Tim: Need to get the word out if they are connected. The media needs to stop condemning and present useful information.
Tons of garbage? Hey! Do you have a camera in my house!?! LOL
But yeah, give it to me straight. I’m a grown-up. I can take it.
Yes!
Well, dear heart, 70 isn’t going to sound so old to you one of these fine days. ;0)
Hmm, I’m not sure I agree with the same objective fact-based goal for everyone even though we are sort of dealing with a lot of the same facts.
A very quick google brought up this http://spectrum.diabetesjournals.org/content/15/2/69.full that suggests the national average A1C is 9.2. While I agree that low goals are partially responsible for the low results, I don’t think that it is necessarily reasonable to take someone with a very low level of care and support (e.g. a low # of test strips, b/c of budget and/ or unsupportive doctors…) and shift their gears into 7.0/6.5/5.5 or whatever. if the national average is 9.2, the approach has to be through doctors but I think that a sliding scale of goals may actually be appropriate? A lot of the steps would require a “will to improve” outside of the community of people with diabetes as this would require support from the insurance market which seems as if it may not be there right now. In which case it’s a grim picture? I dunno.
A bunch of things wrong with this:
- I think A1c targets are dumb in general. It’s a useful scorecard, but I think that telling patients to aim for a particular A1c is pointless without giving them specific fasting and postprandial targets. I also think that building your fasting and postprandial targets around a specific A1c is sort of pointless, cart-before-the-horse thinking. I don’t understand why more doctors can’t just say “Test regularly, keep your fasting below 110, your 2 hour postprandials below 140, and don’t worry too much if you miss those targets sometimes unless it becomes a pattern.”
- I think A1c floors are especially dumb. I don’t think everyone needs to aim for an A1c in the 5s, and I think there’s legitimate debate about what a “normal” non-diabetic A1c is, but there’s no reason to tell a patient in the 5s or the 6s that his or her control is too tight unless they are struggling with frequent and/or severe hypos.
- Obviously tighter control is generally better, no need to belabor this.
I agree with someone (I think it was Maurie) in this thread who said that the best approach is just to tell doctors to set specific targets for specific patients (I would add that the AACE recommendation of 6.5 is a fine starting point if there’s not enough information to set a different target). Really, this is what my endo does (he actually got referenced by name and given some flack as an “ADA flunky” in another thread, which is the furthest thing from the truth–neither here nor there)–he sort of recognizes that I’m an “overachiever” (his words, not mine) and takes the position that there’s nothing wrong with ultra-tight control but there’s not necessarily a need for it in most patients.
Hi Peetie,
BG response is such an individual thing. Alcohol tends to lower BG when consumed on its own but not with food. I don’t recommend drinking alcohol at night without food, though, or you do risk going low overnight even if you’re not on insulin (liver will be unable to release glucose). Maybe try some fat with your protein snack, like nuts or avocado? Good luck
I know, that was a little young – 70 is not considered old these days! Someone in their 70s could conceivably live an additional 20+ years. I’m in my mid-40s, so it’s is not even that far off for me
Thanks, Capin101! No, I don’t think we’ll lose any patients. I don’t have a poster like the one you mention, but I like the idea. I’d definitely have to talk that over with my supervisor. She is actually pretty open-minded about things-- as I said, this directive came from the higher-ups in our organization.
Thanks to everyone for all of your comments – I don’t want to make this the longest thread in TuD history by replying to each one! For those of you who feel I’m being too strict and am not supporting those who are unable to get their A1cs <6-7%, let me assure you that I provide encouragement for ALL my patients, especially if they have made any improvement at all, i.e., going from 10% to 8%, but also for those whose numbers have worsened for whatever reason. I got into this field to try to help people improve their health, and I truly love my job. But in the end it’s up to the individual to manage their D.
Thank you so much, Jean
I think it’s important that diabetics of all types, duration, and styles feel free to come here to tudiabetes without being judged by the diabetes police.
I think the OP is stating many opinions on the verge of the judgemental “diabetes police”. In that sense, yes, it is important to me whether the OP is diabetic or not. Actually it’s pretty clear to me from her attitudes, that she is not.
Maybe you have a point. If someone came up to my face and told me a 6% A1C doesn’t reflect tight control, I’d just bite my tongue and walk away and not try to point out the obvious.
It is sort of tight but it’s not “normal” either, in the sense Dr. Bernstein suggests PWD are entitled to normal BG. To me, it’s also important to recognize that it’s a “target” and that missing it also can provide very useful data for your ongoing “experiment”? Getting rid of feelings of failure is very important and I think that focusing on A1C as a “big goal” is sort of a mistake as the A1C is composed of your overall plan and your ability to manage each blood sugar. A1C doesn’t occur in a vacuum but you should have a pretty good idea going in about where you’ll end up? If you don’t have an idea, maybe figuring out where you are would be a good place to start. Sort of teaching yourself to run the show as it were. I haven’t ever really given up although I have ups and downs like everyone does. I think that giving up may be the conclusion of a lot of people who end up stuck in the higher ranges because of faulty medical advice. 
Thanks LCD!
Agreed the deck is certainly stacked against a person with the average A1C of 9.2 lowering it significantly.
The correlation between high A1Cs and complications is a fact. We are in the midst of a diabetes epidemic and down the road an epidemic of diabetes complications. This is going to have a tremendous negative effect on health care costs and the quality of life for millions.
We are careening toward a health abyss but instead of putting on the brakes we’re hitting the accelerator by raising targets, cheaping out on test strips, and offering advice on diet that is bound to fail for most. All to avoid telling people the truth. If you are a T2 (who are the bulk of the epidemic) you have a damaged carbohydrate metabolism and you will have to lower your intake of carbs to whatever level your body can tolerate. If you fail to deal with this your chances of contracting very nasty complications rises significantly.
People are free to make whatever choice they want in facing this disease, but they should be given goals that reduce complications significantly and the tools and advice to succeed if they so choose.
Please don’t go away yet LCD …I like to add a link of " research " done at the University of Saskatoon , Canada …but need to eat first
PS I have bolussed( sp ??) for my meal
To me from the OPs descriptions she is very pragmatic in approach to her patients. Yes she recommends lowering carbs but for those who cant or won’t her attitude is still supportive and positive. To quote from another part of this thread she says “I always let my patients know that there are different schools of thought regarding the best approach to eating for DM management”
She also stated “BTW, I am in the early stages of diabetes, and although not on insulin, I see huge variations in my blood sugar readings from day to day. So I do understand a little bit of what you’re going through. My goal is never to make people feel bad or ashamed but rather to assist them in improving their glycemic control in whatever way I can”
As most diabetics are T2s I would assume most of the OPs patients are also T2s. For T2s lowering carbs is always helpful and 200 grams plus is almost always a failure. T1s are of course in a different boat and there are several T1s here at tuD who consume 200g and have excellent A1Cs.
In a disease as widely varied as diabetes pragmatism would seem to be the order of the day.
I agree 100% that PWD of all persuasions should feel comfortable coming to Tu without being judged.
Unfortunately, I think even some PWD on this site ARE acting as the “diabetes police” and I feel a general sense of almost disdain for people who do not have A1c’s in the 5% range and/or those who do not choose to LC. I see a lot of people say how on other sites if LC was even mentioned they get jumped on and although I do not think it is near so overt here I get a general sense of the opposite perusing Tu.
Additionally, I have been wanting to tell other RD’s and/or CDE’s to check out this site to get, for lack of a better word, educated on what the benefits of LC can be but every other day there is a bash fest on RD’s/CDE’s and I know it will accomplish absolutely nothing to suggest they do so in that sort of an environment.
Just my 2 cents.