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2023-11-26

Welcome to News from Loop and Learn

Master Your DIY Closed-Loop Insulin Delivery System

Published on 26 November 2023.

In this edition:

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Topic Recorded? Time Date
Loop and Learn: Informal Discussion no 19:00 UTC 30 November
Loop and Learn: Informal Discussion no 19:00 UTC 14 December

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Your Diabetes May Vary

There was an interesting discussion in the iAPS Facebook group on what are reasonable expectations for results. Many of the ideas apply to any method of diabetes management.

The Loop and Learn team took some of that conversation and summarized it for this edition of the news. Thanks to Odd Stoltenberg for permission to paraphrase his words.

  • Do not ignore the importance of quality of life and your psychological state - it is important not to get burned out

  • Do not compare your diabetes results with others without considering how their lifestyle and personality may differ from yours, as well as what other treatments they may be using

  • Treatments have to work for you (or your child), and nobody but you can say where that balance should be in life and in diabetes management

The American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) published a joint consensus for The Management of Type 1 Diabetes in Adults. They suggest that results be measured over 3 months. Don't just consider your best or worst days. The goals are:

Measurement Goal
Time In Range (TIR) of 70-180 mg/dL (3.9-10.0 mmol/L) >70% of the time
A1C < 7.0% (53 mmol/mol)
Readings <70 mg/dL (3.9 mmol/L) <4% of the time
Readings <54 mg/dL (3.0 mmol/L) <1% of the time
Readings >180 mg/dL (10.0 mmol/L) <25% of the time
Readings >250 mg/dL (13.9 mmol/L) <5% of the time

When taken together, Time In Range (TIR) and A1C are considered the standard way of comparing diabetes status. There are other ways of describing results, but they have not been generally adopted.

There are many posts by enthusiasts for particular methods who present stories that may leave out important information, such as:

  • Individual physical condition and genetics can affect metabolism and how the body reacts overall to food, insulin and exercise

  • The time the individual spent learning about the medical and technical aspects of their diabetes management

  • The personality of the individual

    • Some are more driven, some are very detail-oriented, some forget things all the time - while others do not forget a thing, some give up very easily, some get overwhelmed easily by complexity with regard to technical or medical matters
    • A strict diet or always prebolusing can make diabetes management easier, but others might feel that such limitations make life less enjoyable

  • Whether additional medications are used

    • For example, a GLP-1 (like Ozempic or equivalent) will impact how quickly carbs get absorbed which can reduce high glucose after meals

Any discussion stating what should be achievable can be difficult - since that often leaves a considerable number of people behind that cannot achieve what others say they should. For these people, discussions that are polarized or very assertive - are unfortunate!

Listen to what people say, but also note that there may be more variables than were mentioned - or even realized.