Re-thinking Target Blood Glucose Levels for the Type 1 Diabetic

A couple events over the past six months have spurred me to question the wisdom of attempting to maintain BG levels between 70 – 100 mg/dL.

The first event occurred late last year on my way to an early morning swim workout. According to the driver, I lost consciousness for about five minutes and was unresponsive to his questions. Upon waking, paramedics found BG, blood pressure, and ECG to be normal. The only abnormal finding was a racing heart and the appearance that I just showered in my clothes. The last two symptoms were the only evidence that BG levels may have fallen way too low sparking a flood of adrenaline and cortisol, two hormones released by your body in a crude, but often effective attempt to normalize BG levels. This event was not only terrifying, but embarrassing. Later that day, a thought kept running though my head. “I am a T1 diabetic. Should I constantly and arrogantly be flirting with low BG levels?”.

The second event was a round of lab tests I had done a couple months ago through an organization out of California called Nourish Balance Thrive.  A 24 hour saliva cortisol test revealed a morning cortisol over six times normal levels for my age. Again, probably the result of waking up with a low BG. And yet again, why do i continue to flirt with extremely low BG levels?

For years, I attempted to maintain a BG of a healthy non-diabetic. I would swell with pride every time my A1C was measured in the low 5’s. After all, am I not entitled to reap the health rewards of normal BG? Unfortunately, the ugly truth was that I was having way too many hypos in order to attain those A1C scores. There are mountains of research and evidence that high BG lead to all kinds of complications from kidney disease to blindness to amputation. Therefore, I would always error on the side of too low. For one thing, I don’t want to lose a limb. Moreover, no-one ever told me that repeated hypos might also have long term complications. Because I could always “feel” my lows, I just need to carry around some sugar at all times. No big deal, right? Well, the two events described above seemed pretty good reasons to re-evaluate this strategy.

The Downside of High Cortisol

Adrenal fatigue is a term that gets thrown around a lot and is probably an over simplified model of adrenal function. None the less, it’s a well known phrase that many people can connect with. Cortisol is a fantastic hormone that can get us out of trouble in a hurry, think “fight or flight”. But our daily lives are riddled with too many of these episodes throughout the day and it can take it’s toll lever time. We aren’t getting chased by lions any more, but we have alarm clocks that rattle us at ungodly hours of the morning, we have stressors at work and at home, we go to the gym and flog ourselves with cardio, weight lifting, and high intensity interval training. Add low BG levels to that list of stressors and now we’re talking serious cortisol levels. Chronically high cortisol levels can lead to brain fog, suppressed immune function, and blood sugar dis-regulation. Check out this podcast by Chris Kresser for more on these side effects.

Avoiding high cortisol is one reason I’m re-targeting ideal BG levels. The other reason is spontaneity. My nine year old daughter and I have a game we play daily called tackle time. It’s pretty much exactly what it sounds like. These physical rounds of tickle fights, pillow fights, and general rough housing erupt spontaneously whether or not my BG level is adequate. Generally speaking, I’d like to enjoy some unplanned bike rides with the family or walks around the neighborhood without having to pop some sugar.

One final reason for me to avoid hypos depression. I’ve battled depression most of my life and have adopted many coping strategies that work pretty well most of the time. Unfortunately, low BG levels can spark a pretty good spell of the blues.

Therefore, I’m planning to re-target my ideal BG range between 80 – 140 mg/dL. Since I don’t wear a CGM, I think this may be the best I can do for now. This journey is a long one and my strategies for treating T1 will probably continue to evolve for the rest of my life. As always, I welcome your feedback and comments. Where do you target your BG levels. At what levels do you feel your best?

In my next post, I’d like to share my experience with the alarming lack of accuracy  of two blood glucose meters I’ve used recently.

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