Considering that sugar spills into your urine at 180 or above, which is not normal for a non-diabetic, I am thinking that is why doctors give people that number. Sugar isn’t supposed to spill into your urine is your body is handling it properly. If it was normal and OK, to have BG that high, why would your kidney start to get rid of it?
When I was dx and knew squat about this, I asked the doctor about numbers that were too high - yes, again, they said “As long as you don’t go over 180” you are fine. They didn’t say “that is because that is when sugar starting spiling into the urine which means you have too much.” No of course not, that is too much work for them to educate me that far - I had to find that out on here.
That said, I think the 180 number has nothing to do with damage. I don’t even think most doctor are aware of the scientific studies done on damage numbers for BG. That is why they just quote that 180 as a benchmark.
That said, think about it this way. An A1C of 6.1 is an average BG number of 140. We are told to strive to have A1C’s between 4 and 6%. Any higher of an average your A1C will be out of the desired range for diabetics. http://www.rajeun.net/HbA1c_glucose.html
If you are at or around 180 as an average number, your A1C is 7.1.
Ugh, kind of scarey when you think about it. I was 9.2 at dx that means an average BG number of around 250. I shutter when I think how long it might have been like that pre-dx.
What’s not possible for us probably is not possible because we do not adhere to a lower-carb diet. We have the techniques I have described for dealing with this. But I’m not fully convinced of this…even 15 to 20 grams of an apple or bread will cause a spike. Oatmeal causes a spike. Pasta causes lows, then spike. Adults can lower their carb intake considerably, if they wish to do so, preventing a spike perhaps. But those adults who do not wish to live a low-carb lifestyle still can find ways of minimizing the spike as much as possible.
Whatever we need to find to keep lower responses at meal time, and lower overall numbers throughout the day, then that’s what we need to do. But we need to DO it. And if a food is particularly awful, then drop it… Not trying to figure out super bazillion boluses to consume it… because too much insulin is also really bad. Lots of unpredictable lows, and weight gain issues… AND, it kills the ovaries in a growing child. It causes Polycystic Ovarian Syndrome, and infertility… Big, big concerns to have…
Over 19 years of Type 1 and I have only once or twice had an A1c below 6.5, meaning my average has always been above 7.8 mmol/L.
No complications yet, but I’m only 28 (well, 29 in a week, yikes!) so there is plenty of time. Thinking in terms of “anything above 7.8 is causing damage” stresses me out too much because (for me) it’s impossible to not go over that level, so I tend to just ignore those types of posts.
But it won’t tell you at what level your personal renal threshold is, in fact that’s exactly why the OU unit I referred to dismisses it as a method of glucose monitoring. It also notes that both high and low renal thresholds can occur in healthy kidneys.
Yeah, nowhere in those papers do the researchers conclude that 140 is the magic number for damage. The research is specifically designed to look at the relationship between Impaired Glucose Tolerance and peripheral neurpopathy. They are simply going off the ADA recommended guidelines for establishing Impaired Glucose Tolerance (IGT).
They show a correlation, perhaps even a causal relationship, between IGT and peripheral nerve damage. There was no attempt to determine at exactly what BG the damage occured. In their discussions, they talk about a relationship between prolonged exposure to hyperglycemia as an underlying cause of peripheral neuropathy, again with no reference to a magic number of 140.
So, yeah, keep your BGs below 140 if at all humanly possible and limit your time of exposure to BGs over 140 if humanly possible, but also take the time to read through the research to determine what the research is actually telling you.
So the original question was whether blood sugars over 140 mg/dl cause damage and the answer is yes and no. There has been a lot of studies that seem to show that average blood sugars are clearly associated with increased complication risk (and hence damage). In fact some studies (such as EPIC-NORFOLK) have shown this relationship all the way down to a HbA1c of of 5.5 (110 mg/dl). In most cases, the increased risk reduction below 6% is minimal. That being said, it appears that even if you control your blood sugar you still have an increased risk (over normals) of certain complications like retinopathy. But even still, these measures are based on average blood sugars and they are associations, not treatment findings. It has not been shown that if you have diabetes and reduce your blood sugar down to 5.5 that you can minimize your risk of complications.
On the other side, direct studies of beta cells which show that concentrations of blood sugar > 140 mg/dl start to show glucotoxicity. But normally, beta cells grow and die regularly, who is to know whether transient levels cause a problem. If you want to be conservative and preserve beta-cell function, then you may find it prudent to keep you blood sugar below 140 mg/dl as much as possible.
So if you want to preserve your beta-cells, then keeping below 140 may be helpful. If you have kaput beta-cells, on average, your risk of complications falls with lower blood sugars. But everybody is different (not average) and of course association is not causality.
I feel that this # a rule Of thumb backed by
clinical data but after knowing so many
people living with Diabetes I have personally
come to the conclusion that it comes down to
Individual genetics. Some may have lower
Thresholds for damage and others higher.
Bottom line, try to keep glucose levels as close
To “normal” as possible as hard as that is for
some of us in real life. -Tony
Life
I guess my feeling is that I tried for literally five years to get an A1c below 6.5. I was counting carbohydrates extremely accurately (weighing/measuring with scales and cups whenever at home, not eating foods with unknown content when out, etc.) and went moderately low-carb (100-150 a day). I was exercising daily, testing 10x a day, logging everything, reviewing those logs daily and adjusting pump settings at least once a week or more. Yet despite all this I could not achieve an A1c lower than 6.7 or 6.8. I went on a seven-day blind CGM trial and even though the CDE was impressed, there was not a single day I stayed between 4.0 and 11.1 (70-200), much less below 7.8 (140). There were also dips and rises in my blood sugar that were seemingly not connected to food or activity. I went from having 95% of readings between 4-10 on one day to only 23% in that range the next day, with no difference in terms of food or activity (or any other variable I had recorded). And my diabetes is not particularly “brittle” compared to other childhood-onset Type 1s I’ve talked to in person, so it’s not like I just have a special circumstance that causes control to be difficult.
How long do we keep trying at something we are continually failing at without giving up or at least saying it’s impossible or doesn’t matter? Five years is a pretty long run at trying. This is partly what led to my current burnout: I got so tired of trying and trying and never succeeding (at least according to this criteria). I would probably feel differently if I had experienced some success, gotten an A1c of 6.3 or the CGM had shown I stayed nice and steady all day. But I look at posts like this (and I’m sure I’m not the only one) and go, "God, I’m only 28 and have spent more than 19 years hitting these highs daily. I must be a goner."
I would rather have control that is not quite picture perfect but that lets me be happy with life than spend every hour worrying about what my blood sugar might be doing and what complications my future may hold and feeling horrible about what a bad job I’m doing every time I look at my charts. My new goal is to just get my A1c back to where it was (high 6s) and be happy with that.
Maybe I could try for better control. Maybe I am just deluding myself and an A1c of 6.8 is horrible because, after all, it means more than half the time is spent over 7.8. Maybe I could pay out-of-pocket for a CGM and go super low-carb and pre-bolus for all meals half an hour before eating them … But even the high 6s represents a LOT of work and dedication for me. Maybe when I am 40 or 50 I will feel differently and will go to extremes to get super excellent control. Heck, this will probably happen if or when the first complications show up. But for me striving for perfection drove me insane and was just not worth the stress.
Good for you, Jennifer. I posted a thread recently about the “luck of the draw” or all the variables that come into play where one person can barely do anything at all to manage the D and get good, even great numbers and others knock themselves out and have unexplained highs. It sounds like you really worked hard to get lower and your body had other ideas. It’s easy, being on TuD to get into a perfectionist mode and say "that person has an A1C of 4.7, why don’t I? Or even, that person has a 6.3 and I can’t get below 6.8. We forget about the “YMMV” and the “there are as many kinds of diabetes as diabetics”. I agree that “quality of life” is an important factor. And by this, I don’t mean, indulging yourself in daily banana splits and testing bs once a week, but the choices we all make in the checks and balances of how we manage our own D. I’ve decided not to go low carb but to go moderate carb (under 100) because that way I can remain vegetarian and enjoy the creative cooking that is one of my big pleasures. Doesn’t mean I don’t admire and respect people who make other choices that give them excellent results. I think you have a very healthy attitude!
Honey, You are trying and trying so hard. I agreerwith you:Control, for me, in type one is not ever picture perfect. I have had type one for 42 years, and my a1c’s can range from 8.0 to 5,7 in a single year., I find that sometimes there is no rhyme or reason to a high…it just happens!!! I can say Most times I know what has happened ; But I may, even with much research and testing, not get the same results from indentnical basal rates , identical boluses, even with identical food intake, exercise, and medication, on two separate days… That is what makes you feel like you are crazy. But it is just the nature of type one at times.
I got to an a1c of 6.6 this summer, which I was satisfied with’. However, after my Fall corticosteroid shot expeditions, I am up to 7.6 as of last week. I have been running high and have had to adjust my basals, carb ratios, and insulin sensitivities regularly since I took the steroid shot in October… I even had a naughty low of 22 on Wednesday, as my insulin sensitivity seems to vary from day to day… and I have never been particularly “brittle” until the steroids
I do NOT think that very tight control ( 80-120) is possible without having a lot of lows, too many for me to be comfortable with.
I had a1c’s in the sevens for years… and I went welll over 25 years never knowing what my A1c was, as it was not common practice to check it until the early 90’s, I think.
In terms of possible complications. I am somewhat free of them.I have some strange nerve pain,tingling, and tightness in my feet, legs, and back that comes and goes in severity, from slightly noticable to having to take pain meds for it.None of my medical practitioners can definitely say whether it is diabetic induced neuropathy, neuropathic remnants from pernicious anemia I had 8 years ago, or the results of diagnosed spinal stenosis. I am taking a lot of supplements and expecting the best. I have great kidneys, eyes have no signs of retinopathy, and my autonomic, gastrointestinal, and cardiac systems are all fine, as well as are cholesterol levels .
I do not think that 140 is the magic number. I really would be glad to see 140 today, as I have been between 155 and 210 most of the day,:The insulin is acting like I have bolllussed an Apidra cocktail laced with saline or H20 (LOL).
Just do the best you can, Jennifer. You will be OK.
My thoughts exactly Brunetta. Sometimes I get a good A1C and sometimes (like in August) I get a bad one. I have found that stress affects mine pretty dang good.
I’m not in any way suggesting… that we are always going to be perfect, and that people’s mileage isn’t going to vary… It’s like people think I’m being inflexible, when it is not me who is inflexible… it’s Diabetes who is inflexible. I’m not even suggesting everyone go low carb… We try the hardest we can, and we do what we can, and that’s the most we can do. (I really don’t believe it’s very easy to have good control on 100-150+ carbs a day, but that’s a personal thought/choice on my part… I eat about 60-85 a day…) I don’t make the “rules” as to whether or not we’re going to get complications… I truly wish it was based on merit – that we tried and fought so hard, and did what we could, so we shouldn’t get any… Heck, any of us could get complications… even with tighter control, if genetics predisposes us more, or less. The idea is… if we aren’t doing what we can to keep better numbers… (ie, passing up that hot pocket for a more nutritious meal, like I’ve seen some people gripe the hot pocket spiked them, and not know why…) then we make things more likely than not to happen. These are not hard, fast rules… They are just correlations, and higher likelihoods of things happening… the less control we have, and the more we ignore how we react, every day…
Is it disheartening? Sure… Is it scary? You bet. Am I not going to try to shoot for that number because some claim it’s impossible? No way. I will do my best… Even if some days I have the flu, and I hover above it all day. Do I obsess with it? No. I think we need to have a balanced view in these discussions, though… It is bad to either obsess with it, or ignore it… And some people do ignore it, or they want a pat on the back somehow, that yeah, their super high numbers are okay… And at some point, it is NOT okay. It is not okay to be 8+, and think one will be fine forever… We have to have some reality here.
I just want to know that I personally did ALL of what I could to not give in to this crappy disease… and if it that, to me, is not having a cake, and pizza, and other crap people sometimes bolus for (like oatmeal)… Then so be it.
Jennifer, for me , I have to stop comparing myself to others. What I do know is the huge difference it made to me to feeling then and when I became a pumper in 2001 and what I have learned since that year. I am very grateful to meeting that pumper friend in 2000 here in my community and TuD.org since 2008 . Complications may not show , as in my case with few lower than 7 A1C’s during my 28 D life …just a note on the side : Apidra is the " in thing" for me …hang in gal .
Thanks nel. I got a prescription for Apirda so will be trying it out in a bout a week once the Humalog I’m currently using is used up! I’m hoping it works well for me (is faster acting and less of tail in wearing off).
Jennifer , not to sound extravagant ( I am known as a frugal girl …get rid of the present insulin( store it in the fridge for now if need be ?? ) and try Apidra now .
Alan and I are on your side !!
I think you do represent the norm for child-onset Type 1. Although we do have A1cs in the 6s, usually mid- to low 6s, her postprandials remain higher than what most of the adults have posted on this board. And short of giving her more insulin than she should have (overbolusing), there is NO way to get that number down. Tried for five years. To never go above 140 is an impossible goal to achieve. And I do mean impossible. Unless she eats essentially nothing. And that still would not work because the fluctuations in blood sugar do not occur from food alone. They just happen, even in the absence of food. She may be less active one day than the next which effect the basals. Blood sugar is tested every three or four hours and two hours postpranidal most of the day and at least half the night. To compare her to someone with slow onset Type 1 (LADA) or even a true Type 1 dx’d as an adult is not helpful at all. And there are adult Type 1s whose blood sugars are less stable than hers ever were so I really can’t even say I can’t achieve this because she is not grown. I just know it is not possible at this time. Do the best you can individually do. I don’t believe most who do this will have complications. I think there are other components (genetic risk) that cause complications.
So true, Alan. Carbs like cereal, bread, rice, cake, potatoes hit instantly. Carbs start digesting as soon as they come in contact with saliva. That’s why many avoid these foods. Hard not to hit over 140 with that type of diet. Then, people throw up their hands in disgust & say it’s not possible, so why even try. Attempting to temper the highs with corrections, results in lows. Easier not to eat the things that cause this roller coaster to begin with. Hard on our bodies, even harder on our emotional well-being.
…hang in gal .