How Low Is Too Low When It Comes to A1c and Blood Sugar?

Many people think that keeping their blood sugars and A1c really really low means they’ll have fewer complications down the road, but there’s evidence to show that an A1c far below 7% does not mean your chances for complications will decrease along with it.

This is based on the ADA Standards of Care in Diabetes 2023 Targets for Glycemic Control, which is the gold standard that is respected and followed by healthcare professionals around the world. A link to the full glycemic targets section from the 2023 Standards of Care can be found here.

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    Thanks for the video – it was quite informative. However, if one has a problem getting one’s A1C to the 6-7 range, a CGM for a few weeks could be helpful.

    I suffer from hypoglycemic unawareness, which kept my A1C in the 8-9 range regardless of what I did with diet, exercise and medication. My bs dropped to the upper 40’s/low 50’s while I slept at night. I never felt it. If it happened during the day, I just felt a little off when I got that low. Once I was able to use a CGM for a 2 week trial, the hypoglycemia was discovered. I then qualified for a CGM and dropped my A1C from a 9 to a 7.2 in three months. I’ve been staying between a 6.7-7.2 for over a year. Without TCOYD, I would never have known about CGMs and would still be struggling with a high A1C. Thank you.

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      CGMs are game-changers and life savers. So glad you were able to get one, and thanks for sharing your story!

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      I had low blood sugar during the night, between 60 sometime lower. I found Extent Bars. I take one before bed and they stabilize my blood sugar during night as well as during the day. They are hard to fine. Sometimes at Walgreen’s. There web site is phone # 1800-887-2919. I hope this is helpful.

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    I am currently taking Levemir and have been informed it is no longer on my drug company’s formulary. Going online I found that Levemir vials will be depleted by December 2024. They suggest using Tresiba and 2 things concern me with that. #1 is the fact it works for 42 hours compared to 24 for Levemir and #2 a side effect of possible diarrhea. What can I do? When I turned 65 and changed to Medicare I was on Lantus but was changed to Levemir due to the formulary. Now there is no choice as Levemir will be gone by year’s end. What do I do? – I am concerned about changing to Tresiba with the two items I shared.


    • Tresiba is much better than Levemir. It doesn’t have any peaks and valleys and even though it lasts 42 hours, they’ve studied it extensively giving it every day, and there’s no overlap and no buildup of insulin. And the rate of hypoglycemia is lower than Levemir. It doesn’t cause diarrhea (unless you take it in Mexico).

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    Liked your video and I basically agree. I have type 2 and had my A1C at 6.1. Recently it has gone up so I decided to get a CGM again to help with control and to let me know when my sugar is too low. It has already warned me 3 times so it is working. It is frustrating though that I have to pay for it myself, insurance won’t cover the CGM. I understand being focused on people with High levels using insulin, but going the other way can be important as well at least for a limited time.

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      We couldn’t agree with you more. Continuous glucose monitoring provides valuable insights for anyone with any type of diabetes, and we hope they will covered by insurance for everyone in the not too distant future.

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    My endo changed me from tresiba to trojeo Tresiba has worked well for me but insurance has new formulary. I was told to take the same number of units per day. I also take 6 of humalog in am and at dinner. Is trojeo as good as tresiba and are the disuse equivalent

    • Toujeo and Tresiba have been studied – as us doctors call it – head-to head in people with type 1, and they are exactly the same. I would switch dose for dose, but keep an eye on your CGM as you may have to make small adjustments.

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    Going into my 25th year with T1d and my 50th birthday, I finally gave into a pump. My resistance was always wearing a 2nd device, on top of the FreeStyle Libre I’ve been on since it was made public. Felt like I would look odd, I guess. Anyway, I switched dooctors and when she recommended the OmniPod-Dexcom tandem I gave it a try. My a1c went from 7.7 to 7 in the 6 months I’ve been using it and I lost 5 lbs! It’s a lot of programming, re-applying and beeping sounds, but it has given me some more peace and less hypoglycemic episodes.

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      Hi Jake. That’s a very inspiring testimonial for diabetes technology success for you! I agree wholeheartedly with you that despite the additional electronics than usual stuff, you regained more peace and fewer (energy depleting) occurrences of low blood glucose.

      I was experiencing diabetes symptoms a few months before my 16th birthday, and I’ll be 46 next month. I was busy at age 15 clinging for survival, hydration, and every day activities. Plus, the horror of people in my life not recognizing diabetes symptoms who blamed me with any imaginary reason possible to explain my rapid weightloss and fatigue. So, Happy Diaversary and Happy 50th Birthday!

      Regarding A1C and TIR (Time in Range) measurements, i have noticed some variations between A1C testing devices vs lab testing, even a difference as much as 0.5 %. But in all, having quality and caring medical team support is vital. In many ways, medical care teams are more closely attuned than my immediate family and friends regarding long term diabetes care needs. I hope I didn’t ramble too much, but I relate to having a Diaversary and Birthday the same month. Take care 🙏🏽

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      That’s awesome Jake!

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    Love the CGM meters. They help a lot. My issue is the rashes. I have tried all of them along with under patches and nothing seems to work. I’m sure I’m not the only person with this issue. How can I convince companies to try another method of tape or what ever the issue is. The shape of any transmitter I have used stays on my body for 3 to 6 months.

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    I’m 64 in March, and was diagnosed with t2d at 51 years old. Just last year I was able to get the Libre 2 system. I went from a 15 A1c to currently at 6.3. Everyone with any diabetes should be able to get some form of monitoring system. It’s a game/life changer!!! So easy to start making dietary changes since you can check every 10 minutes if you are that curious. Before the Libre 2, I was only able to check my glucose ONCE a day. That’s all insurance would cover strips for. Basically useless imo. Now, after watching this video and your great explanations, I owe my Pharmaceutical Med. team, well one guy anyway, an apology. He was telling me my A1c was getting too low. I was having low events, usually in the middle of the night. The alarm would wake me, I’d feel fine, but would eat/drink juice to bring glucose back up. I was trying like heck to get to the 5.7 of NORMAL. I would argue with this guy, thinking he just wanted to keep me higher so I’d need more meds. Currently, metformin-for years now. Last couple years was (I go by Long acting or Meal time insulin-easier for me to remember). Mounjaro was added about a year ago.Just recently they added Jardiance. The latest has been stop the meal time insulin, decrease the long acting, increase the Jardiance from 10 to 25mg. The latest seems to be working fine. I’ve only had one low event in past 2 weeks, and I have been slowly decreasing the long term insulin as the higher Jardiance is kicking in. Again, the monitoring helps me to adjust the insulin I’m taking between phone visits with the Pharm. team. I will apologize to him, and stop arguing with him. My bad !!! But, this is the first site I have found that was really helpful. So thank you very much Drs. E and P.

  8. The CGM technology is a big game changer for all diabetics. I lost my employment because I also have hypoglycemia unawareness. This happened before the CGM technology existed. I have been a pumper and CGM user now for almost 14 years,and now this closed loop system has been the greatest thing in my diabetic life. I am very thankful for my medical team and for all those patients who tried this before it was available to us all. Technology keeps getting better and we can’t be afraid to try it.

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    Has it been established what level of relationship between A1C and the ability to lose weight? I have heard that if your blood sugar is too high, you simply can’t lose weight. I am a BMI of about 3.5 and would like to lose 20 to 40 lbs. At what level of a1c, (My current GMI level on my Abbott Libra 3 CGM is 6.1, but I don’t know how accurate that is.) after diagnosis for type 2 diabetes, do I have to be to lose weight?

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    Thank you so much for this info. I grew up watching my two grandfathers experience all of the complications of diabetes (one lost his vision and his kidneys failed and the other had a heart attack and lost part of his foot to infection). Even though I realized this was in the 80s and technology has definitely changed, I’ve still been compelled by the “lower a1c is better” mindset and stressing over every tick up above 5.7. Sharing the data about why anything below 7 is good and why that’s true gives me some peace!

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      Thank you Wendy…we’re glad to provide some peace of mind. We’ve indeed come a long way (thankfully) with technology, devices, mediations, and research. Take good care.

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