Since joining Tudiabetes, I have frequently read postings related to 140 being the level “at which damage occurs.” I was just wondering what people think about this statement. I have never come across the idea of this “magic number” as much anywhere else in my diabetes life or education as I have here. While I certainly strive to be below that (which I believe equals approximately an A1C of 6.5), I am just skeptical that it is that simple, concrete, or straightforward. While any elevation in blood sugar is obviously not a good thing, do we really know definitely that damage “occurs above 140?” Kins of seems too black and white to me. Don’t fluctuations, amount of time spent at higher numbers, and a host of individual factors (many of which we are not even certain about yet) contribute as well? Some people with excellent control do get complications, and some without manage to escape them. Why? Who knows, but it just doesn’t seem to make sense that it all has to do with a magic cut-off number.
So my question is, is this fact, or something that has just gotten out there and keeps getting repeated? Please don’t misunderstand…I do think it is important to keep bs down and strive myself to be below 140, but I am just wondering if the idea of a magic number is falsely reassuring.
Yes I know the recommendation is for 140 after meals and less than that for fasting. I just wonder about the idea that this recommendation is based on the idea that this is the level at which damage occurs. Again, I also shoot for this and lower as well, I just wonder if it is as black and white as sometimes I feel it is made out to be here…
Yes, it is true… that research has shown that in people in which damage occurred, it was when they were typically spending a lot of time averaging 140 blood sugars, or higher. That is the key, though. If you are averaging that number most of the time, than you are likely to be in trouble… And it’s not a black and white rule… All those charts are scatter point charts, and they’re only going to show a tendency or trend of something happening… Not an “oops, you went over 140 two days in a row, you now have neuropathy…” The longer one is at these higher numbers, the more time extra blood glucose in our blood stream has to bombard our internal organs, etc. That’s gonna take more or less time for different people… and some people even have other genetic things that may even help them develop worse complications over other people, who may develop none. It just becomes more likely when we push the envelope.
Large fluctuations are damaging. Of course, this isn’t reflected in A1cs. Not that I achieve it & impossible because I have gastroparesis, but keeping standard deviation low is important. Doctors tend to check for lows, if they look at logs at all, & not at highs & standard deviation.
Postprandial highs are allegedly more risky than overnight/fasting highs, though I’ve not seen an explanation as to why & how.
What I find apalling is the ADA message that 180 pp is acceptable.
The 140 number seems to be just part of the equation. In the studies presented by the link, http://www.phlaunt.com/diabetes/14045678.php
, they do bring in the 2 hour time period quite frequently. So it seems that most studies look not only at the magic 140 but if the number has been crossed 2 hours later after eating.
So I would like to see the results of these studies from people who might have gone over the 140 mark within the 2 hour time period and below and how well they did as far as complications go. Also what was the activity level of the indiviuals tested and if they were type 1 or type 2.
In order to truely analyze data you have to put down all the multiple factors that may impact the outcomes of the study. I believe being under 140 is ideal but I like to see more information before we can truely understand the results of some of those studies.
This is my point exactly. Your profile says you were diagnosed in 1966…almost 45 years ago. And here you are. Many other people are long-termers with times of extreme hypergylcemia and other people here have complications with seemingly good control. I am just wondering if our thinking about this is overly simplified.
This is what I thought too - which is why they want you to test 2 hours after you eat because it will make you aware if what you are eating or how much you are eating is making you too high. That is general not recommended to be at 140 for longer than 2 hours - if you are at 140 or over it at the 2 hour mark, you were probably higher at the 1 hour mark.
A friend of mine who is a a doctor said that damage is mostly likely in people who are over 140 for an extended period of time - like years and years at an almost constant level. Which could be someone who ignores there diabetes and is uncontrolled or perhaps someone who is never diagnosed for many years and starts developing complications and thats out that way that they have diabetes. (that is supposedly what happen with my grandmother). So all that time they were ignoring or not diagnosed, they had BG above 140 the majority of the time.
Hopefully, the Joslin results from their medalists study will yield useful information about why many long-term diabetics have little or no complications. Some people speculate that the C-peptide in animal insulin may play a role.
No-one yet really knows the effect of fluctuations ((and how large and how long) on future complications It’s very much a matter of debate, with several recent papers about it.
As this one sums it up:
Overall lowering of glucose is of pivotal importance in the treatment of diabetes, with proven beneficial effects on microvascular and macrovascular outcomes. Still, patients with similar glycosylated hemoglobin levels and mean glucose values can have markedly different daily glucose excursions. The role of this glucose variability in pathophysiological pathways is the subject of debate. It is strongly related to oxidative stress in in vitro, animal, and human studies in an experimental setting. However, in real-life human studies including type 1 and type 2 diabetes patients, there is neither a reproducible relation with oxidative stress nor a correlation between short-term glucose variability and retinopathy, nephropathy, or neuropathy. On the other hand, there is some evidence that long-term glycemic variability might be related to microvascular complications in type 1 and type 2 diabetes. Regarding mortality, a convincing relationship with short-term glucose variability has only been demonstrated in nondiabetic, critically ill patients
Glucose Variability; Does It Matter?
Sarah E. Siegelaar, Frits Holleman, Joost B. L. Hoekstra and J. Hans DeVries
Endocrine Reviews, doi:10.1210/er.2009-0021
see: also this full paper which summarises the debate
As for 140mg/dl being the ‘cut off level’. In a study of non diabetics (defined as having no history of diabetes, a plasma glucose level ≤5.4 mmol/l (97 mg/dl) after an overnight fast and HbA1c <6.5%.) . 93% of the participants reached glucose concentrations above 7.8 mmol/l (140mg/dl) and spent a median of 26 min/day above this level, a quarter of them were above this level for at least 75min a day.
Not sure how to test the “renal threshhold” but one poster here told me the “renal threshhold was 130, and any BS over 130 exceeds the renal threshhold.” Which may or may not be true, but it is hardly helpful. I’ll have to ask the endo if the 130 number is correct. I doubt it. I have heard 140 or 150 quoted as well. Most nondiabetics rarely have BS over 140, and usually less than that, even after eating a high carb meal. Keeping all blood sugars to 130 or under would be a great, if impossible (for us anyway) goal to achieve. And I don’t believe doing so would mean you would escape complications; you would reduce them. I don’t believe complications are caused by lack of glycemic control alone, diabetes effects every system in your body. I can’t even count the number of times blood sugar has risen over 180 or 200 with nary a snack or meal eaten. The goal is impossible for most with Type 1s to achieve. Certainly, it is impossible for children and teens. I am leaving those on their honeymoon or LADAs out, as they may be able to achieve this goal, at least for a period of time. Do the best you can. The goal for us has been strive for no higher than 200 at the one hour mark, 150 or 160 at the two hour mark. I find that if she is lower than than, I will have to fill in with carbs at hour 3 or 3.5, which is okay, just the way insulin works in her body.
Not sure how to test the “renal threshhold” but one poster here told me the “renal threshhold was 130, and any BS over 130 exceeds the renal threshhold.” Which may or may not be true, but it is hardly helpful. I’ll have to ask the endo if the 130 number is correct. I doubt it
renal threshold: Normally 180mg/dl (10mmol/l) but can be higher or lower
How do you test this? I also think 180 would exceed the renal threshhold, it would be more around 140 to 160? Since endo does not want the two hour postprandial higher than 150 or 160, thinking this must be the threshhold? If 180 is the true renal threshold, that’s better. I know 180 to 200 is too high, of course, just no way, short of giving too much insulin and filling in with carbs later, to achieve this.
I think the thinking is postprandial highs most probably can contribute to complications, though no absolute proof of this yet. Considering that it takes about 2.5 hours for highs to come down, and you eat three or four times a day, technically, you could be high six to eight hours a day. By lowering the carb load breakfast and lunch to 40, her pps are usually at the lower end 180 1 hr, 150 2 hrs and we overbolus dinner and snack if she is at home. Still, if we do follow the correct insulin to carb ratio, she would be 180 to 200 at 1 hr and 150 to 160 at 2 hrs then may 80, 90 or 100 at 3.5 to 4 hrs. Cannot achieve never over 140 unless she is home, sitting on her tush, and we are watching her closely. You can only do the best you can do. If you can stay 140 and under, my hat is off to you, I’m sure it is diffcult, but something to strive for.
Don’t think you can easily. I also don’t think that it’s particularly relevent. (older people tend to have higher thresholds, it maybe that younger ones have lower thresholds…don’t know. )
Personally I never test at 1 hour and agree with you that you have to be aware of how long the insulin lasts. I aim for as low as possible HbA1cs and consistency over time. From what I’ve read I’ve found no evidence that daily and hourly swings are important as indicators of risk in T1. (wildly varying HbA1cs aren’t good though)
Sometimes I wonder if it’s just scare tactics (or, to a lesser extent, just being conservative). Sometimes you hear 180 is the threshold (which is what I’m told at the hospital I visit), then there’s the school of thought where you should never go above 120, because you want to be as “normal” as possible, and everybody will have different studies that will prove their theories (or disprove others). It’s a little confusing, to say the least!
Nothing in life is cut and dried. Everything is going to depend on our genetics, and how well we take care of ourselves, and that also includes standard deviation for our fastings and pps… But I read these discussions sometimes, and people really want to argue a lot how it is impossible to be in good or tight control, or impossible to at least try to be there the majority of the time… or impossible to get complications at those levels… and I feel like people want to be told that it’s okay to be high 24/7. I mean, if it were normal to be above 140 all the time, it wouldn’t be called Diabetes, folks. There’s a reason for the disease. Yeah, a lot of it is Russian Roulette chance, but do we really want to push the envelope all the time because Joe Diabetic has had it for 30 years, and never really taken care of himself, and been lucky enough to not have complications? Really? It is hard to work toward good control. It is HARD work… but it is NOT impossible… And it is NO excuse to stay high all the time, if it can be worked towards, or avoided. Sometimes we get sick, and we’re stressed… I get it. But we are not sick and stressed 24/7. Sorry if I’m insensitive… But I just don’t know what’s so hard to get. It is not fear mongering… It’s a disease, and it’s the nature of the disease… It is what it is!
