yet another question: Numerous times now I ve read that elevated BG numbers are damaging to our bodies when "maintained over longer periods of time", I would like to know what kind of time spans we are talking about here..
I think my BG management is reasonable, although I m definitely not a Bernstein child – even if I tried really hard I dont think I could ever achieve an 85 mg/dl flat line before, during and after eating. My diet is not restricted enough and I personally find that kind of tight management a little too risky as well. Since I m still honeymooning my insulin needs are constantly changing, so I measure a lot. Sometimes both 1 h and 2 h after a meal, just so I ll get a real idea of what my BG is doing.
Often I might have a spike in the 140 range an hour after eating, but will be down in the 120s 2 hours post prandial, and mostly I ll be back down around 100 after 4 hours.
Are these 1-2 hours in the 140 range already something to worry about? Changing my I.C ratio wouldnt be such a good idea I think, since I am back on target 4 h after eating, but maybe I ll need to wait a little longer after injecting before I start my meal and /or eliminate some more foods that will likely spike me?
I remember, at one point, looking for any kind of literature on the effect of time spent above normal BG. I didn't find much of anything and, from what I can tell, there just isn't much, if any, literature on the subject.
By far, the most information I have found is on postmeal BG. Basically, elevated BGs beyond 2 hours postmeal is, by itself, a marker for cardiovascular complications in particular.
it depends what number you're starting at, really. 140 1 hour after a meal is not a spike. some type 1's have troubles with keeping it under 200 2 hrs. ppl. I've heard that it's best to keep it within a 40 point range, i.e., if you start at 80 and go to 120, that's good, if you start at 140 and go to 180, that's still only a 40 point increase...so the goal would be to get the starting (fasting number down), that's a way to measure I:CR too. Thus, you have to calculate in what number you're starting at and how long your insulin lasts you too.
Remember, even a GTT (glucose tolerance test) for type 2's suggest normal blood sugars if below 180 1 hour and 140 2 hours after a meal, above that a type 2 Dx is considered. Non diabetics increase too with meals.
I don't think they really know. It would be hard to tell. They rely on "average" numbers provided by, I presume, A1C. Maybe the way to tell would be to compare SD people with the same A1C, to see if the person with more highs, and higher SD would be prone to more problems than someone flatter. Sometimes, I feel like lows, particularly after highs, are sort of cathartic...
For SD targets, I had never run into much (nor looked for much...) but got the Francine Kaufman book "Insulin Pumps and Continuous Glucose Monitoring" (free Tu giveaway, thank you Medtronic and TU!! It's a good book!!) which had the suggestion to aim for less than 55 mg/ dl or less than 1/2 your average BG which I seem to be able to pull off, although I am hard pressed to articulate exactly what I do to get there.
Bluntly, nobody can tell you, because the information does not exist, at this point.
Get X number of times with a higher/lower number different from the current standard, there is zero guarantee you will have a complication. In a decade, likely, but now... nobody can say X number of times will cause XYZ.
The data did not exist until the current generation of technology. So they cannot guarantee an outcome at this point
Everyone has given you good information. I'd like to share another perspective - largely learned from Acidrock. Whatever, your blood sugars are doing it makes sense to try to improve them. If your control is very tight that improvement might be very small. If you're going through a rough patch like I have the past 6 weeks, there is lot's of room for improvement.
I wouldn't worry at all about an hour or two around 140. In fact, I'd kill right now to have that as my worry. I don't think you'll find many people even in the Bernstein group who think that a flat 85 is possbile using exogenous insulin. How would you even know if you achieved it? - our meters have a +/- range of 17 points around that 85.
You might experiment with waiting a little longer before eating but you might find that you actually end up a bit higher after two hours. Your insulin might not have enough tail to cover your late digesting protein and fat.
It's a crapshoot. You're doing great. Enjoy your success,
I think that it's much easier, particularly with small doses and low carb eating but in general as well, to make observations and fine tune adjustments with a pump and CGM. I am still often surprised by the difference .025U/ hour basal adjustment or .1G carb/U ratio adjustment will make. If it's a shade too high, I sometimes will overeat and see a weight gain, nothing huge but I'm paranoid about that so I'll adjust the pump and it often smooths out things for hours after the target area, the jelly beans sit safely in their bag and I feel a little bit less unhinged by "what the hell is going on after lunch..." (or before dinner or whenever...) every day. The changes don't always work the first day but I give them a try and, many times, they do what I expect them to and have removed the feeling of "slot machine" testing where the results are all over the place. I'm managing it instead of it managing me and I can feel pretty good about that. While the rest of me is, of course, getting old and falling apart...eek!
I try to keep my BG between 70mgldL and 140mg/dL as many hours each day as possible. My BG is always changing and I'm forced to use my CGM readings to steer my BG back toward the middle of "my road" so to speak.
I think there is plenty of evidence that some indaviduls live a normal life with BG averages well into the 200's and then there are some that have problems early in their diabetic life even with good control, unfortunately no one can say with any accuracy, which one's of us are on which list, I think most of us fall somewhere in the middle of these two extremes.
