2 squares of Lindt 70% chocolate is very friendly to my blood sugar. I usually eat it with some almonds or pecans. I think the fat in the nuts and the fat in the chocolate slows down the absorption of the sugar to where my T2 pancreas can handle it. It might have a different effect on T1s
Not all low A1C's are based on frequent bouts of hypoglycemia. I think that is kind of an ADA party line, and doctors imho seem inordinately focused on lows. (The cynic in me thinks "malpractice").They also tend to have low expectations for their patients so they think "anyone that has an A1C below 6.0 must be having lots of highs averaged out by lots of lows." My last A1C was 5.7 without a preponderance of lows. (or highs). I think the key thing for me in achieving that was prompt and accurate correction of spikes. There are lots of other people on here with A1C's in the 5's who don't do it by averaging highs and lows.
Agree, Zoe. It's an assumption, often a sour grapes one. A CDE scowled at my A1c & immediately leapt to the conclusion of frequent hypos. In those days I logged everything & showed her that wasn't the case. Alan, a former Tu member, had A1c's in the 4's without severe lows.
I also agree. My last A1C was 5.5, and the nurse practitioner kept looking at my logs for lows - and kept saying that I don't have a lot of lows. I do correct highs quickly as Zoe said she does, and have a really low standard deviation. I haven't seen any negative side effects from LC in over 4 years. Works for me, doesn't mean it will be for everyone.
Zoe- There is probably some truth to your malpractice assumption.
The research in the T1's that have lived over 50 years also shows that most of them have A1C's in the 6's and 7's. There is also other research concerning A1C and complications, and the risk of complications in diabetics vs. the general population does not start going up until the range of 8 over a prolonged period of time.
If someone wants to strive for a normal range A1C, that's fine and up to them, but I feel it should ALWAYS come with the disclaimer that it could get said someone hurt if they are not careful and diligent about checking. In fact, that's probably where some of the problems have arisen; people not checking frequently enough because they are berated at the doctor's office for checking too often OR the simple fact that testing supplies are incredibly expensive.
And Gerri, responding to your post below Zoe's... it's really unfortunate that some of the medical professionals are as negative as they are. Negativity doesn't help anyone, period. If the patient is doing what they can, getting good results, and is happy with their situation, then it should be a nonissue...
I am trying to correct quickly (within 1.5 to 2 hours post) as well.. because I've already found out that if I don't, the numbers just hover really high until later... and it's that prolonged period of time at a high level that gets you...
Do what makes you feel good!
I wish high A1cs were accompanied with disclaimers. Heartbreaking & infuriating how often PWD are told by doctors that they're doing well when they're not. Healthcare professionals aren't held accountable for diabetic complications from bad medical advice & low standards, but they potentially could be liable for lows.
My understanding is that studies show that complications begin with prolonged time spent above 140 which is why many of us use that as our post prandial target. Not sure what that translates to in A1C but I think it is well below 8.
I understand your frustration..
I heard about a lot of this research after I met with a retired MD and his wife privately at their house... he has had T1 diabetes for 60 years (diagnosed in 1952)..
He's actually a participant in one of the studies I mentioned, and he talked at length about the A1C issue and BG levels with me.. while an individual can be different from the 'norm'.. they don't see complication rates increase until A1C's of 8 or more over a prolonged period of time (years).
So given the current research, an A1C of 6.5 is a reasonable goal if you do not see complications with that level vs. the nondiabetic population. Scientifically, it makes sense...
If that's not what you agree with, I understand; but I'm just providing the reasoning behind it..
Zoe, I will look this up tonight if we are slow and find the articles. I believe the number is 180, which corresponds to an A1C of 8. Either way, I will find them and share..
I think people make well thought out decisions about their management that are about more than just "what makes you feel good".
We've all heard the ADA recommendations of remaining below 180. Those recommendations are based on the DCCT study which has been found to be quite flawed. And most of us are horrified by how outdated that is. More recent research, as I said points more to 140 as the level beyond which complications begin to accumulate.
I agree with thatā¦ but there are obviously different options about how to do it. So do what makes you feel good health wise and other wiseā¦ I wasnāt trying to say that people donāt think about it. People apparently do think a lot about it and come up with solutions that work for them. If they didnāt, I donāt think we would have much to discuss on forums?
Do you have the titles of these articles?
I'm not the article person. I read things, absorb them and move on. I'm sure Gerri or Holger or someone else can post articles titles, but there has been a lot more recent research than the DCCT which was 25 years ago; diabetes research has come a long way in that time.
There is a lot of knowledge and experience on this board. Cumulatively, we once counted and we came to well past 5,000 years experience. I venture to say there is more to be learned here than from any one "article" or "study".
I agree that experience counts for a lot. But having studies to back it up adds to that experienceā¦
The bloodsugar101 website has an extensive list of studies here supporting the idea that 140 is the threshold of organ damage. A lot of these concern T2 and beta cell die off which does not have much relevance for a T1.
The American Association of Clinical Endocrinologists recommends <= 140 2 hours postprandial. Considering the variability that can go into identical A1c's it would seem this goal might be more useful.
In regards to A1C most of the charts I have seem show the increase in complications starting at 5.5. At first the increase is very small but it compounds and the slope of the curve becomes steeper and steeper. You can get a sampling of these charts by Googleing "A1C complications" in the images section.
In the end I don't think any of this is completely settled, the best we can do is make an informed decision about our goals, and them find the means to achieve them.
Just remember that we at TuD are the exception. Most PWD take the info they're given by their doc and don't explore further online or otherwise. People here in general do give a lot of thought, and many are passionate as evidenced by our discussions (love it!).
We are all individuals, there are no rules. I consider myself extremely fortunate to have 23k other PWD to learn from, share with, and discuss with.
But at some point for each of us, a lower A1c probably starts resulting in too many lows. Last summer I hit that point with a 5.3. Neither my doctor nor I was happy with that situation and with a little help I was able to push the A1c up to 5.7 and cut down on the lows. Diabetes is a game of inches.
Maurie
The DCCT found a regular decrease in complications as the A1c decreased with the curve beginning to flatten out at around 7. That according to my Endo (who participated in the DCCT) is why a 7 was given as a treatment goal.
A study I read about in the last year or so of kidney complications found a decrease in risk as A1c fell into the 5s although diabetics with A1cs in the 5s were still at increased risk as compared to the general population.
Maurie