Okay so glad to finally find people to help answer some questions. The diabetes association says one thing but people say another. What I mean is the diabetes association says that diabetics should aim for specific levels...I have met so many diabetics lately that say that those numbers are nonsense and we should be lower than those and to strive for lower numbers. My BS normally falls within the guidlines but wondering if I should aim lower?? Thoughts please!
It appears that the latest research focuses on a couple of factors, your average BG value and the Standard Deviation (SD) from that value. I have spent the last few months reading this research and what is readily apparent is that diabetics follow trends and nothing is always certain. For example, 2 diabetics could have identical BG readings and one of them may develop complications after a year and the other not. But this is where the power of statistics really come into play because there are some things we really do know and the newer research regarding SD appears to better identify what is good vs not-so-good. High BG variability as calculated by SD and other measures, such as the Glycemic Variability Index, positively correlate for accurately with diabetes related complications and is more accurate than A1c results alone--combined the results are even better. Meaning, John Doe may have a low average BG of 115, but because he is constantly shooting up to 300 and down to 30 his prognosis is worse than the person who has a higher average BG of 150, but never goes much above 180 or below 120.
AmyT at diabetesmine has two great articles you should check out:
The ADA gives very high parameters, saying it is ok to be 180 after meal. Studies have shown that damage starts to happen at prolonged time spent over 140 so many of us use that number as an outside limit. Some of us use 120 as they believe that diabetics can achieve normal blood sugars much of the time.
It bothers me a bit that the associations seem to sort of ignore the possibility of achieving the more normalized BG numbers that Zoe talks about. Yes, hypoglycemia is dangerous and all that but I don't feel any more "threatened" by hypos running my A1C in the 5s (30 day SD is 22.3, I keep an eye on it, sort of a "wrongometer". If it runs up, there's usually something amiss that I'd be aware of BG wise or whatever but it's like a double-check on it?) than when my A1C was in the 6s and 7s before I got a pump/CGM and got things in line. I think that aiming at the higher targets may end up pushing a lot of people higher and sort of substantiates the image that people with diabetes CAN'T have normal BG. It much more difficult to have normal BG averaged for any length of time if you are shooting for 180 post-meal than if you are shooting for 140 or 120 post meal. It's a change and any change should be approached carefully but really, with diabetes, everything has to be approached carefully so I think the amount of risk in approaching change is worth accepting, as long as you are careful, have enough test strips, snacks and use them.
Acidrock23:
While I respect the issues and commenst you raised but there are other factors that enter this riot having to do with the liver and its signalling.
In my own situation, yes I would like to obtain the numbers you mention.
Due to my faulty liver signalling; my doctor recommended I not let my Blood Glucose go sub 100 as on my body; numbers can drop quickly sub 70 and then when liver goes to add glucose it shoots it up over 511 and averages back to 278/311.
To stop that nonsense, it turned out that keeping blood glucose at 100 or above stopped that crap and using snacks to play external liver.
These discussions while of great value and interest completely overlook the complexity of a multiorgan - multihormone system and some of the footwork needed to maintain some sense of stability on some folks pranged systems.
I would prefer to run better low glycemic diets and lower numbers but that has proven impractical given I cannot trust my liver to signal properly and do its fifo job properly whne blood glucose drops sub 70.
I try to keep my BG as close to normal as possible. My Doctor's do not recommend my behavior but they do like my results, they just turn their backs and let me do my own thing so everyone is happy that way.
Bingo!
I have sort of come to disregard my liver in the equation as, once I got basal rates in the ballpark of where they should be and cut back on snacks, I haven't had the issues with bouncing high I used to have all the time. Then again, I drink a lot too and sometimes wonder if a few brewskis settles my liver or something like that.
Improving Basil rates by pumping is supposed to fix some of the cases.
For me - not so. That was tried.
The unfortunate parts is that there is a common set of cases and issues that most type 2's fall under.
The rest of us fall outside this fishnet web and are on our own attempting to arrest the mess. Yes, I finally got there but not without a whole bunch of goofy ideas, stares and you must be eating too much.
Thank god science has moved on, mri spectography is adding data to puzzle and for me the miracle of metformin which finally on Jan 6, 2013 - 6 years after I started fixing my mess, actual science findings and data explain what metformin was doing on my body and oberved on my liver. Forget the insulin resistance dance and metformin's role there.
AND yes,as observed here; once my liver issues resolved, diet and exercise were in fact critical to fixing rest of puzzle.
I'm starting to think that T2 is harder to deal with than T1, which is no picnic either! This article that either Brian linked or posted the guy's name so I looked it up, lays out all the things T2 folks have to deal with and the sort of approach that I've always done ("high take insulin, low eat..if it happens 3 days in a row, change your pump...") clearly is not detailed enough for all of the issues with T2.
I was told the same thing when I was at the Joslin DOIT program. The CDE said that T1s have an easier job self managing because there are fewer drugs and fewer variables involved
I disregard ADA & CDA guidelines. ADA funding comes from big Pharma, the food industry, & others who profit from our disease. Do any of those have our health as their goal?
My theory is their too high BG targets are related to their too high carb dietary recommendations. Difficult to have normal BG eating as they prescribe, so set the target to justify it. It's especially challenging for you as T2 using larger insulin doses.
My goal is to have as normal BG as possible.
Another thing that bothers me about the quest for normalized BG is that there don't seem to be any studies of people who achieve that sort of goal. I have seen bunches of folks online who are hitting it but there's no science aimed at developing a plan so everyone or at least more people can do what I do or Gerri or any of our other acquaintances "doing it" have accomplished. Gerri has a plan and I have a plan but they are not "the" plan. I'm, of course, not a doctor/ CDE otherwise able to really provide a plan but, given the costs and problems with aiming higher, which are well-chronicled all over the DOC. Any way you slice it, diabetes is hard work but incrementally lowering targets would offer an opportunity for people to succeed that they lose when their doctor says "7.5, good job" while looking at a log of 180 PP numbers, the corrections of which crash out into lows that may be more symptomatic as the change in BG is greater*.
*Acidrock23 theory, unsubstantiated by scientific evidence but consistent with my own experiences...
Im struggling with my sugar levels as well...my doctor tells me 8 is too high and the dietitian i see is constantly telling me that i am wrong in having nothing to eat after 7 but a glass of milk, in fact she states i am putting my body in starvation mode....but my levels are fine in th am#confused
My experience is limited to the ADA (American Diabetes Association), but those who claim to know tell me that the ADA and the CDA are near-clones of one another. That being said, the ADA's recommended targets are way too high. (They used to be even worse and were lowered somewhat in recent years, but that just took them out of the "ridiculous and absurd" range, not down to where they really belong.)
Empirical data argues strongly that "normal" blood sugar for a fasting, non-diabetic, non-obese, non-pregnant individual is between 75 and 90, or about 4.2 to 5.0 on the Canadian scale. The midpoint of that range equates to an A1c value of about 4.5, and research indicates that for each tenth of a point above 5.0 A1c, there is a statistically significant increase in the risk of complications. So any way you analyze it, the "targets" recommended by groups like the CDA and ADA are . . . . let us be kind and just say, "generous".
The challenge, of course, is to maintain blood sugar as close to the normal range as possible without sharp swings high or low. Easy to say, tricky to do -- but that's why it's a "challenge." Makes you realize how smart the pancreas really is, to do it automatically, day in and day out.
Okay I agree that they are clones of each other.
but folks here is my question at those that say we should be "normal" ranges. Have we all forgotten that our pancreas isn't working the way it should be? Its not a "normal" pancreas. If we are to focus all our energy on one organ do we not infact ignore the others? I'm not saying go out and eat cake and chocolate and white flour foods...but are we doing our bodies long term good in not eating fruit and vegetables (natures good food)?
This is what shocks me. I have read that yes those that long term low carb do get closer to "normal" BS readings...but did also find in more than one reading (good lord no wonder my eyes hurt lol) that they yet have to determine what type of affect eating 30 to 40 grams per day does to a human body.
Keep in mind I am still learning...but I want my whole body to be healthy not just my poor pancreas...it doesn't get all the attention lol
Keeping the carbs down doesn't mean not eating fruits and vegetables. I eat 30 to 40 carbs a day and I eat vegetables every day with some occasional fruit. It's just a matter of portion size.
What controlling blood sugar "does to a human body" is to sharply reduce the otherwise high risk of heart attack, stroke, renal failure, blindness and amputation. Those things are not theory; I've seen them up close and personal. That's enough for me.
The amount of carbohydrate in the modern diet is anything but "normal". Human beings evolved eating protein and vegetables and whatever small amounts of fruit they were lucky enough to find. We didn't eat grain in any significant amount until agriculture was invented, and that's only been about 10,000 years. Evolution does not work that fast. The human body is not engineered to process large amounts of carbohydrate. Full stop.
To give it some perspective, 100 years ago the average American consumed about 4 pounds of sugar a year. Today, according to the U.S. Department of Agriculture, the average (including the sugars hidden in packaged processed foods) is close to 200 pounds. Whatever that is, it certainly isn't "normal".
There are a great many diabetics out there who have been controlling their blood sugar tightly for decades and who are still going strong. Bernstein, who is crowding 80, is just one example among a great many. There is a 75 year Joslin medalist right here in our small town -- that's another.
With respect, make sure the trees don't keep you from noticing the forest. First things first.
The 180 postmeal target is not for me. I think accepting this ADA goal threatens my long term health. I agree with Dr. Bernstein’s statement that we have a right to normal blood glucose. My unwillingness to accept this lowered expectation finally drove me to discover some key personal breakthroughs: a low carb way of eating, dosing insulin to cover protein and fat, smaller insulin doses, and the critical importance of everyday exercise.
I now experience many postmeal BG’s that flatline on my CGM. Not every time but often enough to make me feel good. I download my CGM everyday and act on negative trends. I target 100-110 mg/dl for my average but just as important, I also target 30 or less for the standard deviation (SD). I’ve read several articles that found that to much glucose variability is bad for your health. When my SD is near my target of 30, I feel better physically and emotionally, and have more energy.
I have little patience with so called diabetes advocates (such as the ADA and many doctors) that give their authoritative stamp of approval on a low-expectation standard that harms us. I agree with acidrock. Why has there never been a study that identifies individuals that live well with diabetes and find out what they’re doing? I feel that many in the credentialed elite dismiss the over 200,000 hours that I’ve lived with this disease.
Excellent comments on target. High blood glucose rots out the pipes and organs like gasoline destroys natural rubber. Portion control - ie energy balance is absolutely crucial. Our ancient body and its optimizations were geared to prevent starvation in ancient times not protect against over energy supply in a reduced energy burn world as is ours is now.
I also believe that keeping numbers down as practical as possible is extremely important as well as the historical perspective provided by DNS about a ancient hunter gatherer body in modern times and refined foods.
more great points. Keeping the numbers down is still very important and gives a clue to energy balance in body.
I also agree Terry makes an important point about lack of science studies ( not statistical dancing) about folks who are managing their situation effectively and living longer and better.
I would take this further and further offer that there has not been pratical cure studies done to properly invetsigat cure approaches versus body defects.