustworthy! 

Murky, isn't it? I don't begrudge anybody making a living through work in diabetes, by the way. I have made a tiny income from Buy Me a Coffee, ads and speaking engagements. It would be hypocritical of me. I do strongly dislike the practices of diet merchants and even if those practices are legal, many are morally bankrupt. Please get your diet and diabetes advice from your HCP team and block anybody who tries to sell you a diet.

If you enjoyed this blog and you'd like to support me and the time that I give to others then check out these links (no diets are for sale)

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL

HbA1c and Time In Range

As I wrote the title to this blog, I immediately worried about how boring it might be. When you are diagnosed with diabetes, pretty much any type, then numbers and data (hence the image above) quickly become a part of your life. Firstly, I promise that this post will not be examining any numbers in great detail - that would be horrendously dull and you're probably not here to find out what my HbA1c and TIR currently are. If you are, then I'll tweet those numbers especially if they're good ones! 

Shall we start wth HbA1c? You might get yours in a plain number format or a percentage and it gives a reasonable indication of how well things have been going over the last 90 days. Or does it? An average, kind of, number based upon your blood glucose? Hmm. Perhaps if your BG is generally very stable and it's floating around in the happy zone for the majority of the time then your A1c might reflect that you're doing well. What happens if you're having several hypos per day, over treating them, and correcting several hypers per day? Lots of numbers such as 2, 3, 18 and 19 might be on your CGM/Flash/BG Meter and your time in the happy zone might be very infrequent yet your HbA1c might show that you're doing quite well with it's average BG offering. Clearly, you're not and that's why HbA1c alone can't be trusted to give an accurate picture of your diabetes management.

Time in Range seems like a better way of monitoring how well things are going. The picture is more detailed with this data. We can identify problem periods of time and change what we've been doing to reduce those instances. Time in Range data may just be one of the most simple yet brilliantly effective innovations in diabetes care in the last decade. I wonder how many of you have left a diabetes review with your HCP with the news of elevated HbA1c ringing in your ears? "It's too high, you need to get that under 8%... around 7%.... 6.5%?" and you nod and agree and off you trot, back to work or home, with absolutely no idea why your A1c is elevated. Perhaps it was that sandwich? or maybe your entire diet?! Oh no! "Keto, that'll solve it". Well, maybe. 

Time in Range should help to stop the overreacting to HbA1c results. If it's a bit high, all that data can be looked through and if you leave notes on your CGM/Flash device app then it's even easier to identify what might have caused the hyper on that day.  

Can TIR be problematic? 

I'll wager that you've seen a few 100% TIR screenshots on your socials. Maybe you've reached the unicorn zone, too? It's a nice feeling even if it's not really that much better than a 90% or 80% TIR. Of course, 100% doesn't always tell the full story. If your TIR was at 100% over 90 days but your BG was between 8 mmol/l and 10 mmol/l in that period then your A1c would reflect a more sketchier management compared to the incredible management indicated by the 100% alone.

100% over 90 days is likely impossible for most but a high TIR might also indicate inaccurate CGM/Flash readings. I don't know of a single device which hasn't had accuracy questioned or complained about on social media. That includes me, I've made noises about inaccuracies dating back to 2017 and the issue is still a big one, six years later. Artificially inflated TIR might be noticed by a higher than expected HbA1c - just as the fictional blood glucose diaries of old proved, the wrong numbers from BG checks can be picked up when your A1c comes back at 11%  

Also, numbers and targets and TIR can get a little overwhelming for some. Some feel an incredible sense of failure because their Time in Range is 69% and they've read that it needs to be 70% or better. That's such a shame because 69% TIR is probably pretty good! and 1% off your "goal" is such a small amount. 5% is a small amount, so is 10, yet not reaching that target number can deeply affect some.

Also! You're not a number. Your life is wonderfully unique to you and your diabetes will likely reflect just how much time and energy you have to manage it. In the late 1990s, during one of my infrequent diabetes reviews, a consultant decided that it would be motivating for me to know of the previous patient's HbA1c. The guy walked by me on his way out of the building. During my consultation, I found out what his first name is and his last HbA1c result. "X is doing brilliantly, his A1c is..." Can you imagine being offered that information at your next review? There would be uproar on socials and I'd be leading the roaring. In the 90s, I was less concerned but I responded sarcastically (Me! Sarcastic? No!). It left me feeling totally uncared about by that diabetes team. My hurt aside, the guy with the great A1c was also being viewed as a number! What a crap time to be a diabetic. Things are much better now. At least they should be for us all, as diabetes care has evolved hugely.

Back to the subject! It seems to me that HbA1c and TIR can be useful when viewed together. Alone they can be problematic and as much as HCPs and your peers might focus on those numbers, please remember that they are just numbers and not your wonderful unique diabetic self.

Sorry if this post was a bit "numbery" and boring. 

BUY DIABETIC DAD A COFFEE HERE

BECOME A BLOG MEMBER

GET MENTORING SUPPORT FROM DIABETIC DAD

Prefer PayPal?

BUY DIABETIC DAD A COFFEE THROUGH PAYPAL