You question about does "1 hour at 10 (180 mg/dl for those of us in the US)" cause damage is, in my opinion, not answerable by science at present. There is no way to do an experiment to tell this at such a small time scale. Think about it....how would you do the experiment ? Even if you could have 2 groups, an experimental group and a control group and expose the experimental group to 1 hour at 10 mmol , how would you look for the damage ? We'd need a machine that could take the people apart molecule by molecule and look for changes,
The only data we have , unfortunately, are the long term studies which correlate A1c with complication rates...the graph posted at the top of the thread.
The ADA recommendation is to shoot for an A1C of 7% or less and the AACE recommendation is to aim for 6.5% or less (with the proviso in both cases that only if it does not lead to excessive hypoglycemic events). Some researchers believe that below 6.5% you are near the rate of complication of non-diabetic people and approaching a point of diminishing returns.
Many T1s would consider 6.7 excellent control. There are people on here who go below 6, but with frequently they use things like CGMS and very low carb diets to help get to these levels without dangerous hypoglycemic episodes.
My own personal goal is to get below 6.5, BUT not to have any hypoglycemic episodes that require external assistance.
There seem to be two type of diabetic craziness: 1) Those who are so fearful of hypoglycemia that they run way too high
2) Those who are so fearful of complications they have frequent hypoglycemic episodes that require the assitance of others/end up in the ER or crash cars.
Oh, yes, and the very good news is that there are lots of people who have had this for 50 years and doing well. And they had much more primitive technology to work with for most of those years...no BG meters, slow insulins, etc.
With today's technologies and insulins I think we will see even more people going for the long term with few/no complications...and things are getting better every year.
I was 23 when I was diagnosed. I was just outta college and burnin' the candle at all ends; livin' like there was no tomorrow; playing in rock bands and therefore had a really erratic schedule; I didn't have any health-consciousness whatsoever; I ate whatever was laying around; I'd been an athlete as a high schooler, but was worn out by all that and had lost all interest in keeping my body tuned up and had stopped exercising. But, I was always skinny (funny how that ended up being a telltale sign after all...).
Any A1c below 7 is considered 'good' by medical professionals. My doc has his doubts about A1cs below 6 -- he feels that you must experience far too many hypo lows to be down in that range. And I agree with him. Of course, as I have said before here in other threads so it is starting to sound like a broken record at this point -- we are all wired a bit differently -- so some here are certainly able to withstand what hypos do to them more than me. I just hate the feeling of being 'down there,' so I choose to ride further up the scale so I don't feel that way.
Damage happens over years, not hours.
DX'ed -- January 15, 1982 No complications (lucky?... mebbe...)
I started with a new doctor, recently, Alan and I'd done a home A1C and shared with him my latest A1C which is 5.7. I was pleased with his response: He did sound surprised but complemented me. If he'd lectured me about it being too low he would have failed a test in my mind. Though I've moved to a rural area with few (good) options for doctors, so I might have just had to "educate him" (nicely of course).
Some websites you read might try to convince you that a single reading of 6.1 mmol (140) means that damage has been done and all hope is lost.
Minor correction, but 6.1 mmol/L is equivalent to 110 mg/dl. A blood sugar of 7.8 mmol/L is equivalent to 140 mg/dl. (To convert between mmol/L and mg/dl, multiply or divide by 18.)
I tried the Bernstein diet as well, and that diet sucks, really. I'd rather eat good food and really small portions, That guy says the only thing you can eat is cabbage, meat, and eggs. There has got to be a way to eat that's more exciting than that.
You guys ever eat white flour or is that just the worst? I noticed that white rice isn't as bad and potatoes are a good filler without sending the blood sugar to high. I eat oats for breakfast, but perhaps you guys know of something to fill you up in the morning that won't send the ol blood sugar through the roof. Oats in musli don't seem too bad though. any thought
Hey Alan, glad to see you doing so well these days. Are you back on MDI?
Anway, yeah, no doubt, the EDIC follow-up to the DCCT shows that even if you fall off of your control and see your A1cs go back up, you're still at a lower risk for complications than those who never had tight control to start with. I wouldn't use that as carte blanche to "go for it" either, but is is encouraging regarding those periods of time when control just doesn't seem to be there.
I'm busting my keister trying to control spikes and keep those periods to a minimum and it's good to look at those times when we succeed as money in the bank.
Lot's of people on Bernstein on this forum. There's a big Bernstein group and if you are trying to eat low-carb like you say in your OP, check out the group.
You'll see that it isn't just cabbage, meat, and eggs. =P
To answer your question, I'm not even on waht most would consider a low-carb diet and I really try to limit white rice, potatos, and white flour. They all spike my BGs to hell and any differences between them are marginal.
Hi zip, one reason why u maybe able to eat a lot of these higher carb foods like rice and potatoes is as a newly diagnosed type 1 diabetic you maybe going through what is called a honeymoon period. This essentially means that after starting insulin therapy, your pancreas temporarily recovers a bit, and is able to produce "some" insulin. This honeymoon phase is a very common thing most Type 1's experience, unfortunately over time though, the pancreas does give out and foods like rice, potatoes etc do tend to cause a much higher spike.
That being said, I do tend to watch my carbs however Im not ultra low carb, I try to average between 30 and 40 grams of carbs a meal and for me that works very well. I don't totally eliminate things like potatoes and rice, but I do tend to limit them in my diet and when I do eat them eat a very small amount. A small order of french fries if Im getting a hamburger. The smaller you can keep your total carb intake, the smaller the amount of insulin required to cover that food and the less chances of mistakes and lows...I am a firm believer when Dr Bernstein says that.
Everyone's diabetes is totally different and over time, especially as this honeymoon period wears off, you will really get a better idea of what foods you can eat, what your carb threshold is etc. I too eat for breakfast a lot of times certain cereals and oatmeal, however if Im running a bit higher in the AM I usually will pass on that and have some eggs instead. For me I usually range between 80-110 in the mornings now. As long as Im in that range I will have my cereal. Also certain cereals I have noticed for me I am able to handle better than others. I tend to eat a lot of the Koshi cereal, versus more higly processed cereals.
Good luck with your management, like everyone has said on here there are going to be days you are going to run a bit high, the key to good management is minimizing those high days, and the amount of time you stay high. A good rule of thumb is after eating...2 hours later your bg SHOULD be 130-140 AND coming down. Try to minimize those real dangerous spikes in your bg. If you are at 2 hours after eating say 180, then you might want to consider less carbs, or a different I/C ratio, or reviewing what you ate and the insulin you took to cover it and see where any miscalculations took place, etc. There is a lot of data that goes into good management but over time it really does become a part of your life. And as others have said on here, frequent lows can be just as dangerous as frequently running high. Try to shoot for that good middle ground.
Is getting rid of your glasses a recent thing? I know you've had great BG control for ahwile now and if you are still having breakthroughs like that, it's very encouraging.
>> I recommend finding a Doctor that believes the ideal A1c is exactly the one you happen to have.
Yeah. Interesting thought. The long-lived ADA standard is anything below 7% is considered 'on target'. Glad to hear you don't have any hypos. That's amazing, Alan!
thanks for the reply. It's finally nice to have some people that understand this stuff. My docotr is like just eat what you want as long as you keep your BG low. I live in Denmark so everything is all potatoes and bread and the doctors seem to think that's fine. I've discussed the Bernstein diet with him. He hasn't read the book and says that there is no science behind it, which is not true.
You are probably right on the honeymoon thing. I'm still producing a little insulin, but not enough to make a huge difference says the doc. Does metabolism have anything to do with BG? Some people gain weight faster than others I was curious if a person with a slow metabolism reacts different to insulin than somebody with a fast matabolism?
that's the problem as I can see it. There are only long term studies where people have been using "old school" insulin. I mean hasn't there been a huge change in the last 20 years?
So a person like myself that has just been diagnosed have a completely different set of circumstances and treatment options available. I really think that pumps are in the beginning phase. It won't be long before all that is automated. Really in 10 years from now, it will be different. Look at cell phones 10 years ago-
I don't think they'll find a cure soon. but they'll invent a super expensive pump that does everything except make our food :)
You cannot compare the high tech world of computers and cell phones with the medical industry.
In the medical industry the government protects the manufacturers products from competition. And the government has the final word on when we can purchase a new product...In the U.S.A the FDA even decides if we need a new product, or not.
With computers and cell phones, change is market driven it's pure greed and capitalism...the fastest way to market for every product.
We have been using the same U100 insulin's for over 10 years and there is nothing new in pump therapy just a new package. The CGM was new 5-6 years ago and now it has gone stagnant.
We have been waiting 4 years now for the industry to put two proven products in the same box...that should be easy..HaHa
how about over seas markets? They are not controlled by the FDA. It would be a huge money maker. well at least they could start making the pumps super super small. I think they are still pretty bulky.
