I don't mean to aggravate any one

Type 2
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i thought i would control BS with diet and exercise. over time I was not as successful as I thought I could be, so i am boring down on the strategies to limit BGL.

After having read and posted here I have found a pretty wide range of opinions on the matter of BGL. In fact I have posted about my frustration in the communications of BGL by bloggers or experts. Namely they say, they , the bloggers, are at low BGL numbers. Those are the numbers for non-diabetics, But then they fail to mention if they got those numbers from meds or insulin. So it left me feeling very much insecure about my plan.

so i persist in this quest to understand the acceptable BGL ranges for a NON MEDICATING DIET AND EXERCISE ONLY T2.

Here is verbatim from ADA website. It definitely says the goal of a diabetic is to maintain in a range, matter not how you get there.

Managing diabetes means getting as close to a normal (nondiabetic) blood glucose level as you safely can. Generally, this means levels between 70 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin (A1C) level less than 7 percent. Those targets should be individuallized depending on a variety of factors. Set your goals with your doctor.

some posters here, there and everywhere will tell you 140 PM is terrible. One person told me when i did 180 PM i was in dangerous territory. and very importantly i get on average <130 FBGL with current diet and exercise.

I would not be the only person to distrust the Med establishment, knowing their conflicts of interest and competition for resources.

but in terms of BGL numbers, isn’t it okay to follow ADA?

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It is far better for your long-term prospects of good health to remain under 6 rather than to strive for 7
The only reason not to try for 6 is if you feel you’re going to have life-threatening hypos. Other than that there’s absolutely no way it makes sense to have an A1C of 7 if you can get to 6 or less

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@frog
There is a good deal that CAN and (imho) SHOULD be read into the huge amount of potentially conflicting and non-specific target advice.

As mentioned previously, if you want a specific answer with a specific number, you will find one.

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Acceptable ranges are not determined by your treatment (e.g. exercise and diet only). Rather, your treatment should be determined by whether or not your levels remain in an acceptable range.

You’ve come to a website with many people who are trying to obtain non-D levels so as to minimize their chances of complications. You can also look through the forum and find many posts from people who have experienced these complications and are trying to manage them by tightening control (or maintaining tight control).

A particularly important portion of the ADA quote:

How concerned are you with developing complications? If you’re more concerned, then aim for the non-D levels. If you think that will comprise your quality of life too much, then aim for slightly higher levels. In a prior post you stated that your doctor recommended Metformin. Based on the responses on this forum and the recommendation of your doctor, you may want to consider tightening control. This is definitely a personal decision though.

If you are interested in trying Metformin, I’ve heard that the extended release version is much easier on your gastrointestinal tract.

I think @Tim35 summed up the situation well.

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I like this part of the ADA’s quote:

Realize that the ADA makes these recommendations based on a large population of people and their wide spectrum of abilities, interests and needs. Nothing should stop you from improving these goals providing you do not elevate your hypoglycemia risk.

The best way to safely lower a blood glucose average is to first lower BG variability. The easiest way to monitor variability is by watching the standard deviation statistic. You’ll need sufficient data to do this; a CGM works best but enough consistent fingersticks will work, too.

The standard deviation measures how tightly packed your data points are. I believe that a safe average is no lower than one standard deviation above your hypoglycemia limit. If you place your lower limit at 70 mg/dL (3.8 mmol/L) and your standard deviation is at 50 mg/dL (2.8 mmol/L) then you should not attempt to lower your BG average to less than 120 mg/dL or 6.6 mmol/L (70 + 50 or 3.8 +2.8). If you can reduce your SD to 30 (1.7) then you may lower your average to 100 mg/dL or 5.6 mmol/L (70 + 30 or 3.9 + 1.7).

Doctors are almost universally hypo-phobic and will not feel comfortable discussing a rational plan like I propose. I believe that over-reaction and fear interferes with discussing any plan to reduce BG averages toward the normal range.

I use a lower-carb diet, pre-bolusing, and advanced pump techniques to lower BG variability.

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You are not “aggravating “anyone. We are all in this together! And to answer your question, yes it is ok to use the ADA standards. They work very well for most people. Especially those who are new to diabetes.
And as you have learned, many don’t use those numbers and strive for tighter or looser numbers. The key is finding the range and treatment plan that will work for you and keep you in a safe zone. Your medical team with your input needs to find that range for you. Questions you need to work with them might include if you live alone or with others, cost of living issues (being able to afford drugs and food and shelter-things we all need and unfortunately some have to pick and choose) concern of lows, highs complications, how willing to make changes and how big those changes can be. You and your team need to have some heart to heart conversations.
And as i’m sure you are learning here, what works for one will not work for the next person. My numbers would not work for you but they work for me and my team and I have come to realize what is a good range for me and my life style. So hang in, take little baby steps and don’t sweat the small stuff. It all works out in the end.

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If you get numbers that work for you, of course it is okay…But if not, than it’s not okay. Numbers that help keep you healthy are what matter. However you get them! ADA never worked for me and I resent them for steering me in such a wrong direction when I was a naive newbie…

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Our bodies and options should be individualized to us. Use your doctors guidance to help you set up goals. Diabetes is a progressive disease,changes will happen in the future to most of us. Nancy

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It is perfectly ok to follow ADA to the letter, e.g. acceptable to be <180 after meals, and A1C < 7.

But it is also ok to set individual/personal goals, to do better than the ‘high’ end stated by ADA. As stated, goals are individualized and set during discussions between patient and doctor. Or in some cases, set by patient to be lower or higher than what doctors opinion is, or may change based on circumstances.

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OMG, you think 180 is “acceptable”? WHY? That is way too high, and if it persists for hours, day in and day out, month in and month out…that’s a ticket to complications. Those ADA numbers are not for people who want to survive for decades of diabetic life, without serious complications. So if 180 is “acceptable”, is 225 just a “little bit unacceptable”? How about 300? Is that just a “bit” bad?

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180 is definitely acceptable if you are struggling to keep it under 250.

Everything is relative.

Aiming for 120 is worse than pointless if you can’t get it under 200.

IMHO It is better to have a small goal that can be achieved. Then move the goal post and aim for the next goal. Small steps lead to success. Large jumps often times end in giving up.

My opinion.

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But who said we can’t get it under 200? That’s defeatism, right out of the gate. With CGM’s and pumps (or really, really good MDI therapy) and a good diet, there is no reason to be high all the time, or even part of the time. Years ago when I was dumber than I am now, and had no meter, no pump, no analog insulins I would climb into the 300’s sometimes. And my A1c’s were lousy. As time goes on, I learned more, better equipment became available, better insulins, and now I’m getting better bgs as a result. Especially, I give credit to a CGM.

I don’t believe in telling people what they WANT to hear, btw. I tell them what is good for them, like me or don’t. :slight_smile:

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For decades I was lucky if I could get my A1c to 7.5 and by lucky I mean I don’t know why it was 7.5 sometimes and just blah others. I have recently changed my diabetes regimen and for the first time got my A1c down to 6.7. This was a huge breakthrough for me and now I am trying to get my A1c down lower and I have had some success with eliminating those awful spikes I had my whole life.

My point is when you are doing poorly BG wise then every little step toward better control is a victory. If getting your BG down to 180 is your goal then get to that goal and set yourself a new one. The safest place to be in regards to avoiding complications is below 140 which is a non-diabetic number and if I can get there then I will be one happy camper.

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Can you guarantee that if this person goes to 180 after some meals, but gets back to 80-100 by next meal, that he is guaranteed to have complications? NO.

I lived my first 20+ years with T1D diabetes, taking 1 injection of lente, and spilling glucose in urine 24 hours a day. My next 30 years, I started MDI with NPH, then pump, and later CGMS, all resulting in continued reductions in A1C from 14 to 5s. Yes I have some vision loss and other issues, but have also led a happy productive life. No complications in the first 20 years. It takes a long time at high BGs to cause damage.

In other posts, Frog has mentioned T2 diagnosis at age 60, and certainly does better than I did my first 20 years. If he keeps A1C at 6-7, with post meal BG occasionally 200, he could remain complication free.

He has not stated it, but assume that if his A1C got > 7, he would make more changes to reduce.

We are here to support people in the choices they make, and provide suggestions/alternatives. Each person chooses the balance of their choices, quality of life, and assessment of risk for their choices. What you choose is only right for you.

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The ADA range of 70-180 mg/dl seems reasonable to me as a start for a diabetic, assuming that one has numbers high enough to make 180 peak after meals a challenge. Whether one wants to keep that range as the target range IMO should vary, depending upon the individual’s circumstances.

In my case, I’ve decided to leave that as my target range, even though I’m a type 1 and have now been on insulin almost five years. Some reasons: (1) I was age 70 when first diagnosed. In all probability I won’t live long enough to develop complications if I keep the excursions over 180 limited. (2) I have a hard time keeping my weight up with a high fat, low carb diet. Too much fat kills my appetite before I can possibly eat enough. Even on a moderate carb diet (120-150 grams/day) I’m currently 14 pounds below what I consider my ideal weight. (3) I have a higher than normal BG reaction to carbs. Whereas according to the charts an average type 1 person my weight sees a 5 point increase in BG per gram of carb, mine goes up 8-10 points. Avoiding peaks while eating carbs becomes very challenging. But the BG comes back down.

That said, in spite of my target range, my last A1c was 5.5 and only once have I exceeded a 6.0 since going on MDI. In the last month I’ve started using a CGM and see that only 1% of the time have I been over 180 and 4% under 70. And my guess is that about half of that hypo time was not an actual hypo, but false readings while lying on the sensor.

I expect that Frog, like the rest of us, will have to come to his/her own personal conclusions over time as to what level to target based upon his own circumstances.

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Have you had an a1c done? Sorry if I missed that. That will let you know which direction you may want to go. I’d try metformin too. My a1c have been in 6-6.1 range mostly lately and I have no complications almost 6 years after dka and diagnosis other than what happened from that. I had them lower at first but I was having way too many lows and it was miserable. It’s still a pretty miserable life and more lows lately but a bit more relaxed. I keep myself lower a lot of the time because there are times when I know I’m going to stay higher for hours no matter what I do. My dex range is 80-130 now, when I hit 130 I increase basal, I’m mostly at 130% a lot of the time now. I can often get myself back to 80-100with just basal now if I’m out shopping or whatever. When I get to 80 I can crash even with no iob, badly. So I shut off basal and eat fruit or drink juice etc until I stabilize.

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Guidelines? Even the ADA and endocrinologists don’t agree.
According to the American Association of Clinical Endocrinologists clinical guidelines:

In general, the goal of therapy should be an A1C level ≤6.5% for most nonpregnant adults, if it can be achieved safely.
To achieve this target A1C level, FPG may need to be <110 mg/dL, and the 2-hour PPG may need to be <140 mg/dL

https://www.aace.com/files/dm-guidelines-ccp.pdf

Looking for guidelines? 1st, keep in mind the money. If the official guidelines for treatment are lowered to actually achieve optimal health, what happens?

  • The guidelines for diagnosis must be lowered too, increasing the already overtaxed health care system. Can we really afford to admit and then pay to treat the. possibly 75% or more of our population that is pre or actually diabetic? (Joseph Kraft, MD, “Diabetes Epidemic & You”)
  • What happens to all the money generated if people, not type 1’s, start getting their insulin resistance and high blood glucose under control BEFORE their pancreas and other systems become damaged beyond repair?
    – No more chronic wound care clinics, amputations, pain meds, antibiotics, anti inflammatory meds, physical rehab days, and prosthetics.
    — Sever decrease in cardiac disease with fewer cardiac caths , angioplasties, CABG surgeries, hospital stays, medications, in and out patient cardiac rehab days.
    —. OMG! Fewer people on dialysis with nephrologists and clinics to follow their care, surgeries to place dialysis lines or fistula, meds for managing electrolytes, pain, and/or infections
    The list goes on and on.

While the individuals in all these groups may have your best welfare in mind, their administrative organizations cannot be assumed to. Diabetes and it’s complications is big money. So, what organization do you want to follow? Me, I don’t follow any of them. I educate myself and work, not without lapses and blunders, to achieve my own goals.

I like Jenny Ruhl’s book and website because she backs up everything with actual studies. She is also diabetic, not perfect, and gives you information to make your own choices.
http://www.phlaunt.com/diabetes/index.php

I like all the information on Dr Jason Fung, MD’s blog, although it used to be a bit easier to navigate. Just query diabetes.

I respect and admire Dr Richard Bernstein, MD. He has a gazillion videos, but his book, Dr Bernstein’s Diabetes Solution” is great. Yes, it has a lot about type 1’s and managing insulin, but the way I see it, if I can’t manage to control my blood glucose now, I will end up on insulin and need that info. For now, I mostly ignore it.

Bottom line? We are all individuals. How our diabetes effects us and our lives may be similar, but is also unique to each of us. What we are willing to live with and what we are willing to do is our choice. The only thing that is universal is that our diabetes is not going to magically go away, at least not this week. We can guide, encourage, and educate each other, but we must all make our own choice. Just remember that your choice is not in stone. You can reevaluate and modify as you go. That’s how we all improve. And, yes, we all have room for improvement :slight_smile:

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Frog - I would say Terry just gave you excellent advice. The problem all diabetics/prediabetics have is their pancreas is not producing enough insulin for its needs.

The first thing all diabetics lose is a robust insulin release at the start of a meal. That results in post meal spikes which are 200, 250 mg/dl or more which are pretty typical for T2s. The first thing I would do is get a 2 week 24/7 blood glucose profile (AGP). The easiest way is with the Abbott Libre.

As Terry said you want limit variability and keep as close to non-diabetic as possible for you. The best way is by taking insulin.

All antiglycemics rely on the pancreas to produce insulin from an already damaged pancreas. This just leads to further beta cell damage.

There is an ongoing study in Qatar showing that by keeping near non-diabetic time in range they are in some cases stopping the progression and in some showing improved beta cell function. This study is using a combination of a TZDs and GLP-1s.

Al Mann did private studies which showed a similar ability to stop the progression and improve beta cell function by keeping near non-diabetic time in range by using his inhaled insulin, afrezza. Many early insulin intervention studies also show early use of insulin to be the best approach.

Additionally Dr. David Kendall who was the CMO for the ADA recently went to Mannkind and announced he is in the process of releasing the Al Mann studies. He also said that he believes afrezza should be the standard of care for most T2s after seeing the work done by Al Mann. As the standard of care afrezza would replace the use of all the antiglycemics. The biggest issue with the antiglycemics is they do not address the post meal BG spikes and most have potential severe undesired side effects.

Getting most doctors to prescribe you insulin as a first step will be very difficult as “Step 1” in the current standard of care is metformin. Ralph DeFronzo who was a huge proponent of metformin 25 years ago has since changed his opinion as over time most continue to progress and lose beta cell function and sooner or later progress to the fourth step which is insulin.

There was also a press release today saying that at ADA2018 new study results on afrezza’s ability to improve time in range over existing rapid acting analogs will be presented.

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just to clear up any confusion, that I or other posters might have: I was trying to treat T2 with diet and exercise_only._

for a year my FBGL were below the range for diabetic minimun. 126 ADA FBGL. something changed and that number has increased to 130. It affects your attitude to go from pre-diabetec to diabetic #'s regardless of the reliability of those guidance numbers.

I could no longer think of myself as pre-diabetic.

reading at TU or elsewhere was frustrating because folks would talk about numbers without saying how they got those number. For instance someone would talk about FBGL of 80 but not mention how he managed to get that.

so i got very interested and very involved in my diabetes. I assume many others have had a similar ephipany. I have looked at lots of posts, websites , read summaries of studies, thought about the consequences and choices and decisions.

your comments have been instructive , helpful and much much appreciated.

I will read and reread the comments and hope to come to a healty approach to my diabetes.

again i appreciate all your comments.

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Lots of good info here, so I just have one small point to aid. Many in the medical profession and perhaps a number of PWD think of hypoglycemia as a number. Lets say 70 as a possible number of concern (or pick your own.) It’s one thing to lightly kiss that number with the last of your insulin on board getting you there. It’s an entirely different matter if you missed your calculation on a mega-dose of insulin to cover your mega-dose of carbs. This is no longer a touch-and-go landing. This is not going to turn out well!

I think of hypoglycemia as a combination of the number, but also how fast and how forcefully your sugar is dropping. Both need to be considered when setting goals.

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