My theory is that the corrupt goals lead to poor control. I don't think A1C should really be a target because A1C is the result of one test at a time. You are certainly a person that I think of when I blather about my ability to nonchalantly (not really, I'm a total psycho about watching my BG but only you guys have a clue about that stuff...) fire off decent BG results but, recently, you discovered something that was messed up and that you've been able to fix. I think that if we just tried ***everyone*** aiming for 85, gave everyone enough test strips [***JOB CREATION!!***] and sat back to see what happened, I don't think we'd see very many casualties, I think we'd see a lot of happierpeople with diabetes feeling like they were taking control of the disease, you'd see less depression ("my results suck!" which is pretty much what I think any time my BG isn't 85, unless I'm doing something nutso...) and perhaps, across the board, lower medical costs by removing some of the dramatically higher costs that result from complications, heart attacks, etc. that occur more frequently with higher A1C ranges.
Jen - 100 grams carbs/day is a huge reduction from some medical/nutritional advice we have historically received. A 2000 calorie/day diet with 60% calories from carbs yields 300 carbs per day. I could not achieve good control with that tactic in a dozen lifetimes!
The challenge that all doctors should assign to all newly diagnosed diabetics is to find the level of daily carbs that they can consume and still maintain good post-meal BGs. If doctors simply told diabetics to "eat to your meter" and avoid all BGs > 140, then that would be drastically improved advice.
I also think educating relatively insulin-sensitive diabetics (most T1s and many T2s) that less carbs = less insulin = smaller mistakes (Dr. B's mantra), that would have a positive effect on many patients.
Dave - One thing I don't like about the term "non-compliant" is that it implies a willful choice to not follow the doctors advice. While that may be true in some cases, it's often just too hard to produce the doctor's hoped-for numbers with the doctor's fantasy of what his/her advice can produce. They sometimes live with an unrealistic understanding of what we deal with in the real world.
I had not realized that you had diabetes in 1940 when the ADA was formed. you just look a lot younger in your picture.
I realize that you really don't like Bernstein, but it is really unfair to say that I just make things up. Here is the the NYTimes on the DCCT trial in an article entitled "'Vindication' for a Diabetes Expert."
I agree with lower goals BUT only if people have the support of their doctors (i.e., aim for say 25 grams per meal instead of 60, which makes low goals impossible to achieve), insurance companies (to get any test strips, CGMs, pumps, insulin, etc. needed for tight control), and also support to troubleshoot any random problems like what I experienced (which I got virtually no help from any medical professional with).
I went to a D conference yesterday in Worcester. The lunch was provided and the carb count of the main entree was 25 grams of carbs, it was grilled chicken breast with mango salsa and Baja vegetable stir fry. The dessert if one wanted was a flourless chocolate cake with optional whipped topping and berries - 21 grams of carbs so lunch was 46 grams of carbs or 59 if one has the roll and butter. I didn't eat the roll but totally enjoyed the entrée and dessert. It was really nice having the actual carb count of everything, so I didn't have to guesstimate myself. I also think the whole thing minus the roll was gluten free.
I try to aim for 100 grams of carbs a day. Not because my CDE, endo, or dietitian said that was a good number, it's because I feel better when I don't have to overdose on insulin to cover some ridiculous number of carbs at a meal. The ADA "guideline" is 45 grams of carbs for a meal and 15 for a snack 3 times a day. So roughly 180 grams of carbs a day is what is recommended. That would most certainly ruin any chance I have at controlling my blood sugars.
I was told 45-60 and 15-30 or 180-270G of carbs/ day, a bit higher. That being said, I don't totally have to avoid carbs. I have days where I eat more and days where I eat less. I loathe the idea of saying "I have to eat X carbs or my BG will be yutzed up." If C/I is a ratio, it should work for any number of carbs and, most of the time for me, it seems to work out that way and I mostly eat less because I don't want to get chunkier.
Hi Jen -
I eat more than 60g of carbs for breakfast every day and it is my steadiest meal. I rarely eat fewer than 50 carbs per meal and I manage tight control. I consider myself lucky but I'm also proof by existence that low goals are possible to achieve with moderate carbs.
Maurie
Agreed, jen...this is frickin so difficult, in our faces 24/7. However, i don't really think it's just down to carbs. I went to a Type 1 Sports Group, most of whom are very competitive athletes (cyclists, etc..) who indeed eat carbs and are extremely fit, healthy and have good (probably great) control. I do, however, low carb. But, as you said, you've never had an A1C below 7% and low carb. We've got AR - Rock Star :) who eats carbs, maurie too and many others who have incredible A1C's and don't low carb. So, it's about many things; testing, correcting, having basal-bolus set correctly, changing rates/ratios when needed...complete dedication, working out - exercising, active, etc..and many other things. Also, denial..I don't think so. Smokes who still smoke aren't in denial, everyone knows smoking is horrible, they just don't or can't quit. Same with diabetes. I don't even see how type 1's manage with high A1C's. When I read on here T1's with A1C's in the 11 - 13%'s...i wonder how they even function, how they're not DKA all the time and many of them are or just plain sick. Type 2's know that high blood sugars cause damage..although many of them have food and weight issues, which brought them to their Dx in the first place, so it's not something easily changed. But yes...because we can't see what's happening in our bodies (although I know I sure feel it when I'm high or low) it can lead a person to think, maybe, 'i'll work on this later' all the while nerves, cells, organs, everything within our bodies are being slowly challenged and destroyed little by little. this is indeed a nasty disease.
Clare - What a breath of fresh air from the D conference organizers! Not only did they graciously provide the carb count and help lighten the burden for diabetic guests, they also seem to get that carb limits are important to some people with D. I would have definitely enjoyed both the entree and dessert.
Oh, I agree it's not just carbs! :) That's partly why I don't like Dr. Bernstein, he makes it sound like it's all about carbs. And it's definitely not. But when I was diagnosed I remember a "triad" of insulin/exercise/food that all mattered and had to be managed in order to achieve good control. I think food has somehow been forgotten by the medical professionals these days. (This makes me feel old saying this!)
Everyone is individual, and obviously there are a few who are able to achieve excellent control while still eating carbs (although even people like AR say they eat 100-150 or so a day, I think, which is lower than most average people eat). But for most who are not honeymooning and/or LADA, it may not be possible ... Athletes, etc. present a whole different challenge and have different needs as far as nutrition goes than most average people, so I don't think it's possible to compare to them.
But, as you said, you've never had an A1C below 7% and low carb.
Oh, yeah, I wanted to respond to this. I low carb off and on but have never done it consistently. I used to be adamantly against the idea, and even now don't really like Dr. Bernstein (although I respect those who do). But, until recently I've also had major problems with infusion sets (allergies) which I believe has negatively affected my control. Now that I think I've solved that issue, my control has improved a lot. The past few days I've had a lot more highs (previously was having way too many lows so backed off on my pump settings), so I think I need to start back to eating lower carb (which for me is aiming for 100g a day or less). I'm not holding my breath for fear of being disappointed, but for the first time ever I feel like my A1c just MIGHT be under 7% in another six weeks if I can keep this level of control up. (I have had a handful of A1c's in the high 6% range in the past, but none for many years.) So, I don't think carbs are everything, but I definitely think trying to aim for 20-30g per meal or telling people to use their meter to find their limit (as someone else mentioned) would be reasonable advice and would probably be easier for keeping blood sugar steady than trying to properly cover 45-60g per meal, especially for those of us who don't have a CGM.
I definitely think that's how it originated, Shawnmarie. But I see it as much less benign in that I see it catering to the indulgent nature of our society, which the powers that be then turn around and blame it for the Type 2 epidemic to begin with. Wow, that makes a lot of sense! I agree with Terry that educating people about making personal choices based on results would be a lot more helpful, than saying "eat whatever you want." And it would be actually empowering people to make adult informed decisions. What a concept!
I think nowadays too much attention is paid to the actual numbers themselves (A1C or BG value) & not enough to the reasons for trying to keep those numbers low. What's the point, as I see it the goal is that I feel good & that I can live the life I want to live, obviously not developing complications is part of that, & the DCCT showed that tight control helps that. But other factors like genes probably apply, I've had T1 for 52 years now & until the mid-80s tight control was not possible, & touch wood I have few complications, just some retinopathy damage to my left eye.
Also A1C is an average, it can mask large swings in BG which may be worse for you than a slightly higher but consistent BG number. Unfortunately I have always had wild unpredictable swings, I try very hard to avoid this but I find I'll have 1 pattern for 2 or 3 weeks & then it changes, so my basal settings are being constantly adjusted. Since going on the pump I've had A1C between 5.9 & 6.3, I probably eat moderate carbs, 30 to 50 carbs per meal. I'm Celiac also & gluten free goods are usually higher carb than the wheat equivalents.
I agree with what was said that Celiac & T1 don't really compare, theoretically more insulin will cover more carbs but nothing corrects gluten for a Celiac, & if you eat a lot it takes a lot longer to recover.
I think what I'm saying is: don't loose sight of the reason for the low numbers & just get hung up by numbers.
I wish the medical profession would focus on that & not numbers but it is much easier to just look at numbers than find out how the patient is really feeling. I have a great Endo he leaves me alone to adjust basals etc as I deem necessary but will give advice if I ask.
Oh, I'm not anti numbers, I was a Mathematician & Software programmer & I love numbers & charts!
It was a TCOYD conference and you're right Terry they do get it. The speakers were excellent and I did thoroughly enjoy both the entrée and dessert.
When I look at the numbers they seem to have everyone covered from the less than 25 per meal low carbers to the 60 grams per meal ADA folks to the middle of the road types like me. They also provided a vegetarian option of the grilled vegetables which were excellent on their own.
I believe the menu was developed by Chef Robert Lewis the happy diabetic who was also a very pleasant fellow in person.
300 g carb per day is indeed a lot of carb. I haven't seen anyone advising eating that much carb every day, though, neither the ADA nor any of the other usual punching bags.
At the other extreme, Bernstein writes that no diabetic should ever eat more than 30g carb per day, which in your example would be 6% of calories from carb. That almost certainly requires eating a tremendous amount of animal fat every day and strikes me as a similarly extreme position, just at the other extreme.
I think we agree about the value of each T1 finding a diet that works for them based on measuring their BG and regularizing their diet. I also agree that part of that is to find a level of carb in their diet that is predictable and manageable. If that were the extent of Bernstein's advice, then I would be all for him. But unfortunately the main thrust of his book is all about limiting carb to 30g per day, and limiting food choices and eliminating whole food groups to accomplish that. That is where I think Bernstein goes deeply into the weeds.
Hmmm, where did that come from?? You really think I was claiming I was diagnosed in 1940?? Really???
I was diagnosed in 1975 (picture taken last year). 1975 was long enough ago that I had to manage my diabetes with one shot a day of NPH insulin and TesTape. It was also well before the DCCT study was started, which is of course what I was referring to since that is what this whole thread is discussing.
Sorry if you were using that NYTimes article as a reliable source, because it is no better than the vast majority of mainstream media articles attempting to report on diabetes. In other words there are a few kernels of truth padded with lots of nonsense. About as informative as the average "New Diabetes Cure" article that gets published every year.
I don't understand why we always end up discussing the good the bad the ugly about low carb diet. The DCCT had nothing to do with amount of carbs we ate and back when it was started we measured our diet a different way anyway. When I was learning about my own dx of diabetes back in the day no doctor, dietician or other ever told me to eat 2000 calories a day or how many carbs are the right amount for me. The simple old school is still how I manage today, with some improved measureability in all things diabetes. If you can manage on 30 grams of carbs then YAY. I can manage with quite a few more, but I need them to do what I need to do every single day. I will be ever thankful that the DCCT proved that intensive blood glucose control is key to living with this stupid condition. This is nothing worth arguing over. I believe that our own levels of "Tight control" should be determined by ourself and our ability. Thanks for the summary Dave :)
I think this started out as more of an "eat whatever you want" versus "restrict what you eat" discussion, and then just got into carbs since that's what we all use to measure eating. I haven't participated in any of the other discussions about carbs, but I don't see any arguing going on here, just discussion. (At least if I came across as argumentative, I didn't mean to!) I'm finding this whole discussion and everyone's perspectives quite interesting! :)
I have the same thing, too, related to my cycle. The annoying part is that it's not that predictable. I'll spend a couple of weeks high, a week low, a couple of weeks "normal" and then it will start all over again. But I can't just plug into my calendar to increase or decrease my pump settings on X day because it doesn't happen on that rigid of a schedule.