Which matters most to you or are they equally important? I tend to get freaked out with individual highs and lows. But, my averages don’t look that bad. So, should I not sweat the small stuff and just care about the averages?
The time spent high matters and there’s a bunch of evidence that it is time spent high that does the damage.
When you are high, glucose flows into certain kinds of cells that don’t need insulin to accept glucose–nerves and retina for example and damages them. So if you want to keep your nerves and retinas normal, you really need to keep your spikes as low as possible and as brief as possible.
You can get the same A1c with very different blood sugar patterns and the actual pattern probably tells you more about how your health will work out.
So the average isn’t a good measure for health. The studies look at AVERAGES over large groups, and on average the GROUP of people with one average do better than those with another, but there are always people in that group with the one average who do very well and those who do very poorly, and it was adding up their blood sugar values and averaging them gives you the average for the group that is helpful to the researcher but not to the poor schnucks who did poorly.
When they look at people with diabetic complications and look at their glucose tolerance test blood sugar levels, it looks like the post-challenge (i.e. post meal) levels at which complications start is when blood sugars is still over 140 mg/dl at 2 hours after. That doesn’t mean that everyone who goes over that level will get them, only that if you stay under 140 mg/dl at 2 hours you have much much less chance of complications. After that it depends on your own personal genetic make-up and luck if you are one of ones that do or one that doesn’t get complications. There are people who are high for many years and stay fine but there are people with “pre-diabetes” who develop “diabetic” retinopathy. I like the idea of not counting on luck, so I try to stay under 140, though naturally I don’t manage it all the time.
People forget that the 7% A1c in the DCCT trials lowered the incidence of retinopathy, but a significant percentage of people with Type 1 who had that A1c still got it. With type 2s, another study, UKPDS showed that the 7% A1c made a much smaller difference and a huge number of the Type 2s with the 7% a1cs developed retinopathy.
Doctors like averages because they don’t have to look at your logs and talk to you but can give you one test and imagine they know all about your blood sugar. Easy for them, and they get to see more patients in an hour and make more money. Kind of hard on you if you go blind!
My web site at http://www.phlaunt.com/diabetes “What they don’t tell you about diabetes” has a link to all the research I have hunted up over the years connecting organ damage and blood sugar levels. Hope it helps!
Thank you for all that information! I get upset with high numbers and didn’t know if I should just be concerned about the averages. So, now I know. I should be concerned about the high numbers.
So far, I’ve been dealing with fasting sugars but I think I need to take a look at the 2 hours after readings. I know I’m above 140 on those many times. I never get the answers I need from the doctor. So, I really appreciate everyone online sharing what they’ve learned. Thanks, again!
Sherrie,
The only training most doctors get about diabetes is an hour or two in med school followed by treating patients in the hospital who are way out of control. Unless they have a personal interest in Diabetes, they may still be going with what they learned in 1985! And because they have been telling people that any A1c under 10% is “good control” they figure all people with TYpe 2 deteriorate (as their patients with those high A1cs do!) so why nag you about doing stuff you probably won’t do.
If you read the newsletters intended for practicing physicians, as I do, you’ll also see that 99% of the articles considered important for them are just press releases touting the latest expensive drug. They don’t have the time to read research and frankly, diabetes isn’t very interesting compared to many of the other conditions they treat.
I was very fortunate to finally get a doctor who did read research, who put me on insulin while my A1c was in the low 6% range because he knew I was only eating 60-80 grams of carb a day and agreed with me that going over 140 mg/dl eating 8 grams of carbs was NOT a good sign. But my other doctors, including an endo looked at the A1c and said, “You’re doing great come back when your A1c is 8%!”
By that time, i figured I’d have neuropathy and all the other “pathies” to say nothing of mostly dead beta cells, instead of the ones hanging in by their fingernails I still retained.
But the great part about getting aggressive early is that based on my response now after using meal time insulin for almost 2 years, if I eat a low carb meal without insulin, my beta cells are doing MUCH better now than they were 2 years ago–no more 140s with 8 grams! And it is SO much easier to use insulin when you still have some residual beta cell response to clean up what the insulin doesn’t!
Do check out http://alt-support-diabetes.org/newlydiagnosed.htm I have heard from hundreds of people who have used the combination of diet and careful testing approach described there dropped their A1cs from as high as 13% down to the 5%s.
Check out this article in the New York Times.
“Nearly 73,000 Americans die from diabetes annually, more than from any disease except heart disease, cancer, stroke and pulmonary disease. Yet, largely because of a misunderstanding of the proper treatment, most patients are not doing even close to what they should to protect themselves.”
If you have diabetes, you should be sure your cholesterol and blood pressure are under control. My HMO prescribes meds for both for me, one pill a day each.
Hi John - any chance you could find this story again? The link isn’t working.
Personally I believe that the average BGs are not enough. I think we should be avoiding spikes, where possible. We’re bound to get some, and without going super low carb it’s almost impossible to get a diabetic with excellent ‘smooth’ numbers most of the time, but I think we have to give it our best - without pushing ourselves too hard (stress isn’t going to help us either…).
It’s a matter of balance though. How much energy are you willing to put into your disease?
How much food are you willing to ‘sacrifice’?
Are you willing to test / jab / pop pills as many times a day as needed?
On one hand, I am willing to put my all into my health. On the other hand, I still find it hard to put my health first so often. I still want ‘treat’ foods. I want to have a relaxed normal life. I haven’t found my perfect balance yet, and I’m sure I never will! but I’m armed with knowledge and I’m keen to try my best.
Ever heard of an older diabetic with complications saying they wished they’d look after themselves better? I’ve seen that a lot. I’d like to be the one that says ‘I’m glad I looked after myself’ while I’m sitting out on my rocking chair, enjoying the sun on my feet, on my 99th birthday.
I never once heard a diabetic say “I wish I let it all go and didn’t worry about complications, carbs are better than keeping my feet/kidneys/eyes”
I have to agree with Jenny - It’s watching those highs on a daily basis and working for low blood sugar’s that is important. I gott a lot of hhelp off her website and from Dr. Bernstein’s excellent book. I freaquently get sugars now in the 90’s! And if I see on above 120 - I freak out & retest, try and figure out what I ate & where I went wrong - do a control test, whatever it takes. I do NOT want diabetic complications, so I’m doing everything I can to keep my sugars as normal as I can!
Wish I could get my doctor to realize that spikes matter. How in the world she can tell me “they look good” when I had numbers between 140 and 160 5 times within 5 days is beyond me. Maybe she gets an award for not prescribing medications.
Thank you for your honesty and knowledge. I am definitely going to look for your postings regarding diet as I may be able to learn and apply some of that knowlege to bring down my nieces ridiculous – truly – postprandial highs. We are now prebolusing and of course we adjust ICR and basals but as a Type 1 Juvenile Diabetic, she can get extremely high after eating. We then give more insulin for the food, but sometimes she responds well to the insulin, other times she still spikes. I have a call in to the endo to see if we should reduce carbs per meal and space out the meals more. But you are very knowledgeable and although her diet will be high carb because she is growing, I will try to learn and apply what I can. Of course I will have to check with her endo but I’m open to suggestion. We are getting a continuous monitor for her and one of the first things I will do is feed her and log the results of different foods so at least I can mix and match better. Our guidelines are to somehow get her to 180 two hours post prandial and I can’t usually do that. I have at times, not always.
Unless you have a continous glucose monitor, its not very practical to catch every high or every low, but what you can do is learn how your body responds after meals, during fasting periods, even in the middle of the night with FREQUENT individual tests. Ultimately, if you fix the individual readings, your averages will also go down, your A1C will drop, your fructosamine will go down, etc. So, simply put: control the frequent individual readings, and the averages will follow!
Thanks, Tim. Good way to look at all this. Sometimes having the blood sugar testing makes no sense to me (a Type 2) at all. What’s the point? I guess the point is, it is supposed to help us modify and control.
That’s very true, and it is important to note how important frequent testing is. Its probably a little different with type II, but you will want to know how you sugar looks at some very key times throughout the day: (1) Right away when you wake, (2) after breakfast/before lunch, (3) after lunch/before dinner, (4) after dinner, and (5) before bedtime. If you really want to be complete, you should take a couple of nights and do some 2:00am or 3:00am test just to see how you are overnight.
Eventually you will learn the patterns throughout your day and adjust your diet/medications accordingly.
I dont know anything about diabetes. I was diagnosed with type 2 and I take Metformin. Everytime I check my blood sugar it is above 140 and It is usually in the 175 range after I eat. It has been this way for 8 months. I take my metformin after I eat lunch and after dinner. I was told to only take it once a day. I have other medical problems that have been causing me to forget alot of things and the doctors cant figure it out. I often forget to take my metformin after lunch. Usually dont forget to take it after dinner because I take 6 other medications then aswell.
David: Do you have a really good dr. that you trust? You may need more or different meds. I’ve been diagnosed with Type 2 for 2 months. I take Janumet (a one pill combination of metformin and Januvia) morning and night and Actose in the AM. I am also on insulin AM and PM. I avoid any sugar and allow myself carbs only at one meal–usually a sandwich at lunch. When I was diagnosed in the ER my blood glucose level was over 600. My 1st A1C test was 11.8. Now my A1C is down to 8.7(still too high), but I test twice a day–AM and PM and I am usually around 100. There are devices you can set to beep after lunch so you will remember your metformin. Have you thought about seeing an endocrinologist? They can help you get better control if your dr. can’t. I would seriously consider seeing a dr. for a 2nd opinion about your treatment, at least. I take 5 other meds myself and right now I am just turning the bottles upside down when I take them. 8 months is way too long to still be in the blood glucose levels you have been experiencing. You must know about the serious consequences of long term high glucose levels. Basically–try something else: your regimen is not working. Know your A1c level–does your dr. even have you get tested? Good luck!!
The non-working link is likely this one http://tinyurl.com/ypt2lv
The family DR I have I have only seen once. I have not been real focused on my diabetes because of my other problems. I have seen every Dr under the sun including an endo, psyciatrist, and nuerologist. I have had sleep studies, MRIs, EEG, EMG, spinal tap, and ECTs. I am currently on antidepressents and pills to help me sleep. I have seen the endo a few times and we were also focused on my other problems. He prescribed me Metformin but didnt really follow up on it. He also prescribed me Androgel. Which is a testosterone gel, because they found out I have a low testosterone about the same time they found out I have diabetes. Thats when my memory first started to get bad.
I have to agree with you about needing different medication.
I just checked my blood sugar (1 hour after I ate) and it was 226.
So I went and rode my sons bicycle around the block and checked it again and it is 176.
I took my metformin after I ate lunch (20 chicken Mcnuggets). Should I take it before I eat? ( I know dont eat 20 chicken nuggets)
Just checked it again and it is 210- 2 hours after I ate.
I have had my A1c level checked and they never said anything about it so I never really thought it was bad. They told me I could control it with diet at first and I tried to but it wasnt working. I cant see how you can go without ANY carbs. In my job I have to eat at fast food places for lunch and that would be impossible.
What types of medication should I ask the doctor about?
David,
If you have to eat at fast food places, try the double cheeseburgers and don’t eat the buns. Have a couple of side salads also (without the croutons). If you cut back on the carbs, you WILL get lower BG numbers and you might start to feel better also. Add some fiber to your diet- snack on carrots, cheese, apples with peanut butter.
Try lower carb for a couple of weeks and see if it makes a difference. Good luck.
I sweat the small stuff because my sugar levels are all over the place. When my sugar levels are low they are very low and when my sugar levels are high they are dangerously high. When you test your sugars lets you know how that food breaks down. Foods raise blood sugars differently for different people. It also tells the doctor if the medication you are on is working like it should.
Thanks Libby. I was thinking about doing that today but I didnt want to look stupid in front of my coworkers. Today I had an apple for breakfast and a salad for lunch and my BS was still at 122 when I got home. I am gonna start trying to take my machine to work with me and check it after meals. I always thought it was supposed to be high after you ate and that the numbers that counted were the ones after fasting.