I agree. and I think there have been numerous studies supporting your point but one might argue that all of our friends and indeed most of the world population is “pre-diabetic” 
Maurie
I agree that a lot of non-pumpers won’t correct a 110 but there are some of us that do - I am one and I know several other people that do. Granted it is much easier on a pump when you can take a 0.05 correction, but it is still possible on MDI. They do make 1/2 unit syringes & I know someone that even gets a solution from Lily to water-down her insulin so those 1/2 unit shots are even smaller than 1/2 unit.
I’ve said it before - I think, given a reasonable mean BG - that SD is more important than A1C over time. Right now my mean over the last 10 days is 102 - a good 10 pts higher than I like it - but my SD is 19, which I’m happy with.
I do correct anything over 110 which is easy with the pump/CGM. I don’t consider a hypo (for me) anything >65. I find that I’m very comfortable running around 80 if I’m not doing a lot of activity. Without the CGM to alert me when I go under 70 I don’t know that I’d feel safe running at 80 without a FS every hour.
SD of 5??? Don’t remember that from his book but I do know that my non-D family/friends generally have 1-2 hour post-prandials around 20 or so higher than their pre-prandials. I’m still happy with my SD<20. 5 seems almost unachievable to me, even low carbing at ~30 carbs a day.
Couple of questions brought up by this thread, and I honor all you folks who have worked so hard to research it!
- How do you tell the difference between a malicious liver dump, and a simple lack of insulin?
- Since there is no consensus on what is low-carb, are we just talking past each other?
- Is there another unrecognized category – carb-sensitive vs. non-carb sensitive?
- Should the definition of the cut-off for diabetes be the place, whether FBG, PPBG, A1c or SD, that correlates with NO diabetes complications? I know this question is probably unanswerable at the time, so the question becomes, are heart attacks and strokes really diabetes/hyperglycemic/caloric overnutrition complications, since they were nearly unheard of in reports on indigenous populations eating native diets?
- How low DO truly non-diabetic, non-starving people go?
- If you are very insulin-sensitive, then even 0.1u could conceivably make enough of a difference to nudge you below 110 into a zone under 100?
More if I think of them.
I think, to a certain point, what one’s body tolerates depends on what it’s used to. I’m not suggesting that really low hypos don’t do damage, just that for some people low is 90, for some it’s 50. Someone whose body is used to being at 140 with a SD of 80 would, I suspect, suffer more ‘upset’ at 60 than someone with a low mean bg and tighter SD. Though I could make an argument for the opposite scenario too I think LOL
I’m happy aiming to keep my BGs under 140 simply because it is often achievable, and by using this number as a goal, and by watching my diet carefully, I am ALMOST always able to stay under the 200’s and up that I used to think were acceptable before I encountered this group. My big downfall is restaurant and party eating.
I’m also very distrustful of the A1c, because mine has not ever correlated with my BGs (it’s always lower). I warn my docs not to pay attention to it, but I’m sure they don’t listen to me. But at least, I’m in control of my own insulin dosage. I feel sorry for the folks who are also low glycators, but are dependent on docs for meds or dosages of insulin, based on their A1cs.
I think Tim’s way of thinking is good for those of us who have never been able to achieve an “under 140” (or even “under 200”) goal. I can make it so most of my readings are under 200, but it’s rare I go an entire day where I don’t spike over that level. And I already know what trying (and failing) to aim for an A1c of < 6.5% for five years does (giving up and major burnout).
So instead of reading a thread like this and thinking that I haven’t been able to hit either of these goals even once in the past 20 years and wondering what kind of damage I’ve done (and I really hope I am not the only one here thinking this!), I can think that I work really hard at my diabetes and have been doing the best I can, I have rarely outright ignored my diabetes (note I didn’t say “never”!), and I can just focus on improving my A1c and SD even if the “goals” of 140 and 5.5% seem somewhat impossible to me at the moment.
Here's some diabetes statistics from the National Diabetes Information Clearinghouse (NDIC)
Diabetes affects 25.8 million people of all ages or 8.3 percent of the U.S. population. Diagnosed 18.8 million people, Undiagnosed 7.0 million people.
Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.
In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had pre-diabetes—50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with pre-diabetes.
So 8.3% with diabetes and 35% with prediabetes = 43.3% with damaged metabolisms. There are even more with numbers that are not truly normal but don't meet the criteria for pre-diabetes.
For many with pre-diabetes the fasting number is the last to go., meaning many are spiking well above 140 regularly, but then returning to a normal number before the next meal. One wonders how many heart attacks this causes without the true cause, an inability to handle high carb loads, ever being discovered.
A total range of +/- 10 would be 2 standard deviations around a mean with a SD of 5 according to the normal distribution.
As far as #4 goes, I personally feel that they have the levels set way to high for diagnosing diabetes. People should not be walking in with neuropathy and other complications before being diagnosed. That alone should be setting off some red flags but these morons just keep upping the level even higher. Guess in that respect, the grass is greener on this side of the fence because we already have the juice we need!
I think the vast majority of us here are not sitting in the high and mighty ivory tower with perfect bg’s. The majority of us here are slogging our way through the trenches. Even if you go beyond the book jacket quotes on Dr. B’s books, and get into the books, you discover that he has good advice on slogging through the trenches as well, he’s not really looking down on us from that high and mighty ivory tower.
On a really good day I might not have any readings above 140. Of course on some not so good days I might be teetering along in the 40’s and 50’s for periods too.
I would hate anyone to think that just because they have some numbers above 140, that they are doomed and may as well just give up. That’s not true. Any improvement in control is worthwhile, and the incremental benefit from improving from a 340 average to a 300 average, is probably a bigger incremental benefit than improving from a 180 to a 140. Yet to the “140 is the magic number” crowd 180 is probably as bad as 340. When really 180 is way better than 340.
But there’s still obvious benefit from improving from 140 to 100, or from 120 to 80.
I spent my first couple years as a diabetic without any home bg tests at all. I remember as a kid going to a local doctor’s office, getting my blood drawn, and a week later they’d call my parents with the number. Which meant almost nothing to me or my parents at the time. I’m sure I was zooming around in the 200-400 range all the time. I know that a urine test that came up with no spilled glucose was very very rare.
I think Jen and Tim are getting at this (from Dlife): For Every 1% drop in A1C...
for every point you lower your A1C levels, you lower your risk of developing a variety of complications:
1. eye disease risk is reduced by 76%
2. kidney disease risk is reduced by 50%
3. nerve disease risk is reduced by 60%
4. any cardiovascular disease event risk is reduced by 42%
5. nonfatal heart attack, stroke, or risk of death from cardiovascular causes is reduced by 57%
It is not a straight line…look at the curves posted earlier from the DCCT study. Those numbers are an approximation for a certain range of the curve.
There is certainly a point of diminishing returns as an A1C approaches normal. The gerneral point is any reduction in A1C is a good thing, assuming that it is not accompanied by extreme hypos.
1- Boy, I’d love to know the answer to that one. I think some of my D gremlins are actually liver gremlins, but no way to tell.
2 - I think we need to define low carb when we use it. I’ve been trying to do so - will try harder!
3 - Is anyone non-carb sensitive?
4 - From BS 101: The Point of No Return for Fasting Blood Sugar?:
A study of 344 people published in November 2007 examined the relationship of their fasting blood sugar to the presence of metabolic syndrome. They broke their study subjects into four groups by fasting blood sugar rather than the usual three. The groups were: Normal (<101 mg/dl or 5.6 mmol/L), FBG1 (101-109 mg/dl 5.6 and 6.0 mmol/L), FBG2 (110-124 mg/dl 6.1-6.9 mmol/L) and Diabetic (>125 mg/dl 7 mmol/L).
This is unusual, because most studies will lump people with fasting blood sugars between 100 and 110 mg/dl (the FBG1 group) with the either the normal or the pre-diabetic group. By breaking that group out separately it was possible to discover a relationship between fasting blood sugar and health that might have otherwise been missed. And that is exactly what happened.
This study found that people in the FBG2 group had the same cardiovascular and metabolic syndrome incidence as people with diabetes. Which backs up what we have seen above: for most people, the deterioration of fasting blood sugar over 110 mg/dl occurs only after many years of exposure to very high post-meal blood sugars and by the time fasting blood sugar deteriorates this much, diabetic complications, most notably heart disease are well established.
In contrast, the intermediate FBG1 group was a lot more normal as far as cardiovascular and metabolic syndrome markers went. This suggests that the fasting blood sugar between 100 mg/dl and 110 mg/dl, should be treated as a major watershed and that if you test into this fasting blood sugar range on a screening, you should take aggressive steps to lower your post-meal blood sugars, because you have caught the abnormality early enough to be able to prevent cardiovascular deterioration.
Thanks all, excellent feedback all around and some useful food for thought. FWIW, my motivation for asking this is that I have successfully managed to avoid the 140+ numbers with pretty incredible consistency (honestly I really don’t know what I’m doing to make that possible, other than testing a lot, making some small dietary adjustments, and staying active) but I still see 120-135 postprandials and post-postprandials with some frequency, and I could probably tweak my diet to make those less frequent, but honestly if the potential for microvascular damage is low-to-negligible at those numbers it’s really not worth it to me.
Maybe I am even more " fortunate " , not saying it may work for You , the reader …living with d almost 29 years, no complications , eat an av. of as per pump reference : 165 grams of carbs daily for the past 31 days …and my last A1C is 7.1 …really I can’t explain the numbers and results , but here’s to living a healthy , rewarding life .
That’s why I brought up the question of carb-sensitive vs. non-carb-sensitive. Today I had lunch with a friend, and had a cup of potato cauliflower soup (20g?), a grilled cheese sandwich (30g) and a cupcake (30g?), all of which were “normal” size, not restaurant huge. I bolused for it, was 189 4 hours afterward, corrected, and was 187 3 hours after that, corrected again, and finally came down to 87 a total of 8 hours after lunch. I don’t THINK I have gastroparesis, but I was full for a long time, and I really don’t want to be in the 180’s for that long. And I don’t think it was a liver dump – I just stayed high because the food was digesting, and I don’t think it was an extraordinarily big meal. I DO think I’m carb-sensitive, rather than insulin-resistant because if my stomach is empty, it doesn’t take much insulin to bring down my BGs drastically, but a carby lunch does me in. Maybe I’ll post this as a discussion, because I’m really interested in the experiences of others.
I am not aware of Bernstein ever suggesting a specific SD. He does talk about limiting after meal glucose surges. A study of post meal glucose surges in non-diabetics suggest that an average postprandial from a high carb breakfast is about 125-130 mg/dl (from a baseline of 80 mg/dl), a surge of 55-60 mg/dl. That is an order of magnitude larger than an SD of 5.
My experience is that I feel tightly controlled if I can get my SD under 20. I can often achieve an SD of 15 with tight control of diet (Bernstein level), but I have never been able to really achieve any SD under 10. I am more inclined to thing a normal SD would be 25 of more.